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Pharmacological synergy: the next frontier on therapeutic advancement for migraine.

The burden of migraine significantly impacts the individual sufferer, their families, the workplace, and society. The World Health Organization has identified migraine as an urgent public health priority and has initiated a global initiative to reduce the burden of migraine. Underlying the World Health Organization initiative is the need to discover means of optimizing migraine treatments and make them accessible to the broader portion of the world population. Development of acute migraine medications over the past several decades has largely centered on engineering highly specific receptor mo

Relative bioavailability of the fentanyl effervescent buccal tablet (FEBT) 1,080 pg versus oral transmucosal fentanyl citrate 1,600 pg and dose proportionality of FEBT 270 to 1,300 microg: a single-dose, randomized, open-label, three-period study in healthy adult volunteers.

BACKGROUND: The fentanyl effervescent buccal tablet (FEBT) was designed to enhance the rate and extent of absorption of fentanyl through the buccal mucosa. FEBT is being investigated for the management of breakthrough pain. OBJECTIVES: The primary objective of this study was to compare the relative bioavailability of FEBT 1,080 microg with that of oral transmucosal fentanyl citrate (OTFC) 1,600 microg, and the secondary objective was to assess the dose proportionality of FEBT 270 to 1,300 microg in healthy adult volunteers. METHODS: This single-dose, randomized, open-label, 3-period study wa…

A year in pharmacology: new drugs approved by the US food and drug administration in 2025.

The US Food and Drug Administration approved 45 new drugs and 4 new cellular and gene therapy products in 2025, that is, a total of 49 new medical therapies. Oncology, hematology/immunotherapy, and cardiovascular/respiratory drugs remain most frequent. Among oncology drugs, there is a trend for targeting ever smaller subtypes of malignancies and/or rarer malignancies. Trends over the past 6 years include steady levels of first-in-indication (about 10%), first-in-class (about 38%), and next-in-class (about 51%) approvals. Along with a large share of approvals in orphan indications (> 50%), fast

Characteristics and Outcomes of Patients with Cancer Pain Placed in an Emergency Department Observation Unit.

Pain remains an undertreated complication of cancer, with poor pain control decreasing patients’ quality of life. Traditionally, patients presenting to an emergency department with pain have only had two dispositions available to them: hospitalization or discharge. A third emerging healthcare environment, the emergency department observation unit (EDOU), affords patients access to a hospital’s resources without hospitalization. To define the role of an EDOU in the management of cancer pain, we conducted a retrospective study analyzing patients placed in an EDOU with uncontrolled cancer pain fo

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… Whereas Wang et al. found that gastrointestinal cancer-related breakthrough pain took a median of 3 days to control and lung cancer-related breakthrough pain took a median of 2 days to control, our study found no significant predictors of admission with regards to the type of cancer a patient had ( Table … A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain J. Pain 2002 3 38 44 10.1054/jpai.2002.27136 14622852 18. Laviana A.A. Luckenbaugh A.N. Resnick M.J. …

Efficacy and safety of combining low-dose methadone with ongoing opioid treatment for uncontrolled cancer pain: an open-label single-arm study.

BACKGROUND: Pharmacological options for refractory cancer pain are limited. This study aimed to investigate the efficacy and safety of the combined use of low-dose methadone and ongoing opioid treatment for uncontrolled cancer pain. METHODS: This was a prospective, open-label study. Participants were patients with uncontrolled cancer pain despite dose titration of opioids. Patients received low-dose methadone (starting dose of 5 or 10 mg/day) combined with another ongoing opioid therapy. The primary outcome was the proportion of responders (defined as ≥33% reduction in average pain intensity

When to Use Methadone for pain: A Case-Based Approach.

The case studies are written in this article to illustrate how methadone might be used for pain in the Indian context. These cases might be used for discussion in a multidisciplinary team, or for individual study. It is important to understand that pain requires a multidisciplinary approach as opioids will assist only with physical, i.e. neuropathic and nociceptive pain, but not emotional, spiritual, or relational pain or the pain of immobility. The social determinants of pain were included to demonstrate how emotional, relational, and psychological dimensions of pain amplify the physical aspe

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… She had not needed any breakthrough pain medication. The dexamethasone was slowly tapered to 4 mgs and stabilized at that dose. In subsequent weeks, her general condition worsened and she stopped eating. … He is also advised to take morphine 10 mg not more than every 4 h if required for breakthrough pain.. C ASE 4 : P OORLY C ONTROLLED N EUROPATHIC P AIN IN A C HILD Rudra is a 13-year-old boy (weight 30 kg) with advanced Ewings Sarcoma diagnosed 1 year ago. …

A year in pharmacology: new drugs approved by the US Food and Drug Administration in 2021.

The second year of the COVID-19 pandemic had no adverse effect on the number of new drug approvals by the US Food and Drug Administration (FDA). Quite the contrary, with a total of 50 new drugs, 2021 belongs to the most successful FDA years. We assign these new drugs to one of three levels of innovation: (1) first drug against a condition ("first-in-indication"), (2) first drug using a novel molecular mechanism ("first-in-class"), and (3) "next-in-class", i.e., a drug using an already exploited molecular mechanism. We identify 21 first-in-class, 28 next-in-class, and only one first-in-indicati

Understanding the Experience of Cancer Pain From the Perspective of Patients and Family Caregivers to Inform Design of an In-Home Smart Health System: Multimethod Approach.

BackgroundInadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input.ObjectiveThis study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system.MethodsThis was a descriptive pilot study using a multimethod approach. Dyads of patients w

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… This type of pain is commonly referred to as breakthrough pain and is notoriously difficult to manage [ 19 , 71 , 72 ]. … Breakthrough pain can be an out of control experience for patients and caregivers, resulting in feelings of hopelessness [ 19 , 71 ]. …

A year in pharmacology: new drugs approved by the US Food and Drug Administration in 2023.

With 54 new drugs and seven cellular and gene therapy products, the approvals by the US Food and Drug Administration (FDA) recovered 2023 from the 2022 dent back to the levels of 2020-2021. As in previous years of this annual review, we assign these new drugs to one of three levels of innovation: first drug against a condition ("first-in-indication"), first drug using a novel molecular mechanism ("first-in-class"), and "next-in-class," i.e., a drug using an already exploited molecular mechanism. We identify four (7%) "first-in-indication," 22 (36%) "first-in-class," and 35 (57%) "next-in-class

Nirogacestat-the pathway to approval of the first treatment for desmoid tumors, a rare disease.

Drug development for rare diseases can be long, complex, and costly. Desmoid tumors (DT), a rare type of soft-tissue tumor, are associated with substantial and debilitating burden, including disease-specific symptoms (e.g., pain, impaired mobility), reduce functioning for daily activities, and worsen quality of life for patients with this condition. These tumors can be potentially life-threatening when they invade surrounding tissues, affect vital structures, or interfere with the body's functions. Until recently, there were no approved treatments specific to DT and little alignment on disease

Emergency Department Management of Common End-of-Life and Palliative Care Symptoms: Three Cases

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… For patients already taking opioids, dyspnea can be treated by calculating 50% of their home breakthrough pain medication dose and then converting it to an IV equivalent dose. The appropriate dose for breakthrough pain is 10% of the total daily opioid dose (Figure 3 ) [ 18 ]. … PC patients should have a home regimen with oral pain medications but often present to the ED if it is insufficient with breakthrough pain. …

Pain in blood cancers.

Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based o

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… pain. … Br J Anaesth 2010 105 Suppl 1 i69 85 21148657 10.1093/bja/aeq323 11 Caraceni A Martini C Zecca E Portenoy RK Ashby MA Hawson G Breakthrough pain characteristics and syndromes in patients with cancer pain.An international survey Palliat Med 2004 18 177 83 15198130 10.1191/0269216304pm890oa 12 Tendas …

Antibodies to watch in 2021.

In this 12th annual installment of the Antibodies to Watch article series, we discuss key events in antibody therapeutics development that occurred in 2020 and forecast events that might occur in 2021. The coronavirus disease 2019 (COVID-19) pandemic posed an array of challenges and opportunities to the healthcare system in 2020, and it will continue to do so in 2021. Remarkably, by late November 2020, two anti-SARS-CoV antibody products, bamlanivimab and the casirivimab and imdevimab cocktail, were authorized for emergency use by the US Food and Drug Administration (FDA) and the repurposed an

A nationwide survey of knowledge of and compliance with cancer pain management guidelines by korean physicians.

PurposeAlthough cancer pain is prevalent, under-treatment still remains a problem. Knowledge of and compliance with guidelines for management of cancer pain were analyzed for exploration of physician-related barriers to cancer pain management. In addition, physicians' knowledge and its correlation with cancer pain control were audited.Materials and methodsFrom July 8 to December 2, 2010, a nationwide survey of house staff enquired about their knowledge of cancer pain control guidelines, and the medical records of patients under their care were analyzed.ResultsIn total, 180 physicians participa

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… Adherence in clinical practice to cancer pain management guidelines Assessments performed included an audit of pain assessment records, medical records of pain assessment, and medications used for control of continuous and/or breakthrough pain. … Pro re nata (PRN) prescriptions for control of breakthrough pain were not given to 40% of patients. …

Cancer Pain Is Not One-Size-Fits-All: Evolving from Tradition to Precision.

Cancer pain remains a significant challenge in oncology, profoundly affecting patients' quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved outcomes, yet traditional algorithms frequently fail to address the complex, heterogeneous nature of cancer pain. Contemporary management is shifting toward precision and personalized medicine, integrating genetic, molecular, and biomarker data with individu

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… Opioids for Breakthrough Pain | For patients on continuous opioid therapy, short-acting opioids should be administered at a dosage of 5–20% of the total daily morphine equivalent for the management of breakthrough pain. … Breakthrough Cancer Pain Breakthrough pain is a transitory, acute pain that occurs on a background of adequately controlled chronic pain. Breakthrough pain is severe in intensity, has a rapid onset, and usually lasts <30 min. …

A Multimodal Clinical Approach for the Treatment of Bone Metastases in Solid Tumors.

ContextBone metastasis (BM) is a frequent complication of cancer, representing the third most common site of secondary spread in solid cancers behind the lung and liver. Bone metastasis is found in up to 90% of prostate and breast cancer patients. They can cause significant complications, such as pathological fractures and paralysis of the spine, which decrease daily functioning and quality of life (QoL) and worsen prognosis. The growing life expectancy of cancer patients due to improvements in systemic therapies may further increase BM's eventuality and clinical burden in cancer patients.Evid

Treatment-related pain in refractory cancer pain: prevalence, mechanisms, and clinical implications in a tertiary referral cohort.

BackgroundThe long-term effects of cancer treatment are increasingly driving persistent pain in cancer survivors; however, the contribution and clinical profile of cancer treatment-related pain (CTRP) in refractory pain populations remain poorly defined.MethodsWe conducted a retrospective cohort study of consecutive patients (N = 622) referred to a tertiary multidisciplinary cancer pain clinic for initial evaluation of refractory pain (January 2021-June 2025). Pain etiology was classified using ICD-11 criteria as treatment-related pain (TRP; MG30.11), tumor-related pain (MG30.10), or non-cance

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… Ferrero VT Oset MM Masferrer JP Pardo EH Sorolla EJ Largo SC Prevalence and characterization of breakthrough pain in cancer patients with proctalgia treated with 3D pelvic radiotherapy Clin Transl Oncol 2019 21 12 1707 1711 10.1007/s12094-019-02102-1 30949931 Ferrero VT, Oset MM, Masferrer JP, Pardo … EH, Sorolla EJ, Largo SC et al (2019) Prevalence and characterization of breakthrough pain in cancer patients with proctalgia treated with 3D pelvic radiotherapy. …

Bone Pain in Cancer Patients: Mechanisms and Current Treatment.

The skeletal system is the third most common site for cancer metastases, surpassed only by the lungs and liver. Many tumors, especially those of the breast, prostate, lungs, and kidneys, have a strong predilection to metastasize to bone, which causes pain, hypercalcemia, pathological skeletal fractures, compression of the spinal cord or other nervous structures, decreased mobility, and increased mortality. Metastatic cancer-induced bone pain (CIBP) is a type of chronic pain with unique and complex pathophysiology characterized by nociceptive and neuropathic components. Its treatment should be

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… Patients treated with pregabalin reported an improvement in mood and fewer episodes of breakthrough pain [ 79 ]. One explanation for this inconsistency in clinical trials is that a neuropathic component can be identified in only approximately 17% of patients with CIBP. … Gabapentin for breakthrough pain due to bone metastases. Palliat. Med. 2008;22:392–393. doi: 10.1177/0269216308089304. 78. Sjölund K.F., Yang R., Lee K.H., Resnick M. Randomized study of pregabalin in patients with cancer–induced bone pain. …

Pain Management in Patients with Multiple Myeloma: An Update.

Most patients with multiple myeloma (MM) suffer from chronic pain at every stage of the natural disease process. This review focuses on the most common causes of chronic pain in MM patients: (1) pain from myeloma bone disease (MBD); (2) chemotherapy-induced peripheral neuropathy as a possible consequence of proteasome inhibitor therapy (i.e., bortezomib-induced); (3) post-herpetic neuralgia as a possible complication of varicella zoster virus reactivation because of post-transplantation immunodepression; and (4) pain in cancer survivors, with increasing numbers due to the success of antiblasti

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… Mercadante S., Marchetti P., Cuomo A., Mammucari M., Caraceni A., IOPS MS study Group Breakthrough pain and its treatment: Critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group. Support. Care Cancer. 2016;24:961–968. doi: 10.1007/s00520-015-2951-y. 62. … Fentanyl in a pectin gel treating breakthrough pain in vertebral compression fracture due to multiple myeloma: A descriptive study of three cases. J. Opioid Manag. 2016;12:197–203. doi: 10.5055/jom.2016.0332. 65. Mercadante S., Cuomo A. Breakthrough Cancer Pain: Ten Commandments. …

Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies.

The incidence rate of invasive mucormycosis (IM) in patients with hematological malignancies (HMs) is increasing year by year, ranging from 0.07% to 4.29%, and the mortality rate is mostly higher than 50%. With the ongoing pandemic of COVID-19, COVID-19-associated mucormycosis (CAM) also became a global health threat. Patients with high risk factors such as active HMs, relapsed/refractory leukemia, prolonged neutropenia may still develop breakthrough mucormycosis (BT-MCR) even under the prophylaxis of Mucorales-active antifungals, and such patients often have higher mortality. Rhizopus spp. is