Articles of interest in other scholarly journals
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Harmful effects of NSAIDs among patients with hypertension and coronary artery disease.
Bavry AA, Khaliq A, Gong Y, Handberg EM, Cooper-Dehoff RM, Pepine CJ.
This was a post hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST), in patients with hypertension and coronary artery disease. At each visit, patients were asked by the local site investigator if they were currently taking non-steroidal anti-inflammatory drugs (NSAIDs). Patients who reported NSAID use at every visit were defined as chronic NSAID users, while all others (occasional or never users) were defined as non-chronic NSAID users. The primary composite outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Cox regression was used to construct a multivariate analysis for the primary outcome.
There were 882 chronic NSAID users and 21,694 non-chronic NSAID users (14,408 never users and 7286 intermittent users). At a mean follow-up of 2.7 years, all-cause mortality occurred at a rate of 4.4 events per 100 patient-years in the chronic NSAID group, versus 3.7 events per 100 patient-years in the non-chronic NSAID group. This was due to an increase in cardiovascular mortality. Long-term NSAID use had no significant effect on the risk for stroke. Among long-term NSAID users, a systolic blood pressure above 150 mm Hg was a strong risk factor for cardiovascular events. Gastrointestinal tract bleeding occurred among 0.8% of non-chronic NSAID users but in none of the chronic NSAID users. This may be accounted for by selection-bias, as chronic NSAID users in the study, had already shown they were able to tolerate these medications.
Increased clearance of morphine in sickle cell disease: implications for pain management.
Darbari DS, Neely M, van den Anker J, Rana S.
As patients with sickle cell disease (SCD) often require relatively high doses of morphine to achieve optimal analgesia, the pharmacokinetics of morphine in this group was studied. 21 SCD patients were administered a 0.1 mg/Kg infusion of morphine sulfate. Morphine clearance was 3-10 fold higher than published estimates in the non-SCD population. This suggests that due to increased clearance, SCD patients may require higher dose and frequency of morphine to achieve comparable plasma levels, although inter-individual variability of morphine metabolism highlights the importance of individualisation of therapy.
Rueda JR, Solà I, Pascual A, Subirana Casacuberta M.
This Cochrane review assessed the effectiveness of non-invasive interventions delivered by healthcare professionals in improving symptoms, psychological functioning and quality of life in patients with lung cancer. Fifteen trials were included but with variability of the interventions assessed and the approaches to measuring the considered outcomes, and the lack of data reported in the trials regarding allocation of patients to treatment groups and blinding. Three trials of a nursing intervention to manage breathlessness showed benefit in symptom experience, performance status and emotional functioning. Four trials assessed structured nursing programmes and found positive effects on delay in clinical deterioration, dependency and symptom distress. One trial assessing counselling showed a non-conclusive benefit for some emotional components of the illness. One trial found that coaching slightly increases the amount of pain data communicated to providers by patients with lung cancer. One trial compared telephone-based sessions of either caregiver-assisted coping skills training or education/support involving the caregiver and found that patients in both treatment conditions showed improvements in pain, depression, quality of life and self-efficacy. Two trials assessed exercise programmes, showing some benefit. One trial found some positive effects for increasing energy intake. Two small trials of reflexology showed short-lasting benefit on anxiety and pain intensity.
Restoring a sense of wellness following colorectal cancer: a grounded theory.
Beech N, Arber A, Faithfull S.
A longitudinal study using grounded theory was conducted with 12 individuals, who had received surgery for colorectal cancer. Semi-structured interviews were conducted over 1 year after surgery. Recovery is described in three phases: disrupting the self; repairing the self; restoring the self. The core category is restoring a sense of wellness through awareness and enjoyment of the physical, emotional, spiritual and social aspects of life. A sense of wellness exists as a duality with a sense of illness, where both perspectives may co-exist but one usually takes precedence. A sense of illness pervades when the individual is preoccupied with illness. Recovery takes time and energy, particularly when the individual is at home and in relative isolation from health professionals.
Martin YB, Herradón G, Ezquerra L.
This is a review of recent advances identifying potential pharmacological targets in the treatment of the cause of neuropathic pain. Current drugs to treat the symptoms of neuropathic pain fail in up to 50% of patients. Recent progress in the experimental methods for understanding the neurobiology of neuropathic pain could result in significant advances. One possibility for the pharmaceutical development of new drugs could focus on mimicking what the organism does to limit nerve damage or to enhance the regeneration of injured axons. Following this strategy, neurotrophic factors such as nerve growth factor, brain-derived neurotrophic factor and pleiotrophin have been postulated as potential pharmacological targets to treat neuropathic pain and limit neuropathic pain development because of their remodeling and angiogenic actions in the injured area.
Sicras-Mainar A, Rejas-Gutiérrez J, Navarro-Artieda R, Planas-Comes A.
In this Spanish retrospective observational study of over 1000 patients, the cost of adding either pregabalin or gabapentin to the management of community-treated patients with peripheral neuropathic pain was compared. An economic evaluation included health care resource utilisation costs and costs due to sick leave. Concomitant use of analgesics was higher in the gabapentin cohort, mainly due to non-steroidal anti-inflammatory drugs and opioids. Adjusted total costs per patient were considerably lower in pregabalin-treated patients due to less sick leave and lower health care costs. The higher acquisition cost of pregabalin was compensated with lower costs in medical visits, physiotherapy, hospital stays and concomitant analgesics.
By Jason Boland, Consultant in Palliative Medicine, Barnsley Hospice, United Kingdom