Journal of pain & palliative care pharmacotherapy
-
J Pain Palliat Care Pharmacother · Mar 2024
The Impact of a Clinical Pharmacist Practitioner on Perioperative Pain Management for Orthopedic Surgeries.
The objective of this quality improvement (QI) project was to assess the impact of an evidence based clinical pharmacist practitioner (CPP) model applied to perioperative pain management by integrating a CPP into the perioperative orthopedic surgery clinical pathway. Secondary objective was to assess the effect of CPP pain management service on surgical team satisfaction. This QI project expanded CPP pain management services for patients who were scheduled for an orthopedic surgery. ⋯ The impact of the Pain CPP on perioperative pain management was demonstrated by improvement in the Clinically Aligned Pain Assessment Tool, which was similar in patients where CPP recommendations were accepted compared to surgeon only recommended regimens (p = 0.048). Five orthopedic surgical providers responded to our satisfaction survey, 80% (n = 4/5) strongly agree that a pain management CPP should become a permanent member of the care team. Through an evidence-based CPP model we observed a reduction in quantity of opioid prescribed and morphine equivalent daily dose utilized in patients who underwent an orthopedic surgery.
-
J Pain Palliat Care Pharmacother · Mar 2024
Data-Based Opioid Risk Review in Patients with Chronic Pain: A Retrospective Chart Review.
A retrospective, cohort, single center, chart review was conducted to compare rates of opioid-associated serious adverse events (SAEs) in a patient cohort 6 months before and 6 months after data-based opioid risk review. The primary objective was the composite reduction in opioid-related SAEs including suicide-related events and opioid overdoses. The impact of the reviews was assessed via multivariate logistic regression and a McNemar's test to analyze difference in rates of opioid-associated SAEs. ⋯ The HR for suicide-related events and opioid-related SAEs when opioid therapy was discontinued were 9.95 (2.16-45.94, p = 0.009) and 15.64 (1.09-225.19, p = 0.001) respectively when compared to continuation of opioids. This study showed that data-based opioid risk review may reduce incidence of opioid-related SAEs in patients with chronic pain. Additionally, opioid tapers and discontinuations are significant risk factors for suicide-related events and opioid-related SAEs.
-
J Pain Palliat Care Pharmacother · Apr 2024
The Effect of Guided Imagery and Progressive Muscle Relaxation on Sedation in Patients Undergoing Noninvasive Mechanical Ventilation.
Mental imagery and relaxation are noninvasive methods and can easily be used by the patient. Accordingly, this study aimed to detect the effect of guided mental imagery (GI) and progressive muscle relaxation (PMR) on sedation in patients undergoing noninvasive mechanical ventilation (NIV). This clinical trial study was carried out in the Shahid Modarres Hospital in 2022 and encompassed 80 patients with COVID-19 undergoing NIV, who were assigned to two intervention and control groups. ⋯ The Quade nonparametric ANCOVA revealed the significant impact of intervention on the post values of Total score (p-value < 0.001), Tolerance (p-value < 0.001), Calmness (p-value < 0.001), Ventilator synchrony (p-value < 0.001), face relaxation (p-value < 0.001), Consciousness (p-value = 0.009) and Awakeness (p-value = 0.020). The study findings demonstrated the effectiveness of relaxation program in promoting sedation in patients undergoing NIV. Accordingly, intensive care unit (ICU) nurses at our institution are encouraged to use PMR and GI to sedation of patients under NIV.
-
J Pain Palliat Care Pharmacother · Apr 2024
Assessment of Clinical Outcomes in Patients With Osteoarthritis: Analysis From the UK Medical Cannabis Registry.
Osteoarthritis accounts for 0.6% of disability-adjusted life years globally. There is a paucity of research focused on cannabis-based medicinal products (CBMPs) for osteoarthritic chronic pain management. This study aims to assess changes in validated patient-reported outcome measures (PROMs) and CBMP clinical safety in patients with osteoarthritis. ⋯ There were improvements in the EQ-5D-5L index (p = 0.026), SQS (p < 0.001), and GAD-7 (p = 0.038) up to 6 and 3 months, respectively. Seventeen participants (22.08%) recorded 76 mild AEs (34.86%), 104 moderate AEs (47.71%), and 38 severe AEs (17.43%). Though causality cannot be assumed in this observational study, results support development of randomized control trials for osteoarthritis pain management with CBMPs.
-
J Pain Palliat Care Pharmacother · Apr 2024
Initial Experiences With Integration of Palliative Medicine and Specialist Pain Services in a Tertiary Cancer Care Center in India.
Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient outcomes. ⋯ Each patient was exposed to a comprehensive pain management regimen, with the most frequently conducted procedure being an intercostal nerve block, which was administered in 9.30% of cases. For the provision of effective pain relief within the palliative care context, the confluence of joint consultations from cancer pain specialists emerges as a requisite measure. This approach carries the promise of optimizing pain control and augmenting the quality of palliative care.