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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.

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.

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.

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