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.

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.