Journal of palliative medicine
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Methadone (ME) is a highly effective opioid agonist used for difficult pain syndromes. However, in the management of cancer pain with strong opioids, rotation to a different opioid (opioid rotation) may be required because of side effects or poor pain control. Rotation from methadone to another opioid has received limited study and therefore may be difficult because of the absence of a uniformly accepted dose conversion ratio. ⋯ These dose ratios are new findings that may assist in switching patients more safely to alternative opioids when side effects or pain problems occur when patients are receiving methadone. An important difference in analgesic potency appears to exist between IV and oral ME. Future research with prospective studies is required.
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Because many Americans are decisionally incapacitated at the end of life, the last treatment decisions are often made by family proxies. Family discord concerning end-of-life (EOL) care may not only exacerbate a family crisis but also influence treatment decisions. We tested the extent to which family discord would be associated with preferences for types of end-of-life care, predicting that greater discord would be associated with weaker preferences for palliative care and stronger preferences for life-prolonging care. ⋯ In counseling patients with life-limiting illnesses and their families, clinicians should explore possible family discord surroundings EOL care. Counseling protocols should be developed and clinicians should be trained in counseling to minimize family conflict.