-
Effect of Inhaled Cannabis for Pain in Adults With Sickle Cell Disease: A Randomized Clinical Trial.JAMA Network Open Jul 2020Sickle cell disease (SCD) is characterized by chronic pain and episodic acute pain caused by vasoocclusive crises, often requiring high doses of opioids for prolonged... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Sickle cell disease (SCD) is characterized by chronic pain and episodic acute pain caused by vasoocclusive crises, often requiring high doses of opioids for prolonged periods. In humanized mouse models of SCD, a synthetic cannabinoid has been found to attenuate both chronic and acute hyperalgesia. The effect of cannabis on chronic pain in adults with SCD is unknown.
OBJECTIVE
To determine whether inhaled cannabis is more effective than inhaled placebo in relieving chronic pain in adults with SCD.
DESIGN, SETTING, AND PARTICIPANTS
This pilot randomized clinical trial included participants with SCD with chronic pain admitted to a single inpatient clinical research center for 2 separate 5-day stays from August 2014 to April 2017. Participants inhaled either vaporized cannabis (4.4% Δ-9-tetrahydrocannabinol to 4.9% cannabidiol) 3 times daily or vaporized placebo cannabis. Pain and pain interference ratings using the Brief Pain Inventory were assessed throughout each 5-day period. Participants with SCD and chronic pain on stable analgesics were eligible to enroll. A total of 90 participants were assessed for eligibility; 56 participants were deemed ineligible, and 34 participants were enrolled. Of these, 7 participants dropped out before randomization. Of 27 randomized participants, 23 completed both treatment arms of the crossover study and were included in the final per protocol analysis. Data analysis was completed in June 2019, with the sensitivity analysis conducted in April 2020.
INTERVENTIONS
Inhalation of vaporized cannabis plant (4.4% Δ-9-tetrahydrocannbinol to 4.9% cannabidiol) or placebo cannabis plant using a vaporizer 3 times daily for 5 days.
MAIN OUTCOMES AND MEASURES
Daily pain assessed with visual analog scale and Brief Pain Inventory.
RESULTS
A total of 23 participants (mean [SD] age, 37.6 [11.4] years; 13 [56%] women) completed the trial. The mean (SD) difference in pain rating assessment between the cannabis and placebo groups was -5.3 (8.1) for day 1, -10.9 (7.0) for day 2, -16.5 (9.2) for day 3, -8.9 (6.7) for day 4, and -8.2 (8.1) for day 5; however, none of these differences were statistically significant. There was no statistically significant mean (SD) difference in pain interference ratings between cannabis and placebo between days 1 and 5 for interference in general activities (day 1: 0.27 [0.35]; day 5: -1.0 [0.5]), walking (day 1: 0.14 [0.73]; day 5: -0.87 [0.63]), sleep (day 1: 0.59 [0.74]; day 5: -1.3 [0.8]), or enjoyment (day 1: 0.23 [0.69]; day 5: -0.91 [0.48]), but there was a statistically significant mean (SD) difference in decrease in interference with mood (day 1: 0.96 [0.59]; day 5: -1.4 [0.6]; P = .02). No differences in treatment-related adverse effects were observed. Use of concomitant opioids was similar during both treatment periods.
CONCLUSIONS AND RELEVANCE
This randomized clinical trial found that, compared with vaporized placebo, vaporized cannabis did not statistically significantly reduce pain and associated symptoms, except interference in mood, in patients with SCD with chronic pain.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01771731.
Topics: Administration, Inhalation; Adult; Analgesics; Anemia, Sickle Cell; California; Cross-Over Studies; Female; Humans; Male; Medical Marijuana; Middle Aged; Pain Management; Pain Measurement; Pilot Projects
PubMed: 32678452
DOI: 10.1001/jamanetworkopen.2020.10874 -
PDA Journal of Pharmaceutical Science... 2020
Topics: COVID-19; Drug Contamination; Drug Packaging; Patient Safety; Pharmaceutical Preparations; Quality Control; Risk Assessment; Technology, Pharmaceutical
PubMed: 32737241
DOI: 10.5731/pdajpst.2019.001120 -
BMJ Health & Care Informatics Aug 2020Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication...
Changes in medication administration error rates associated with the introduction of electronic medication systems in hospitals: a multisite controlled before and after study.
BACKGROUND
Electronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).
OBJECTIVE
To assess changes in MAE rates and types associated with EMS implementation.
METHODS
This was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.
RESULTS
7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; p<0.05). EMS use was associated with an absolute decline in potentially serious MAEs by 2.4% (95% CI 0.8 to 3.9; p=0.003), a 56% reduction in the proportion of potentially serious MAEs. At baseline, 74.1% of administrations were non-compliant with ≥1 of 10 procedures and this rate did not significantly improve post-EMS.
CONCLUSIONS
Implementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.
Topics: Drug Administration Schedule; Efficiency, Organizational; Hospitals, Teaching; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations
PubMed: 32796084
DOI: 10.1136/bmjhci-2020-100170 -
JAAPA : Official Journal of the... Oct 2019Despite the high incidence of hyponatremia, the correct approach to management, particularly in patients with severe hyponatremia (serum sodium of 120 mEq/L or less), is... (Review)
Review
Despite the high incidence of hyponatremia, the correct approach to management, particularly in patients with severe hyponatremia (serum sodium of 120 mEq/L or less), is controversial. This article reviews two major consensus guidelines and recent studies that can help clinicians make evidence-based treatment decisions and reduce patient risk for iatrogenic osmotic demyelination from overly aggressive treatment.
Topics: Demyelinating Diseases; Disease Management; Humans; Hyponatremia; Iatrogenic Disease; Practice Guidelines as Topic; Risk Assessment; Saline Solution, Hypertonic
PubMed: 31567743
DOI: 10.1097/01.JAA.0000578796.15417.09 -
Trends in Pharmacological Sciences Jul 2021The ongoing opioid crisis highlighted the need for non-steroidal anti-inflammatory drugs (NSAIDs), nonaddictive analgesics against pain, fever, and inflammation.... (Review)
Review
The ongoing opioid crisis highlighted the need for non-steroidal anti-inflammatory drugs (NSAIDs), nonaddictive analgesics against pain, fever, and inflammation. However, NSAIDs may cause gastrointestinal and cardiovascular adverse effects. To avoid systemic toxicity and deliver drugs to diseased tissues, nanotechnology methods of NSAID encapsulation have been reported and some have reached clinical development. Currently, 57 micro- and nanodrugs are approved by the US FDA. Already approved nanoanalgesics have revealed superior efficacy or reduced toxicity compared with placebo or lower doses of systemically administered active comparators. In this review, the evidence for approval of the marketed nanodrugs will be discussed, with a focus on therapies for pain and inflammation. Nanomedicine remains an attractive field for the development of targeted analgesics.
Topics: Analgesia; Anti-Inflammatory Agents, Non-Steroidal; Humans; Pain; Pain Management; Pharmaceutical Preparations
PubMed: 33883067
DOI: 10.1016/j.tips.2021.03.007 -
Vaccine Feb 2020Cholera still affects about three million people a year and kills approximately 100,000. Cholera can be effectively managed in the majority of cases with oral... (Review)
Review
Cholera still affects about three million people a year and kills approximately 100,000. Cholera can be effectively managed in the majority of cases with oral rehydration solution alone. Up to one third of patients present with severe dehydration, which can be diagnosed clinically, and will require rapid intravenous rehydration with Ringers Lactate or other appropriate fluid before being managed with oral rehydration solution. Antibiotics reduce the duration of illness and should be used in patients with severe dehydration. Resistance is common and local sensitivities should guide the choice of antibiotic. All children between six months and five years should receive zinc supplements. Effective case management with strict attention to detail including infection control and the use of protocolized approaches can reduce the mortality to around 1% even in resource poor settings.
Topics: Anti-Bacterial Agents; Child; Cholera; Dehydration; Diarrhea; Disease Management; Fluid Therapy; Humans; Practice Guidelines as Topic; Ringer's Lactate; Zinc
PubMed: 31668817
DOI: 10.1016/j.vaccine.2019.09.098 -
The Journal of the American Academy of... Apr 2020Cannabis has gained widespread public advocacy since its legalization in several states with recent evidence suggesting that its self-reported use has increased in... (Review)
Review
Cannabis has gained widespread public advocacy since its legalization in several states with recent evidence suggesting that its self-reported use has increased in patients undergoing a primary total joint arthroplasty. The endocannabinoid system has been proposed to play a role in decreasing the inflammatory cascade and enhancing pain management. For these reasons, interest has emerged in the orthopaedic community as a potential treatment or adjunct to treatment in many musculoskeletal conditions. However, the evidence to date is scant and precludes recommendations for its widespread use. Given the current paucity of evidence in the orthopaedic cohort, future research is warranted in this area to determine the efficacy and safety before endorsements can be made by orthopaedic surgeons.
Topics: Arthroplasty; Drug Utilization; Humans; Medical Marijuana; Musculoskeletal Diseases; Pain Management; United States
PubMed: 31800438
DOI: 10.5435/JAAOS-D-19-00438 -
Expert Opinion on Drug Delivery May 2020: Recent technological progress in pain management includes patient´s stratification depending on their disease subtype, prognosis, risk, or treatment response using... (Review)
Review
: Recent technological progress in pain management includes patient´s stratification depending on their disease subtype, prognosis, risk, or treatment response using data analysis and genetic testing in order to select the most appropriate drug for each group. A spatiotemporal control on the release of the selected anesthetic drug is also desirable in order to minimize side effects and to provide the patient with the appropriate dose above the therapeutic threshold and below the maximum desirable concentration. Light can be used non-invasively as an exogenous trigger to allow multiple drug administrations with precise spatiotemporal control. By controlling light fluence/irradiance, pulse structure, and duration of the irradiation drug release kinetics can be controlled in a pulsatile manner to release totally or partially the drug loaded into particulate carriers.: Recent advances in the field of light-triggered nanoparticles used in pain management specially those studies which include preclinical models are reviewed.: Two decades later after the first light-sensitive drug delivery systems reported still several limitations hinder their clinical translation. Additional efforts should be undertaken to understand the nanoparticles biological fate, to satisfy their large-scale production, and to facilitate the technology to apply this therapeutic approach at a low cost.
Topics: Drug Delivery Systems; Drug Liberation; Humans; Nanoparticles; Pain; Pain Management; Pharmaceutical Preparations
PubMed: 32116072
DOI: 10.1080/17425247.2020.1737670 -
Current Pain and Headache Reports Sep 2023The present investigation explores multi-agent systems, their function in cancer pain management, and how they might enhance patient care. Since cancer is a complex... (Review)
Review
PURPOSE
The present investigation explores multi-agent systems, their function in cancer pain management, and how they might enhance patient care. Since cancer is a complex disease, technology can help doctors and patients coordinate care and communicate effectively. Even when a patient has a dedicated team, treatment may be fragmented. Multi-agent systems (MAS) are one component of technology that is making progress for cancer patients. Wireless sensory networks (WSN) and body area sensory networks (BASN) are examples of MAS.
RECENT FINDINGS
Technology is advancing the care of patients, not only in everyday clinical practice, but also in creating accessible communication between patients and provider. Many hospitals have utilized electronic medical records (EHR), but recent advancements allowed the pre-existing infrastructure to network with personal devices creating a more congruent form of communications. Better communication can better organize pain management, leading to better clinical outcomes for patients, integrating body sensors, such as smart watch, or using self-reporting apps. Certain software applications are also used to help providers in early detections of some cancers, having accurate results. The integration of technology in the field of cancer management helps create an organized structure for cancer patients trying to understand/manage their complex diagnosis. The systems for the various healthcare entities can receive and access frequently updated information that can better provide better coverage of the patient's pain and still be within the legalities as it pertains to opioid medications. The systems include the EHR communicating with the information provided by the patient's cellular devices and then communicating with the healthcare team to determine the next step in management. This all happens automatically with much physical input from the patient decreasing the amount of effort from the patient and hopefully decreasing the number of patients' loss to follow-up.
Topics: Humans; Pain Management; Electronic Health Records; Pain; Neoplasms; Patient Care Team
PubMed: 37382870
DOI: 10.1007/s11916-023-01131-4 -
Games For Health Journal Aug 2019A large number of children report fear and distress when undergoing blood work and intravenous placement. In pediatric departments, Child Life interventions are... (Randomized Controlled Trial)
Randomized Controlled Trial
A large number of children report fear and distress when undergoing blood work and intravenous placement. In pediatric departments, Child Life interventions are considered to be the gold standard in nonmedical pain management techniques. Virtual reality (VR) has also been identified as an effective tool for pain distraction in children undergoing painful medical procedures. The aim of this study was to document the efficacy of VR as a mode of distraction during a medical procedure compared with two comparison conditions: watching television (TV, minimal control condition) and distraction provided by the Child Life (CL, gold standard control condition) program. A total of 59 children aged 8-17 years (35% female) were recruited through the emergency department (ED) of the Children's Hospital of Eastern Ontario and randomly assigned to one of the three conditions. The key outcome measures were visual analog scale ratings of pain intensity and fear of pain, administrated before and right after the procedure. Patient satisfaction was also measured after the intervention. A significant reduction in fear of pain and pain intensity was reported in all three conditions. A larger and statistically significant reduction in fear of pain was observed among children who used VR distraction compared with the CL and TV conditions, but this effect was not observed for pain intensity. The children's satisfaction with the VR procedure was significantly higher than for TV and comparable to CL. The advantages of using VR in the ED to manage pain in children are discussed.
Topics: Adolescent; Analysis of Variance; Child; Emergency Service, Hospital; Fear; Female; Humans; Male; Ontario; Pain Management; Phlebotomy; Virtual Reality
PubMed: 31135178
DOI: 10.1089/g4h.2018.0111