DOCSLIB.ORG

Pain Management & Palliative Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Guidelines on Pain Management & Palliative Care A. Paez Borda (chair), F. Charnay-Sonnek, V. Fonteyne, E.G. Papaioannou © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 The Guideline 6 1.2 Methodology 6 1.3 Publication history 6 1.4 Acknowledgements 6 1.5 Level of evidence and grade of guideline recommendations* 6 1.6 References 7 2. BACKGROUND 7 2.1 Definition of pain 7 2.2 Pain evaluation and measurement 7 2.2.1 Pain evaluation 7 2.2.2 Assessing pain intensity and quality of life (QoL) 8 2.3 References 9 3. CANCER PAIN MANAGEMENT (GENERAL) 10 3.1 Classification of cancer pain 10 3.2 General principles of cancer pain management 10 3.3 Non-pharmacological therapies 11 3.3.1 Surgery 11 3.3.2 Radionuclides 11 3.3.2.1 Clinical background 11 3.3.2.2 Radiopharmaceuticals 11 3.3.3 Radiotherapy for metastatic bone pain 13 3.3.3.1 Clinical background 13 3.3.3.2 Radiotherapy scheme 13 3.3.3.3 Spinal cord compression 13 3.3.3.4 Pathological fractures 14 3.3.3.5 Side effects 14 3.3.4 Psychological and adjunctive therapy 14 3.3.4.1 Psychological therapies 14 3.3.4.2 Adjunctive therapy 14 3.4 Pharmacotherapy 15 3.4.1 Chemotherapy 15 3.4.2 Bisphosphonates 15 3.4.2.1 Mechanisms of action 15 3.4.2.2 Effects and side effects 15 3.4.3 Denosumab 16 3.4.4 Systemic analgesic pharmacotherapy - the analgesic ladder 16 3.4.4.1 Non-opioid analgesics 17 3.4.4.2 Opioid analgesics 17 3.4.5 Treatment of neuropathic pain 21 3.4.5.1 Antidepressants 21 3.4.5.2 Anticonvulsant medication 21 3.4.5.3 Local analgesics 22 3.4.5.4 NMDA receptor antagonists 22 3.4.5.5 Other drug treatments 23 3.4.5.6 Invasive analgesic techniques 23 3.4.6 Breakthrough cancer pain 24 3.5 Quality of life (QoL) 25 3.6 Conclusions 26 3.7 References 26 4. PAIN MANAGEMENT IN UROLOGICAL CANCERS 38 4.1 Pain management in prostate cancer patients 38 4.1.1 Clinical presentation 38 4.1.2 Pain due to local impairment 38 4.1.2.1 Invasion of soft tissue or a hollow viscus 38 2 PAIN MANAGEMENT & PALLIATIVE CARE - UPDATE MARCH 2013 4.1.2.2 Bladder outlet obstruction 39 4.1.2.3 Ureteric obstruction 39 4.1.2.4 Lymphoedema 39 4.1.2.5 Ileus 39 4.1.3 Pain due to metastases 39 4.1.3.1 Bone metastases 39 4.1.3.2 Hormone therapy 40 4.1.3.3 Radiotherapy 40 4.1.3.4 Orthopaedic surgery 40 4.1.3.5 Radioisotopes 40 4.1.3.6 Bisphosphonates 41 4.1.3.7 Denosumab 41 4.1.3.8 Calcitonin 41 4.1.3.9 Chemotherapy 41 4.1.3.10 Systemic analgesic pharmacotherapy (the analgesic ladder) 41 4.1.4 Spinal cord compression 42 4.1.5 Hepatic invasion 42 4.1.6 Pain due to cancer treatment 42 4.1.6.1 Acute pain associated with hormonal therapy 42 4.1.6.2 Chronic pain associated with hormonal therapy 42 4.1.7 Recommendations at a glance (stage M1) (60-65) 43 4.2 Pain management in transitional cell carcinoma patients 43 4.2.1 Clinical presentation 43 4.2.2 Origin of tumour-related pain 43 4.2.2.1 Bladder TCC 43 4.2.2.2 Upper urinary tract TCC 43 4.2.3 Pain due to local impairment 44 4.2.3.1 Bladder TCC 44 4.2.3.2 Upper urinary tract TCC 44 4.2.4 Pain due to metastases 44 4.2.5 Conclusion for symptomatic locally advanced or metastatic urothelial cancer 45 4.3. Pain management in renal cell carcinoma patients 45 4.3.1 Clinical presentation 45 4.3.2 Pain due to local impairment 45 4.3.3 Pain due to metastases 46 4.4 Pain management in patients with adrenal carcinoma 46 4.4.1 Malignant phaeochromocytoma 46 4.4.2 Treatment of pain 47 4.4.2.1 Adrenocortical carcinomas 47 4.4.2.2 Treatment of the pain depending on its origin 47 4.5 Pain management in penile cancer patients 47 4.5.1 Clinical presentation 47 4.5.2 Pain due to local impairment 47 4.5.3 Lymphoedema 48 4.5.4 Pain due to metastases 48 4.5.5 Conclusions 48 4.6 Pain management in testicular cancer patients 48 4.6.1 Clinical presentation 48 4.6.2 Pain due to local impairment 48 4.6.3 Pain due to metastases 48 4.7 Recommendations at a glance 49 4.8 References 49 5. POSTOPERATIVE PAIN MANAGEMENT 56 5.1 Background 56 5.2 Importance of effective postoperative pain management 56 5.2.1 Aims of effective postoperative pain management 57 5.3 Pre- and postoperative pain management methods 57 5.3.1 Preoperative patient preparation 57 5.3.2 Pain assessment 57 PAIN MANAGEMENT & PALLIATIVE CARE - UPDATE MARCH 2013 3 5.3.3 Pre-emptive analgesia 57 5.3.4 Systemic analgesic techniques 57 5.3.4.1 Non-steroidal anti-inflammatory drugs 57 5.3.4.2 Paracetamol 58 5.3.4.3 Metamizole (dipyrone) 58 5.3.4.4 Opioids 59 5.3.4.5 Patient-controlled analgesia 59 5.3.4.6 Adjuncts to postoperative analgesia 59 5.3.5 Regional analgesic techniques 60 5.3.5.1 Local anaesthetic agents 60 5.3.5.2 Epidural analgesia 60 5.3.5.3 Patient-controlled epidural analgesia 60 5.3.5.4 Neural blocks 60 5.3.5.5 Wound infiltration 61 5.3.5.6 Continuous wound instillation 61 5.3.6 Multimodal analgesia 61 5.3.7 Special populations 61 5.3.7.1 Ambulatory surgical patients 61 5.3.7.2 Geriatric patients 61 5.3.7.3 Obese patients 61 5.3.7.4 Drug- or alcohol-dependent patients 62 5.3.7.5 Other groups 62 5.3.8 Postoperative pain management teams 62 5.4 Specific pain treatment after different urological operations 62 5.4.1 Extracorporeal shock wave lithotripsy 62 5.4.2 Endoscopic procedures 63 5.4.2.1 Transurethral procedures 63 5.4.2.2 Percutaneous endoscopic procedures 63 5.4.2.3 Laparoscopic procedures 63 5.4.3 Open surgery 63 5.4.3.1 Minor operations of the scrotum/penis and the inguinal approach 63 5.4.3.2 Transvaginal surgery 64 5.4.3.3 Perineal open surgery 64 5.4.3.4 Transperitoneal laparotomy 64 5.4.3.5 Suprapubic/retropubic extraperitoneal laparotomy 64 5.4.3.6 Retroperitoneal approach - flank incision - thoracoabdominal approach 64 5.5 Dosage and method of delivery of some important analgesics 65 5.5.1 NSAIDs 65 5.5.2 Opioids 65 5.6 Perioperative pain management in children 66 5.6.1 Perioperative problems 66 5.6.2 Postoperative analgesia 67 5.7 References 68 6. NON-TRAUMATIC ACUTE FLANK PAIN 73 6.1 Background 73 6.2 Initial diagnostic approach 73 6.2.1 Symptomatology 73 6.2.2 Laboratory evaluation 74 6.2.3 Diagnostic imaging 74 6.2.3.1 Ultrasonography 74 6.2.3.2 Intravenous urography 74 6.2.3.3 Unenhanced helical CT 74 6.3 Initial emergency treatment 77 6.3.1 Systemic analgesia 77 6.3.2 Local analgesia 77 6.3.3 Supportive therapy 77 6.3.4 Upper urinary tract decompression 78 6.4 Aetiological treatment 78 6.4.1 Urolithiasis 78 4 PAIN MANAGEMENT & PALLIATIVE CARE - UPDATE MARCH 2013 6.4.2 Infectious conditions 78 6.4.3 Other conditions 78 6.4.3.1 Ureteropelvic junction obstruction 78 6.4.3.2 Papillary necrosis 78 6.4.3.3 Renal infarction 78 6.4.3.4 Renal vein thrombosis 78 6.4.3.5 Intra- or perirenal bleeding 78 6.4.3.6 Testicular cord torsion 79 6.5 References 79 7. PALLIATIVE CARE 81 7.1 Background 81 7.2 Definition and aim of palliative care 81 7.3 General principles 82 7.3.1 Communication 82 7.3.2 Patient-centred treatment 84 7.3.3 Cultural and spiritual approach 84 7.3.4 Multidisciplinary approach 84 7.3.5 Can anyone provide palliative care? Health care staff and advanced urological diseases 84 7.4 Treatment of physical symptoms 84 7.4.1 Pain 84 7.4.2 Dyspnoea and respiratory symptoms 84 7.4.3 Cancer anorexia-cachexia syndrome 85 7.4.4 Vomiting 85 7.4.5 Other symptoms 85 7.4.5.1 Fatigue 85 7.4.5.2 Restlessness 86 7.4.5.3 Agitated delirium 86 7.4.5.4 Constipation 86 7.4.5.5 Anxiety 86 7.5 Terminal care 86 7.5.1 When and how to withdraw specific treatment 87 7.5.2 Parenteral hydration: should it be discontinued in the terminal phases? 87 7.5.3 Palliative sedation 88 7.6 Treatment of psychological aspects 88 7.6.1 Fear 88 7.6.2 Depression 89 7.6.3 Family care 89 7.6.4 Communication of bad news 90 7.7 References 90 8. ABBREVIATIONS USED IN THE TEXT 96 PAIN MANAGEMENT & PALLIATIVE CARE - UPDATE MARCH 2013 5 1. INTRODUCTION 1.1 The Guideline The new European Association of Urology (EAU) Guidelines expert panel for Pain Management and Palliative Care have prepared this guidelines document to assist medical professionals in appraising the evidence-based management of pain and palliation in urological practice.
Recommended publications
  • RELISTOR, INN: Methylnaltrexone Bromide

    RELISTOR, INN: Methylnaltrexone Bromide

    The European Medicines Agency Evaluation of Medicines for Human Use EMEA/CHMP/10906/2008 ASSESSMENT REPORT FOR RELISTOR International Nonproprietary Name: METHYLNALTREXONE BROMIDE Procedure No. EMEA/H/C/870 Assessment Report as adopted by the CHMP with all information of a commercially confidential nature deleted. 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 8613 E-mail: [email protected] http://www.emea.eu.int TABLE OF CONTENTS Page 1 BACKGROUND INFORMATION ON THE PROCEDURE......................................... 3 1.1 Submission of the dossier ...................................................................................................... 3 1.2 Steps taken for the assessment of the product ....................................................................... 3 2 SCIENTIFIC DISCUSSION............................................................................................... 4 2.1 Introduction............................................................................................................................ 4 2.2 Quality aspects....................................................................................................................... 5 2.3 Non-clinical aspects............................................................................................................... 7 2.4 Clinical aspects .................................................................................................................... 13 2.5 Pharmacovigilance...............................................................................................................41
  • Albany-Molecular-Research-Regulatory

    Albany-Molecular-Research-Regulatory

    PRODUCT CATALOGUE API COMMERCIAL US EU Japan US EU Japan API Name Site CEP India API Name Site CEP India DMF DMF DMF DMF DMF DMF A Abiraterone Malta • Benztropine Mesylate Cedarburg • Adenosine Rozzano - Quinto de' Stampi • • * Betaine Citrate Anhydrous Bon Encontre • Betametasone-17,21- Alcaftadine Spain Spain • • Dipropionate Sterile • Alclometasone-17, 21- Spain Betamethasone Acetate Spain Dipropionate • • Altrenogest Spain • • Betamethasone Base Spain Amphetamine Aspartate Rensselaer Betamethasone Benzoate Spain * Monohydrate Milled • Betamethasone Valerate Amphetamine Sulfate Rensselaer Spain * • Acetate Betamethasone-17,21- Argatroban Rozzano - Quinto de' Stampi Spain • • Dipropionate • • • Atenolol India • • Betamethasone-17-Valerate Spain • • Betamethasone-21- Atracurium Besylate Rozzano - Quinto de' Stampi Spain • Phosphate Disodium Salt • • Bromfenac Monosodium Atropine Sulfate Cedarburg Lodi * • Salt Sesquihydrate • • Azanidazole Lodi Bromocriptine Mesylate Rozzano - Quinto de' Stampi • • • • • Azelastine HCl Rozzano - Quinto de' Stampi • • Budesonide Spain • • Aztreonam Rozzano - Valle Ambrosia • • Budesonide Sterile Spain • • B Bamifylline HCl Bon Encontre • Butorphanol Tartrate Cedarburg • Beclomethasone-17, 21- Spain Capecitabine Lodi Dipropionate • C • 2 *Please contact our Accounts Managers in case you are interested in this API. 3 PRODUCT CATALOGUE API COMMERCIAL US EU Japan US EU Japan API Name Site CEP India API Name Site CEP India DMF DMF DMF DMF DMF DMF Dexamethasone-17,21- Carbimazole Bon Encontre Spain • Dipropionate
  • Design and Synthesis of Cyclic Analogs of the Kappa Opioid Receptor Antagonist Arodyn

    Design and Synthesis of Cyclic Analogs of the Kappa Opioid Receptor Antagonist Arodyn

    Design and synthesis of cyclic analogs of the kappa opioid receptor antagonist arodyn By © 2018 Solomon Aguta Gisemba Submitted to the graduate degree program in Medicinal Chemistry and the Graduate Faculty of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Chair: Dr. Blake Peterson Co-Chair: Dr. Jane Aldrich Dr. Michael Rafferty Dr. Teruna Siahaan Dr. Thomas Tolbert Date Defended: 18 April 2018 The dissertation committee for Solomon Aguta Gisemba certifies that this is the approved version of the following dissertation: Design and synthesis of cyclic analogs of the kappa opioid receptor antagonist arodyn Chair: Dr. Blake Peterson Co-Chair: Dr. Jane Aldrich Date Approved: 10 June 2018 ii Abstract Opioid receptors are important therapeutic targets for mood disorders and pain. Kappa opioid receptor (KOR) antagonists have recently shown potential for treating drug addiction and 1,2,3 4 8 depression. Arodyn (Ac[Phe ,Arg ,D-Ala ]Dyn A(1-11)-NH2), an acetylated dynorphin A (Dyn A) analog, has demonstrated potent and selective KOR antagonism, but can be rapidly metabolized by proteases. Cyclization of arodyn could enhance metabolic stability and potentially stabilize the bioactive conformation to give potent and selective analogs. Accordingly, novel cyclization strategies utilizing ring closing metathesis (RCM) were pursued. However, side reactions involving olefin isomerization of O-allyl groups limited the scope of the RCM reactions, and their use to explore structure-activity relationships of aromatic residues. Here we developed synthetic methodology in a model dipeptide study to facilitate RCM involving Tyr(All) residues. Optimized conditions that included microwave heating and the use of isomerization suppressants were applied to the synthesis of cyclic arodyn analogs.
  • A Review of Unique Opioids and Their Conversions

    A Review of Unique Opioids and Their Conversions

    A Review of Unique Opioids and Their Conversions Jacqueline Cleary, PharmD, BCACP Assistant Professor Albany College of Pharmacy and Health Sciences Adjunct Professor SAGE College of Nursing DISCLOSURES • Kaleo • Remitigate, LLC OBJECTIVES • Compare and contrast unique pharmacotherapy options for the treatment of chronic pain including: methadone, buprenoprhine, tapentadol, and tramadol • Select methadone, buprenorphine, tapentadol, or tramadol based on patient specific factors • Apply appropriate opioid conversion strategies to unique opioids • Understand opioid overdose risk surrounding opioid conversions and the use of unique opioids UNIQUE OPIOIDS METHADONE, BUPRENORPHINE, TRAMADOL, TAPENTADOL METHADONE My favorite drug because….? METHADONE- INDICATIONS • FDA labeled indications – (1) chronic pain (2) detoxification Oral soluble tablets for suspension NOT indicated for chronic pain treatment • Initial inpatient detoxification of opioids by a licensed trained provider with methadone and supportive care is appropriate • Methadone maintenance provider must have special credentialing and training as required by state Outpatient prescription must be for pain ONLY and say “for pain” on RX • Continuation of methadone maintenance from outside provider while patient is inpatient for another condition is appropriate http://cdn.atforum.com/wp-content/uploads/SAMHSA-2015-Guidelines-for-OTPs.pdf MECHANISM OF ACTION • Potent µ-opioid agonist • NMDA receptor antagonist • Norepinephrine reuptake inhibitor • Serotonin reuptake inhibitor ADVERSE EVENTS
  • Clinical Data Mining Reveals Analgesic Effects of Lapatinib in Cancer Patients

    Clinical Data Mining Reveals Analgesic Effects of Lapatinib in Cancer Patients

    www.nature.com/scientificreports OPEN Clinical data mining reveals analgesic efects of lapatinib in cancer patients Shuo Zhou1,2, Fang Zheng1,2* & Chang‑Guo Zhan1,2* Microsomal prostaglandin E2 synthase 1 (mPGES‑1) is recognized as a promising target for a next generation of anti‑infammatory drugs that are not expected to have the side efects of currently available anti‑infammatory drugs. Lapatinib, an FDA‑approved drug for cancer treatment, has recently been identifed as an mPGES‑1 inhibitor. But the efcacy of lapatinib as an analgesic remains to be evaluated. In the present clinical data mining (CDM) study, we have collected and analyzed all lapatinib‑related clinical data retrieved from clinicaltrials.gov. Our CDM utilized a meta‑analysis protocol, but the clinical data analyzed were not limited to the primary and secondary outcomes of clinical trials, unlike conventional meta‑analyses. All the pain‑related data were used to determine the numbers and odd ratios (ORs) of various forms of pain in cancer patients with lapatinib treatment. The ORs, 95% confdence intervals, and P values for the diferences in pain were calculated and the heterogeneous data across the trials were evaluated. For all forms of pain analyzed, the patients received lapatinib treatment have a reduced occurrence (OR 0.79; CI 0.70–0.89; P = 0.0002 for the overall efect). According to our CDM results, available clinical data for 12,765 patients enrolled in 20 randomized clinical trials indicate that lapatinib therapy is associated with a signifcant reduction in various forms of pain, including musculoskeletal pain, bone pain, headache, arthralgia, and pain in extremity, in cancer patients.
  • Approach to Polyarthritis for the Primary Care Physician

    Approach to Polyarthritis for the Primary Care Physician

    24 Osteopathic Family Physician (2018) 24 - 31 Osteopathic Family Physician | Volume 10, No. 5 | September / October, 2018 REVIEW ARTICLE Approach to Polyarthritis for the Primary Care Physician Arielle Freilich, DO, PGY2 & Helaine Larsen, DO Good Samaritan Hospital Medical Center, West Islip, New York KEYWORDS: Complaints of joint pain are commonly seen in clinical practice. Primary care physicians are frequently the frst practitioners to work up these complaints. Polyarthritis can be seen in a multitude of diseases. It Polyarthritis can be a challenging diagnostic process. In this article, we review the approach to diagnosing polyarthritis Synovitis joint pain in the primary care setting. Starting with history and physical, we outline the defning characteristics of various causes of arthralgia. We discuss the use of certain laboratory studies including Joint Pain sedimentation rate, antinuclear antibody, and rheumatoid factor. Aspiration of synovial fuid is often required for diagnosis, and we discuss the interpretation of possible results. Primary care physicians can Rheumatic Disease initiate the evaluation of polyarthralgia, and this article outlines a diagnostic approach. Rheumatology INTRODUCTION PATIENT HISTORY Polyarticular joint pain is a common complaint seen Although laboratory studies can shed much light on a possible diagnosis, a in primary care practices. The diferential diagnosis detailed history and physical examination remain crucial in the evaluation is extensive, thus making the diagnostic process of polyarticular symptoms. The vast diferential for polyarticular pain can difcult. A comprehensive history and physical exam be greatly narrowed using a thorough history. can help point towards the more likely etiology of the complaint. The physician must frst ensure that there are no symptoms pointing towards a more serious Emergencies diagnosis, which may require urgent management or During the initial evaluation, the physician must frst exclude any life- referral.
  • Update on the Management of Pain, Agitation, and Delirium in the ICU

    Update on the Management of Pain, Agitation, and Delirium in the ICU

    Update on the Management of Pain, Agitation, and Delirium in the ICU Kevin E. Anger, Pharm.D., BCPS Gilles Fraser, Pharm.D., MCCM Paul M. Szumita, Pharm.D., BCCCP, Manager Investigational Drug Clinical Pharmacist in Critical BCPS, FCCM Service Brigham and Women’s Care Clinical Pharmacy Practice Manager Hospital Maine Medical Center Brigham and Women’s Hospital Boston, Massachusetts Portland, Maine Boston, Massachusetts Disclosures • Faculty have nothing to disclose. Objectives • Describe recent literature on management of pain, agitation, and delirium (PAD) in the intensive care unit (ICU). • Apply key concepts in the selection of sedatives, analgesics, and antipsychotic agents in critically ill patients. • Recommend methods to overcome key barriers to optimizing pain, sedation, and delirium pharmacotherapy in critically ill patients. Case-Based Approach to Pain Management in the ICU Kevin E. Anger, Pharm.D., BCPS Manager Investigational Drug Service Brigham and Women’s Hospital Boston, Massachusetts Time for a Poll How to vote via the web or text messaging From any browser From a text message Pollev.com/ashp 22333 152964 How to vote via text message How to vote via the web Question #1 DT is a 70 yo male w/ COPD, S/P XRT for NSC lung CA, now admitted to the medical ICU for respiratory failure secondary to pneumonia meeting ARDS criteria. Significant home medications include oxycodone sustained release 40mg TID, oxycodone 10- 20mg Q4hrs PRN pain, Advair 500/50mcg BID, ASA 81mg QD, and albuterol neb Q4hrs PRN. DT is intubated is currently
  • Methylnaltrexone Nonf

    Methylnaltrexone Nonf

    Methylnaltrexone Bromide Subcutaneous Injection and Tablets Criteria for Use May 2020 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The following recommendations are based on medical evidence, clinician input, and expert opinion. The content of the document is dynamic and will be revised as new information becomes available. The purpose of this document is to assist practitioners in clinical decision-making, to standardize and improve the quality of patient care, and to promote cost- effective drug prescribing. THE CLINICIAN SHOULD USE THIS GUIDANCE AND INTERPRET IT IN THE CLINICAL CONTEXT OF THE INDIVIDUAL PATIENT. INDIVIDUAL CASES THAT ARE EXCEPTIONS TO THE EXCLUSION AND INCLUSION CRITERIA SHOULD BE ADJUDICATED AT THE LOCAL FACILITY ACCORDING TO THE POLICY AND PROCEDURES OF ITS P&T COMMITTEE AND PHARMACY SERVICES. The Product Information should be consulted for detailed prescribing information. Exclusion Criteria If ANY item below applies, the patient should NOT receive methylnaltrexone subcutaneous injections. Known or suspected mechanical gastrointestinal obstruction or other condition that may compromise drug action or cause bowel dysfunction (e.g., acute abdomen, ostomy, active diverticulitis, ischemic bowel, etc.) Placement of peritoneal catheter for chemotherapy or dialysis (not studied) End-stage renal impairment on dialysis (not studied) Use of methylnaltrexone solely for prevention of opioid-induced constipation or impaction (no supporting evidence). Use of methylnaltrexone for postoperative ileus (preliminary results showed inefficacy). Use of methylnaltrexone for constipation that is not opioid-related (not studied) Concomitant use of other opioid antagonists (potential for increased risks of additive effects and opioid withdrawal) Inclusion Criteria for Opioid-induced Constipation in Adults with Chronic Noncancer Pain All of the following criteria must be fulfilled.
  • Pathological Cause of Low Back Pain in a Patient Seen Through Direct Margaret M

    Pathological Cause of Low Back Pain in a Patient Seen Through Direct Margaret M

    Pathological Cause of Low Back Pain in a Patient Seen through Direct Margaret M. Gebhardt PT, DPT, OCS Access in a Physical Therapy Clinic: A Case Report Staff Physical Therapist, Motion Stability, LLC, and Adjunct Clinical Faculty, Mercer University, Atlanta, GA ABSTRACT cal therapists primarily treat patients that sporadic.9 Deyo and Diehl6 found that the Background and Purpose: A 66-year- fall into the mechanical LBP category, but 4 clinical findings with the highest positive old male presented directly to a physical need to be aware that although infrequent, likelihood ratios for detecting the presence therapy clinic with complaints of low back 7% to 8% of LBP complaints are due to of cancer in LBP were: a previous history of pain (LBP). The purpose of this case report is nonmechanical spinal conditions or visceral cancer, failure to improve with conservative to describe the clinical reasoning that led to disease.5 Malignant neoplasms are the most medical treatment in the past month, an age a medical referral for a patient not respond- common of the nonmechanical spinal con- of at least 50 years or older, and unexplained ing to conservative treatment that ultimately ditions causing LBP, but comprise less than weight loss of more than 4.5 kg in 6 months led to the diagnosis of multiple myeloma. 1% of all total LBP conditions.6 (Table 1).10 In Deyo and Diehl’s6 study, they Methods: Data was collected during the In this era of autonomous practice, analyzed 1975 patients that presented with course of the patient’s treatment in an out- increasing numbers of physical therapists are LBP and found 13 to have cancer.
  • Pharmacists' Roles on the Pain Management Team, Fall 2014

    Pharmacists' Roles on the Pain Management Team, Fall 2014

    Fall 2014, Volume 8, Issue 2 Canadian Pharmacy > Research > Health Policy > Practice > Better Health Pharmacists’ Roles on the Pain Management Team harmacists are an important resource for managing pain in their patients, in order to both optimize treatment and Pprevent the unintended consequences of potent analgesics. While the role of pharmacists in pain management was first addressed inthe Translator Summer 2012 edition1, this rapidly evolving area of pharmacy practice has generated a number of innovative models that highlight the unique role of the pharmacist. As Canadian pharmacists embrace expanded scopes of practice, there is an opportunity to specifically leverage their services to assist patients in managing their pain. This issue of the Translator highlights four different approaches to enhanced involvement of pharmacists in the management of chronic pain: n Pharmacist-led management of chronic pain: a randomized controlled exploratory trial from the UK n A pharmacist-initiated intervention trial in osteoarthritis n A pharmacist-led pain consultation for patients with concomitant substance use disorders n The impact of pharmacists in translating evidence to patients with low back pain 1 The Translator, Summer 2012, 6:3 Pharmacist-led management of chronic pain in primary care: results from a randomized controlled exploratory trial Bruhn H, Bond CM, Elliott AM, et al. Pharmacist-led management of chronic pain in primary care; results from a randomized controlled exploratory trial. BMJ Open 2013;3:e002361. Issue: In the UK, an estimated 80% of medication review of each patient’s medical chronic pain sufferers still report pain after Pharmacist prescribing and records, followed by a face-to-face consul- four years of follow-up.1 Most patients refer reviewing pain medication may tation.
  • Pain Management in People Who Have OUD; Acute Vs. Chronic Pain

    Pain Management in People Who Have OUD; Acute Vs. Chronic Pain

    Pain Management in People Who Have OUD; Acute vs. Chronic Pain Developer: Stephen A. Wyatt, DO Medical Director, Addiction Medicine Carolinas HealthCare System Reviewer/Editor: Miriam Komaromy, MD, The ECHO Institute™ This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under contract number HHSH250201600015C. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Disclosures Stephen Wyatt has nothing to disclose Objectives • Understand the complexities of treating acute and chronic pain in patients with opioid use disorder (OUD). • Understand the various approaches to treating the OUD patient on an agonist medication for acute or chronic pain. • Understand how acute and chronic pain can be treated when the OUD patient is on an antagonist medication. Speaker Notes: The general Outline of the module is to first address the difficulties surrounding treating pain in the opioid dependent patient. Then to address the ways that patients with pain can be approached on either an agonist of antagonist opioid use disorder treatment. Pain and Substance Use Disorder • Potential for mutual mistrust: – Provider • drug seeking • dependency/intolerance • fear – Patient • lack of empathy • avoidance • fear Speaker Notes: It is the provider that needs to be well educated and skillful in working with this population. Through a better understanding of opioid use disorders as a disease, the prejudice surrounding the encounter with the patient may be reduced.
  • Perioperative Pain Management for the Chronic Pain Patient with Long-Term Opioid Use

    Perioperative Pain Management for the Chronic Pain Patient with Long-Term Opioid Use

    1.5 ANCC Contact Hours Perioperative Pain Management for the Chronic Pain Patient With Long-Term Opioid Use Carina Jackman In the United States nearly one in four patients present- patterns of preoperative opioid use. Approximately one ing for surgery reports current opioid use. Many of these in four patients undergoing surgery in the study re- patients suffer from chronic pain disorders and opioid ported preoperative opioid use (23.1% of the 34,186-pa- tolerance or dependence. Opioid tolerance and preexisting tient study population). Opioid use was most common chronic pain disorders present unique challenges in regard in patients undergoing orthopaedic spinal surgery to postoperative pain management. These patients benefi t (65%). This was followed by neurosurgical spinal sur- geries (55.1%). Hydrocodone bitartrate was the most from providers who are not only familiar with multimodal prevalent medication. Tramadol and oxycodone hydro- pain management and skilled in the assessment of acute pain, chloride were also common ( Hilliard et al., 2018 ). but also empathetic to their specifi c struggles. Chronic pain Given this signifi cant population of surgical patients patients often face stigmas surrounding their opioid use, with established opioid use, it is imperative for both and this may lead to underestimation and undertreatment nurses and all other providers to gain an understanding of their pain. This article aims to review the challenges of the complex challenges chronic pain patients intro- presented by these complex patients and provide strate- duce to the postoperative setting. gies for treating acute postoperative pain in opioid-tolerant patients. Defi nitions Common pain terminology as defined by the Chronic Pain and Long-Term International Association for the Study of Pain, a joint Opioid Use consensus statement by the American Society of Addiction Medicine, the American Academy of Pain The burden of chronic pain in the United States is stag- Medicine and the American Pain Society (2001 ), and the gering.