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Here, we describe a case of a patient with multiple myeloma who reported symptoms of lucid dreams. This patient was taking methadone for neoplasm related pain. The patient was also taking pregabalin which was initially started at dosing of 50 mg taken orally three times a day. Five days after initiation of pregabalin, the dosing was increased to 100 mg taken orally three times daily. The patient developed lucid dreams during a hospital stay and methadone was initially thought to be the cause of her lucid dreams. Methadone dosing was decreased with no success, and her lucid dreams persisted. On the patient's thirteenth day of hospital admission, the pregabalin dose was decreased from 100 mg three times a day to 75 mg twice daily. Five days later, the pregabalin was decreased from 75 mg twice daily to 50 mg twice daily. Pregabalin was continued for five more days and then discontinued. Resolution of the lucid dreams occurred following discontinuation of pregabalin. To our knowledge, this is the first reported case of an association between pregabalin and lucid dreams. Given that pregabalin is a widely used medication, we found this case to be relevant to describe this unique presentation. [ABSTRACT FROM AUTHOR]

Dr. Craig describes the drug's pharmacology, pharmacokinetics, efficacy, and safety; the process of switching from other agents; and ways pharmacists can help prevent abuse of this controlled substance. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration Amendments Act of 2007 extended the agency's regulatory authority over drug products that have been shown to place patients at risk. This Act authorizes the FDA to require pharmaceutical manufacturers and distributors to ensure that the safety of their products continue to outweigh the risks. This article discusses in more detail the proposed elements of an acceptable Risk Evaluation and Mitigation Strategy (REMS) for any drug product, including extended-release opioid analgesics. [ABSTRACT FROM AUTHOR]

Pain continues to be undertreated, and numerous barriers to adequate pain management have been identified. Some clinicians believe that the words which health prolcssionals use to describe analgesics may be a hidden barrier. Possible implications of using the term "'narcotic" are described. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Use of Very-low-dose Methadone for Palliative Pain Control and the Prevention of Opioid Hyperalgesia," by S. R. Salpeter et al. in the 2013 issue.

The article entitled 'Risk Evaluation and Mitigation Strategies (REMS) for Extended-Release and Long-Acting Opioid Analgesics: Considerations for Pain and Palliative Care Practice' that appears in this issue of the journal addresses the important new Food and Drug Administration (FDA) REMS program. This commentary expands on themes introduced by Dr. Gudin, projects future directions for REMS, and discusses possible benefits, limitations, and risks associated with the extended-release long-acting opioid REMS. [ABSTRACT FROM AUTHOR]

The article discusses various reports within the issue, including one by Hall and O'Lenie on strategies to overcome end-of-dose failure with oral or transdermal opioids, one by Marlowe on the role of pharmacists in dispensing opioids for acute and chronic pain and one by Juba on the value of professional credentialing for pharmacists in pain management and palliative care.

The article presents the American Society of Health-System Pharmacists (ASHP) guidelines on the palliative and hospice care roles of the pharmacist. Topics include the patient-centered care approach stipulated by the U.S. Department of Health and Human Services, palliative care description by the National Consensus Project for Quality Palliative Care of the National Quality Forum (NQF) as well as medical care tenets endorsed by the World Health Organization (WHO).

Abstract: Pain and symptoms related to palliative care (pain and palliative care [PPC]) are often undertreated. This is largely owing to the complexity in the provision of care and the potential discrepancy in education among the various health care professionals required to deliver care. Pharmacists are frequently involved in the care of PPC patients, although pharmacy education currently does not offer or require a strong curriculum commitment to this area of practice. The Strategic Planning Summit for the Advancement of Pain and Palliative Care Pharmacy was convened to address opportunities to improve the education of pharmacists and pharmacy students on PPC. Six working groups were charged with objectives to address barriers and opportunities in the areas of student and professional assessment, model curricula, postgraduate training, professional education, and credentialing. Consensus was reached among the working groups and presented to the Summit Advisory Board for adoption. These recommendations will provide guidance on improving the care provided to PPC patients by pharmacists through integrating education at all points along the professional education continuum. [Copyright &y& Elsevier]