Browse Items · Pediatric Palliative Care Library

Pain and symptom control in terminally ill children

The management of pain in terminally ill pediatric patients has incalculable benefits to patients, their families, and physicians and nurses. A therapeutic management plan is dependent on a thorough understanding of the causes of pain in these…

Pain control by immune-derived opioids

1. The nervous and immune systems communicate with each other by use of cytokines and neuropeptides. 2. Interactions between immune cell-derived opioid peptides and opioid receptors located in peripheral inflamed tissue lead to endogenous analgesia.…

Tags: 2000, Analgesics, Backlog, Biomarkers of Pain, Clinical And Experimental Pharmacology & Physiology, Humans, Journal Article, Machelska H, Neuropeptides/therapeutic use, Opioid/drug effects/immunology, Opioid/therapeutic use, Pain/drug therapy/immunology, Peripheral Nervous System/drug effects, Receptors, Stein C

Pain management: a fundamental human right

This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the…

Tags: 2007, Analgesics, Anesthesia & Analgesia, Backlog, Brennan F, Carr DB, Chronic Disease, Cousins M, Drug and Narcotic Control/legislation & jurisprudence, Human Rights/legislation & jurisprudence, Humans, Journal Article, Opioid/therapeutic use, Pain/epidemiology/therapy, World Health Organization

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…

Pain, sedation and morphine metabolism in cancer patients during long-term treatment with sustained-release morphine

BACKGROUND: Morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G) are the two most important metabolites of morphine. Both are pharmacologically active, however, with different effects. M-6-G has been demonstrated capable of inducing…

Palliative care tips: Commonly administered sub-cutaneous medications in palliative care

2002

Tags: "Hypnotics and Sedatives", 2002, Analgesics, Antiemetics, Backlog, Bielech M, Journal Article, Morphine, Narcotics, Opioid, Palliative Care, Pharmaceutical Preparations, Terminal Care, Turnbull K, Watanabe S

Patient-controlled analgesia

In appropriately selected patients, PCA safely provides analgesia superior to that obtained with traditional IM prn opioid administration; however, to date, no compelling evidence shows that PCA is associated with a reduction in morbidity or a more…

Patient-controlled analgesia for mucositis pain in children: a three-period crossover study comparing morphine and hydromorphone

OBJECTIVES: (1) To test the safety and efficacy of a clinical protocol for administering opioid by using patient-controlled analgesia (PCA) for the management of mucositis pain in children after bone marrow transplantation, (2) to compare the…

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

Patient-controlled analgesia with oral methadone in cancer pain: preliminary report

BACKGROUND: Methadone is a very useful drug in cancer pain because of its low cost, lack of active metabolites, high oral availability, and the rapid onset of its analgesic effect. It seems to be well tolerated in patients with difficult pain…

Patients with malignant hematological disorders treated on a palliative care unit: prognostic impact of clinical factors

A reliable estimation of prognosis in patients receiving palliative care is desirable in order to facilitate clinical decision finding. For patients with advanced hematological malignancies, only few data are available to estimate prognosis of the…

Pediatric acute pain management

The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid…

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

Pediatric sedation with analgesia

Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia…

Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability

BACKGROUND: Codeine analgesia is wholly or mostly due to its metabolism to morphine by the cytochrome P450 enzyme CYP2D6, which shows significant genetic variation in activity. The aims of this study were to investigate genotype, phenotype and…

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…

Pharmacokinetics of methadone in children and adolescents in the perioperative period

Introduction Previous studies by Gourlay and coworkers1-3 have demonstrated that in adults undergoing surgery, methadone has slow elimination and a very long duration of effective analgesia. For children, intramuscular injections are a major source…

Population pharmacokinetics of oral morphine and its glucuronides in children receiving morphine as immediate-release liquid or sustained-release tablets for cancer pain

OBJECTIVES: (1) To determine the pharmacokinetics of morphine, morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) in children with cancer receiving morphine as immediate-release morphine liquid or sustained-release tablets. (2) To…

Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases

BACKGROUND: The objective of this prospective study was the evaluation of the analgesia provided by an epidural infusion of bupivacaine and fentanyl after different types of surgery in children. METHODS: Data were collected from 348 epidural…

Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone

INTRODUCTION: Opioid-related mortality appears to be increasing in Canada. We examined the true extent of the problem and the impact of the introduction of long-acting oxycodone. METHODS: We examined trends in the prescribing of opioid analgesics in…

Tags: 2009, Analgesics, Backlog, Canadian Medical Association Journal, Delivery of Health Care/utilization, Dhalla IA, Humans, Journal Article, Juurlink DN, Kopp A, Mamdani M, Mortality/trends, Ontario/epidemiology, Opioid/poisoning/therapeutic use, Oxycodone/therapeutic use, Poisoning/mortality/prevention & control, Prescription Drugs/poisoning/therapeutic use, Qureshi O, Sivilotti ML

Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory ('triple-agent') therapy for episodes of acute on chronic pain

AIM: This prospective audit was undertaken in order to document the analgesic response and adverse effects of concurrent short-term ('burst') triple-agent analgesic (ketamine, an opioid and an anti-inflammatory agent--either steroidal or…

Recognition and management of iatrogenically induced opioid dependence and withdrawal in children

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the…

Tags: 2014, American Academy of Pediatrics, Analgesics, Backlog, Child, Committee on Drugs, Galinkin J, Humans, Iatrogenic Disease, Journal Article, Koh JL, Opioid, Opioid-Related Disorders, Pain Medicine, Pediatrics, Section On Anesthesiology, Substance Withdrawal Syndrome, United States

Recommendations for using opioids in chronic non-cancer pain

1. The management of chronic pain should be directed by the underlying cause of the pain. Whatever the cause, the primary goal of patient care should be symptom control. 2. Opioid treatment should be considered for both continuous neuropathic and…

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…

Should we be reluctant to prescribe opioids for chronic non-malignant pain?

2007

Tags: 2007, Analgesics, Attitude Of Health Personnel, Backlog, Chronic Disease, Fields HL, Humans, Journal Article, Neoplasms/complications, Opioid-Related Disorders/etiology/prevention & control, Opioid/adverse effects/therapeutic use, Pain, Pain/drug therapy/etiology, Physician's Practice Patterns/trends

Strong opioids in pediatric palliative medicine

2005

Tags: 2005, Analgesics, Backlog, Devins M, early research in children does suggest some significant differences in opioid pharmacokinetics, Hain RD, illustrated by the WHO guidelines, is essential for the adequate management of pain complicating the palliative phase in children with life-limiting conditions., Journal Article, Miser A, much of what has been published regarding the management of pain in palliative medicine in adults can be extrapolated. On saying that, Opioid/administration & dosage/adverse effects/therapeutic use Child Child, Paediatr Drugs, particularly with respect to morphine clearance, PedPal Lit, Preschool Half-Life Humans InfantMorphine/adverse effects/pharmacokinetics/therapeutic use Pain/classification/drug therapy Palliative Care/methods Tissue Distribution, the use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of o pioids by pediatricians, unsuitable for use in children, Wallace WH, which seems to be faster in adults. Thus

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

Sublingual absorption of selected opioid analgesics

Ongoing interest in the improvement of pain management with opioid analgesics had led to the investigation of sublingual opioid absorption. The present report determined the percent absorption of selected opioid analgesics from the oral cavity of…

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study

PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine…

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…

The challenge of preemptive analgesia

2005

Tags: 2005, Adult, Aida S, Analgesia, Analgesics, Anesthesia, Backlog, Journal Article, Pain, Pain: Clinical Updates, Preoperative Care

The double effect of pain medication: separating myth from reality

The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression. Although a review of…

Tags: 1998, Analgesics, Assisted, Backlog, Death and Euthanasia, Double Effect Principle, Euthanasia, Fohr SA, Humans, Intention, Journal Article, Journal of Palliative Medicine, Opioid/adverse effects/therapeutic use, Pain/drug Therapy, Palliative Care/ethics, Refusal to Treat, Respiratory Insufficiency/chemically induced, Suicide

The efficacy and side effects of continuous infusion intravenous morphine (CIVM) for pain and symptoms due to advanced cancer

Morphine is the strong opioid of choice in the management of moderate-to-severe chronic cancer pain. The preferred route of administration is oral, in individually titrated doses, regularly scheduled around the clock We conducted a retrospective…

The management of pain in children with life-limiting illnesses

The management of pain in children with life-limiting illnesses is complex and unfortunately not often done effectively. Pain is a multidimensional symptom that can overshadow all other experiences of both the child and family. This article focuses…

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

The use of an intrathecal pump to manage intractable cancer pain in a pediatric patient: a case report

A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was…

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…

Tissue monocytes/macrophages in inflammation: hyperalgesia versus opioid-mediated peripheral antinociception

BACKGROUND: Opioid-containing leukocytes migrate to peripheral sites of inflammation. On exposure to stress, opioid peptides are released, bind to opioid receptors on peripheral sensory neurons, and induce endogenous antinociception. In later stages…

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

Transdermal fentanyl for pain relief in a paediatric palliative care population

This multicentre, observational study examined the efficacy of the therapeutic transdermal fentanyl system (TTS-fentanyl) in children requiring opioids for pain in life-threatening disease. Forty-one children receiving oral morphine (median dose 60…

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