Shortcuts May 2013
J Pain. 2013 Feb 26. [Epub ahead of print]
Chen L, Vo T, Seefeld L, Malarick C, Houghton M, Ahmed S, Zhang Y, Cohen A, Retamozo C, St Hilaire K, Zhang V, Mao J.
In this retrospective chart review study, using data from the Research Patient Database Registry, a final set of 109 chronic pain patients over a 7-year period were evaluated for the impact of opioid dose adjustment on pain, gender and age differences in response to opioid therapy, and the influence of clinical pain conditions (neuropathic pain, nociceptive pain, mixed pain conditions and ﬁbromyalgia) on the opioid analgesic efficacy. Changes in the opioid dose did not affect the pain score in patients on long term opioids (averaging nearly 2 years), irrespective of pain type, gender and age. Thus individualised opioid therapy based on the clinical effectiveness is needed to optimise treatment outcome.
BMC Palliat Care. 2013 Feb 18;12(1):9. [Epub ahead of print]
Gott M, Gardiner C, Ingleton C, Cobb M, Noble B, Bennett MI, Seymour J.
Using a cross sectional survey of palliative care needs, this study assessed potentially avoidable hospital admissions in 580 inpatients with palliative care needs (from the standpoint of the admitting clinician and within the context of existing local health and social care services) as evaluated by two Palliative Medicine Consultants. The case note data collected included reasons for admission, diagnoses, cognitive impairment, age, living arrangements, time and route of admission, care plan, and specialist palliative care involvement. From the 208 patients meeting the criteria for needing palliative care, 6.7% were ‘potentially avoidable’ admissions, half of whom lived in a care homes and most of these could have received care in this setting. This study indicates that patients with palliative care needs have a relatively low level of potentially avoidable hospital admissions, but improvements could be made in the care home setting.
JAMA. 2013 Apr 3;309(13):1359-67.
Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Fadul CE, Knox C, Le-Lindqwister N, Gilman PB, Shapiro CL; Alliance for Clinical Trials in Oncology.
This randomised, double-blind, placebo-controlled multi centre crossover trial of 231 patients evaluated the effect of duloxetine in painful chemotherapy-induced peripheral neuropathy. The peripheral neuropathy was grade 1 or higher sensory neuropathy caused by taxane (mostly paclitaxel) or oxaliplatin causing pain of at least 4/10 from the Brief Pain Inventory-Short Form “average pain” item for at least three months. Patients were randomised (1:1 allocation ratio) to either duloxetine followed by placebo or placebo followed by duloxetine (30 mg per day for a week, then 60 mg daily for 4 weeks). In the patients receiving duloxetine first, they reported a mean decrease in average pain of 1.06 on an 11 point numeric rating scale (0.34 in the placebo group). Nearly 60% of patients initially receiving duloxetine had some reduction of pain (38% in the placebo group). A 30% and 50% pain reduction was 2 and 2.4 times more common with duloxetine than with placebo. Duloxetine also improved pain interfering with daily functioning, quality of life, numbness and tingling in the feet, and use of analgesics. Duloxetine was more effective in people treated with platinums than with taxanes. More people in the duloxetine first group dropped out because of side effects (11% v 1%), most commonly fatigue, insomnia and nausea, although none were serious.
Cochrane Database Syst Rev. 2013 Mar 28;3:CD004310.
Ruiz Garcia V, López-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S.
This update of the 2005 Cochrane review evaluated the efficacy and safety of Megestrol acetate (MA) in anorexia-cachexia syndrome in patients with including cancer, AIDS and other underlying pathologies such as chronic obstructive pulmonary disease. This update included 35 randomised controlled trials (A total of 4234 patients were included with a total of 3963 patients for effectiveness and 3180 patients for safety) which compared MA to either placebo, another drug or another dose of MA in patients with anorexia-cachexia syndrome. Of the included studies, 16 trials were placebo controlled, 7 were compared with other drugs (including dronabinol, steroids and oxandrolone) and 10 compared different doses of MA; most of the trials had a follow-up of 56 to 84 days. Meta-analysis showed quality of life and appetite improvement as well as some weight gain with MA compared with placebo, in cancer and AIDS, with a mean follow-up of 4 to 12 weeks. There was no benefit of MA compared to other drugs with a mean follow-up of 8 to 15 weeks. Although higher doses (>800 mg/d) of MA were linked to greater increases in weight, there was not enough dose information to confirm this. There is limited long term safety data on MA, but reported side effects which could be related to the MA included oedema and thromboembolism; there were also an increased number of deaths with MA, which seemed more related to higher doses. In general the quality of the evidence was rated as very low.
by Jason Boland