Debbie Rigby takes a look at the latest in research news
Patients with pain and addiction often have multiple psychological, psychiatric, and medical comorbidities with associated polypharmacy, all interacting with each other in complex ways. Chronic pain combined with substance use disorder and medication dependence often presents as a disabling multimorbid disease state with polypharmacy or polysubstance use associated with excess risk of adverse outcomes, including death. Simple strategies like opioid tapering and nonpharmacologic treatment of pain are insufficient by themselves.
Med Clin N Am 2018;102:745-63.
About 0.5-2% of injury/trauma pateitns develop complex regional pain disorder. Symptoms and signs such as warm or cold limb, oedema, allodynia, hyperalgesia, abnormal sweating and skin and nail tissue changes. CRPS is mostly unresponsive to standard neuropathic pain treatments. The peripheral signs of CRPS mostly fade and disappear in the chronic phase of the condition, although the pain mostly remains. Immunomodulatory drugs (zolendronic acid, oral corticosteroids) with wide and varied mechanisms of action that inhibit dendritic cell function are more likely to be found effective for this condition.
Medical Hypotheses 2018;119:41-53.
Paracetamol, on its own or in combination with other analgesics, is widely used to treat pain associated with acute and chronic conditions. This paper reviews the use of paracetamol, its pharmacokinetics, the mechanisms by which it can cause liver damage and consider whether frail older people are at greater risk of adverse effects. A maximum dose of 60mg/kg/day for those weighing 45–50kg is recommended which equates to a total daily dose of 2,700–3,000g and, therefore, for some patients, a dose of 500mg four times per day or 1g three times per day may be appropriate.
Drug and Therapeutics Bulletin, June 2018.
A systematic review of 29 clinical and pharmacokinetic outcomes studies does not support the existence of drug interactions between hormonal contraception and non-rifamycin antibiotics. There was no difference in pregnancy rates for women who used OCs alone and women who used OCs concurrently with antibiotics.
American Journal of Obstetrics & Gynecology 2018;218(1):88-97.e14