1
|
Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [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: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
Collapse
Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
| |
Collapse
|
2
|
Biancuzzi H, Dal Mas F, Brescia V, Campostrini S, Cascella M, Cuomo A, Cobianchi L, Dorken-Gallastegi A, Gebran A, Kaafarani HM, Marinangeli F, Massaro M, Renne A, Scaioli G, Bednarova R, Vittori A, Miceli L. Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811754. [PMID: 36142028 PMCID: PMC9517221 DOI: 10.3390/ijerph191811754] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 05/23/2023]
Abstract
In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.
Collapse
Affiliation(s)
- Helena Biancuzzi
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Valerio Brescia
- Department of Management, University of Turin, 10134 Turin, Italy
- Department of Finance, Wrocław University of Economics and Business, 53-345 Wrocław, Poland
| | - Stefano Campostrini
- Department of Economics, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, Fondazione Pascale, 80131 Naples, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- General Surgery Department, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Ander Dorken-Gallastegi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anthony Gebran
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Haytham M. Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maurizio Massaro
- Department of Management, Ca’ Foscari University of Venice, 30100 Venice, Italy
| | - Angela Renne
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giacomo Scaioli
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Rym Bednarova
- Department of Pain Medicine, Hospital of Latisana, 33053 Latisana, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO, Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS, 00165 Rome, Italy
| | - Luca Miceli
- Department of Clinical and Experimental Pain Medicine, Istituto di Ricovero e Cura a Carattere Scientifico—IRCCS Centro di Riferimento Oncologico—CRO of Aviano, 33081 Aviano, Italy
| |
Collapse
|
3
|
Stoicea N, Costa A, Periel L, Uribe A, Weaver T, Bergese SD. Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review. Medicine (Baltimore) 2019; 98:e15425. [PMID: 31096439 PMCID: PMC6531094 DOI: 10.1097/md.0000000000015425] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription. Several reviews attempted to summarize the epidemiology and management of opioid misuse, this integrative review seeks to summarize the current literature related with responsible parties of this opioid abuse crisis and discuss potential associations between demographics (ethnicity, culture, gender, religion) and opioid accessibility, abuse and overdose. METHODS We performed an extensive literature search in Google Scholar and Pub Med databases that were published between December 7, 1999 and January 9, 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines. Searches were referenced using medical subject headings (MeSH) that included "opioids", "over-prescription", "opioid consumption", or "opioid epidemic". The final review of all data bases was conducted on July 24, 2018. RESULTS A total of 7160 articles were originally identified. After 3340 duplicate articles were removed, 3820 manuscripts were removed after title and abstract screening. Following this, 120 manuscripts underwent eligibility selection with only 70 publications being selected as reliable full-texts addressing related factors surrounding the opioid crisis. CONCLUSION With approximately 100 million people suffering from both chronic and acute pain in the United States (US) in 2016, opiates will continue to remain a prominent class of medication in healthcare facilities and homes across the US. Over 66% of total overdose episodes in 2016 were opioid-related, a figure that attests to the severity and wide-spread nature of this issue. A three-point approach accentuating the prevention, treatment, and rehabilitation of both those currently affected and at-risk in the future may be the comprehensive solution.
Collapse
Affiliation(s)
| | | | | | | | - Tristan Weaver
- Department of Anesthesiology
- Department of Anesthesiology, Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | | |
Collapse
|
4
|
Bauer M, Glenn T, Monteith S, Bauer R, Whybrow PC, Geddes J. Ethical perspectives on recommending digital technology for patients with mental illness. Int J Bipolar Disord 2017; 5:6. [PMID: 28155206 PMCID: PMC5293713 DOI: 10.1186/s40345-017-0073-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022] Open
Abstract
The digital revolution in medicine not only offers exciting new directions for the treatment of mental illness, but also presents challenges to patient privacy and security. Changes in medicine are part of the complex digital economy based on creating value from analysis of behavioral data acquired by the tracking of daily digital activities. Without an understanding of the digital economy, recommending the use of technology to patients with mental illness can inadvertently lead to harm. Behavioral data are sold in the secondary data market, combined with other data from many sources, and used in algorithms that automatically classify people. These classifications are used in commerce and government, may be discriminatory, and result in non-medical harm to patients with mental illness. There is also potential for medical harm related to poor quality online information, self-diagnosis and self-treatment, passive monitoring, and the use of unvalidated smartphone apps. The goal of this paper is to increase awareness and foster discussion of the new ethical issues. To maximize the potential of technology to help patients with mental illness, physicians need education about the digital economy, and patients need help understanding the appropriate use and limitations of online websites and smartphone apps.
Collapse
Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Inc., Fullerton, CA, 92834, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, 1400 Medical Campus Drive, Traverse City, MI, 49684, USA
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Los Angeles, CA, 90095, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| |
Collapse
|