Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2005
Comparative StudyContinuous morphine infusions for cancer pain in resource-scarce environments: comparison of the subcutaneous and intravenous routes of administration.
Acute onset of severe pain in cancer patients may be due to multiple causes. Irrespective of the etiology, adequate analgesia has to be provided as quickly as possible. ⋯ Both routes were found to be equally effective in producing good analgesia without side effects. The drip method is a cost-effective way of providing subcutaneous morphine infusion for cancer patients and is applicable for both inpatients and home care.
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J Pain Palliat Care Pharmacother · Jan 2005
Case ReportsRotation to methadone after opioid dose escalation: How should individualization of dosing occur?
Methadone is a synthetic opioid agonist and N-methyl-D-aspartate (NMDA) receptor antagonist that is being increasingly used in pain management, particularly for pain that is resistant to conventional opioids. We describe two patients with neurotoxic side effects on escalating doses of parenteral hydromorphone with uncontrolled cancer pain who were successfully converted to oral methadone at a dose much smaller than predicted. ⋯ Clinical guidelines for rotation to methadone after dose escalation of the previous opioid are needed to avoid toxicity including respiratory depression. A possible conversion method for rotation to methadone for patients with escalating pain and opioid use is suggested.
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J Pain Palliat Care Pharmacother · Jan 2005
Clinical TrialIntermittent subcutaneous methadone administration in the management of cancer pain.
Methadone is a strong opioid analgesic that has been used successfully in cancer pain management. The oral route of administration is generally preferred for opioid analgesics. However that route sometimes cannot be used. ⋯ The two patients who were intolerant of the subcutaneous injections were receiving injected doses which were significantly higher than the others (42 mg as compared to 25 mg). Dose adjustments needed when changing from the oral to the subcutaneous methadone route were minimal. Subcutaneous intermittent administration of methadone appears to be a useful alternative to oral administration in selected clinical situations when oral administration is not feasible.
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J Pain Palliat Care Pharmacother · Jan 2005
Model policy for the use of controlled substances for the treatment of pain.
The Federation of State Medical Boards of the United States published Model Guideline for the Use of Controlled Substances in the Management of Pain in 1998 and expanded it to this Model Policy in October 2004. The Model Policy is designed to communicate to licensees that the state medical board views pain management to be important and integral to the practice of medicine; that opioid analgesics may be necessary for the relief of pain; that the use of opioids for other than legitimate medical purposes poses a threat to the individual and society; that physicians have a responsibility to minimize the potential for the abuse and diversion of controlled substances; and that physicians will not be sanctioned solely for prescribing opioid analgesics for legitimate medical purposes.
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Patient controlled analgesia (PCA) offers meaningful advantages over traditional analgesia. However, PCA medical errors with PCA can be dangerous and even fatal. Errors associated with patient controlled analgesia (PCA) therapy are described as are ways to minimize such errors. ⋯ Staff training is addressed. Methods to minimize errors associated with pump purchasing, PCA prrescribing, initiation, and monitoring are described. Recommendations for pharmaceutical manufacturers elated to PCA therapy are provided.