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Friday, March 30, 2012

Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials

NYCTCM Acupuncture Clinic visit
NYCTCM Acupuncture Clinic visit (Photo credit: NYCTCM)
Pain Management - Oncology News Article | Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials |3998569

OncoPRN Commentary: Those working in any way in supportive oncology encounter a myriad of question with respect to complementary and alternative therapies (CAT). This article may better equip one to deal with the question of acupuncture and its use in cancer pain.

Excerpt:

Supportive Care in Cancer, 03/30/2012  Evidence Based Medicine

Choi TY et al. – The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy. The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain. The total number of randomised clinical trials (RCTs) included in the analysis and their methodological quality were too low to draw firm conclusions.
Methods:

"Fourteen databases were searched from their inception through April 2011.

Randomised clinical trials (RCTs) were included if acupuncture was used as the sole treatment or as a part of a combination therapy for cancer pain.

Studies were included if they were controlled with a placebo or controlled against a drug-therapy or no-treatment group.

The Cochrane criteria were used to assess the risk of bias.


Results:

  • A total of 15 RCTs met the inclusion criteria.
  • All of the included RCTs were associated with a high risk of bias.
  • The majority of acupuncture treatments or combination therapies with analgesics exhibited favourable effects compared with conventional treatments in individual studies.
  • However, a meta-analysis suggested that acupuncture did not generate a better effect than drug therapy (n=886; risk ratio (RR), 1.12; 95% CI 0.98 to 1.28; P=0.09).
  • The comparison between acupuncture plus drug therapy and drug therapy alone demonstrated a significant difference in favour of the combination therapy (n=437; RR, 1.36; 95% CI 1.13 to 1.64; P=0.003).
  • The results of this systematic review provide no strong evidence for the effectiveness of acupuncture in the management of cancer pain."

{Reference Link}
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Tuesday, March 27, 2012

Deep Brain Stimulation: TEDxUF - Michael Okun and Kelly Foote - We Control Your Brain

Deep Brain Stimulation
Deep Brain Stimulation (Photo credit: Ryan Somma)
A presentation at TEDxUF (University of Florida) by a neurologist and neurosurgeon and the amazing utilization of a procedure/technique/intervention called Deep Brain Stimulation


The uses:

  • multiple sclerosis
  • essential tremors
  • bipolar
  • dystonia
I wonder about its potential in neuropathic pain.

The presenters also discuss the ethics surrounding the procedure given the ability to control the brain.


Summary:
1. Identify the abnormal circuit in the brain
2. Intervene with deep brain stimulation
3. Personalize/tailor to the individual



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Wednesday, March 21, 2012

Introducing…the CAPhO Compass Blog


The CAPhO Compass is the latest initiative I have undertaken via the CAPhO Communications Committee as another means to communicate with CAPhO (Canadian Association of Pharmacy in Oncology) members. The Compass marks the official CAPhO entry into the blogosphere!

Excerpt:
Contents of the blog:The CAPhO Compass intends to help navigate CAPhO members through resources on the world wide web, oncology pharmacy news and happenings, and much more.
Here are some of the exciting new things to look forward to:
  • CAPhO Research Project Updates (For instance, Sean Hopkins will be providing updates on his progress)
  • Top 10 News/Articles/Highlights of the past 10 days
  • Highlighting awards open to members
  • Drug shortage updates
  • Member spotlights
  • Pearls of Wisdom
  • What’s happening and initiatives that are happening provincially/regionally
  • What’s happening in other relevant organizations – HOPA, ISOPP, CSHP, BOPA, etc.
  • Pharmacy related and relevant videos

*To view the blog click here:

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OxyNeo: Innovation In Pain Management or Patent Extender of OxyContin?



The premise is great; OxyNeo is a fairly innovative oral tablet (Concerta [methylphenidate controlled release] also utilizes this formulation) to possibly help curb abuse of one of the most highly abused prescription medications - OxyContin.

OxyNeo is not clear of problems, however, and is actually NOT desirable in a variety of patient populations.

OxyNeo tablets are formulated to make them harder to break or crush, making it difficult for people to chew OxyNeo to release all of the drug at once or crush it into a powder to snort. If one attempts to dissolve the tablets in water or alcohol, the result is a gummy gel that cannot be drawn up in a syringe.

OxyNeo and OxyContin are bioequivalent but there are slight differences:



  • OxyNeo takes slightly longer to reach peak levels, which may be perceived as being less effective.
  • have a slightly higher peak, which may ptentially lead to more side effects.
Of course, OxyNeo will not curb all abuse. Patients can still take larger amounts orally. As well, creative people are already trying to figure out how to get oxycodone more readily out of the new tablets.  Crushing the tablets followed by dissolution can release over 75% of the dose, depending on the solvent utilized.  There is no proof that OxyNeo is less subject to abuse or diversion.


Patients have to be cautioned NOT to wet or lick OxyNeo tablets prior to putting them in their mouth. There are reports of patients choking because the tablet forms a gummy gel when it is wet. Patients are to be told to swallow each tablet one at a time if they have to take multiple tablets per dose.

This poses a major risk to cancer patients, especially those in head and neck tumour groupings who have fiddiculties swallowing as it is.
One is left to ponder if this is simply a case of altering the controlled release formulation to allow a pharmaceutical company to extend the patent (although I admittely am not certain of what that date would be and company did not disclose when asked).

 

Reference:
Pharmacist Letter 

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Wednesday, March 14, 2012

Paul Ehrlich: "Father of Chemotherapy"

Deutsch: Paul Ehrlich, in seinem Arbeitszimmer...
Image via Wikipedia
Paul Ehrlich: "Father of Chemotherapy"
Born March 14, 1854 - Paul Ehrlich

*Information below gathered from: http://www.medindia.net/patients/patientinfo/chemotherapy-history.htm

Much of the original work leading to the ‘magic bullets’ is credited to a German bacteriologist from Frankfurt - Paul Ehrlich.

He was awarded a Nobel prize in Physiology or Medicine in 1908 for some of his pioneering work and is considered the ‘father of modern Immunology and Chemotherapy’

After Ehrlich laid down the principles, the treatment of cancer cells using chemotherapeutic agents was first carried out in the 1950s.

The first drug used in treating cancer is an accidental discovery. During the World War II, mustard gas was used as a warfare agent. It was discovered that individuals who were accidentally exposed to mustard gas had low WBC counts.

It was reasoned that an agent with such an effect on the rapidly-dividing WBC could have the same effect on cancer cells too.

As a result, the drug was intravenously used to treat individuals with late-stage lymphomas with dramatic early results.
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About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia: http://en.wikipedia.org/wiki/Pharmacy#History_of_pharmacy

Journal of Palliative Medicine - Table of Contents

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