Journal of pain and symptom management
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J Pain Symptom Manage · Jul 1999
Randomized Controlled Trial Clinical TrialContinuous subcutaneous infusion of morphine vs. hydromorphone: a controlled trial.
Seventy-four patients were included in a double-blind, randomized, controlled trial comparing the analgesic efficacy and adverse effects of hydromorphone and morphine delivered by continuous subcutaneous infusion. Patients completed the Memorial Pain Assessment Card and a checklist of opioid-related adverse effects immediately before commencing subcutaneous infusion and 24, 48, and 72 hours later. An assessment tool was developed for the 60 patients who were too ill to complete their own questionnaire. ⋯ The hydromorphone group required more analgesia for breakthrough pain in the first 24 hours of the study (P = 0.03) and had a greater improvement in the behavior of frowning on movement and the comfort visual analogue scale (P = 0.08) over the course of the study. Adverse effects were rare and similar in both groups. This study found hydromorphone to be at least as effective as morphine when delivered by continuous subcutaneous infusion.
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J Pain Symptom Manage · Jul 1999
Case ReportsAnalgesic effect of oral ketamine in chronic neuropathic pain of spinal origin: a case report.
Ketamine is an injectable anesthetic induction agent that has been reported to have analgesic activity in pain from a variety of mechanisms, but predominantly in neuralgic and dysesthetic neuropathic pain. In this case report we illustrate the effectiveness of ketamine in a patient with neuropathic pain resulting from cauda equina trauma. Among the issues addressed are the role of pretreatment with haloperidol to prevent ketamine-induced psychomimetic effects, the potential for fewer side effects and a need for lower doses when ketamine is administered orally, and the need for further study regarding appropriate monitoring parameters during the titration phase. Oral ketamine can be effective in treatment refractory chronic neuropathic pain of spinal origin.
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J Pain Symptom Manage · Jul 1999
Case ReportsThe relative potency between high dose oral oxycodone and intravenous morphine: a case illustration.
Oxycodone is an effective opioid analgesic for cancer pain. In the United States, it is available exclusively as an oral formulation, predominantly in fixed dose combination with acetaminophen or aspirin. ⋯ The following case report of an opioid tolerant cancer patient taking repeated high doses of oral oxycodone supports the use of a 1:1 milligram conversion ratio for oral morphine and oral oxycodone. This patient's clinical course indicates that oral oxycodone can be used safely and to good effect at high dose, that the milligram relative potency ratio for oral oxycodone to parenteral morphine during repeated dosing is 3:1, and suggests that availability of multiple formulations of oxycodone may benefit cancer patients.
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J Pain Symptom Manage · Jul 1999
Subcutaneous methadone in terminally ill patients: manageable local toxicity.
Methadone has been found to be useful in pain uncontrolled by large doses of conventional opioids such as hydromorphone and morphine. While the subcutaneous route is effective and may afford cost-savings over the intravenous route in patients unable to take oral medication, its utility for the administration of methadone may be hampered by local toxicity, specifically erythema and induration. ⋯ Furthermore, toxicity is uniformly manageable by site rotation and the use of dexamethasone infused concurrently with the methadone. We recommend that the infusion of subcutaneous methadone should be considered in the appropriate patients who can be closely monitored.