| Journal of Opioid Management ® | |||||||||||||
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Publications American Journal of Hospice & Palliative Medicine Journal of Cancer Integrative Medicine
Journal of Opioid
Management
American
Journal of Alzheimer's Disease & Other Dementias Activities Directors' Quarterly
for Alzheimer's & Other Dementia Patients American
Journal of Recreation Therapy |
March/April 2005; pages 5-5 Newsbriefs MPA as effective as leuprolide in treating endometriosis pain. New epidural injection provides two days of postsurgical pain relief. Patient-controlled transdermal fentanyl analgesic convenient, effective after hysterectomy. Sustained-release morphine may alleviate pain in refractory patients. March/April 2005; pages 6-7
March/April 2005; pages 9-10
March/April 2005; pages 11-12
March/April 2005; pages 13-16 Abstract Introduction Opioids are often used in combination with other analgesics in multimodal approach. Pharmacotherapy in alleviating pain may require, in addition to an opioid, nonsteroidal anti-inflammatory agents. This article will help the clinician determine when to use nonsteroidal anti-inflammatory agents and which nonsteroidal anti-inflammatory agents may be better options to use in conjunction with opioid management. The cyclooxygenase 2 (COX-2) selective nonsteroidal anti-inflammatory drug (NSAID) rofecoxib (Vioxx®) was voluntarily removed from the worldwide market in September 2004. Its manufacturer (Merck) announced that the decision was based on new data from a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial called APPROVe (Adenomatous Polyp Prevention on Vioxx). The APPROVe trial revealed a twofold increase in the risk of developing cardiovascular (CV) embolic events, such as stroke and myocardial infarction, in patients receiving rofecoxib 25 mg daily for 18 months or more.1 More recently, the news of a CV signal with celecoxib (Celebrex®, Pfizer) has raised concerns that the problem of an increased CV risk may be a class effect shared by all the selective COX-2 inhibitors. In light of these apparent risks to patients, physicians and other practitioners should become familiar with the mechanisms of NSAID action, the differences among COX-2 selective NSAIDs, and alternative NSAID options.
March/April 2005; pages 17-23 Abstract This study compares two methods of detoxification available to heroin users in Western Australia: clonidine-assisted detoxification (CD) or clonidine-naloxone precipitated withdrawal under sedation (rapid opioid detoxification [ROD]). Oral naltrexone was made available to all participants following detoxification. Eighty heroin-dependent persons were randomly assigned to either ROD or CD. Most undertaking ROD commenced and completed this treatment. Less than one-third undertaking CD completed this treatment. There was no significant difference in those treated by CD or ROD in subjective assessment of degree or duration of pain, severity of withdrawal and craving, nor was there an increase in the withdrawal sequelae after treatment. Induction of oral naltrexone following ROD was greater, but oral naltrexone compliance levels and abstinence from heroin four weeks following detoxification were similar between ROD and CD groups. The level of patient satisfaction between the two treatments was also similar. The authors discuss why ROD is considered more effective than CD. Key words: rapid opioid detoxification, naloxone/naltrexone, clonidine-assisted withdrawal
March/April 2005; pages 25-30 Abstract This study aimed to investigate factors associated with analgesic use of morphine in end-of-life care. French general practitioners (GPs) and oncologists (N = 719) were asked whether they would prescribe morphine as first-line therapy to patients with terminal lung cancer suffering from dyspnea associated with cough and great anxiety. Overall, 54 percent of oncologists and 40 percent of GPs stated that they would prescribe morphine in the presented case. This prescriptive attitude correlated with physicians’ age, professional background, communication skills, and attitude toward terminally ill patients. The findings of this study indicate that improving analgesic use of opioids in end-of-life care is not only a matter of enhancing technical skills acquired through training or experience but also a matter of improving communication and empathy between physicians and patients. Key words: morphine, dyspnea, end-of-life care, lung cancer, France
March/April 2005; pages 31-35 Abstract Detoxification from opioids remains an important first step in the treatment of many patients with opioid dependence. Several pharmacologic regimens have been used for opioid detoxification. In the United States, the partial µ-opioid agonist, buprenorphine (BUP) is the most recently approved pharmacotherapy for opioid detoxification and replacement. The literature in recent years has described detoxification protocols using a single high dose of BUP and a three-day BUP regimen. In many settings, such as drug-free programs, a single-dose detoxification protocol would be of significant benefit. There have been no prior studies comparing one-day and three-day BUP- assisted opioid withdrawal. In this pilot study, we conducted an open-label, randomized trial of one-day vs. three-day BUP/naloxone sublingual tablet-assisted opioid withdrawal. Twenty patients from a therapeutic community treatment program were randomly assigned to receive either 32 mg sublingual BUP over one hour (one-day group), or 32 mg sublingual BUP over three days (three-day group). Nine of 10 subjects (90 percent) in each group completed seven days in the detoxification protocol. There was no statistically significant difference between the two groups in all other outcome variables, including retention in the treatment program, intensity of withdrawal signs and symptoms, amounts of adjunct medications used, and ability to produce opiate-free urine. This study further validates the feasibility of the single high dose of BUP as a rapid detoxification method. Key words: buprenorphine, detoxification, withdrawal, opioid, heroin
March/April 2005; pages 36-40 Abstract Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; brand name Actiq®, Chephalon Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent. Key words: oral transmucosal fentanyl citrate, breakthrough pain, cancer
March/April 2005; pages 41-48 Abstract The primary goal of this single-group study was to determine the safety of a standard opioid titration order sheet to manage pain in ambulatory cancer patients. Secondary goals were to examine opioid toxicity and efficacy of this pain protocol. Twenty-seven patients who required fixed-dose opioids and who had uncontrolled pain were enrolled. All patients had their initial opioid dose titrated by the study physician using the opioid titration order sheet. Data were obtained by the study nurse during a weekly telephone interview and used to determine if pain was controlled. After initial titration, a trained study nurse titrated opioid doses based upon the standing order sheet. At each contact, patients were assessed for adverse effects, pain intensity, and analgesics used. Patients who completed the four-week trial (n = 17) did not differ from patients who did not complete the trial. No adverse effects were observed in 39 opioid titrations completed by the study nurse. Opioid toxicities, worst pain, usual pain, and pain-related distress declined from baseline to week four. Patients who were adherent to their prescribed medications reported significantly lower pain intensity and distress (ps £ 0.06). The opioid titration order sheet, used by a trained nurse, is safe to use in ambulatory cancer patients who have moderate to severe pain. Common opioid toxicities were reduced. The protocol also demonstrated initial efficacy in improving worst and usual pain and pain-related distress. Further research to establish efficacy of the protocol is recommended. Key words: cancer pain, standing orders, opioid titration
March/April 2005; pages 49-53 Abstract Many studies have brought to light the facts that repeated use of drugs significantly influences one’s cognitive functions, and that cognitive problems could interfere directly with one’s capacity to participate in a rehabilitation program. In this research, we used the Global Deterioration Scale (GDS) to assess the cognitive status of 101 hospitalized patients in an opiate detoxification program. The results reveal that a majority of the tested patients present cognitive abnormalities to varying degrees of severity. Furthermore, these cognitive deficits are correlated with four Addiction Severity Index (ASI) scales (medical, alcohol use, drug use, and psychiatry, respectively). Considering the results, because cognition is a major issue in detoxification and rehabilitation programs, simple cognitive screening (as with the GDS) coupled with a particular interest in some aspects of a patient’s anamnesis could lead to better management of opiate-dependent patients. Key words: detoxification, rehabilitation, cognitive function, addiction Book review Pain Medicine and Management: Just the Facts, edited by Mark S. Wallace and Peter S. Staats. New York: McGraw-Hill, 2005; 379 pages. Gilbert J. Fanciullo, MD, MS March/April 2005; pages 54-55 | ||||||||||||
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