Browse Items · Pediatric Palliative Care Library

Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 'N of 1' studies

Three Cannabis Based Medicinal Extracts (CBMEs) for sublingual use became available in 2000. A total of 34 'N of 1' studies were undertaken using this novel therapy for patients with chronic, mainly neuropathic, pain and associated symptoms to…

Clinical pharmacokinetics and pharmacodynamics of opioid analgesics in infants and children

Pain in childhood has not always been managed as actively as that in adults because of the limited amount of research available to provide guidelines for the management of paediatric pain. However, for many years now the pharmacokinetics and…

Tags: 1995, Analgesics, Backlog, Child, Clinical Pharmacokinetics, Hamunen K, Humans, Infant, Journal Article, Maunuksela EL, Olkkola KT, Opioid/administration & dosage/pharmacokinetics/pharmacology, Preschool

Management of burn pain in children

In spite of the many possible methods of pain control in the burned child satisfactory pain management may still be a problem, at times formidable. The most fruitful approach would seem to be frequent assessment of pain in the individual patient with…

Tags: 1989, Analgesics, Analgesics/administration & dosage/therapeutic use, Backlog, Bandages/adverse effects, Burns/complications/physiopathology, Child, Humans, Journal Article, Opioid/administration & dosage/pharmacokinetics/pharmacology/therapeutic use, Osgood PF, Pain/physiopathology/therapy, Patient Compliance, Pediatric Clinics of North America, Szyfelbein SK

Tramadol: does it have a role in cancer pain management?

Tramadol (Ultram, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) is considered a Step 2 analgesic under the World Health Organization's guidelines for the treatment of patients with cancer pain. It is a centrally acting analgesic that has affinity…

Tags: 2005, Analgesics, Backlog, Humans, Journal Article, Journal of opioid management, Methadone, Neoplasms/complications, Opioid/adverse effects/chemistry/pharmacokinetics/therapeutic use, Pain/drug therapy/etiology, Prommer EE, Tramadol/adverse effects/chemistry/pharmacokinetics/therapeutic use

High-dose oral morphine in cancer pain management: a report of twelve cases

We present 12 case reports from patients treated with more than 600 mg of morphine per day. We found no "opioid-nonresponsive pain" under treatment with a combination of morphine and nonopioids, supplemented with coanalgesics where appropriate. Side…

Nociceptin levels in the cerebrospinal fluid of chronic pain patients with or without intrathecal administration of morphine

The neuropeptide nociceptin/orphanin FQ (N/OFQ) is the endogenous ligand for the opioid-like receptor ORL-1 and is thought to be involved in pain transmission and modulation. Human studies have not yet defined its role in pain patients. The aims of…

Neuropathic cancer pain: prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative-Computerised Symptom Assessment study

BACKGROUND: Neuropathic pain causes greater pain intensity and worse quality of life than nociceptive pain. There are no published data that confirm this in the cancer population. AIM: We hypothesised that patients with neuropathic cancer pain had…

The use of methadone for cancer pain

Methadone is not a new analgesic drug [69]. Several studies have demonstrated that methadone is a valid alternative to morphine, hydromorphone, and fentanyl for the treatment of cancer-related pain, and extensive reviews on the subject have been…

Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio?

PURPOSE: To define the dose ratio between morphine and methadone in relation to the previous morphine dose and the number of days needed to achieve the same level of analgesia in a group of patients with advanced cancer with pain who switched from…

An update on the clinical use of methadone for cancer pain

Methadone is a synthetic opioid agonist considered a second choice drug in the management of cancer pain. Methadone has a number of unique characteristics including excellent oral and rectal absorption, no known active metabolites, high potency, low…

Tags: 1997, Administration, Analgesics, Backlog, Bruera E, Evaluation Studies, Humans, Journal Article, Methadone/administration & dosage/adverse effects/therapeutic use, Neoplasms/drug therapy, Non-U.S. Gov't, Opioid/administration & dosage/adverse effects/therapeutic use, Oral, Pain, Palliative Care/trends, Rectal, Research Support, Ripamonti C, Zecca E

Safety of subcutaneous clodronate and efficacy in hypercalcemia of malignancy: a novel route of administration

Bisphosphonates have become standard treatment in management of malignancy-induced hypercalcemia and malignant bone pain. One obstacle to the routine use of bisphosphonates in palliative patients is that oral bisphosphonates have low bioavailability…

Assessment of nurses' judgement for analgesic requirements of postoperative children

Over the last 5-10 years, there has been significant growth in the knowledge and strategies of pain management in children. Investigations are required to discern whether concomitant improvements in clinical practice have occurred. The purpose of…

Tags: 1996, Acetaminophen/administration & dosage/therapeutic use, Analgesics, Backlog, Child, Female, Humans, Journal Article, Journal Of Clinical Pharmacy And Therapeutics, Male, Non-Narcotic/administration & dosage/therapeutic use, Nursing Assessment, Pain, Postoperative/drug therapy/psychology, Preschool, Romsing J, Suppositories, Tonsillectomy

Oral opioid therapy for chronic peripheral and central neuropathic pain

BACKGROUND: Although opioids are commonly used to treat chronic neuropathic pain, there are limited data to guide their use. Few controlled trials have been performed, and many types of neuropathic pain remain unstudied. METHODS: Adults with…

Trends in the use of opioids at the end of life and the expected effects on hastening death

The aim of our study was to describe trends in opioid use and perceptions of having hastened the end of life of a patient. In 2005, a questionnaire was sent to 6860 physicians in The Netherlands who had attended a death. The response rate was 78%. In…

Patient-controlled analgesia with intravenous L-methadone in a child with cancer pain refractory to high-dose morphine

Are one or two dangerous? Opioid exposure in toddlers

Ingestions of opioid analgesics by children may lead to significant toxicity as a result of depression of the respiratory and central nervous systems. A review of the medical literature was performed to determine whether low doses of opioids are…

Fast fact and concepts #107: Controlled sedation for refractory symptoms: Part II

This fact fact will review sedation techniques.

Tags: 2004, Analgesia/methods, Analgesics, Anesthesia/methods, Backlog, Journal Article, Salacz ME, Weissman DE

The opiate hypothesis in autism and self-injury

The opiate hypothesis maintains that patients engage in self-injurious behavior (SIB) either because they are partially analgesic (pathologically altered pain threshold) or because SIB supplies a "fix" for an addicted endogenous opiate system. The…

Tags: 1990, Analgesics, Autism, Autistic disorder, Backlog, Journal Article, Journal Of Child And Adolescent Psychopharmacology, Naloxone, Naltrexone, Opioid, Pain, Pain Measurement, Pain Threshold, Sandman CA, Self Mutiliation, Self-Injurious behavior

Challenges in using opioids to treat pain in persons with substance use disorders

Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist's efficacy with many patients, both in the substance…

Modulation of peripheral endogenous opioid analgesia by central afferent blockade

BACKGROUND: Peripheral tissue injury causes a migration of opioid peptide-containing immune cells to the inflamed site. The subsequent release and action of these peptides on opioid receptors localized on peripheral sensory nerve terminals causes…

Methadone titration in opioid-resistant cancer pain

AIM: To assess the use of methadone in patients with cancer pain who fail to respond to increasing doses of other opioids or experience intolerable side-effects from them. METHOD: Inpatients of a specialist palliative care unit were titrated onto…

Pediatric palliative pain and symptom management

Tags: 2012, Analgesics, Backlog, Child, Disease Management, Humans, Journal Article, Opioid, Pain, Pain Management, Palliative Care, Pediatric Annals, Shaw TM

Methadone is safe for treating hospitalized patients with severe pain

PURPOSE: Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to…

Oral methadone for the treatment of severe pain in hospitalized children: a report of five cases

OBJECTIVE: Pain relief is still inadequate in many hospitalized patients, especially children in whom suboptimal use of analgesic drugs is still common. In the past 2 years, oral methadone has been used extensively in our institution for treating…

High dose opioids in pediatric palliative care.

Pain medication during terminal care of children with cancer

The purpose of this study was to evaluate the need for pain medication and the adequacy or inadequacy of the analgesia achieved, in children with cancer who died while in terminal care. Of the 100 pediatric patients with cancer treated at the…

Disappearance of morphine-induced hyperalgesia after discontinuing or substituting morphine with other opioid agonists

Hyperalgesia and allodynia in 4 cancer patients treated with morphine disappeared after discontinuing or substituting morphine with other opioid agonists. The first case describes a young female who developed hyperalgesia and myoclonus during…

Intravenous fentanyl for cancer pain: a "fast titration" protocol for the emergency room

Patients with cancer sometimes are admitted to the emergency room due to severe pain. Despite the fact that morphine's hydrophilicity can delay its peak effects after intravenous administration up to 30 minutes, it is still the most commonly used…

New and lingering controversies in pediatric end-of-life care

OBJECTIVES: Professional societies, ethics institutes, and the courts have recommended principles to guide the care of children with life-threatening conditions; however, little is known about the degree to which pediatric care providers are aware of…

Attacking pain at its source: new perspectives on opioids

The treatment of severe pain with opioids has thus far been limited by their unwanted central side effects. Recent research promises new approaches, including opioid analgesics acting outside the central nervous system, targeting of opioid…

Methadone as treatment for iatrogenic narcotic dependency in pediatric intensive care unit patients

A comparison of two regimens of patient-controlled analgesia for children with sickle cell disease

Recently, patient controlled analgesia (PCA) has gained prominence in the treatment of pain for children suffering from vaso-occlusive crisis associated with sickle cell disease. Because there are several different regimens that can be used for PCA,…

Intravenous ketamine infusion as an adjuvant to morphine in a 2-year-old with severe cancer pain from metastatic neuroblastoma

A 2.8-year-old female patient (11.6 kg) was admitted to the hospital for uncontrolled pain and swelling in the left leg relating to a metastatic neuroblastoma. Initially, her pain was managed with oral morphine 2 mg (approx. 0.2 mg/kg) every 4 hours.…

View through a window may influence recovery from surgery

Records on recovery after cholecystectomy of patients in a suburban Pennsylvania hospital between 1972 and 1981 were examined to determine whether assignment to a room with a window view of a natural setting might have restorative influences.…

Pharmacokinetic optimisation of opioid treatment in acute pain therapy

Traditionally, opioids have been administered as fixed doses at fixed dose intervals. This approach has been largely ineffective. Patient-controlled analgesia (PCA) and upgraded traditional approaches incorporating flexibility in dose size and dose…

End-of-life practices in the Netherlands under the Euthanasia Act

BACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and…

Subcutaneous clodronate

1996

Tags: 1996, Aged, Analgesics, Backlog, Bruera E, Clodronic Acid/administration & dosage, Humans, Hypercalcemia/drug therapy, Infusions, Journal Article, Lancet, Lawlor P, Male, Middle Aged, Non-Narcotic/administration & dosage, Parenteral, Walker P, Watanabe S

Tags: 2005, Analgesics, Animals, Backlog, Brain/drug effects/metabolism, Drug Tolerance, Humans, Hutchinson MR, Johnston IN, Journal Article, Maier SF, Neuroglia/drug effects/metabolism, Neurotransmitter Agents/metabolism, Nociceptors/drug effects/metabolism, Opioid/administration & dosage, Pain/metabolism/prevention & control, Spinal Cord/drug effects/metabolism, Trends In Neurosciences, Watkins LR

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