Articles of interest in other scholarly journals
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Fallon MT, Laird BJ. Palliat Med 2011; 25 (5): 597-603
As the use of combinations of opioids is a common clinical practice a systematic review of the use of strong opioids in combination in cancer pain was conducted. Only two eligible studies, which were grade C and grade D evidence, were found. These examined morphine in combination with oxycodone or fentanyl/methadone.
Only a weak recommendation can be made to support combination opioid therapy. This recommendation also includes the caveat that the desirable effects of combination opioid therapy is outweighed by any disadvantages that this would confer. Prospective randomized trials are needed to clarify the benefits and safety of combination opioid therapy.
King S, Forbes K, Hanks G, Ferro C, Chambers E. Palliat Med 2011; (25) (5) 525-552
This narrative systematic review without a meta-analysis identified 15 articles (8 prospective and 7 retrospective clinical studies). Overall evidence was of very low quality. The direct clinical evidence in cancer-related pain and renal impairment is suggestive of differences in risk between opioids. The authors recommend Fentanyl, alfentanil and methadone as they are the least likely to cause harm. Morphine may be associated with toxicity in patients with renal impairment, but can be reduced by increasing the dose or dosing interval or switching to an alternative opioid.
Zaccara G, Gangemi P, Perucca P, Specchio L. Epilepsia 2011; 52 (4): 826–836
This systematic review with a meta-analysis of adverse events (AEs) from pregabalin assessed all RCTs, including neurologic and psychiatric disorders. From the 38 RCTs there were 20 AEs associated with pregabalin, especially cognition and coordination AEs (none serious). Some AEs occured at lower doses than others (i.e. dizziness and somnolence). Most AEs displayed a dose-response pattern, especially balance disorders, cognitive functions and constipation.
This data is from a range of patient groups with heterogeneous diseases, including several studies from various pain disorders (including diabetic and post herpetic neuropathy)
Memory functions in chronic pain: examining contributions of attention and age to test performance
Oosterman JM, Derksen LC, van Wijck AJ, Veldhuijzen DS, Kessels RP.Clinical Journal of Pain 2011; 27 (1): 70–75
34 participants with chronic pain and 32 pain-free participants completed tests of episodic, semantic, and working memory to assess memory performance and a test of attention. Chronic pain adversely affected working memory and verbal episodic memory, which was partly accounted for by a decline in attention. An increase in age in combination with the presence of chronic pain did not additionally affect memory performance.
Primary thromboprophylaxis for hospice inpatients: Who needs it?
Gillon S, Noble S, Ward J, Lodge KM, Nunn A, Koon S, Johnson MJ. Palliat Med 2011 Feb 10 [Epub ahead of print]
In this study 300 case notes were reviewed before and 350 after the implementation of the Pan Birmingham Cancer Network venous thromboembolism (PBCNVTE) prophylaxis prevention guidelines in 3 hospices. Just under half of all patients had a contraindication to anticoagulation and 9% had a temporary increased risk of VTE. However, only 3.6% before and 6.3% after implementation had a temporary increased risk of VTE without contraindication to primary thromboprophylaxis (PTP). Patients receiving PTP increased from 1% to 3.6% and documentation of PTP decisions increased from 5% to 81%. The authors suggest that quality clinical trials including patients with advanced disease are needed to help inform decision making about PTP.
Short Cuts by Jason Boland, Consultant in Palliative Medicine, Barnsley Hospice, United Kingdom