Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2008
Case ReportsInconsistencies in opioid equianalgesic ratios: clinical and research implications.
Cancer pain is common, occurring in up to 60% of patients and opioid conversion may be required for effective pain management. Conversion from one opioid to another can be problematic due to differences in equianalgesic ratios found in established resources. This study explores the implications of using various published equianalgesic ratios when converting to a common opioid unit. ⋯ First, this study substantiates the use of these ratios as only guidelines for treatment. Second, it supports the need for well-designed, rigorous studies to evaluate opioid conversions. Third, this study demonstrates the need for a standard reporting system of opioid equianalgesic ratios employed in clinical trials.
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The described ratio for methadone conversion from oral route (PO) to parenteral route (PAR) is 2:1 and from PAR to PO is 1:2. Frequently, good control of pain with methadone is PR to PO. We use methadone as a function of opioid rotation and not in the context of mortality outcome and we have noted that the traditional ratio produces toxicity problems. We present our experience with patients who we converted from PAR to PO methadone and we recommend a conversion ratio of 0.7 (PO:PAR = 1:0.7), which approximates the bioavailability of the drug administered orally.
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Current approaches to the management of pain due to amputation are presented by two Spanish pain specialists with additional commentaries on care of such patients by pain specialists from Belgium and the United Kingdom. Contemporary pharmacotherapy and nondrug interventions are described.
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J Pain Palliat Care Pharmacother · Jan 2008
Comparative StudyHealth care providers' assessments of the quality of advanced-cancer care in Latin American medical institutions: a comparison of predictors in five countries: Argentina, Brazil, Cuba, Mexico, and Peru.
This paper describes an innovative Pan-American survey on advanced-cancer care and examines the quality-of-care provided by Latin American institutions. A convenience sample of 777 physicians and nurses who treat cancer patients in Argentina, Brazil, Cuba, Mexico, and Peru were surveyed. Providers were identified through mass mailings, distribution at professional meetings and conferences, collaboration with regional institutions, professional organizations, and PAHO and online posting. ⋯ Other institutional quality-of-care predictors included type of city, affordability-of-care ratings, availability of opioid analgesics, where patients die, barriers to cancer pain management, and the provider's specialty and gender. These findings highlight the need for providing accessible care and services to improve the quality of advanced-cancer care in Latin American institutions. Efforts should be aimed at improving the care offered in public institutions and addressing other types of disparities that may exist within countries by creating supportive and palliative cancer care programs that are accessible and affordable to those most in need.
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J Pain Palliat Care Pharmacother · Jan 2008
Pain and palliative care pharmacotherapy literature summaries and analyses.
Timely and important studies are reviewed and commentaries provided by leading palliative care clinicians. Symptoms, interventions, mechanisms of action, and treatment-related adverse events addressed in this issue are: analgesia in the management of the acute abdomen; comparative antibiotic treatment of Clostridium difficile; impact of weather on joint pain; treatment of constipation; and, risk of increased mortality with antipsychotics in dementia patients.