Literature Review

Brain biomarkers for pain sensitivityJAMA Neurology; Prasad Shirvalkar, MD, PhD; Christopher J. Rozell, PhD; 1/25Identifying objective biomarkers that track individual pain severity has been dubbed “the holy grail” of pain neuroscience. Chronic pain affects up to one-fifth of US adults, and its complexity is attributed to a confluence of physical, emotional, and cognitive factors that contribute to suffering and disability. The epidemic of chronic pain initially contributed to the rise of the opioid epidemic and continues to plague nearly all fields of clinical medicine. Identifying and validating biomarkers to predict individual risk for chronic pain facilitate a precision medicine approach to pain medicine. Despite the unknown provenance of the proposed biomarkers, the results of the present study have the potential to aid in the practical development of personalized pain management strategies.

Suzetrigine: First-in-class nonopioid pain therapy is approved by FDAAmerican Journal of Managed Care; Giuliana Grossi; 1/25Suzetrigine (Journavx; Vertex Pharmaceuticals) received approval from the FDA for the treatment of adults with moderate-to-severe acute pain, according to an announcement from Vertex. The therapy is a novel oral, non-opioid, highly selective NaV1.8 pain signal inhibitor ... offering a non-opioid alternative amid the opioid crisis. Clinical trials demonstrated significant efficacy in postsurgical pain relief, though results varied across different conditions. Despite this, suzetrigine offers the potential to energize the nonopioid pain market, which includes other companies like Tris Pharma, Latigo Biotherapeutics, and SiteOne Therapeutics—all actively developing alternatives to opioids. Key findings from the Institute for Clinical and Economic Review analysis of the phase 3 trials include potential lifetime cost savings of $200 per patient when comparing suzetrigine with opioids, assuming a 1-week course priced at $420.

DEA unveils long-overdue special registration for telemedicine in proposed ruleThe National Law Review; by Marika Miller, Nathan A. Beaver of Foley & Lardner LLP; 1/21/25 In the final days of the Biden administration, the Drug Enforcement Administration (DEA) released a proposed rule that would allow practitioners with a Special Registration to prescribe Schedule III-V, and in limited circumstances Schedule II, controlled substances via telemedicine. Practitioners with a Special Registration would still need to obtain a DEA registration in each state where they prescribe or dispense controlled substances. However, the proposed rule establishes a limited, less expensive State Telemedicine Registration as an alternative to the traditional DEA registration. The proposed rule imposes several obligations on practitioners with Special Registrations when they prescribe controlled substances via telemedicine.  [Click on the title's link to continue reading.]

Home … where we all want to be The Journal; Dr. Sarah Phillips, Medical Director Hospice of the Panhandle; 1/12/25 Two days before Christmas, I arrived at the home of a patient who had been recently admitted to Hospice services. ... [Story of the patient being on a ventilator in a hospital.] This courageous and self-determined woman expressed the desire to be free from pain, suffering, and the complications and progression of her disease. Knowing that the ventilator was life-sustaining and essentially breathing for her, she made the decision to stop it. To ensure her comfort during discontinuation of the ventilator, the hospice team was present before, during, and after the procedure. Medications were used to ease shortness of breath, pain, and anxiety. ... “It’s a Wonderful Life” was playing on the TV, the Christmas tree was lit. I looked over and see the daughter wiping away her mother’s tears. Each reassured the other that everything will be OK and that they are at peace with this decision. As the medications took effect, the patient drifted off to sleep. The ventilator was stopped. Next, something happens that I will never forget. The daughter leans in and whispers to the patient, “Mom, the ventilator is off now, you are back in total control. This was profound to me on many levels. It certainly spoke to the power and importance of autonomy, the ability to make independent decisions that are aligned with one’s values and goals. ... Despite working in end-of-life care for over a decade, I still have these moments of being overwhelmed by the human spirit.

As drugstores close, more people are left in ‘pharmacy deserts’ The San Diego Union-Tribune; by The New York Times Service Syndicate; 12/31/24 In July, a notice appeared on the front door of The Drug Store, the only pharmacy in rural Kernville, in Kern County. After 45 years, the proprietor wrote regretfully, it would be closing in four days and transferring customers’ prescriptions to a Rite Aid about 12 miles away. ... Its closing created practical concerns. “We are an aging population,” Gordon, 69, said of the townspeople. ... Now, those services require a 20- to 30-minute drive to the Rite Aid, which is in Lake Isabella and which Gordon described as understaffed for its growing number of customers. “On any given day, there’s a line of 10 to 15 people waiting at the pickup window,” she said. Unlike The Drug Store, the Rite Aid doesn’t deliver. That leaves Kernville residents in what researchers call a pharmacy desert, defined as living more than 10 miles from the nearest pharmacy in rural areas, 2 miles away in suburban communities or 1 mile away in urban neighborhoods. Nearly 30% of pharmacies in the United States closed between 2010 and 2021, according to a new study in the journal Health Affairs. 

High-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing. 

Early hospice care has transformative impact McKnights Senior Living; guest column by Aaron Housh, CEO of Good Samaritan Hospice in Roanoke and Christiansburg, VA; 11/25/24 Hospice care is more than a medical service — it’s a lifeline of compassion, connection and support during one of life’s most vulnerable moments. For more than 20 years, I’ve witnessed the profound impact hospice can have, not just on residents and patients but on the families who love and care for them. But this impact is magnified when hospice care is introduced early. ... One of the greatest gifts hospice provides is time — time to prepare, time to connect and time to say goodbye. A friend once shared how hospice changed her family’s experience with her mother’s death. The nurse spent time explaining what to expect, answering questions and normalizing the changes they were seeing. That preparation eliminated panic, allowing the family to focus on being present. Her mother passed with dignity, surrounded by love and understanding. This story illustrates what I’ve seen time and again: families who enter hospice early have the opportunity to build trust with their care team, process emotions and fully use the services available to them. Those families are better equipped to navigate the physical and emotional challenges of end-of-life care, creating space for meaningful moments and lasting memories.

Virtual reality videos for symptom management in hospice and palliative careMayo Clinic Proceedings - Digital Health; by James R Deming, Kassie J Dunbar, Joshua F Lueck, Yoonsin Oh; 8/24Nature scenes significantly improved total symptom scores, as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved. Patients with lower functional status tended to have more symptoms beforehand and improve the most.

What the heck is a PBM, and why does it matter? Forbes; by Web Golinkin; 10/14/24... [Pharmacy Benefit Managers] PBM BasicsUnless you are a healthcare industry insider—and even if you are— it’s difficult to understand exactly how PBMs work. While they are essentially invisible to the average health plan member, PBMs have a tremendous impact on which medications are covered, the prices paid for these medications, and how patients access them. Here’s a summary of key PBM functions: Formulary Management. ... Negotiating Discounts and Rebates. ... Pharmacy Network Management. ... Claims Processing. ... Clinical Management. ... How PBMs Influence Drug Costs: Rebate System. ... High Deductible Health Plans. ... Prior Authorization and Step Therapy. ... Spread Pricing. ... What Are the Alternatives? ...

Palliative care in kidney cancer more than just relieving symptoms Cure; by Ashley Chan; 9/26/24 Patients with kidney cancer who want more support during treatment can consider palliative care, whether it’s for symptoms or discussing goals and values. ... For patients with kidney cancer, understanding how palliative care can help is essential throughout the treatment process. Palliative care, according to the Mayo Clinic, is medical care that specializes in relieving pain and symptoms associated with an illness. This type of care can also help patients cope with treatment-related side effects. However, there’s more to palliative care than just relieving symptoms. It also “aims to help patients and families in one of three major categories,” Dr. Pallavi Kumar explained during an interview with CURE®. Kumar is the director of Oncology Palliative Care and assistant professor of Clinical Medicine in the hematology-oncology division at the University of Pennsylvania. She noted that the three categories of palliative care include:

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

Integration of palliative pharmacists to elevate oncologic care Pharmacy Times; by Alexis Beachy, PharmD and Jessica Geiger, PharmD, MS, BCPS; 8/20/24... Conclusion: This case demonstrates several aspects of care palliative pharmacists can assist with, though it is certainly not all-encompassing. All things considered, pharmacists are an essential asset of the palliative team. Their experience further enriches the interdisciplinary team and grants all patients and families many benefits. Specifically, patients receiving oncologic care benefit from collaboration with a palliative care pharmacist. In addition to offering a more individualized and holistic approach to care, palliative pharmacists can also provide patients with quicker and improved symptom management, which often improves quality of life and may also increase survival rates.Editor's Note: This article provides excellent history, definitions, and descriptions of the pharmacist's significant role in providing expert palliative and hospice care.

Pain management inequities by demographic and geriatric-related variables in older adult inpatientsJournal of the American Geriatrics Society; by Aksharananda Rambachan, Torsten B Neilands, Leah Karliner, Kenneth Covinsky, Margaret Fang, Tung Nguyen; 7/24Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables. Conclusion: Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.