Prescribing cascades and medications most frequently involved in pain therapy: a review

P. Nunnari, G. Ceccarelli, N. Ladiana, P. Notaro

Pain Medicine, Neuroscience Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 3, Ospedale Maggiore Square, Milan, Italy. paolo.notaro@ospedaleniguarda.it

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• Pharmacology

OBJECTIVE: The aging of the population and chronic pain represents topical issues in developed countries. These often translate into polypharmacy, inappropriate medications, and adverse drug events, with the risk of misinterpreting these latter with new medical conditions, generating what is referred to prescribing cascade. Prescribing cascades may lead to the prescription of new drugs, which could cause new potential side effects and unnecessary costs for individuals and healthcare systems. Therefore, the purpose of our review was to collect a good deal of prescribing cascades examples involving pain therapy medicines, to help clinicians minimize drug-related clinical outcomes.

MATERIALS AND METHODS: We search in MEDLINE database through PubMed, including 31 studies and 80 different examples of prescribing cascades.

RESULTS: The medications most commonly resulting in the initial drug therapy prescribed were represented by psychoanaleptics (27/80, 33.7%). Among adverse drug events, the most common one, misinterpreted as a new medical condition, was represented by tremor and extrapyramidal symptoms (20/80, 25%). As regards the new drug therapies prescribed for adverse drug events, the therapeutic subgroups most commonly resulting in the new drug therapy prescribed were represented by psycholeptics (12/80, 15%), and by anti-Parkinson drugs (12/80, 15%).

CONCLUSIONS: This study provides a list of several examples of prescribing cascades in pain medicine and is essential to raise awareness of the potential dangers they could involve in all patient populations. Collaboration between clinicians and clinical pharmacologists may lead to more appropriate polypharmacy schemes.

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