Annals of palliative medicine
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Rapid titration with intravenous morphine (IV-MO) provides fast and efficient pain relief in cancer patients with severe-excruciating pain. However, some patients, after an initially favourable response, can develop an hyperexcitated state unrelieved or worsened by further dose increments. ⋯ In escalating opioid doses rapidly a recognition of the development of hyperalgesia should be suspected. Increasing doses of opioids may stimulate rather than inhibiting the central nervous system, with complex mechanisms already recognized in experimental studies. Switching to IV-ME and titrating the doses could be taken into consideration to break this vicious circle before pain conditions worsen irreversibly.
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The palliative care population is generally vulnerable to experiencing medication-induced adverse effects and drug-drug interactions. Neuromodulation may offer particular advantages over systemic medications in this population. Although brain electrical stimulation has not been adequately trialed or in some cases even tried at all for management of a variety of symptoms, it is conceivable that in the future that it may be a potential therapeutic option in efforts to palliate various severe refractory symptoms.
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Opioids are potent broad-spectrum analgesics useful to treat a variety of painful conditions. Opioids have been classified by many different categorizations (e.g. natural, semisynthetic, synthetic). One classification that may be useful in terms of selecting specific opioid agents is based on the pharmacokinetic characteristics of the various opioid formulations (e.g. longacting opioids, short-acting opioids, and rapid onset opioids). ⋯ Rapid onset opioids appear especially well-suited to treat breakthrough pain and in particular, rapidonset breakthrough pain. This article will briefly review 5 rapid onset opioids that are FDA approved in the U. S.