Conjoint Sessions With Clinical Pharmacy and Health Psychology for Chronic Pain: Enhancing Participation in Behavioral Management.

This quality improvement project suggests the utility of an interdisciplinary, coordinated team approach to chronic pain management and behavioral health services.

Management of severe neuropathic cancer pain: an illustrative case and review.

Neuropathic cancer pain is common, very disabling and difficult to treat. It can be related to tumor invasion of neural structures and neuronal damage by surgery, chemotherapy and radiation therapy. Adjuvant analgesics are often used with opioids to control neuropathic pain in cancer patients. Methadone, a synthetic opioid with multiple mechanisms of action, is gaining increasing importance as an effective agent in the treatment of cancer related neuropathic pain. This case illustrates the challenges of managing severe pain in a patient with head and neck cancer while undergoing anti-tumor treatment. A review of the adjuvant analgesics and opioids, particularly methadone, in the management of neuropathic pain is also included.

The management of neuropathic pain with a focus upon older adults.

By the year 2030, it is projected that the US population over the age of 65 years will be 70 million (one-fifth of the US population). Pain of various etiologies initiates about 50% of yearly physician visits and is the most frequent reason for health care consultation in the United States identified commonly by the older patient. The negative impact on the patient coupled with less than optimal treatments often presented to the patient elicit patient and prescriber frustration with inadequate outcomes. This article is focused at pharmacotherapeutic selections to be utilized in a polymodal fashion for the older adult presenting with neuropathic pain. The pharmacotherapies are to be titrated in a patient-specific patient centered-patient focused-personalized pharmacotherapeutic care. The classes of agents discussed include antidepressants, mood stabilizers/antiseizure agents, opioids, anesthetics, and miscellaneous agents.

Pharmacological management of cancer pain.

Pain is one of the most common symptoms experienced by cancer patients during the course of their illness. It can negatively impact patients' quality of life, functional status, and progress during rehabilitation. Despite the widespread availability of analgesic therapies, cancer pain remains undertreated. Developing knowledge and skills on cancer pain management is of extreme importance for healthcare providers dealing with cancer patients. The goal of this article is to review the principles of pharmacological therapy of cancer pain, to describe the basic pathophysiological mechanisms and etiologies of cancer pain, and to highlight the elements of a thorough pain assessment.

Safety of outpatient dalteparin therapy in veterans with mechanical heart valves.

STUDY OBJECTIVES: To determine the rate of bleeding and thromboembolic events within 1 month of outpatient dalteparin therapy in veterans with mechanical heart valves, to evaluate potential risk factors associated with these events, and to examine the prescribing patterns of dalteparin in this patient population. DESIGN: Single-center retrospective electronic chart review. SETTING: Large, academically affiliated Veterans Affairs hospital. SUBJECTS: Thirty-eight men with mechanical heart valves who received outpatient prescriptions for dalteparin from October 1, 1998-June 30, 2003. MEASUREMENTS AND MAIN RESULTS: Charts were reviewed for thromboembolic and bleeding events. Demographic, clinical, and drug utilization variables were assessed. The associations of adverse events with potential risk factors, indication for dalteparin therapy, and prescribing clinic were analyzed. Sixty-four dalteparin regimens were evaluated. No thromboembolic events were reported in any case within 1 month after receiving dalteparin for thromboembolic prophylaxis during warfarin interruption for periprocedural anticoagulation or for anticoagulation during an unintentional subtherapeutic international normalized ratio. Bleeding events occurred in 15 (23%) of the 64 regimens. Most bleeding events resolved spontaneously and without intervention. No potential risk factors for bleeding were identified. CONCLUSION: Dalteparin appeared to be a safe, effective means of short-term thromboembolic prophylaxis in this population of ambulatory male veterans with mechanical heart valves. Large, randomized, controlled, prospective trials are warranted.