Journal of pain and symptom management
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This article describes the use of a subcutaneous infusion of midazolam to control restlessness and agitation in 23 patients during the final stages of advanced cancer. Midazolam effectively controlled symptoms in 22 of the patients at an initial dose of 0.4-0.8 mg/hr rising to a mean maximum dose of 2.9 mg/hr. ⋯ At high doses, the volume of injection required presented some practical difficulties, but otherwise there were no major problems with this technique. Midazolam by subcutaneous infusion is a well-tolerated, safe and effective treatment for terminal restlessness and agitation, and deserves more extensive evaluation.
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This article reviews the currently published articles regarding the use of spinal opioids in pediatric patients and discusses the important clinical considerations for the application and monitoring of this technique in children.
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Spinal opioids have dramatically influenced the way intractable pain of malignant origin is managed. To provide optimal pain relief, spinal opioids must be used in the context of a comprehensive cancer pain management treatment plan. ⋯ During therapy, side effects must be anticipated and treated aggressively to assure patient comfort and safety. Although the chronic administration of opioids and other drugs into the epidural or subarachnoid space is in its infancy, advances in the pharmacology of spinal drugs and the development of new delivery system technology will probably expand the options available for the relief of cancer pain.
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Spinal opioids have dramatically changed the way acute, obstetrical and pain of malignant origin is managed. The development of various implantable narcotic delivery systems has complemented and facilitated the growth of this treatment modality. By interfacing appropriate patient selection with the unique advantages and disadvantages of each of the six types of implantable narcotic delivery systems, improved results both in terms of pain relief and patient satisfaction can be achieved.
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This review presents the pharmacology of spinal opioid receptor systems which are primarily involved in pain processing. The major areas upon which we will focus are: the structure and cellular functioning of the opioid receptor systems; the physiologic effects induced by spinally administered opioids, particularly in pain modulation; and pharmacokinetic and dynamic considerations, with special attention to the problem of opioid tolerance development.