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Dash S, Singh PA, Bajwa N, Choudhury A, Bisht P, Sharma R. Why Pharmacovigilance of Non-steroidal Anti-inflammatory Drugs is Important in India? Endocr Metab Immune Disord Drug Targets 2024; 24:731-748. [PMID: 37855282 DOI: 10.2174/0118715303247469230926092404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/15/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are among the drugs that are most regularly administered to manage inflammation and pain. Over-the-Counter (OTC) NSAIDs are widely accessible, particularly in developing countries like India. This casual approach to using NSAIDs may operate as a magnet for NSAID-related adverse drug reactions (ADRs) among patients. OBJECTIVES As patients in India are less informed about the appropriate use of NSAIDs and consumption patttern, adverse drug reactions, and the importance of reporting ADRs, the current study's objective is to promote patient safety by using pharmacovigilance as a tool to educate patients. METHODS A targeted literature methodology was utilized to gather the data pertaining to NSAIDs, their ADRs and their pharmacovigilance. Different scientific databases, such as Science Direct, PubMed, Wiley Online Library, Springer, and Google Scholar, along with authentic textbooks, were explored as reference literature. RESULTS In general, NSAIDs consumption pattern depends upon the different age groups. Around 1.6 billion tablets of NSAIDs are consumed in India for ailments, such as headaches, arthritis, menstrual cramps, osteoarthritis, back pain, rheumatoid arthritis, gout, osteoporosis, tendinitis, cancer pain and chronic pain. Common ADRs of NSAIDs include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhoea. Also, they can cause renal damage and cardiovascular problems if not consumed in a dose-dependent manner. However, Diclofenac and Ibuprofen have both been linked to depression and dementia. There have been reports of aplastic anaemia, agranulocytosis linked to phenylbutazone, Stevens-Johnson, and Lyell's syndrome linked to isoxicam and piroxicam, as well as the vulnerability of new-borns to Reye's syndrome after aspirin use. Lack of awareness, time constraints and unpredictability, poor training in ADRs identification, etc., are some of the reasons for the under-reporting of ADR of NSAIDs in India. CONCLUSION In order to rationally prescribe NSAIDs, it is essential to be aware of probable ADR's and establish prescription guidelines. Prescribers' behaviour can be changed toward excellent prescribing practices by conducting routine prescription assessments dealing with NSAIDs and providing feedback. In the near future, it will be critical to strengthen ADR data management and expand the reach of pharmacovigilance programs, ADR monitoring centers, and healthcare professionals' especially pharmacists' training in rural locations.
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Affiliation(s)
- Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Rajiv Sharma
- College of Pharmacy, Desh Bhagat University, Mandi Gobindgarh, Punjab, India
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Vega-Morales D, Pérez-Luna IRM, Aguirre-García VA, Vázquez-Fuentes BR. Non-steroidal anti-inflammatory drugs in the elderly. Agreement with safe prescription recommendations according to cardiovascular and gastrointestinal risks. REUMATOLOGIA CLINICA 2021; 17:499-503. [PMID: 34756310 DOI: 10.1016/j.reumae.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION/OBJECTIVE Non-Steroidal Anti-Inflammatory Drugs are the cornerstone in the treatment of acute and chronic pain due to inflammation in musculoskeletal conditions. Even though adverse side-effects are associated, their use is common in the elderly patients. Our aim is to determine the prescription trend of NSAIDs, the evaluation for gastrointestinal (GI) and cardiovascular (CV) risks, and the level of agreement with prescription guidelines. METHODS We conducted an observation and descriptive study in a general hospital geriatrics consultation. RESULTS From the 231 patients only 59 patients had a NSAIDs prescription. The most frequently prescribed was Acetaminophen, in 29(49.1%) patients, Celecoxib was prescribed in 11(18.6%) patients, Piroxicam in 5(8.4%) patients, Acetaminophen plus Celecoxib plus Omeprazole in 4 (6.7%), Acetaminophen plus Piroxicam in 2 (0.3%) patients, and Acetaminophen plus Diclofenac plus Celecoxib in 1 patient (1.6%). In the Framingham risk classification there were 160/231 (69.3%) patients in Very High Risk and 71/231 (30.7%) patients in High Risk. There were no patients in Low Risk. GI Risk: 79 patients (34.1%) had a peptic ulcer disease history. There were 55/231 (23.8%) in the High GI Risk classification, 102/231 (44.1%) in Intermediate GI Risk and 74/231 (32%) in the Low Risk. The level of agreement between the prescribed versus recommended NSAIDs according the CV and GI risks was measured with a contingence table and the kappa statistic of 0.37 p=0.001. CONCLUSION There is a low level of agreement between prescribed and recommended NSAID in elderly population.
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Affiliation(s)
- David Vega-Morales
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico; Hospital General de Zona No 17, Mexican Institute of Social Security, Nuevo Leon, Mexico.
| | | | - Virginia Alejandra Aguirre-García
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
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Yasky AF, Zawawi AH. Characterization of potentially inappropriate medication prescriptions for the elderly in primary care and hospital settings. J Family Med Prim Care 2021; 10:3111-3115. [PMID: 34660455 PMCID: PMC8483109 DOI: 10.4103/jfmpc.jfmpc_271_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022] Open
Abstract
Background Polypharmacy cannot be defined numerically due to its varied definitions, and inclusion of comorbidities aggravates the dilemma, creating challenges for the healthcare system and the patients' course of treatment. The introduction of the potentially inappropriate medication (PIM) list developed by the American Geriatrics Society (AGS) (AGS Beers Criteria®; updated in 2019) was deemed a solution. However, several risk factors are associated with PIMs, including increased emergency room visits, hospitalization and mortality, and a decline in daily activity. Differences in PIM prescription rates have been reported; however, with the recent Beers criteria update, the number of patients exposed to PIMs is expected to increase significantly due to the addition of new medications to the list. Objectives This study aimed to describe the characteristics of PIM prescriptions for the elderly in primary care and hospital settings. Methods Medications for elderly patients prescribed in our hospital between 2016 and 2019 were reviewed and sorted based on Beers criteria to identify patients with the most PIMs. Correlations were made between gender and facility. Results This study included 40,168 patients (51% males). The total and average numbers of PIM per elderly patient were 260,753 and 6.5, respectively. Proton pump inhibitors were prescribed the most, followed by nonsteroidal anti-inflammatory drugs. Conclusions We found that increasing numbers of PIMs are prescribed to the elderly in our healthcare facilities. Therefore, further recommendations from local geriatric communities and the implementation of reminders for physicians through electronic prescription systems are needed to decrease the rate of prescribed PIMs.
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Affiliation(s)
- Adel F Yasky
- Department of Family Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Alia H Zawawi
- Department of Family Medicine, King Abdulaziz Medical City, Assistant Professor College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Vega-Morales D, Pérez-Luna IRM, Aguirre-García VA, Vázquez-Fuentes BR. Non-Steroidal Anti-Inflammatory Drugs in the Elderly. Agreement With Safe Prescription Recommendations According to Cardiovascular and Gastrointestinal Risks. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30133-9. [PMID: 32660837 DOI: 10.1016/j.reuma.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION/OBJECTIVE Non-Steroidal Anti-Inflammatory Drugs are the cornerstone in the treatment of acute and chronic pain due to inflammation in musculoskeletal conditions. Even though adverse side-effects are associated, their use is common in the elderly patients. Our aim is to determine the prescription trend of NSAIDs, the evaluation for gastrointestinal (GI) and cardiovascular (CV) risks, and the level of agreement with prescription guidelines. METHODS We conducted an observation and descriptive study in a general hospital geriatrics consultation. RESULTS From the 231 patients only 59 patients had a NSAIDs prescription. The most frequently prescribed was Acetaminophen, in 29(49.1%) patients, Celecoxib was prescribed in 11(18.6%) patients, Piroxicam in 5(8.4%) patients, Acetaminophen plus Celecoxib plus Omeprazole in 4 (6.7%), Acetaminophen plus Piroxicam in 2 (0.3%) patients, and Acetaminophen plus Diclofenac plus Celecoxib in 1 patient (1.6%). In the Framingham risk classification there were 160/231 (69.3%) patients in Very High Risk and 71/231 (30.7%) patients in High Risk. There were no patients in Low Risk. GI Risk: 79 patients (34.1%) had a peptic ulcer disease history. There were 55/231 (23.8%) in the High GI Risk classification, 102/231 (44.1%) in Intermediate GI Risk and 74/231 (32%) in the Low Risk. The level of agreement between the prescribed versus recommended NSAIDs according the CV and GI risks was measured with a contingence table and the kappa statistic of 0.37 p=0.001. CONCLUSION There is a low level of agreement between prescribed and recommended NSAID in elderly population.
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Affiliation(s)
- David Vega-Morales
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico; Hospital General de Zona No 17, Mexican Institute of Social Security, Nuevo Leon, Mexico.
| | | | - Virginia Alejandra Aguirre-García
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service, Department of Internal Medicine, University Hospital "Dr. José Eleuterio González", Autonomous University of Nuevo Leon, Monterrey, Mexico
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Asfandiyarova NS, Philippov EV. [The use of nonsteroidal anti - inflammatory drugs in polymorbid pathology]. TERAPEVT ARKH 2020; 92:82-88. [PMID: 32598668 DOI: 10.26442/00403660.2020.01.000480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The literature review presents the possibilities of using non - steroidal anti - inflammatory drugs (NSAIDs) for polymorbid pathology. The mechanism of NSAIDs action, risk factors for the development of undesirable effects on the cardiovascular, digestive, urinary and other systems are considered; prevention measures and drug selection options are discussed, NSAIDs prescribing algorithm is considered.
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Bloom L, Boyle KE, Myers AE, Blacketer C, Weinstein R. Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: a retrospective database review. Ther Clin Risk Manag 2019; 15:579-588. [PMID: 31114212 PMCID: PMC6488163 DOI: 10.2147/tcrm.s189833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coexisting medical conditions and concomitant medications contribute to treatment challenges primary-care professionals (PCPs) face daily. The current study assessed the extent and distribution of nonaspirin NSAID-relevant coexisting medical conditions of interest (CMCOI) in patients visiting PCPs. METHODS This retrospective database review analyzed data from three large health-care claim databases to identify the frequency of nonaspirin NSAID-relevant CMCOI among adults aged ≥18 years with a PCP visit in 2013. Claim databases employed were the Truven Health MarketScan® Commercial Claims and Encounters database, representative of the privately insured (PI) population; Truven Health MarketScan Multi-State Medicaid, representative of the Medicaid population (Medicaid); and Truven MarketScan Medicare Supplemental, representative of the Medicare population with employer-based supplemental Medicare insurance (Medicare-Supplement). Nonaspirin NSAID-relevant CMCOI, asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency were chosen based on US NSAID over-the-counter Drug Facts label warnings. Frequency of CMCOI was determined for those without and with a musculoskeletal diagnosis. RESULTS In each database, ≥19% (19.0% PI, 29.9% Medicaid, 33.6% Medicare-Supplement) had a musculoskeletal diagnosis. A greater proportion of individuals with a musculoskeletal diagnosis had one or more CMCOI compared with those without a musculoskeletal diagnosis (61.3% vs 50.4% PI, 78.1% vs 66.8% Medicaid, 87.1% vs 82.3% Medicare-Supplement). The frequency of one or more CMCOI increased with age in each database. Across databases among CMCOI, cardiovascular risk factors were most common, followed by gastrointestinal bleeding risk factors, and proportions were higher among those with a musculoskeletal diagnosis. CONCLUSION These data confirm the high frequency of nonaspirin NSAID-relevant CMCOI among patients presenting to PCPs for musculoskeletal diagnosis, as well as among older patients. These analyses reinforce the critical role health-care professionals can play in identifying patients with nonaspirin NSAID-relevant CMCOI, providing those patients with ongoing guidance on appropriate choice and use of over-the-counter analgesics, and educating patients about the impact aging, health status, concomitant conditions, and medicines have on selection of all medicines, including analgesics.
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Affiliation(s)
- Leslie Bloom
- Johnson & Johnson Consumer Inc, McNeil Consumer Healthcare Division, Fort Washington, PA, USA,
| | | | - Andrew E Myers
- Johnson & Johnson Consumer Inc, McNeil Consumer Healthcare Division, Fort Washington, PA, USA,
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Kabbara WK, Dimassi H, Sheikh-Taha M. Patterns of pain medication use in older individuals with cardiovascular disease. Curr Med Res Opin 2018; 34:931-934. [PMID: 29490511 DOI: 10.1080/03007995.2018.1447453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain is common in older adults and clinicians are often faced by many challenges when selecting appropriate treatment due to age-related changes in pharmacokinetics, pharmacodynamics, increased comorbidities, and polypharmacy. METHODS This study assessed the patterns of pain medications used at home among older adults admitted to the cardiology service in a tertiary care teaching center in the US from March to May 2016. A retrospective chart review was conducted where adults, 65 years of age or older, with cardiovascular diseases admitted to the cardiology service and taking at least one pain medication at home were studied. RESULTS Out of 404 patients who were admitted to the cardiology service, 228 (56.4%) were on at least one pain medication. Among the admitted patients, 64.2% of the females received at least one pain medication, as compared to 49% of the males (p = 0.002). Participants had a mean age of 76.34 ± 7.43 years, and received a mean of 1.81 ± 0.83 pain medications. Neuropathic pain was the most common indication (33.4%), followed by arthritis (17.5%), and cancer (15.8%). The most commonly used pain medications were gabapentin/pregabalin 79 (34.6%), acetaminophen plus an opiate 78 (34.2%), opiates 56 (24.6%), tramadol 36 (15.8%), followed by non-selective NSAIDs 21 (9.2%). Twelve (5.3%) patients received duplication of pain medications, while 14 (5.7%) received an inappropriate combination of pain medications. Twenty-three patients (10.1%) received muscle relaxants in conjunction with pain medications, 20 of which are considered poorly tolerated by older adults. CONCLUSION This stufy described the patterns of use of pain medications among older adults with cardiovascular disease. Careful selection of appropriate pain medications based on different clinical parameters is very essential to avoid prescribing inappropriate therapy that can lead to patient harm.
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Affiliation(s)
- Wissam K Kabbara
- a Lebanese American University , Department of Pharmacy Practice , Byblos , Lebanon
| | - Hani Dimassi
- b Lebanese American University , Department of Pharmaceutical Sciences , Byblos , Lebanon
| | - Marwan Sheikh-Taha
- a Lebanese American University , Department of Pharmacy Practice , Byblos , Lebanon
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van den Berg-Wolf M, Burgoon T. Acupuncture and Cutaneous Medicine: Is It Effective? Med Acupunct 2017; 29:269-275. [PMID: 29067137 DOI: 10.1089/acu.2017.1227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: In China, acupuncture has been used as a form of medical therapy for more than 2500 years. It is a part of traditional medical practice and is used to treat the entire spectrum of human and veterinary disease. Although dermatologic disease has received much less attention in worldwide acupuncture research than pain and musculoskeletal conditions, there is a growing body of evidence suggesting acupuncture's usefulness in this area. Objective: The aim of this article was to review the evidence in the literature regarding the usefulness of acupuncture in managing dermatologic illness. Results: Trials and case reports of patients using acupuncture have been published in the areas of atopic dermatitis and urticaria, herpes zoster, psoriasis, acne, melasma, and hyperhidrosis, as well as in promoting wound healing. Itch modulation by acupuncture has been the focus of recent research as itch is a predominant symptom in allergic skin diseases and leads to serious impairment of quality of life. Conclusions: Although more research is needed, acupuncture's use in cutaneous medicine is promising in the area of itch modulation, in treating atopic dermatitis and herpes zoster pain, and in promoting wound healing.
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Tacconelli S, Bruno A, Grande R, Ballerini P, Patrignani P. Nonsteroidal anti-inflammatory drugs and cardiovascular safety – translating pharmacological data into clinical readouts. Expert Opin Drug Saf 2017; 16:791-807. [DOI: 10.1080/14740338.2017.1338272] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Stefania Tacconelli
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Annalisa Bruno
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Rosalia Grande
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
| | - Patrizia Ballerini
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
- Department of Psychological, Health and Territorial Sciences, ‘G.d’Annunzio’ University, Chieti, Italy
| | - Paola Patrignani
- Department of Neuroscience, Imaging and Clinical Sciences, ‘G. d’Annunzio’ University, Chieti, Italy
- Center for Aging and Translational Medicine (CeSI-MeT), ‘G. d’Annunzio’ University, Chieti, Italy
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Guerriero F, Reid MC. New opioid prescribing guidelines released in the US: what impact will they have in the care of older patients with persistent pain? Curr Med Res Opin 2017; 33:275-278. [PMID: 27786538 PMCID: PMC5472202 DOI: 10.1080/03007995.2016.1254603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Fabio Guerriero
- a Department of Internal Medicine and Medical Therapy , University of Pavia , Pavia , Italy
| | - M Carrington Reid
- b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
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Kennedy MC, Henman MC, Cousins G. General Practitioners and Chronic Non-Malignant Pain Management in Older Patients: A Qualitative Study. PHARMACY 2016; 4:E15. [PMID: 28970388 PMCID: PMC5419349 DOI: 10.3390/pharmacy4010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/28/2022] Open
Abstract
Chronic non-malignant pain (CNMP) is commonly managed by General Practitioners (GPs) in primary care. Analgesics are the mainstay of CNMP management in this setting. Selection of medications by GPs may be influenced by micro factors which are relevant to the practice setting, meso factors which relate to the local or regional environment or macro factors such as those arising from national or international influences. The aim of this study is to explore influences on GP practises in relation to pain management for older adults with CNMP. Semi-structured interviews were conducted with 12 GPs. Transcripts were organised using the Framework Method of Data Management while an applied thematic analysis was used to identify the themes emerging from the data. Clinical considerations such as the efficacy of analgesics, adverse effects and co-morbidities strongly influence prescribing decisions. The GPs interviewed identified the lack of guidance on this subject in Ireland and described the impact of organisational and structural barriers of the Irish healthcare system on the management of CNMP. Changes in practice behaviours coupled with health system reforms are required to improve the quality and consistency of pharmacotherapeutic management of CNMP in primary care.
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Affiliation(s)
| | - Martin C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| | - Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, St. Stephens Green, Dublin , Ireland.
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Alexander K, Goldberg J, Korc-Grodzicki B. Palliative Care and Symptom Management in Older Patients with Cancer. Clin Geriatr Med 2015; 32:45-62. [PMID: 26614860 DOI: 10.1016/j.cger.2015.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Older patients with cancer are best served by a multidisciplinary approach with palliative care (PC) playing an integral role. PC focuses on symptom control irrespective of its cause and should not be associated only with terminal care. It provides an additional layer of support in the care of patients with cancer with an emphasis on quality of life. This article discusses the evaluation and management of pain and other common nonpain symptoms that occur in elderly patients with cancer, as well as end-of-life care.
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Affiliation(s)
- Koshy Alexander
- Geriatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 205, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA.
| | - Jessica Goldberg
- Palliative Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 205, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, USA
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Pergolizzi JV, Taylor R, Raffa RB. The Potential Role of an Extended-Release, Abuse-Deterrent Oxycodone/Acetaminophen Fixed-Dose Combination Product for the Treatment of Acute Pain. Adv Ther 2015; 32:485-95. [PMID: 26026272 PMCID: PMC4487354 DOI: 10.1007/s12325-015-0213-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Indexed: 02/06/2023]
Abstract
Acute pain, prevalent as part of postoperative and traumatic pain, is often sub-optimally or inadequately treated. Fixed-dose combination analgesic products that combine a reduced amount of opioid with a nonopioid analgesic such as acetaminophen (paracetamol) in a single tablet offer potential pharmacodynamic and/or pharmacokinetic benefits, and may also result in an opioid-sparing effect. A new analgesic product (XARTEMIS™ XR, Mallinckrodt Brand Pharmaceuticals, Dublin, Ireland) combines oxycodone (7.5 mg) with acetaminophen (325 mg) in an immediate-release/extended-release (ER) formulation that is indicated for the treatment of acute pain. The ER formulation of this product provides stable serum drug concentrations that in this case lasts 12 h. Oxycodone/acetaminophen is a drug combination that offers safe and effective pain relief in a variety of acute pain syndromes such as postoperative pain. The combination formulation allows a smaller amount of oxycodone per tablet and the biphasic-layered matrix of the pill for ER may present obstacles to potential abusers. No opioid is totally abuse resistant, but the lower opioid content and tamper-resistant formulation of this product might discourage abuse. Clinicians must still be mindful of the acetaminophen part of this product in the patient’s overall daily intake (in light of acetaminophen hepatotoxicity). The new product appears to provide an important new choice in the armamentarium against acute pain.
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Pham TT, Miller MJ, Harrison DL, Lloyd AE, Crosby KM, Johnson JL. Cardiovascular disease and non-steroidal anti-inflammatory drug prescribing in the midst of evolving guidelines. J Eval Clin Pract 2013; 19:1026-34. [PMID: 23163341 DOI: 10.1111/jep.12014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2012] [Indexed: 12/17/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Responding to safety concerns, the American Heart Association (AHA) published guidelines for non-steroidal anti-inflammatory drug (NSAID) use in patients with pre-existing cardiovascular disease (CVD) during 2005 and revised them in 2007. In the revision, a stepped approach to pain management recommended non-selective NSAIDs over highly selective NSAIDs. This research evaluated NSAID prescribing during and after guideline dissemination. METHOD A cross-sectional sample of 8666 adult, community-based practice visits with one NSAID prescription representing approximately 305 million visits from the National Ambulatory Medical Care Survey (NAMCS) from 2005 to 2010 was studied. Multivariable logistic regression controlling for patient, provider and visit characteristics assessed the associations between diagnosis of CVD and NSAID type prescribed during each calendar year. Visits were stratified by arthritis diagnosis to model short-term/intermittent and long-term NSAID use. RESULTS Approximately one-third (36.8%) of visits involving a NSAID prescription included at least one of four diagnoses for CVD (i.e. hypertension, congestive heart failure, ischaemic heart disease or cerebrovascular disease). Visits involving a CVD diagnosis had increased odds of a prescription for celecoxib, a highly selective NSAIDs, overall [adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.06-1.57] and in the subgroup of visits without an arthritis diagnosis (AOR = 1.45, 95% CI: 1.11-1.89). Results were not statistically significant for visits with an arthritis diagnosis (AOR = 1.10, 95% CI: 0.47-2.57). When analysed by year, the relationship was statistically significant in 2005 and 2006, but not statistically significant in each subsequent year. CONCLUSION National prescribing trends suggest partial implementation of AHA guidelines for NSAID prescribing in CVD from 2005 to 2010.
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Affiliation(s)
- Timothy T Pham
- Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Tulsa, Oklahoma, USA
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Becquemont L, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Delespierre T, Derumeaux G, Falissard B, Forette F, Hanon O, Pasquier F, Pinget M, Ourabah R, Piedvache C. National observatory on the therapeutic management in ambulatory care patients aged 65 and over, with type 2 diabetes, chronic pain or atrial fibrillation. Therapie 2013; 68:265-83. [PMID: 23981265 DOI: 10.2515/therapie/2013043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/19/2013] [Indexed: 11/20/2022]
Abstract
The primary objective of the S.AGES cohort is to describe the real-life therapeutic care of elderly patients. Patients and methods. This is a prospective observational cohort study of 3 700 non-institutionalized patients over the age of 65 years with either type 2 diabetes mellitus (T2DM), chronic pain or atrial fibrillation (AF) recruited by French general practitioners (GPs). Follow-up is planned for 3 years. Baseline characteristics. In the chronic pain sub-cohort, 33% of patients are treated with only grade 1 analgesics, 29% with grade 2 analgesics and 3% with grade 3 analgesics, and 22% have no pain treatment. In the T2DM sub-cohort, 61% of patients have well-controlled diabetes (Hb1c<7%) and 18% are treated with insulin. In the AF sub-cohort, 65% of patients have a CHADS2 score greater than 2, 77% are treated with oral anticoagulants, 17% with platelet inhibitors, 40% with antiarrhythmic drugs and 56% with rate slowing medications. Conclusion. The S.AGES cohort presents a unique opportunity to clarify the real-life therapeutic management of ambulatory elderly subjects and will help to identify the factors associated with the occurrence of major clinical events.
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Affiliation(s)
- Laurent Becquemont
- Pharmacology Department Faculty of Medicine Paris-Sud, University Paris-Sud; Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Bertin P, Becquemont L, Corruble E, Derumeaux G, Falissard B, Hanon O, Pinget M, Forette F. The therapeutic management of chronic pain in ambulatory care patients aged 65 and over in France: the S.AGES Cohort. Baseline data. J Nutr Health Aging 2013; 17:681-6. [PMID: 24097022 DOI: 10.1007/s12603-013-0338-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The main objective of the S.AGES (Elderly Subjects) cohort study is to describe the current therapeutic strategy for chronic pain in non-institutionalised elderly patients in France. METHODS In this prospective cohort study, non-institutionalised patients aged 65 years and over with chronic pain were recruited by general practitioners (GP) across France. All medicinal and non- medicinal prescriptions were recorded at inclusion and will be followed up over 3 years via an eCRF. Data recorded at baseline are presented in this paper. RESULTS Two hundred and sixty GPs enrolled 1379 evaluable patients between June 3rd, 2009 and June 3rd, 2011. Pain was mainly of a mechanical nature, due to osteoarthritis or common back pain. 80% of the patients had moderate or severe pain. More than a third of patients were treated with a step 1 analgesic (mainly paracetamol), and approximately 30% received a step 2 analgesic (23% dextropropoxyphene and 40.3% tramadol/paracetamol combination). Only 3% received step 3 analgesics; this rate remained low even in patients with severe pain. The proportion of patients treated with an antiepileptic was higher in case of neuropathic pain. More than 25% of patients did not receive any analgesic medication. CONCLUSION The baseline S.AGES study results exhibit a well-balanced therapeutic management of chronic pain by GPs for ambulatory elderly patients. Clinicaltrials.org NCT01065909.
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Affiliation(s)
- P Bertin
- Ph. Bertin, Rheumatology Department, Centre Hospitalier Universitaire Dupuytren, 2 avenue M-L-King, 87042 LIMOGES Cédex France, , Tel: 00 33 5 55 05 68 71, Fax: 00 33 5 55 05 68 89
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Halla-aho SM, Tilvis RS, Strandberg TE, Pitkälä KH. Musculoskeletal pain and its treatment among older home-dwelling people: ten-year changes in two Finnish birth cohorts. Arch Gerontol Geriatr 2012; 56:285-9. [PMID: 23022058 DOI: 10.1016/j.archger.2012.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/22/2012] [Accepted: 08/24/2012] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to evaluate the prevalence of musculoskeletal pain and the use of analgesics in two random cohorts of home-dwelling older people 10 years apart (1999 (N = 2044) and 2009 (N = 1610)) in Helsinki, Finland, and to explore which patients characteristics are associated with potential undertreatment or overtreatment of pain. In 1999, the prevalence of daily joint pain interfering with functioning was 16.4% and that of back pain 13.9% among 75-85-year-old people, the respective figures being 21.9% and 17.1% in 2009 (p < 0.001). The proportion of those patients suffering from joint pain and using prescribed analgesics for that was 35.5% in 1999 and 41.5% in 2009 (p < 0.001). The corresponding figures for patients suffering from back pain with analgesics were 38.2% and 48.2% (p < 0.001), respectively. In 2009, 66.1% suffered from any musculoskeletal pain and 28.7% of them were prescribed analgesics, the figures being more frequent among women than men. In addition to higher age, female gender, and painful conditions, also psychiatric symptoms and dizziness tended to be independently associated with analgesic prescriptions. Among persons not reporting pain (N = 545) psychiatric symptoms were overrepresented in the group using prescribed analgesics (22.4% vs. 8.1%, p < 0.05). In conclusion, musculoskeletal pain is still clearly undertreated, but the coverage has increased during 10 years. In addition to pain, several patient characteristics, functioning and psychiatric symptoms, especially, were associated with analgesic prescriptions.
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Affiliation(s)
- S M Halla-aho
- Helsinki University Central Hospital, Unit of Primary Health Care and University of Helsinki, Department of General Practice, Finland
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