Literature Review

The power of collaboration: Pharmacists and nurses partner to enhance patient care American Society of Health-System Pharmacists (ASHP) News Center; by Karen Blum; 9/23/24 Pharmacists and nurses work together on today's most pressing health challenges - from managing heart failure to deprescribing in palliative care to tackling obesity in pre-transplant patients. The Collaborative Care Grant for Nurses and Pharmacists from the ASHP Foundation and American Nurses Foundation recognizes the potential impact of this interdisciplinary teamwork on improving healthcare outcomes. At UPMC Presbyterian Hospital, the grant program helped fund the creation of a medication optimization clinic (MOC) for those with heart failure with reduced ejection fraction. “It made a lot of sense to bring together our collective expertise to manage these patients to get them on more optimal medications,” said James Coons, a clinical pharmacist in cardiology at UPMC Presbyterian Hospital. Coons, an ASHP member and professor at the University of Pittsburgh School of Pharmacy, worked with nurse practitioner and longtime collaborator, Jennifer Kliner, on the project.

Novel drug treatments for pain in advanced cancer and serious illness: a focus on neuropathic pain and chemotherapy-induced peripheral neuropathyPalliative Care and Social Practice; by Mellar P Davis; 7/24This review will discuss haloperidol, miragabalin, palmitoylethanolamide (PEA), and clonidine as adjuvant analgesics or analgesics. Haloperidol [demonstrates] ... only low-grade evidence that [it] improves pain when combined with morphine, methadone, or tramadol in patients who have cancer, pain from fibrosis, radiation necrosis, or neuropathic pain. Miragabalin is a gabapentinoid approved for the treatment of neuropathic pain ... [and] in randomized trials, patients with diabetic neuropathy have responded to miragabalin. Multiple randomized trials and meta-analyses have demonstrated PEA's effectiveness in reducing pain severity arising from diverse pain phenotypes. Intravenous clonidine has been used in terminally ill patients with poorly controlled symptoms, in particular pain and agitation.

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 patients aren’t 'drug users': Exposing a dangerous myth American Council on Science and Health; by Cameron English; 7/18/24 Chronic pain patients who take opioids under medical supervision are fundamentally different from recreational users who take drugs to get high. In their bid to destigmatize and legalize drugs, some drug policy reformers have attempted to blur this clear distinction. [Read case study of a hospice patient who was denied pain meds for longterm conditions, and was put on an opioid for which she had informed the hospice that she could not tolerate. Access to talking with her physician was denied. Result: She changed to a different hospice.]

Pain management in the wake of the opioid crisis Forbes; by Web Golinkin; 7/15/24 Pain is the single most frequent reason for patient visits in the United States. An estimated 20 percent of adults experience chronic pain, and nearly seven percent experience a level of chronic pain that limits their daily activities. However, most doctors and other healthcare professionals have very little education in pain management, according to Scott Fishman, MD, an internationally recognized expert in pain management, ... This lack of education was one of the main causes of the Opioid Crisis, Fishman says ... of the part of the crisis that was caused by the over-prescribing of opioids, many clinicians have become so wary of the medical-legal issues surrounding pain management that they have gone from an overly liberal approach to a restrictive one in which some prescribers are effectively abandoning patients who need to have their symptoms treated. Both extremes are frequently fueled by lack of knowledge and training, according to Fishman. ... The solution is to close the education gap ...

Aligning pill burden and palliative care needs in late-stage CVD: AHA TCTMD - Cardiovascular Research Foundation; by L.A. McKeown; 7/2/24 The first scientific statement from the American Heart Association (AHA) that focuses specifically on pharmacotherapy considerations in the palliative management of patients with CVD [cardiovascular diesease] urges a patient-centered, compassionate approach to de-escalating and deprescribing. ... In addition to shedding light on how and when to start deprescribing and de-escalating common cardiovascular drugs, the statement discusses palliative drugs for pain, shortness of breath, and appetite in the context of CVD, which [Katherine E.] Di Palo [PharmD (Montefoiore Medical Center, NY)] said the committee identified as a gap in knowledge given that much of the evidence for these drugs comes from patients with serious illnesses like cancer. ... Important Takeaways: Di Palo and colleagues note that palliative care complements cardiovascular care in several important ways, including reducing physical symptom burden, managing emotional and spiritual distress, providing sufficient support for caregivers, and helping patients choose treatment in line with their goals for care. Editor's Note: Click here for the American Heart Association's statement, which we posted on 7/2/24. 

Factors affecting palliative care collaboration with pain medicine specialists Clinical Pain Advisor; by James Maitlall, MD; 6/27/24 Structured collaboration between physicians working in palliative care (PC) and pain medicine (PM) may increase PC physician referral of seriously ill patients to PM specialists and potentially optimize their care, according to study results published in the Journal of Pain and Symptom Management. ... In a survey study, a multicenter team of investigators explored attitudes and beliefs among US PC physicians regarding PM specialists, as well as factors potentially impacting collaboration between physicians in these 2 areas of practice. ... The American Academy of Hospice and Palliative Medicine (AAHPM) approved the survey for distribution to 1000 of its physician members, who were selected at random. ... The investigators concluded, “Although we found that PC physicians have highly positive attitudes about the value of PM specialists, referral rates remain low, even for IDDS implantation, which has perhaps the largest body of evidence for patients with complex cancer-associated pain.”  

Managing palliative care challenges for patients with complex symptoms Pharmacy Times; 6/7/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. ... Pharmacy Times: What do you wish pharmacists understood about hospice and palliative care in terms of patient care for patients with complicated symptoms? Kullgren: So, I think, number 1, pharmacists across all healthcare systems, in the hospital, at community pharmacies, long-term care, you are all going to be involved in these patients— it’s just to what degree. ... We want to do those therapies that ... are going to have the least amount of risk for our patients, or at least side effects for our patients. ...

The latest research indicates massage therapy has benefits from birth to end of life Cision PR Newswire; by American Massage Therapy Association; 6/5/24 The American Massage Therapy Association (AMTA) is sharing recent research on how massage therapy can provide benefits from infancy through end of life. Across all ages, massage therapy can be a therapeutic approach to enhancing physical and emotional well-being. Explore the latest studies on how massage therapy can help improve the quality of life for infants, middle-aged individuals, and older adults. ... A nationwide survey of physicians, physician assistants, and nurse practitioners in palliative care documented recommendation rates of integrative therapies to target symptoms of palliative care patients. The survey found that massage therapy was the third most recommended integrative care modality behind mind-body interventions like meditation and biofeedback. The integrative therapies aimed to reduce pain, anxiety, mood disturbances, and distress.Editor's Note: While hiring a professional massage therapist might not be practical for your budget, explore contracting with massage therapist who is trained in working with medically-fragile persons to provide simple trainings for your nurses and nurse aides. Additionally, professionally trained massage therapists might be interested in volunteering their services, within appropriate parameters (i.e., not transferring the medically-fragile patient to a massage table, having a caregiver present to assist with communication, etc.). 

Palliative care and harm reduction: Improving outcomes for patients with cancer, substance use disorderPharmacy Times; by Alexandra Gerlach; 5/24/24Pain management and substance use disorder (SUD) present unique challenges for patients with cancer. At the 2024 Society of Pain and Palliative Care (SPPCP) Virtual Conference, presenters Sachin Kale, MD, MBOE, and Kyle Quirk, PharmD, discussed challenges related to limited training of health care professionals (HCPs) in the management of patients with cancer-related pain and SUD. They highlight a need for a more comprehensive medical model that incorporates harm reduction strategies in palliative care and fosters a patient-centric approach to treatment.

A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist Annals of Palliative Medicine; by Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick Key content and findings: A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.

Ordered to pay $1.536B in criminal fines and forfeiture for distributing misbranded opioid medication Office of Public Affairs, U.S. Department of Justice; Press Release; 5/3/24Endo Health Solutions Inc. (EHSI) was ordered to pay $1.086 billion in criminal fines and an additional $450 million in criminal forfeiture — the second-largest set of criminal financial penalties ever levied against a pharmaceutical company —for violations of the Federal Food, Drug and Cosmetic Act related to the distribution of the opioid medication Opana ER with INTAC (Opana ER). ...