Summer 2010 - The British Pain Society

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To amend Article 26 as follows: 26.1 The Council may at any time appoint a person eligible under Article 22 to fill a vacancy in any Office, even if he has held that Office for the maximum term allowed under Article 19. Any person so appointed shall be deemed to be appointed on an interim basis and must then resign at the next following Annual General Meeting. Provided that any such person has not held the Office in question for the maximum term allowed, he shall be eligible for re-election. 26.2 In the event that there is no Officer Elect able and willing to take on the vacancy in Office, the Council must have recourse to the procedure laid out in Regulations 11.5 and 11.6. To amend Article 27 as follows: 27 A person will only be eligible to be elected an Ordinary Council Member if he is an Ordinary or Honorary Member of the Society. This provision precludes the election of an Ordinary Council Member if he is an International or a Retired Member of the Society. To amend Article 50.1 as follows: The President or the Council may whenever he or it thinks fit call General Meetings and, on the requisition of 10 percent of Ordinary Members, shall forthwith proceed to convene an Extraordinary General Meeting. (i) within 21 days from the date on which he or it becomes subject to the requirement; (ii) the meeting must be held on a date not more than 28 days after the date of the notice calling the meeting or with the consent of a simple majority of those members calling the meeting within such longer period as may be agreed by mutual consent provided such period does not exceed 56 days; (iii) if the requests received by the company identify a resolution either special or otherwise intended to be moved at the meeting, the notice of the meeting must include notice of such resolution whether special or otherwise; (iv) the business that may be dealt with at the meeting includes a resolution whether special or otherwise of which notice is given in accordance with section 303 of the Act. The Special Resolution was passed unanimously by 75% of the Members present and voting in person or by proxy. Updates Those who attended the ASM will know that the National Pain Audit for England and Wales – Phase I is about to launch. Information will arrive to you in November and the information should be collected by the Clinical Lead and signed off by the Chief Executive of your Trust. The information will be core data relating to the service composition and personnel involved in delivering the service. Phase two and three are case mix and patient outcome. Further information can be found on the BPS website http://www.britishpainsociety. org/members_sigs_clinical.htm . Another very important document has just been launched by the BPS – Opioids for persistent pain – Good Practice 2010. A consensus statement prepared on behalf of the British Pain Society, the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of General Practitioners and the Faculty of Addictions, Royal College of Psychiatrists. This document can be downloaded from the website http://www.britishpainsociety.org/ pub_professional.htm#opioids . Or hard copies can be requested from the Secretariat. There is also information for patients leaflet that can be requested and members are entitled to two free copies. Finally, we have a new Special Interest Group forming (Primary Care SIG). I have also written an article about setting up a SIG in this edition to help with this process. Lay Chairman Vacancy The British Pain Society Patient Liaison Committee Do you know any patients or contacts who might make a good Chair for the Patient Liaison Committee? We are looking for a new Chair for our Patient Liaison Committee. The suitable applicant will be a lay person and must have an interest in the NHS and in how to make sure people get the best care from the health service, particularly people living with pain. Experience of living with pain or of a voluntary sector organisation linked to pain would be useful. Applicants must be available to Chair the committee meetings and attend council meetings within London for a minimum of eight days per year. The British Pain Society will reimburse travel costs. Interviews will be held at the British Pain Society Secretariat, London. Closing Date for Applications: 5pm, Monday 2nd August 2010 For an application pack please contact Rikke Susgaard-Vigon, Communications Officer on 0207 269 7840 or email: rsusgaardvigon@britishpainsociety.org 10 PAI N N E W S S U M M E R 2010
Breakthrough Cancer Pain (BTcP)* Fast relief as early as 10 minutes 1 UK PRESCRIBING INFORMATION: Effentora ® ▼ 100 micrograms, 200 micrograms, 400 micrograms, 600 micrograms, 800 micrograms fentanyl buccal tablet (fentanyl) Please refer to Summary of Product Characteristics (SmPC) before prescribing. Presentation: Effentora buccal tablet containing 100 micrograms, 200 micrograms,400micrograms,600microgramsand800microgramsfentanyl. Indications:Treatmentofbreakthroughpain(BTP)inadultswithcancerwho are already receiving maintenance opioid therapy for chronic cancer pain. Patients receiving maintenance opioid therapy are taking at least: 60 mg oforalmorphinedaily,or25microgramsoftransdermalfentanylperhour, or 30 mg of oxycodone daily, or 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer. Dosage and Administration:SeeSmPCforfullinformation.Method:Placetheentiretablet inthebuccalcavity(nearamolarbetweenthecheekandgum).Alternatively, sublingually(seesection5.2ofSmPC).Retainwithinthebuccalcavitylong enoughforthetablettodisintegrate.Swallowanyremnantswithwaterafter 30minutes.Adult:Treatmentundertheguidanceofaphysicianexperienced inthemanagementofopioidtherapyincancerpatients.Beawareofpotential abuseoffentanyl.Individuallytitratetoan“effective”doseprovidingadequate analgesia,minimisingundesirableeffects.Therequireddosemayincrease over time due to progression of the underlying cancer disease. A second doseofthesamestrengthmaybetakenifrequired.Afterasecondtablet, wait4hoursbeforetakinganother.Ifaseconddoseistakenseveraltimes in a row, consider adjusting maintenance dose. Children and adolescents: Notrecommendedforuseinpatientsbelow18yearsofage.Elderly:Patients over65tendtoneedalowerdose.Hepaticandrenalimpairment:Cautionin patientswithmoderatetoseverehepaticorrenalimpairment.Seesection4.4 ofSmPCformoreinformation.Xerostomia:Drinkwatertomoistenthebuccal cavitypriortoadministrationofEffentora.Ifstillinadequatedisintegration, switchtherapy. Contraindications:Hypersensitivitytotheactivesubstance ortoanyoftheexcipients.Treatmentofacutepainotherthanbreakthrough pain. Patients not on maintenance opioid therapy (see SmPC section 4.1). Severe respiratory depression or severe obstructive lung conditions. Building Confidence in BTcP Treatment Warnings and Precautions: Keep all Effentora tablets out of the reach and sight of children. Monitor patients closely during the titration process. StabiliselongactingmaintenancetreatmentbeforeEffentoratherapybegins. Continue maintenance treatment whilst taking Effentora. Risk of clinically significant respiratory depression. Increase dose with caution. Particular cautionwhentitratingpatientswithchronicobstructivepulmonarydisease orothermedicalconditionspredisposingtorespiratorydepression.Extreme cautioninpatientssusceptibletointracranialeffectsofCO2retention,suchas increasedintracranialpressureorimpairedconsciousness.Cautioninpatients withpre-existingbradyarrhythmias,withhepaticorrenalimpairment.Care withpatientswithhypovolaemiaandhypotension.Interactions:Metabolised mainly via cytochrome P450 3A4 isoenzyme system (CYP3A4), therefore potential interactions with agents that affect CYP3A4 activity. Inducers of 3A4activitymayreducetheefficacyofEffentora.StrongCYP3A4inhibitors ormoderateCYP3A4inhibitorsmayincreasefentanylplasmaconcentrations, potentiallycausingfatalrespiratorydepression.Additivedepressanteffects withconcomitantuseofothercentralnervoussystemdepressants(referto theSmPCforfulllist).Notrecommendedforusewithin14daysofreceiving MonoamineOxidaseInhibitors.Concomitantuseofpartialopioidagonists/ antagonistsnotrecommendedduetopartialantagonismofanalgesiaand potential withdrawal symptoms. Pregnancy and lactation: Not to be used in pregnancy unless clearly necessary. Use of Fentanyl may cause opioid withdrawalinthenew-borninfant.Useduringlabouranddelivery(including caesareansection)maycausefoetalrespiratorydepression,requiringready availabilityofanantidoteforthechild.Notbeusedbybreastfeedingwomen andnobreastfeedinguntilatleast48hoursafterthelastadministrationof fentanyl.Effects on ability to drive and use machines:Mayimpairmentaland/ or physical ability required for potentially dangerous tasks (e.g., driving a caroroperatingmachinery).Advisenottodriveoroperatemachinerywhile taking Effentora until reaction to Effentora is known. Undesirable effects: Please see the SmPC for complete list of adverse effects. Typical opioid undesirable effects. Serious adverse reactions: Respiratory depression (potentiallyleadingtoapnoeaorrespiratoryarrest),Circulatorydepression, Hypotension and shock. Monitor for these. Very common effects (>10%) – Nausea, Vomiting, Dizziness and Headaches, Application site reactions. Common(>1%-10%)–Weightdecreased,Tachycardia,Anaemia,Neutropenia, Dysgeusia,Somnolence,Lethargy,Tremor,Sedation,Hypoaesthesia,Migraine, Dyspnoea, Pharyngolaryngeal pain, Constipation, Stomatitis, Dry mouth, Diarrhoea, Abdominal pain, Gastro-oesophageal reflux disease, Stomach discomfort, Dyspepsia. Toothache, Pruritis, Hyperhidrosis, Rash, Myalgia, Back pain, Anorexia, Oral candidiasis, Fall, Hypotension, Hypertension, Peripheral oedema, Fatigue, Asthenia, Drug withdrawal syndrome, Chills, Depression, Anxiety, Confusional state, Insomnia. Tolerance, physical and/ orpsychologicaldependence.OpioidwithdrawalsymptomssuchasNausea, Vomiting, Diarrhoea, Anxiety and Shivering. Loss of consciousness and Respiratory arrest have been observed in the context of overdose. See fullSmPCforotherundesirableeffectsclassifiedasUncommon,Rareand unknown.Overdose:SeeSmPCforfullinformation.Immediatemanagement ofopioidoverdoseincludesremovalofEffentora,ensuringapatentairway, physicalandverbalstimulation,assessmentofthelevelofconsciousness, ventilatoryandcirculatoryassessment,andventilatorysupportifnecessary. Basic UK NHS Costs: Effentora all strengths x 4 £19.96. Legal Category: CD (Sch2), POM. Marketing Authorisation Numbers: EU/1/08/441/001-010. Marketing Authorisation Holder: Cephalon Europe 5 rue Charles Martigny F-94700Maisons-AlfortFrance.Date of SmPC:December 2009.Information, including SmPC, is available from Cephalon UK Limited, 1 Albany Place, HydeWay,WelwynGardenCity,Hertfordshire,AL73BTMedicalInformation ukmedinfo@cephalon.com).Freephone:UK08007834869 Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Cephalon UK Ltd on 0800 783 4869 or ukmedinfo@cephalon.com DateofPrescribingInformation:21DEC2009CE/FE-09121 ©Cephalon UK Ltd. All rights reserved. ®Cephalon and Effentora are registered trademarks CE/FE-10008c/Jan10 * For the treatment of Breakthrough Pain (BTcP) in adults with cancer who are already receiving maintenance opioid therapy for chronic cancer pain. 1. Slatkin NE et al., Fentanyl Buccal Tablet For Relief of Breakthrough Pain in Opioid-Tolerant Patients With Cancer-Related Chronic Pain. J Support Oncol. 2007; 5(7): 327-334.
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R E S E A R C H & D E V E L O P M E
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Summer 2010 - The British Pain Society

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