Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2005
Randomized Controlled Trial Multicenter Study Clinical TrialEfficacy, safety, and steady-state pharmacokinetics of once-a-day controlled-release morphine (MS Contin XL) in cancer pain.
The efficacy, safety, and pharmacokinetics of a novel once-daily morphine formulation (OAD morphine) and a 12-hourly formulation (twice-daily CR morphine) were compared in a double-blind, multi-centered crossover study. Chronic cancer pain patients (n=25) were randomized to OAD morphine (mean 238 +/- 319 mg q24h) or twice-daily CR morphine (mean 119 +/- 159 mg q12h) for one week. They then crossed over to the alternate drug, which also was taken for one week. ⋯ The AUC ratio was 100.3%, indicating equivalent absorption. Fluctuation indices were 93.5 +/- 28.8% and 179.3 +/- 41.3% (P=0.0001) for OAD morphine and twice-daily CR morphine, respectively. OAD morphine provides analgesia similar to twice-daily CR morphine with reduced fluctuation in plasma morphine concentration and more stable pain control.
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J Pain Symptom Manage · Jan 2005
Biography Historical ArticleThe syringe driver and the subcutaneous route in palliative care: the inventor, the history and the implications.
Since the early 1980s, the syringe driver has become a commonly used technology in British palliative care, used to administer continuous subcutaneous infusions (CSCI) for symptom management. Although the device itself has not been adopted universally, it has stimulated interest in the use of CSCI in palliative care and played a significant role in the modern history of this approach. This historical case study of the syringe driver examines the life and work of its inventor, explores its development for use in childhood thalassemia, and analyzes the circumstances surrounding its adoption in palliative care. We conclude by considering the reasons for the continued popularity of the syringe driver, despite problems in its use, and reflect on the lessons which can be learned about the use of CSCI in palliative care internationally.
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J Pain Symptom Manage · Jan 2005
Case ReportsAlcohol withdrawal as an underrated cause of agitated delirium and terminal restlessness in patients with advanced malignancy.
A significant number of patients with terminal cancer experience terminal restlessness or an agitated delirium in the final days of life. Multifactorial etiologies may contribute to agitation and restlessness for any one patient; alcohol withdrawal may be underrated as a contributing factor. ⋯ Formal assessment of alcohol withdrawal may be of more value in the palliative setting than using the currently accepted assessment instruments. Many of the medications utilized for the treatment of agitated delirium and terminal restlessness in the palliative care setting are effective therapies for alcohol withdrawal.