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1.
Orphanet J Rare Dis ; 17(1): 78, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1714660

ABSTRACT

BACKGROUND: Hypophosphatasia (HPP) is a rare inherited metabolic disorder caused by mutations in the ALPL gene, which encodes tissue nonspecific alkaline phosphatase. The severity of HPP is widely diverse from the perinatal form to the adult mild form. The former represents the most severe form and was earlier associated with high mortality due to pneumonia which was caused by severe hypomineralization of the bones-such as chest deformity and fractured ribs-and muscle weakness. Enzyme replacement therapy using asfotase alfa (AA) was approved in 2015 in Japan for treating patients with HPP and has improved their pulmonary function and life prognosis. There are several practical and ethical challenges related to using orphan drugs for a rare disorder in a publicly funded healthcare system. Sharing experiences about their application is essential towards formulating guidelines to assist clinicians with decisions about their initiation and withdrawal. We report the details of AA experience in ten cases of pediatric-onset HPP in nine families from January 2015 to November 2019 (median [interquartile range] age 11.0 [7.6-12.5] years; 60% male). This is a study of a single-center cohort describing the clinical course of patients with HPP, mainly consisting of the mild childhood form of HPP, treated with AA in Japan. RESULTS: One case of perinatal form of HPP, two cases of benign prenatal form, and seven cases of childhood form were observed. The most common symptom at onset was pain. All patients had low serum alkaline phosphatase levels as compared to the age-matched reference range before the commencement of AA. All HPP patients seem to have responded to AA treatment, as evidenced by pain alleviation, increased height standard deviation, improvement in respiratory condition and 6-min walk test result improvement, disappearance of kidney calcification, alleviation of fatigue, and/or increases in bone mineralization. There were no serious adverse events, but all patients had an injection site reaction and skin changes at the injection sites. Genetic analysis showed that eight out of ten patients had compound heterozygosity. CONCLUSIONS: AA may be effective in patients with mild to severe pediatric-onset forms of HPP.


Subject(s)
Hypophosphatasia , Adult , Alkaline Phosphatase/genetics , Child , Female , Humans , Hypophosphatasia/complications , Hypophosphatasia/drug therapy , Immunoglobulin G , Japan , Male , Pain/drug therapy , Rare Diseases/drug therapy , Recombinant Fusion Proteins
2.
PLoS Med ; 18(11): e1003829, 2021 11.
Article in English | MEDLINE | ID: covidwho-1595916

ABSTRACT

BACKGROUND: The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time. METHODS AND FINDINGS: We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period. CONCLUSIONS: In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.


Subject(s)
Analgesics, Opioid/therapeutic use , Drug Prescriptions/statistics & numerical data , Pain/drug therapy , Adolescent , Adult , Aged , Canada , Cohort Studies , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Morphine/administration & dosage , Morphine/therapeutic use , Taiwan , United Kingdom , United States , Young Adult
3.
Reg Anesth Pain Med ; 47(2): 144-145, 2022 02.
Article in English | MEDLINE | ID: covidwho-1597058
4.
Agri ; 33(4): 215-222, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1551923

ABSTRACT

OBJECTIVES: A new type of coronavirus outbreak has emerged in China and caused a pandemic. World Health Organization (WHO) announced the official name of this disease 'COVID-19'. The main purpose of this study is to evaluate pain in COVID-19 patients. METHODS: Patients who were followed in the ward of an infectious diseases department because of possible or confirmed COVID-19 between May and September of 2020 were included in the study. The Turkish version of the Brief Pain Inventory (BPI) was applied. Demographic features, frequency, location, the intensity of pain, and response to analgesics were analyzed. RESULTS: A total of 178 participants were included in the study. Ninety-one (51.1%) of patients had pain complaints and the mean pain score (MPS) was 2.28±2.81 over 10. Fifty-nine (56.0%) of participants with pain required analgesic therapy and 41 (80.3%) of them showed ≥50% pain relief with simple analgesics. Twelve of the remaining 18 who did not get enough pain relief with simple analgesic were taking their analgesics pro re nata (PRN) rather than around the clock (ATC). Pain frequency and intensity and mean hospitalization duration (MHD) were similar between confirmed and possible cases. CONCLUSION: Regarding the results, we conclude that pain is not one of the challenging symptoms and easily manageable in patients with a mild-moderate intensity of COVID-19. Our results were not enough to make a correlation between pain and the clinical course of the disease. Further studies are required for the evaluation of pain including patients in intensive care units.


Subject(s)
COVID-19 , Analgesics/therapeutic use , Humans , Intensive Care Units , Pain/drug therapy , SARS-CoV-2
6.
Pain Manag Nurs ; 23(1): 26-30, 2022 02.
Article in English | MEDLINE | ID: covidwho-1447065

ABSTRACT

BACKGROUND: To investigate the pain and self-management status of patients with cancer and the influencing factors of pain and self-management status during the COVID-19 pandemic. METHODS: A cross-sectional design was used. Eighty-one Chinese patients with cancer were recruited in December 2020. The Brief Pain Inventory, the Pain Management Inventory, and the Pain Self-efficacy Questionnaire were used to evaluate patients' pain and self-management status. Descriptive statistical analysis and multiple linear regression models were conducted for the research aims. RESULTS: Two thirds of the participants experienced moderate to severe pain. Cancer pain had moderate to severe interference on 90.12% of patients' lives. Self-management of pain in these participants was low. The most commonly used methods of pain management included adjusting activity intensity to avoid fatigue, using distraction techniques, and massaging the sore area. The most effective methods to manage pain included taking analgesics prescribed by doctor, taking over-the-counter analgesics, and massaging the sore area. Fifteen patients (18.5%) believed that the COVID-19 pandemic had an impact on pain management and 26 patients (32.1%) needed support. Pain education, pain interference on sleep, chemotherapy, and payment status were significantly associated with cancer patients 'pain self-management. CONCLUSIONS: During the COVID-19 pandemic, patients with cancer had moderate to severe pain intensity with low levels of self-management and self-efficacy towards that pain.


Subject(s)
COVID-19 , Neoplasms , Self-Management , China/epidemiology , Cross-Sectional Studies , Humans , Neoplasms/complications , Neoplasms/therapy , Pain/drug therapy , Pain/epidemiology , Pandemics , SARS-CoV-2
7.
J Pain Palliat Care Pharmacother ; 35(3): 163-166, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1369020

ABSTRACT

Subcutaneous patient-controlled analgesia (SCPCA) is an underutilized method of pain management in palliative care patients. In a select group of patients, including patients in whom enteral analgesia is ineffective or undeliverable, and in patients with limited access to healthcare due to geographical or other logistic issues, SCPCA can provide an effective and safe alternative.


Subject(s)
Analgesia, Patient-Controlled , Palliative Care , Analgesics, Opioid , Humans , Pain/drug therapy , Pain Management , Pain, Postoperative
8.
Soc Work Health Care ; 60(6-7): 499-508, 2021 08 09.
Article in English | MEDLINE | ID: covidwho-1316731

ABSTRACT

As the COVID-19 global pandemic continues, more than 40 states have reported increases in opioid-related mortality. The issue of service access and delivery poses a major concern for those struggling with mental illness and substance use disorders in the United States. To ensure the continuity of health care during the pandemic and the co-occurring opioid crisis, the United States continues to adapt its healthcare delivery strategies, which include the introduction of telehealth. Telehealth is a relatively new concept and requires rapid systems changes as well as adjustments from both service providers and recipients. The proper adaptation to the new service delivery method could result in process optimization and improved outcomes for those struggling with opioid dependency. This study aims to bring attention to the opioid crisis that may be overlooked in light of the global pandemic and encourage social workers and other mental health professionals to utilize modern technological advancements to improve service delivery to their clients. This paper offers a literature review with four themes: (1) a retrospect on pain and opioids, (2) current telehealth models and practical strategies, (3) social work roles and functions in telehealth care, and (4) next steps and implications of telehealth for social work as a much-needed health-care delivery tool at the clinical and community social work practice level.


Subject(s)
COVID-19/epidemiology , Mental Health Services/organization & administration , Opioid-Related Disorders/therapy , Social Work/organization & administration , Telemedicine/organization & administration , Analgesics, Opioid/therapeutic use , Humans , Opioid Epidemic , Opioid-Related Disorders/epidemiology , Pain/drug therapy , Pandemics , Professional Role , SARS-CoV-2 , United States
9.
Pain Med ; 22(6): 1441-1464, 2021 06 04.
Article in English | MEDLINE | ID: covidwho-1174950

ABSTRACT

MYTH: Corticosteroid injection for the treatment of pain is known to decrease the efficacy of the adenovirus vector-based vaccines for COVID-19. FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an adenovirus vector-based COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Janssen and AstraZeneca vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to and no less than 2 weeks following a COVID-19 adenovirus vector-based vaccine dose, whenever possible. We emphasize the importance of risk/benefit analysis and shared decision making in determining the timing of corticosteroid injections for pain indications in relation to receipt of a COVID-19 vaccine given that patient-specific factors will vary.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adenoviridae/genetics , Adrenal Cortex Hormones , Humans , Hypothalamo-Hypophyseal System , Pain/drug therapy , Pituitary-Adrenal System , SARS-CoV-2
10.
Pain Med ; 22(4): 994-1000, 2021 04 20.
Article in English | MEDLINE | ID: covidwho-1091224

ABSTRACT

MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , COVID-19 Vaccines/administration & dosage , COVID-19 , Pain/drug therapy , Vaccines, Synthetic/administration & dosage , Humans , Time Factors
11.
J Colloid Interface Sci ; 586: 673-682, 2021 Mar 15.
Article in English | MEDLINE | ID: covidwho-1065294

ABSTRACT

Paracetamol is the most commonly used antipyretic and analgesic drug in the world. The key challenge in paracetamol therapy is associated with the frequency of the dosing. Depending on the gastric filling within 10-20 min paracetamol is released and rapidly absorbed from the gastrointestinal tract. Therefore, it must be taken three or four times a day. To address the dose challenge it is desirable that the paracetamol release profile follows the zero-order kinetic model (constant rate of drug release per unit time). This goal can be achieved by using a suitable porous carrier system. Herein, non-toxic wrinkled mesoporous carbons with unique morphology were synthesized via the hard template method as new carriers for paracetamol. These particles can precisely modulate the release of paracetamol over 24 h in a simulated gastric fluid according to the zero-order kinetic model completely eliminating the initial burst release. Overall, these systems could significantly enhance the bioavailability of paracetamol and prolong its therapeutic effect in numerous diseases such as cold, flu, COVID-19, and severe pain.


Subject(s)
Acetaminophen , COVID-19/drug therapy , Carbon/chemistry , Drug Carriers , Pain/drug therapy , SARS-CoV-2 , Acetaminophen/chemistry , Acetaminophen/pharmacokinetics , Delayed-Action Preparations/chemistry , Delayed-Action Preparations/pharmacokinetics , Drug Carriers/chemistry , Drug Carriers/pharmacokinetics , Humans
12.
Pain Med ; 22(2): 239-242, 2021 02 23.
Article in English | MEDLINE | ID: covidwho-1042035
13.
Agri ; 33(3): 203-204, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-925954

ABSTRACT

Pain is a common but often ignored symptom in COVID-19 patients. Early and adequate treatment with detailed pain assessment in these patients may reduce the risk of pain chronicization, and mood dysregulation. To provide analgesia, paracetamol can be listed as the first option in these patients, and then NSAIDs can also be reliably used for pain management in patients with COVID-19 if there are no absolute contraindications such as kidney failure or gastric bleeding. Codeine is also a good alternative for patients with anxiety who do not respond to simple pain-relievers.


Subject(s)
Analgesics, Non-Narcotic/therapeutic use , COVID-19/complications , Pain/etiology , SARS-CoV-2 , Acetaminophen/administration & dosage , Acetaminophen/therapeutic use , Administration, Oral , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Humans , Pain/drug therapy
14.
J Neurovirol ; 26(5): 800-801, 2020 10.
Article in English | MEDLINE | ID: covidwho-708986

ABSTRACT

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.


Subject(s)
Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome/complications , Back Pain/complications , Coronavirus Infections/complications , Neck Pain/complications , Olfaction Disorders/complications , Pain/complications , Pneumonia, Viral/complications , Acetaminophen/therapeutic use , Analgesics/therapeutic use , Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome/drug therapy , Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome/pathology , Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome/virology , Back Pain/drug therapy , Back Pain/pathology , Back Pain/virology , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/pathology , Coronavirus Infections/virology , Female , Gabapentin/therapeutic use , Humans , Middle Aged , Neck Pain/drug therapy , Neck Pain/pathology , Neck Pain/virology , Olfaction Disorders/drug therapy , Olfaction Disorders/pathology , Olfaction Disorders/virology , Pain/drug therapy , Pain/pathology , Pain/virology , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2 , Treatment Outcome
18.
JAMA Netw Open ; 3(3): e200802, 2020 03 02.
Article in English | MEDLINE | ID: covidwho-99094

ABSTRACT

Importance: Opioid prescriptions for treatment of pain in emergency departments (EDs) are associated with long-term opioid use. The temporal pattern of opioid prescribing in the context of the opioid epidemic remains unknown. Objective: To examine the temporal pattern of opioid prescribing within an ED for varying pain conditions between 2009 and 2018. Design, Setting, and Participants: A population-based, cross-sectional study was conducted at the ED of an urban academic medical center. All patients treated within that ED between January 1, 2009, and December 31, 2018, were included. Main Outcomes and Measures: The proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber. Results: Between 2009 and 2018, 556 176 patient encounters took place in the ED, with 70 218 unique opioid prescriptions ordered. A total of 316 632 patients (55.9%) were female, 45 070 (42.6%) were of white race, and 43 412 (40.6%) were privately insured; the median age group was 41 to 45 years. Yearly opioid prescriptions decreased by 66.3% (from 16.3 to 5.5 opioids per 100 encounters) between 2013 and 2018, with a yearly adjusted odds ratio (aOR) of 0.808 (95% CI, 0.802-0.814) compared with the prior year. In patients with musculoskeletal pain (back, joint, limb, and neck pain), opioid prescribing decreased by 71.1% (from 36.7 to 10.6 opioids per 100 encounters between 2013 and 2018; aOR, 0.758; 95% CI, 0.744-0.773). In patients with musculoskeletal trauma (fracture, sprain, contusion, and injury), opioid prescribing decreased by 58.0% (from 34.2 to 14.8 opioids per 100 encounters; aOR, 0.811; 95% CI, 0.797-0.824). In patients with nonmusculoskeletal pain (abdominal pain, kidney stone, respiratory distress, and pharyngitis) opioid prescribing decreased by 53.7% (from 20.1 to 9.3 opioids per 100 encounters; aOR, 0.850; 95% CI, 0.834-0.868). Between 2009 and 2018, patients who were black (aOR, 0.760; 95% CI, 0.741-0.779) and those who were Asian (aOR, 0.714; 95% CI, 0.665-0.764) had the lowest odds of receiving an opioid compared with other racial/ethnic groups. Conclusions and Relevance: There was a substantial temporal decrease in the number of opioid prescriptions within this ED during the study period. This decrease was associated with substantial relative reductions in opioid prescribing for treatment of musculoskeletal pain compared with fractures and kidney stones.


Subject(s)
Analgesics, Opioid/pharmacology , Drug Prescriptions/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Hospitals, Urban , Pain Management/methods , Pain/drug therapy , Practice Patterns, Physicians' , Adult , Cross-Sectional Studies , Female , Humans , Incidence , Male , Middle Aged , Pain/ethnology , United States/epidemiology
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