Journal of pain and symptom management
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J Pain Symptom Manage · Feb 1996
Multicenter StudyIntraspinal morphine for chronic pain: a retrospective, multicenter study.
Intraspinal opioids are frequently used in the treatment of cancer and noncancer pain, but few studies have evaluated the efficacy of this technique. This multicenter, retrospective study surveyed physicians in the United States regarding their standard practices when using intraspinal opioids delivered via an implanted drug administration device. Thirty-five physicians (50.0%) responded, providing 429 usable patient forms (52.4%), which sought information about screening, outcomes, dosing, and adverse effects. ⋯ The average dose used by cancer patients escalated quickly and then stabilized, whereas the average doses used by noncancer pain patients exhibited a more gradual, linear increase in dose. Long-term adverse drug effects were uncommon, but system malfunction, usually catheter related, occurred in 21.6% of patients. Prospective, randomized, controlled clinical studies of long-term efficacy and adverse effects are warranted.
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J Pain Symptom Manage · Feb 1996
The pharmacologic management of pain and discomfort in persons with AIDS near the end of life: use of opioid analgesia in the hospice setting.
To determine the prevalence and management of pain and discomfort during the last 2 weeks of life in persons with acquired immunodeficiency syndrome (AIDS) being cared for in hospice settings, and to find the extent to which opioids are used for relief of pain and discomfort during this period, we conducted a retrospective cohort study of patients treated by AIDS hospice agencies in Seattle, Washington (1987-1992). The medical records for the last 2 weeks of life were reviewed for 185 consecutive adults with AIDS who were receiving hospice care. Most [93% (172/185)] experienced at least one 48-hr period of pain and discomfort during the last 2 weeks of life, with prevalence increasing from over one-half of the cohort early in the 2-week course to two-thirds of the cohort late in the course; 88% (162/185) received some form of opioid analgesia (0-100 mg/hr morphine equivalent), with the majority [62% (100/162)] experiencing some relief thereafter. ⋯ Opioids are frequently given in widely varying dosages (and dosing strategies), with variable results. Some patients require high doses yet continue in pain; others are comfortable on no medication. The majority of patients receive opioid medications and experience relief from pain and discomfort.
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J Pain Symptom Manage · Feb 1996
Clinical Trial Controlled Clinical TrialMorphine and morphine-6-glucuronide plasma concentrations and effect in cancer pain.
The relationships between plasma morphine and metabolite (M3G and M6G) concentrations and analgesic efficacy were investigated in an open study of 39 cancer pain patients receiving chronic oral morphine therapy with either morphine sulfate solution or controlled-release morphine tablets. There were no differences in morphine, metabolite kinetics, or analgesic efficacy between equivalent doses of conventional or controlled-release formulations. The increase in morphine plasma concentration after a dose (1 hr for normal release, 2 hr for controlled release) was correlated significantly with the dose of morphine (r = 0.914, P < 0.001). ⋯ Morphine plus M6G concentrations in the "optimal control" group (751.2 +/- 194 nmol/L), however, were more than twice those found in the "moderate control" group (276.9 +/- 41.9 nmol/L) (P < 0.05), and no patient in the moderate control group had a morphine plus M6G concentration greater than 405 nmol/L. These results support the importance of M6G in morphine analgesia. For these hospitalized patients, there appeared to be a therapeutic range of morphine plus M6G plasma concentrations for optimal pain control with a lower limit of 400 nmol/L predose.