Browse Items · Pediatric Palliative Care Library

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…

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…

High dose opioids in pediatric palliative care.

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

Opioids in chronic non-cancer pain: systematic review of efficacy and safety

Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in…

Opioids in renal failure and dialysis patients

This article reviews the literature pertaining to the metabolism of several of the commonly used opioids, and the known activity of their metabolites. The effect of renal failure on the pharmacokinetics of these drugs and metabolites is then…

Tags: 2004, Analgesics, Backlog, Chronic/complications/therapy, Dean M, Humans, Journal Article, Journal of Pain and Symptom Management, Kidney Failure, Opioid/therapeutic use, Pain/drug Therapy, Peritoneal Dialysis

Oral morphine and respiratory function amongst hospice inpatients with advanced cancer

BACKGROUND: Respiratory depression is the opioid adverse effect feared most by physicians. This may hinder adequate dosing in cancer pain. The study was conducted to examine the respiratory function of patients with advanced cancer receiving…

Bisphosphonates for the relief of pain secondary to bone metastases

BACKGROUND: Bisphosphonates form part of standard therapy for hypercalcemia and the prevention of skeletal events in some cancers. However, the role of bisphosphonates in pain relief for bony metastases remains uncertain. OBJECTIVES: To determine the…

Tags: 2002, Analgesics, Antineoplastic Agents/therapeutic use, Backlog, Bone Neoplasms/complications/drug therapy/secondary, Clodronate, Clodronic Acid/therapeutic use, Cochrane Database of Systematic Reviews, Diphosphonates/therapeutic use, Etidronic Acid/therapeutic use, Humans, Journal Article, Non-Narcotic/therapeutic use, Pain/drug Therapy, Randomized Controlled Trials, Wiffen PJ, Wong R

Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial

CONTEXT: 1',1'dimethylheptyl-Delta8-tetrahydrocannabinol-11-oic acid (CT-3), a potent analog of THC-11-oic acid, produces marked antiallodynic and analgesic effects in animals without evoking the typical effects described in models of cannabinoids.…

The challenge of preemptive analgesia

2005

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

Difficult pain

A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients

Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need…

Paediatric fever management: continuing education for clinical nurses

PURPOSE: This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. METHOD: Fifty-one nurses from…

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

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

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…

Can end of life care for the pediatric patient suffering with escalating and intractable symptoms be improved?

Over twelve thousand children are diagnosed each year with cancer, and approximately 2200 children die each year from the disease. A percentage of these patients experiences escalating and intractable distress with symptoms that include pain,…

Tags: 2006, Analgesics, Backlog, Branowicki PA, Dinning C, Houlahan KE, Journal Article, Journal Of Pediatric Oncology Nursing, Mack JW, McCabe M, Opioid/therapeutic use Boston ChildClinical Protocols Humans Neoplasms/nursing Pain/drug therapyPalliative Care/methods/organization & administration Pilot Projects Practice Guidelines, PedPal Lit

A review of the use of methadone for the treatment of chronic noncancer pain

Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of…

Tags: 2005, Analgesics, Backlog, Canada, Chronic Disease, Drug, Humans, Journal Article, Legislation, Lynch ME, Methadone, Methadone/adverse effects/chemistry/pharmacokinetics/pharmacology/therapeutic use, Non-U.S. Gov't, Opioid/adverse effects/chemistry/pharmacokinetics/pharmacology/therapeutic use, Pain Research & Management : The Journal Of The Canadian Pain Society = Journal De La Societe Canadienne Pour Le Traitement De La Douleur, Pain/drug Therapy, Research Support

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…

Analgesic effects of topical methadone: a report of four cases

Topical morphine has been used on open wounds for pain management, but has a variable duration of action not suitable for palliative dressing changes. The objective of this study is to find an opioid and delivery method that would provide…

Opioids and the neuroimmune axis

2005

Tags: 2005, Analgesics, Animals, Backlog, British Journal Of Anaesthesia, Humans, Immune System/drug effects/physiology, Inflammation/immunology, Journal Article, Lambert DG, mu/metabolism, Neuroimmunomodulation/immunology, Opioid, Opioid Peptides/physiology, Opioid/pharmacology, Rats, Receptors, Williams JP

Glia: novel counter-regulators of opioid analgesia

Development of analgesic tolerance and withdrawal-induced pain enhancement present serious difficulties for the use of opioids for pain control. Although neuronal mechanisms to account for these phenomena have been sought for many decades, their…

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

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…

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…

Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?

OBJECTIVES: To describe the potential for interaction between opioids and serotonergic antidepressants leading to the development of serotonin syndrome (SS), mechanism of the interaction, and the spectrum of SS in elderly residents of a long-term…

A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children

2005

Tags: 13-20% for 4-7 days, 2005, 8-13% for 8-14 days, 8% for 15-21 days, Adolescent Age Factors, Analgesics, and 2-4% for more t han 21 days of infusions. The authors recommend that the rate of weaning of opioids and benzodiazepines in critically ill children be tailored to the length of time the child received continuous infusions of these agents., Backlog, Benzodiazepines/administration & dosage/adverse effects Child Child, Carnevale FA, Clermont MS, Ducharme C, Health Care Statistics, Intensive and Critical Care Nursing, Intravenous Intensive Care Units, Journal Article, Methods, methods/standards Critical Illness/therapy Drug Administration Schedule Drug Monitoring/, Newborn Infusions, Nonparametric, Nursing, Opioid/administration & dosage/adverse effects, Pediatric Nursing Assessment Nursing Evaluation Research Pediatric Nursing, PedPal Lit, Preschool Conscious Sedation/adverse effects/methods/nursing Critical Care/, Shea S, standards Humans Infant Infant, standards Prospective Studies Quality Assurance, Substance Withdrawal Syndrome/diagnosis/etiology/prevention & control Time Factors

Transdermal fentanyl in the management of children with chronic severe pain: results from an international study

BACKGROUND: The current study was conducted to assess the safety and tolerability of a transdermal fentanyl delivery system for the relief of chronic pain in a pediatric population, and also to validate titration recommendations and conversion to…

A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

OBJECTIVE: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal…

What we still don't know about treating chronic noncancer pain with opioids

2010

Tags: 2010, Analgesics, Backlog, Canadian Medical Association Journal, Chou R, Chronic Disease, Humans, Journal Article, Opioid/therapeutic use, Pain/drug Therapy, Practice Guidelines As Topic

Opioids for chronic noncancer pain: a new Canadian practice guideline

2010

Tags: 2010, Advisory Committees/organization & administration, Analgesics, Backlog, Canada, Canadian Medical Association Journal, Chronic Disease, Furlan AD, Humans, Journal Article, National Opioid Use Guideline Group, Opioid/administration & dosage/adverse effects/therapeutic use, Pain/drug Therapy, Practice Guidelines As Topic, Reardon R, Weppler C

Deaths related to the use of prescription opioids

2009

Tags: 2009, Analgesics, Backlog, Canadian Medical Association Journal, Fischer B, Humans, Journal Article, Mortality, Ontario/epidemiology, Opioid/poisoning, Prescription Drugs/poisoning, Rehm J

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

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

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…

A systematic review of opioid conversion ratios used with methadone for the treatment of pain

OBJECTIVE: Review and analyze the evidence base comprising methadone conversion methods and associated dosing ratios for the treatment of pain. DESIGN: Systematic review. METHODS: Clinical trials and retrospective analyses, case series, and case…

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…

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…

Opioid dependence and addiction during opioid treatment of chronic pain

Throughout the long history of opioid drug use by humans, it has been known that opioids are powerful analgesics, but they can cause addiction. It has also been observed, and is now substantiated by multiple reports and studies, that during opioid…

Tags: 2007, Analgesics, Backlog, Ballantyne JC, Brain/drug effects/physiopathology, Chronic Disease, Humans, Journal Article, LaForge KS, Models, Neurological, Opioid-Related Disorders/etiology/physiopathology/prevention & control, Opioid/adverse effects/therapeutic use, Pain, Pain/drug therapy/physiopathology/psychology, Physician's Practice Patterns/trends

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

Opioid use in palliative care of children and young people with cancer

OBJECTIVE: Identify opioids prescribed, preferred routes, and doses among children with incurable cancer. STUDY DESIGN: Prospective survey with monthly questionnaires regarding patients 0 to 19 years old from oncology centers. Data were collected by…

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