The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Sep 2005
Comment Letter Case ReportsMethadone for cancer pain: a case report.
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Opioids, intended to abolish pain, can unexpectedly produce hyperalgesia, particularly during rapid opioid escalation. Opioid switching could be a therapeutic option in a condition of opioid-induced tolerance or hyperalgesia, but conversion ratios between opioids are difficult to apply in this context and require strict surveillance and expertise. This situation is challenging, because the rapid escalation of opioid doses, possibly due to the development of opioid-induced tolerance, can cause hyperalgesia. ⋯ The authors present a case report in which switching from fentanyl to methadone was effective in a patient who developed hyperalgesia as a consequence of a rapid opioid escalation. Regardless of the expected clinical improvement of opioid switching using lower doses of the second opioid, the final dose of the second opioid was exaggeratedly low, probably as a consequence of the disappearance of hyperalgesia induced by the first opioid. The results of this case and others like it may help practitioners develop a meaningful approach during opioid escalation, possibly anticipating the need for opioid switching or other alternative measures for patients with uncontrolled cancer pain.
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Am J Hosp Palliat Care · Jul 2005
Anticipatory grief and psychological adjustment to grieving in middle-aged children.
This study examines the effect of anticipatory grief on personal adjustment in middle-aged adult children following the death of their last surviving elderly parent. Data were analyzed from a study of adult children's perspectives of an elderly parent's death conducted by the Philadelphia Geriatric Center, Philadelphia, Pennsylvania. ⋯ This finding was consistent across gender and racial and ethnic distinctions among adult children who participated in this study. The significance of this finding for grief work and its implications for future research are discussed.