A comparison of two regimens of patient-controlled analgesia for children with sickle cell disease
Child; Female; Male; Analgesics; Case-Control Studies; Anemia; Comparative Study; retrospective studies; Human; Adolescence; Patient-Controlled; Midwestern United States; Morphine/administration & dosage; Analgesia; Opioid/administration & dosage; Pain/drug therapy/etiology; Sickle Cell/complications
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, the purpose of this study was to compare and contrast two regimens of patient controlled analgesia (PCA) in terms of safety, efficacy, and cost for the treatment of vaso-occlusive pain associated with sickle cell disease. In this study a retrospective chart review was conducted. The charts of 26 children, hospitalized on 60 different occasions in which PCA was used in the treatment of vaso-occlusive disease were included in the final sample. Patients were grouped according to the type of PCA regimen they received: high dose PCA/low basal infusion (HPCA/LBI) or low dose PCA/high basal infusion (LPCA/HBI). Children in Group 1 (HPCA/LBI) used significantly less morphine during their hospitalization, were hospitalized fewer days, and reported lower pain scores on day 2. There were considerable cost savings due to decreased length of stay, less morphine consumed overall, and fewer days required for rental of the PCA pump.
1998
Trentadue NO; Kachoyeanos MK; Lea G
Journal Of Pediatric Nursing
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
A Descriptive Report Of End-of-life Care Practices Occurring In Two Neonatal Intensive Care Units
Death; Decision Making; Withdrawal; Patterns; Perspectives; Nicu; Infant; Neonatal; Newborns; Support Implementation; End Of Life Care; Public Environmental & Occupational Health; Palliative Care; Medicine General & Internal; Health Care Sciences & Services; Neonatal Intensive Care Unit; Palliative Care; Anesthesia; Analgesics; Intensive Care
Death; End Of Life; Neonatal; Neonatal Intensive Care Unit; Palliative Care
BACKGROUND:
In Canada and other developed countries, the majority of neonatal deaths occur in tertiary neonatal intensive care units. Most deaths occur following the withdrawal of life-sustaining treatments.
AIM:
To explore neonatal death events and end-of-life care practices in two tertiary neonatal intensive care settings.
DESIGN:
A structured, retrospective, cohort study.
SETTING/PARTICIPANTS:
All infants who died under tertiary neonatal intensive care from January 2009 to December 2013 in a regional Canadian neonatal program. Deaths occurring outside the neonatal intensive care unit in delivery rooms, hospital wards, or family homes were not included. Overall, 227 infant deaths were identified.
RESULTS:
The most common reasons for admission included prematurity (53.7%), prematurity with congenital anomaly/syndrome (20.3%), term congenital anomaly (11.5%), and hypoxic ischemic encephalopathy (12.3%). The median age at death was 7 days. Death tended to follow a decision to withdraw life-sustaining treatment with anticipated poor developmental outcome or perceived quality of life, or in the context of a moribund dying infant. Time to death after withdrawal of life-sustaining treatment was uncommonly a protracted event but did vary widely. Most dying infants were held by family members in the neonatal intensive care unit or in a parent room off cardiorespiratory monitors. Analgesic and sedative medications were variably given and not associated with a hastening of death.
CONCLUSION:
Variability exists in end-of-life care practices such as provision of analgesic and sedative medications. Other practices such as discontinuation of cardiorespiratory monitors and use of parent rooms are more uniform. More research is needed to understand variation in neonatal end-of-life care.
Lam V; Kain N; Joynt C; van Manen MA
Journal Of Palliative Medicine
2016
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DOI: 10.1177/0269216316634246
A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients
Female; Humans; Male; Analgesics; Aged; Middle Aged; Treatment Outcome; Drug Therapy; Non-U.S. Gov't; Research Support; Pain/drug therapy; Opioid/therapeutic use; Hypnotics and Sedatives/therapeutic use; Terminal Care/methods; Combination; Anti-Anxiety Agents/therapeutic use; Consciousness/drug effects; Delirium/drug therapy; Dyspnea/drug therapy; Midazolam/therapeutic use; Nausea/drug therapy
The issue of symptom management at the end of life and the need to use sedation has become a controversial topic. This debate has been intensified by the suggestion that sedation may correlate with 'slow euthanasia'. The need to have more facts and less anecdote was a motivating factor in this multicentre study. Four palliative care programmes in Israel, South Africa, and Spain agreed to participate. The target population was palliative care patients in an inpatient setting. Information was collected on demographics, major symptom distress, and intent and need to use sedatives in the last week of life. Further data on level of consciousness, adequacy of symptom control, and opioids and psychotropic agents used during the final week of life was recorded. As the final week of life can be difficult to predict, treating physicians were asked to complete the data at the time of death. The data available for analysis included 100 patients each from Israel and Madrid, 94 patients from Durban, and 93 patients from Cape Town. More than 90% of patients required medical management for pain, dyspnoea, delirium and/or nausea in the final week of life. The intent to sedate varied from 15% to 36%, with delirium being the most common problem requiring sedation. There were variations in the need to sedate patients for dyspnoea, and existential and family distress. Midazolam was the most common medication prescribed to achieve sedation. The diversity in symptom distress, intent to sedate and use of sedatives, provides further knowledge in characterizing and describing the use of deliberate pharmacological sedation for problematic symptoms at the end of life. The international nature of the patient population studied enhances our understanding of potential differences in definition of symptom issues, variation of clinical practice, and cultural and psychosocial influences.
2000
Fainsinger RL; Waller A; Bercovici M; Bengtson K; Landman W; Hosking M; Nunez-Olarte JM; deMoissac D
Palliative Medicine
2000
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Journal Article
<a href="http://doi.org/10.1191/026921600666097479" target="_blank" rel="noreferrer">10.1191/026921600666097479</a>
A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients
Child; Female; Humans; Male; Analgesics; Prospective Studies; Double-Blind Method; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; infant; Comparative Study; Opioid/therapeutic use; Pain/drug therapy/epidemiology; Critical Care/methods/statistics & numerical data; Opioid-Related Disorders/epidemiology; Substance Withdrawal Syndrome/epidemiology
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 to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. We enrolled opioid-dependent children into a prospective, randomized trial of 5- versus 10-day opioid weaning using oral methadone. Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.
2006
Berens RJ; Meyer MT; Mikhailov TA; Colpaert KD; Czarnecki ML; Ghanayem NS; Hoffman GM; Soetenga DJ; Nelson TJ; Weisman SJ
Anesthesia & Analgesia
2006
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Journal Article
A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children
Analgesics; Nursing; PedPal Lit; Nonparametric; methods; Opioid/administration & dosage/adverse effects; 13-20% for 4-7 days; 8-13% for 8-14 days; 8% for 15-21 days; Adolescent Age Factors; 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.; Benzodiazepines/administration & dosage/adverse effects Child Child; Health Care Statistics; Intravenous Intensive Care Units; methods/standards Critical Illness/therapy Drug Administration Schedule Drug Monitoring/; Newborn Infusions; Pediatric Nursing Assessment Nursing Evaluation Research Pediatric Nursing; Preschool Conscious Sedation/adverse effects/methods/nursing Critical Care/; standards Humans Infant Infant; standards Prospective Studies Quality Assurance; Substance Withdrawal Syndrome/diagnosis/etiology/prevention & control Time Factors
2005
Ducharme C; Carnevale FA; Clermont MS; Shea S
Intensive and Critical Care Nursing
2005
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Journal Article
<a href="http://doi.org/10.1016/j.iccn.2004.09.003" target="_blank" rel="noreferrer">10.1016/j.iccn.2004.09.003</a>
A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma
Child; Female; Humans; Male; Pain Measurement; Analgesics; Treatment Outcome; Patient Satisfaction; Acute Disease; adolescent; Administration; Oral; Non-Narcotic/therapeutic use; Dose-Response Relationship; Drug; Opioid/therapeutic use; Pain/diagnosis/drug therapy/etiology; Codeine/therapeutic use; Acetaminophen/therapeutic use; Ibuprofen/therapeutic use; Wounds and Injuries/complications
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 injuries. PATIENTS AND METHODS: Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. RESULTS: A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale <30 mm) than the other 2 groups. There was no significant difference between patients in the codeine and acetaminophen groups in the change in pain score at any time period or in the number of patients achieving adequate analgesia. CONCLUSIONS: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.
2007
Clark E; Plint AC; Correll R; Gaboury I; Passi B
Pediatrics
2007
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Journal Article
<a href="http://doi.org/10.1542/peds.2006-1347" target="_blank" rel="noreferrer">10.1542/peds.2006-1347</a>
A randomized, controlled trial of intravenous clodronate in patients with metastatic bone disease and pain
Female; Humans; Male; Pain; Adult; Analgesics; Aged; Middle Aged; Treatment Outcome; Analysis of Variance; Chi-Square Distribution; Cross-Over Studies; 80 and over; Comparative Study; Injections; Intravenous; Dose-Response Relationship; Drug; Clodronate; Pain Measurement/drug effects; Clodronic Acid/administration & dosage; Non-Narcotic/administration & dosage; Intractable/drug therapy/etiology; Bone Neoplasms/complications/secondary
To evaluate the effectiveness of intravenous clodronate in ameliorating refractory bone pain in patients with metastatic bone disease, 60 patients with established osseous metastases and persistent bone pain were randomized to receive either clodronate (600 mg or 1500 mg in 500 mL of normal saline) or 500 mL of saline as placebo. After 2 weeks, the patients were crossed over to receive the alternate treatment. After another 2 weeks, each patient and investigator made a blinded choice. Daily visual analogue scales (VAS) and analgesic diaries were recorded throughout the study period. Forty-six patients were evaluable (77%). A treatment x period interaction was identified in the VAS and daily morphine equivalent dose (DMED) scores. First period analysis of the VAS scores for general pain, pain at rest, and pain upon movement demonstrated an average reduction of 13, 14, and 24 mm, respectively, from baseline, but were not significantly different from changes following placebo. The average change in DMED was -6.4 (SE = 2.9) following clodronate and was +24.6 (SE = 14.9) following placebo (p = 0.03). In the blinded choice of which agent resulted in improvement in pain, 26 (57%) patients chose clodronate, 12 (26%) chose placebo, and eight (17%) had no preference (p = 0.0021). For the investigators who also made a blinded selection, clodronate was chosen in 30 (65%) patients, placebo in ten (22%) patients, and no difference was apparent in six (13%) (p < 0.0001). Intravenous clodronate appeared to have analgesic effect in patients with refractory bone pain due to metastatic bone disease. The optimal dose and duration of effect require further evaluation, particularly in patients with stable disease and persistent bone pain.
1997
Ernst DS; Brasher P; Hagen N; Paterson AH; MacDonald RN; Bruera E
Journal Of Pain And Symptom Management
1997
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Journal Article
<a href="http://doi.org/10.1016/s0885-3924(97)00075-4" target="_blank" rel="noreferrer">10.1016/s0885-3924(97)00075-4</a>
A review of the use of methadone for the treatment of chronic noncancer pain
Humans; Canada; Analgesics; Methadone; Non-U.S. Gov't; Research Support; Chronic disease; Pain/drug therapy; Drug; Legislation; Methadone/adverse effects/chemistry/pharmacokinetics/pharmacology/therapeutic use; Opioid/adverse effects/chemistry/pharmacokinetics/pharmacology/therapeutic use
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 action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. This, along with methadone's excellent oral and rectal absorption, high bioavailability, long duration of action and low cost, make it a very attractive option for the treatment of chronic pain. The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.
2005
Lynch ME
Pain Research & Management : The Journal Of The Canadian Pain Society = Journal De La Societe Canadienne Pour Le Traitement De La Douleur
2005
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Journal Article
<a href="http://doi.org/10.1155/2005/286713" target="_blank" rel="noreferrer">10.1155/2005/286713</a>
A systematic review of opioid conversion ratios used with methadone for the treatment of pain
Female; Humans; Adult; Analgesics; Middle Aged; Drug Therapy; Clinical Trials as Topic; Chronic disease; Palliative Care/methods; Pain/drug therapy; Methadone/therapeutic use; Opioid/therapeutic use; Statistics as Topic; Combination
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 reports of human subjects published in the English language between January 1966 and June 2006 were included; review articles and reports with incomplete opioid data were excluded. Scatterplots displayed the relationship between previous morphine dose and final methadone dose and dose ratio. Correlation analyses were conducted using Pearson's and Spearman's correlation coefficient with a one-tailed test of significance. RESULTS: Twenty-two clinical studies and 19 case reports or series were reviewed (N = 730 patients). Methadone rotations were most common in cancer patients (N = 625, 88.9%) and those prescribed morphine (N = 259 patients, 41.7% of rotations where prerotation opioid was identified [N = 621]) or hydromorphone (N = 234 patients, 37.7% of rotations). In clinical studies, the most common reason for switching to methadone was a combination of inadequate analgesia and adverse effects (N = 254, 38.6%). Despite various approaches, 46-89% of rotations were successful. Overall, there was a relatively strong, positive correlation between the previous morphine dose and the final methadone dose and dose ratio, but ratios varied widely. CONCLUSIONS: There was no evidence to support the superiority of one method of rotation to methadone over another. Patients may be successfully rotated to methadone despite discrepancies between rotation ratios initially used and those associated with stabilization. Further research is needed to identify patient-level factors that may explain the wide variance in successful methadone rotations.
2008
Weschules DJ; Bain KT
Pain Medicine (malden, Mass.)
2008
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Journal Article
<a href="http://doi.org/10.1111/j.1526-4637.2008.00461.x" target="_blank" rel="noreferrer">10.1111/j.1526-4637.2008.00461.x</a>
Acetaminophen toxicity in children
Child; Humans; Pediatrics; Adult; Analgesics; Age Factors; Acetaminophen/adverse effects/poisoning/therapeutic use; Charcoal/therapeutic use; Ibuprofen/therapeutic use; Non-Narcotic/adverse effects/poisoning/therapeutic use; Overdose/diagnosis/therapy
Acetaminophen is widely used in children, because its safety and efficacy are well established. Although the risk of developing toxic reactions to acetaminophen appears to be lower in children than in adults, such reactions occur in pediatric patients from intentional overdoses. Less frequently, acetaminophen toxicity is attributable to unintended inappropriate dosing or the failure to recognize children at increased risk in whom standard acetaminophen doses have been administered. Because the symptoms of acetaminophen intoxication are nonspecific, the diagnosis and treatment of acetaminophen intoxication are more likely to be delayed in unintentional cases of toxicity. This statement describes situations and conditions that may contribute to acetaminophen toxicity not associated with suicidal intentions.
2001
American Academy of PediatricsCommittee on Drugs
Pediatrics
2001
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Journal Article
<a href="http://doi.org/10.1542/peds.108.4.1020" target="_blank" rel="noreferrer">10.1542/peds.108.4.1020</a>
An update on the clinical use of methadone for cancer pain
Humans; Analgesics; Non-U.S. Gov't; Research Support; Evaluation Studies; Administration; Oral; Neoplasms/drug therapy; Methadone/administration & dosage/adverse effects/therapeutic use; Opioid/administration & dosage/adverse effects/therapeutic use; Rectal; Palliative Care/trends
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 cost, and longer administration intervals, as well as an incomplete cross-tolerance with respect to other mu-opioid receptor agonist drugs. For these reasons, methadone has the potential of playing a major role in the treatment of cancer pain. However, its use is limited by the remarkably long and unpredictable half-life, large inter-individual variations in pharmacokinetics, the potential for delayed toxicity, and above all by the limited knowledge of correct administration intervals and the equianalgesic ratio with other opioids when administered chronically. Recent findings suggest that standard equianalgesic tables are unreliable for methadone titration in patients tolerant to high doses of opioid agonists and that switchovers should take place slowly and should be personalized. Future research has to better define the variation in both bioavailability and elimination of methadone in different patient populations, the interaction between methadone and the most commonly used drugs in cancer patients, the type and activity of potential methadone metabolites, and the equianalgesic doses between methadone and the most commonly used opioids.
1997
Ripamonti C; Zecca E; Bruera E
Pain
1997
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Journal Article
<a href="http://doi.org/10.1016/s0304-3959(96)03286-1" target="_blank" rel="noreferrer">10.1016/s0304-3959(96)03286-1</a>
Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: a randomized controlled trial
Female; Humans; Male; Pain Measurement; Adult; Analgesics; Middle Aged; Double-Blind Method; Cross-Over Studies; Non-U.S. Gov't; Research Support; Chronic disease; Hyperalgesia/complications/drug therapy; Non-Narcotic/therapeutic use; Pain/complications/drug therapy; Tetrahydrocannabinol/analogs & derivatives/therapeutic use
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. Therefore, CT-3 may be an effective analgesic for poorly controlled resistant neuropathic pain. OBJECTIVE: To examine the analgesic efficacy and safety of CT-3 in chronic neuropathic pain in humans. DESIGN AND SETTING: Randomized, placebo-controlled, double-blind crossover trial conducted in Germany from May-September 2002. PARTICIPANTS: Twenty-one patients (8 women and 13 men) aged 29 to 65 years (mean, 51 years) who had a clinical presentation and examination consistent with chronic neuropathic pain (for at least 6 months) with hyperalgesia (n = 21) and allodynia (n = 7). INTERVENTIONS: Patients were randomized to two 7-day treatment orders in a crossover design. Two daily doses of CT-3 (four 10-mg capsules per day) or identical placebo capsules were given during the first 4 days and 8 capsules per day were given in 2 daily doses in the following 3 days. After a washout and baseline period of 1 week each, patients crossed over to the second 7-day treatment period. MAIN OUTCOME MEASURES: Visual analog scale (VAS) and verbal rating scale scores for pain; vital sign, hematologic and blood chemistry, and electrocardiogram measurements; scores on the Trail-Making Test and the Addiction Research Center Inventory-Marijuana scale; and adverse effects. RESULTS: The mean differences over time for the VAS values in the CT-3-placebo sequence measured 3 hours after intake of study drug differed significantly from those in the placebo-CT-3 sequence (mean [SD], -11.54 [14.16] vs 9.86 [21.43]; P =.02). Eight hours after intake of the drug, the pain scale differences between groups were less marked. No dose response was observed. Adverse effects, mainly transient dry mouth and tiredness, were reported significantly more often during CT-3 treatment (mean [SD] difference, -0.67 [0.50] for CT-3-placebo sequence vs 0.10 [0.74] for placebo-CT-3 sequence; P =.02). There were no significant differences with respect to vital signs, blood tests, electrocardiogram, Trail-Making Test, and Addiction Research Center Inventory-Marijuana scale. No carryover or period effects were observed except on the Trail-Making Test. CONCLUSIONS: In this preliminary study, CT-3 was effective in reducing chronic neuropathic pain compared with placebo. No major adverse effects were observed.
2003
Karst M; Salim K; Burstein S; Conrad I; Hoy L; Schneider U
Jama
2003
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Journal Article
<a href="http://doi.org/10.1001/jama.290.13.1757" target="_blank" rel="noreferrer">10.1001/jama.290.13.1757</a>
Analgesic effects of topical methadone: a report of four cases
Female; Humans; Male; Analgesics; Aged; Middle Aged; Treatment Outcome; Bandages; 80 and over; Administration; Pain/drug therapy/etiology; Palliative Care/methods; Opioid/administration & dosage; Wounds; Methadone/administration & dosage; Penetrating/complications; Topical
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 long-lasting pain relief between dressing changes. Methadone powder (100 mg) was mixed in Stomahesive powder (10 g) and sprinkled on the open wound once daily at the time of dressing change. Four cases are presented with varying results using the methadone/Stomahesive mixture. Exudative wounds with exposed tissue work best, whereas dry wounds with eschar show less response. Topical methadone powder can be effective for pain relief in open, exudative wounds with little eschar. Further research questions are raised.
2005
Gallagher RE; Arndt DR; Hunt KL
The Clinical Journal Of Pain
2005
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Journal Article
<a href="http://doi.org/10.1097/00002508-200503000-00012" target="_blank" rel="noreferrer">10.1097/00002508-200503000-00012</a>
Analgesics for the treatment of pain in children
Child; Humans; infant; Analgesics; Analgesia; Anesthetics; Non-U.S. Gov't; P.H.S.; Research Support; U.S. Gov't; infant; Chronic disease; Newborn; Pain/drug therapy/etiology; Anesthesia; Anti-Inflammatory Agents; Neoplasms/complications; Patient-Controlled; Analgesics/administration & dosage/therapeutic use; General; Acetaminophen/therapeutic use; Aspirin/therapeutic use; Local; Non-Steroidal/therapeutic use; Opioid/pharmacokinetics/pharmacology/therapeutic use
2002
Berde CB; Sethna NF
The New England Journal Of Medicine
2002
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Journal Article
<a href="http://doi.org/10.1056/NEJMra012626" target="_blank" rel="noreferrer">10.1056/NEJMra012626</a>
Are one or two dangerous? Opioid exposure in toddlers
Child; Humans; Analgesics; Preschool; infant; Dose-Response Relationship; Drug; Codeine/poisoning; Emergency Medicine/methods; Fentanyl/poisoning; Methadone/poisoning; Opioid/poisoning; Overdose; Pediatrics/methods; Poisoning/diagnosis/physiopathology/therapy; Tramadol/poisoning
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 dangerous in the pediatric population under 6 years old. Methadone was found to be the most toxic of the opioids; doses as low as a single tablet can lead to death. All children who have ingested any amount of methadone need to be observed in an Emergency Department (ED) for at least 6 h and considered for hospital admission. Most other opioids are better tolerated in ingestions as small as one or two tablets. Based on the limited data available for these opioids, we conclude that equianalgesic doses of 5 mg/kg of codeine or greater require 4 to 6 h of observation in the ED. Data for propoxyphene and all extended-release preparations are limited; their prolonged half-lives would suggest the need for longer observation periods. All opioid ingestions leading to respiratory depression or significant central nervous system depression require admission to an intensive care unit.
2005
Sachdeva DK; Stadnyk JM
The Journal Of Emergency Medicine
2005
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Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2004.12.015" target="_blank" rel="noreferrer">10.1016/j.jemermed.2004.12.015</a>
Assessment of nurses' judgement for analgesic requirements of postoperative children
Child; Female; Humans; Male; Pain; Analgesics; Nursing Assessment; Preschool; Non-Narcotic/administration & dosage/therapeutic use; Acetaminophen/administration & dosage/therapeutic use; Postoperative/drug therapy/psychology; Suppositories; Tonsillectomy
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 this study was to identify the nurses' administration of a traditional analgesic (acetaminophen) with regard to appropriate doses and time intervals. This issue was examined, within 24 h after surgery, in 72 children (aged 3-12 years) scheduled for a tonsillectomy. Acetaminophen suppositories were administered in subtherapeutic doses and at too large time intervals. An average single dose administered represented 87% of the calculated dose. Comparison between the correct dose, which should have been given considering the dose levels of the suppositories available, and the actual dose administered indicates that the nurses tended to round doses down to the next lowest. The average dosage administered per day represented only 76% of the recommended dosage. The prevalence of pain amongst the children was high both before and after analgesics, indicating that acetaminophen in the doses used did not provide any significant measure of pain relief. Current practice is still not optimal. Educating nurses on the effective use of traditional pain therapies may improve paediatric pain management.
1996
Romsing J
Journal Of Clinical Pharmacy And Therapeutics
1996
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2710.1996.tb00016.x" target="_blank" rel="noreferrer">10.1111/j.1365-2710.1996.tb00016.x</a>
Association between opioid prescribing patterns and opioid overdose-related deaths
Female; Humans; Male; Young Adult; Cohort Studies; Adult; Analgesics; Aged; Middle Aged; Risk; Acute Disease; Case-Control Studies; adolescent; Physician's Practice Patterns/statistics & numerical data; Chronic disease; United States/epidemiology; Drug Prescriptions/statistics & numerical data; Opioid/administration & dosage/poisoning; Overdose/epidemiology; Pain/drug therapy; Veterans/statistics & numerical data
CONTEXT: The rate of prescription opioid-related overdose death increased substantially in the United States over the past decade. Patterns of opioid prescribing may be related to risk of overdose mortality. OBJECTIVE: To examine the association of maximum prescribed daily opioid dose and dosing schedule ("as needed," regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders. DESIGN: Case-cohort study. SETTING: Veterans Health Administration (VHA), 2004 through 2008. PARTICIPANTS: All unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain. Main Outcome Measure Associations of opioid regimens (dose and schedule) with death by unintentional prescription opioid overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions. RESULTS: The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment. CONCLUSION: Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.
Bohnert AS; Valenstein M; Bair MJ; Ganoczy D; McCarthy JF; Ilgen MA; Blow FC
Jama
2011
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Journal Article
<a href="http://doi.org/10.1001/jama.2011.370" target="_blank" rel="noreferrer">10.1001/jama.2011.370</a>
Attacking pain at its source: new perspectives on opioids
Humans; Analgesics; Animals; Non-U.S. Gov't; Research Support; Drug Tolerance; Receptors; Ligands; Afferent/metabolism; Cell Movement; Neurons; Opioid Peptides/metabolism/therapeutic use; Opioid/genetics/metabolism; Opioid/metabolism/therapeutic use; Pain/drug therapy/metabolism/therapy; Signal Transduction/physiology
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 peptide-containing immune cells to peripheral damaged tissue, and gene transfer to enhance opioid production at sites of injury.
2003
Stein C; Schafer M; Machelska H
Nature Medicine
2003
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Journal Article
<a href="http://doi.org/10.1038/nm908" target="_blank" rel="noreferrer">10.1038/nm908</a>
Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders
depression; anxiety; adolescent headache; adolescent pain; analgesics; child psychiatry; complex pain; pain psychiatry; pediatric headache; pediatric pain; psychotropics; Snri
Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.
Windsor RB; Sierra M; Zappitelli M; McDaniel M
Children (Basel)
2020
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<a href="http://doi.org/10.3390/children7120268" target="_blank" rel="noreferrer noopener">10.3390/children7120268</a>
Biological rhythms in pain and in the effects of opioid analgesics
Humans; Analgesics; Animals; Circadian Rhythm/drug effects/physiology; Opioid/administration & dosage/therapeutic use; Pain/drug therapy/physiopathology
Pain is difficult and sometimes frustrating to treat, even though new devices and new approaches have been developed in recent years. Pain varies tremendously from one patient to the next, and there are also some studies suggesting that the intensity of pain varies according to time of day. In animal experiments, a relationship between the reaction to pain and the rhythmicity of plasma endorphin concentrations was suggested because reactions to pain (such as jumping from a hot plate) were in phase with plasma endorphin levels: latencies were longest and plasma levels were highest during the resting period of rodents. In human studies, pain induced experimentally was reported to be maximal in the morning, or in the afternoon or at night. These divergent findings may be due to methodological differences, as pain was produced by different methods, many parameters were used to quantify pain intensity, and the psychological aspect of pain was rarely considered by authors. A circadian pattern of pain was found in patients suffering from pain produced by different diseases. For instance, highest toothache intensity occurred in the morning, while biliary colic, migraine, and intractable pain were highest at night. Patients with rheumatoid arthritis reported peak pain early in the morning, while those with osteoarthritis of the knee indicated that the maximal pain occurred at the end of the day. The effectiveness of opioids appears also to vary according to time of day, but large differences in the time of peak and low effects were found. Investigators found that peak pain intensity and narcotic demands occurred early in the morning, while others found maximal pain at the end of the day. Pain is a complex phenomenon and efforts should be made to standardize the methods used in studies and to describe accurately the diseases causing pain because the patterns of pain may be specific to each clinical situation. Further research should be aimed at characterizing the chronobiology of pain in different experimental and clinical situations and to determine when the analgesic drugs are producing maximal effectiveness. This information is needed before clinicians can be persuaded to use chronopharmacological data when they prescribe analgesic drugs to their patients.
1995
Labrecque G; Vanier MC
Pharmacology & Therapeutics
1995
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Journal Article
<a href="http://doi.org/10.1016/0163-7258(95)02003-9" target="_blank" rel="noreferrer">10.1016/0163-7258(95)02003-9</a>
Bisphosphonates for the relief of pain secondary to bone metastases
Humans; Analgesics; Pain/drug therapy; Non-Narcotic/therapeutic use; Antineoplastic Agents/therapeutic use; Bone Neoplasms/complications/drug therapy/secondary; Clodronate; Clodronic Acid/therapeutic use; Diphosphonates/therapeutic use; Etidronic Acid/therapeutic use; Randomized Controlled Trials
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 effectiveness of bisphosphonates for the relief of pain from bone metastases. SEARCH STRATEGY: MEDLINE (1966-1999), EMBASE (1980-1999), CancerLit (1966-1999), the Cochrane library (Issue 1, 2000) and the Oxford Pain Database were searched using the strategy devised by the Cochrane Pain, Palliative and Supportive Care Group with additional terms 'diphosphonate', 'bisphosphonate', 'multiple myeloma' and 'bone neoplasms'. (Last search: January 2000). SELECTION CRITERIA: Randomized trials of bisphosphonates compared with open, blinded, or different doses/types of bisphosphonates in cancer patients were included where pain and/or analgesic consumption were outcome measures. Studies where pain was reported only by observers were excluded. DATA COLLECTION AND ANALYSIS: Article eligibility, quality assessment and data extraction were undertaken by both reviewers. The proportions of patients with pain relief at 4, 8 and 12 weeks were assessed. The proportion of patients with analgesic reduction, the mean pain score, mean analgesic consumption, adverse drug reactions, and quality of life data were compared as secondary outcomes. MAIN RESULTS: Thirty randomized controlled studies (21 blinded, four open and five active control) with a total of 3682 subjects were included. For each outcome, there were few studies with available data. For the proportion of patients with pain relief (eight studies) pooled data showed benefits for the treatment group, with an NNT at 4 weeks of 11[95% CI 6-36] and at 12 weeks of 7 [95% CI 5-12]. In terms of adverse drug reactions, the NNH was 16 [95% CI 12-27] for discontinuation of therapy. Nausea and vomiting were reported in 24 studies with a non-significant trend for greater risk in the treatment group. One study showed a small improvement in quality of life for the treatment group at 4 weeks. The small number of studies in each subgroup with relevant data limited our ability to explore the most effective bisphosphonates and their relative effectiveness for different primary neoplasms. REVIEWER'S CONCLUSIONS: There is evidence to support the effectiveness of bisphosphonates in providing some pain relief for bone metastases. There is insufficient evidence to recommend bisphosphonates for immediate effect; as first line therapy; to define the most effective bisphosphonates or their relative effectiveness for different primary neoplasms. Bisphosphonates should be considered where analgesics and/or radiotherapy are inadequate for the management of painful bone metastases.
2002
Wong R; Wiffen PJ
Cochrane Database Of Systematic Reviews
2002
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Journal Article
<a href="http://doi.org/10.1002/14651858.cd002068" target="_blank" rel="noreferrer">10.1002/14651858.cd002068</a>
Can end of life care for the pediatric patient suffering with escalating and intractable symptoms be improved?
Analgesics; PedPal Lit; Opioid/therapeutic use Boston ChildClinical Protocols Humans Neoplasms/nursing Pain/drug therapyPalliative Care/methods/organization & administration Pilot Projects Practice Guidelines
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, dyspnea, and agitation. These symptoms may continue for hours to days. Intractable symptoms of pain, agitation, and dyspnea can be very distressing to the patient, family, and staff and often a challenge for the physicians and nursing staff to treat. To meet this challenge, The Dana-Farber Cancer Institute/Children's Hospital Cancer Care Program has made it a priority to create a process of care that includes identifying barriers to care and the development of an end-of-life (EOL) rapid response model that includes guidelines and physician-templated orders for rapid escalation of opioids. The goal of this quality-improvement initiative was to develop a model of care that would enable the caregivers to provide effective comfort care to any patient experiencing symptoms of rapid escalation of pain, dyspnea, and agitation. A model of care was created to overcome barriers to care. The model includes role clarification, "Guidelines for the Management of Escalating Pain/Dyspnea/Agitation at the End of Life," and "Rapid Titration-Templated Physician Orders." Staff feedback was solicited relative to the content, format, and usability of the guidelines and templated orders. The physician and nursing staff reported that they found the templated orders and guidelines very helpful and effective and suggested only a few edits. A retrospective chart review is currently under way. The purpose of this chart review is to systematically document and compare the record of management of rapidly escalating symptoms of pain and/or dyspnea and/or agitation prior to and after instituting the EOL Rapid Response Model of Care. Care of the EOL patient experiencing symptoms of pain, dyspnea, and agitation is challenging. The EOL Rapid Response Model of Care outlines a process of care and provides recommendations and templated physician orders for rapid titration of opioids.
2006
Houlahan KE; Branowicki PA; Mack JW; Dinning C; McCabe M
Journal Of Pediatric Oncology Nursing
2006
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Journal Article
<a href="http://doi.org/10.1177/1043454205283588" target="_blank" rel="noreferrer">10.1177/1043454205283588</a>
Can we use methadone for analgesia in neonates?
Child; Humans; infant; Adult; Analgesics; Methadone; Preschool; Newborn; Drug Tolerance; Analgesia/methods; Opioid/adverse effects
2001
Chana SK; Anand KJ
Archives Of Disease In Childhood. Fetal And Neonatal Edition
2001
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Journal Article
<a href="http://doi.org/10.1136/fn.85.2.f79" target="_blank" rel="noreferrer">10.1136/fn.85.2.f79</a>
Challenges in using opioids to treat pain in persons with substance use disorders
Humans; Analgesics; Cooperative Behavior; Comorbidity; Long-Term Care; Motivation; Diagnostic and Statistical Manual of Mental Disorders; Primary Health Care; patient care team; Opioid/adverse effects/therapeutic use; Drug Tolerance; Opioid-Related Disorders/diagnosis/epidemiology/etiology/rehabilitation; Pain/drug therapy/epidemiology; Recurrence/prevention & control; Substance Withdrawal Syndrome/diagnosis/etiology; Substance-Related Disorders/epidemiology/rehabilitation
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 abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.
2008
Savage SR; Kirsh KL; Passik SD
Addiction Science & Clinical Practice
2008
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Journal Article
<a href="http://doi.org/10.1151/ascp08424" target="_blank" rel="noreferrer">10.1151/ascp08424</a>
Chronic pain management and the surgeon: barriers and opportunities
Humans; Palliative Care; Pain; Analgesics; Physician's Role; patient care team; Chronic disease; Surgery; Opioid/administration & dosage/therapeutic use; Pain/therapy; Intractable/drug therapy; Neoplasms/surgery; Postoperative/drug therapy
2001
Lee KF; Ray JB; Dunn GP
Journal Of The American College Of Surgeons
2001
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Journal Article
<a href="http://doi.org/10.1016/s1072-7515(01)01091-2" target="_blank" rel="noreferrer">10.1016/s1072-7515(01)01091-2</a>
Clinical experience with oral methadone administration in the treatment of pain in 196 advanced cancer patients
Female; Humans; Male; Analgesics; Aged; Middle Aged; Administration; Oral; retrospective studies; Neoplasms/complications; Methadone/therapeutic use; Opioid/therapeutic use; Pain/etiology/prevention & control
PURPOSE: The aims of this study were to describe the analgesia, side effects, and dosage and the causes of suspension of treatment in a large sample of advanced cancer patients with pain after treatment with oral methadone from 7 to 90 days. PATIENTS AND METHODS: In a retrospective study, data collected for 196 advanced cancer outpatients with moderate to severe pain treated at 8-hour intervals with oral methadone in solution form from February 1993 to February 1995 were analyzed at baseline (time 0) and then at 7, 15, 30, 45, 60, and 90 days. The following parameters were assessed: Karnofsky Performance Status, intensity of pain (using the Integrated Pain Score [IPS], intensity of pain, insomnia, drowsiness, confusion, dry mouth, nausea, vomiting, constipation, and dyspnea (using the Therapy Impact Questionnaire [TIQ], mean daily dose of drug administered, and reasons for withdrawal from study. The period when pain was reduced by > or = 35% with respect to baseline was evaluated with the Palliation Index. The association of the degree of palliation of pain with the age of the patients, tumor site, analgesic treatment taken at baseline, and daily mean dose of methadone administered during the follow-up period was analyzed by means of the Kruskal-Wallis test. RESULTS: A reduction in pain intensity with respect to baseline occurred at each analysis time, and in 55.1% of the patients the reduction during the follow-up period was > or = 35% according to the Palliation Index. The mean dose of oral methadone ranged from 14 mg at day 7 to 23.65 mg at day 90. There was an overall worsening of the other symptoms, but a high percentage of the patients reported an amelioration of insomnia with respect to baseline. There was a statistically significant association (P < .0001) between the Palliation Index and the analgesic therapy administered at baseline. Only 11.2% of the patients withdrew from the study due to analgesic inefficacy and 6.6% due to methadone-related side effects (10 patients with drowsiness and three with severe constipation. CONCLUSION: Oral methadone administered every 8 hours was shown to be an appropriate analgesic therapy in the treatment of advanced cancer-related pain. The worsening of the other symptoms under study can be considered linked to the progression of the disease, and in fact, only a small percentage of the patients reported methadone-related side effects that warranted suspension of treatment. We consider oral methadone to be a useful analgesic therapy, and it should be considered in clinical practice for the treatment of cancer pain.
1996
De Conno F; Groff L; Brunelli C; Zecca E; Ventafridda V; Ripamonti C
Journal Of Clinical Oncology
1996
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Journal Article
<a href="http://doi.org/10.1200/jco.1996.14.10.2836" target="_blank" rel="noreferrer">10.1200/jco.1996.14.10.2836</a>
Clinical pharmacokinetics and pharmacodynamics of opioid analgesics in infants and children
Child; Humans; Analgesics; Preschool; infant; Opioid/administration & dosage/pharmacokinetics/pharmacology
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 pharmacodynamics of opioid analgesics in infants and children have been studied intensively. Morphine is the standard for opioid analgesics and its pharmacology is the best studied in paediatric patients. During the neonatal period, the volume of distribution (Vd) appears to be smaller in neonates than in adults, but adult values are reached soon after the neonatal period. Although morphine is absorbed both orally and rectally, there is little information on the pharmacokinetics of morphine administered by these routes. The bioavailability of morphine after rectal administration appears to be highly variable. For all the opioid analgesics studied, the elimination of the opioids is slower in neonates than in adults. However, the rate of elimination usually reaches and even exceeds adult values within the first year of life. The high rate of drug metabolism means higher dosage requirements. In regard to the pharmacodynamics of opioid analgesics, infants and children do not appear to be more sensitive to the effects of opioids than adults. Thus, except for the neonatal period, the pharmacokinetics and pharmacodynamics of opioid analgesics are not markedly different from those of adults, and the risk of using opioids in infants and children is not higher.
1995
Olkkola KT; Hamunen K; Maunuksela EL
Clinical Pharmacokinetics
1995
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Journal Article
<a href="http://doi.org/10.2165/00003088-199528050-00004" target="_blank" rel="noreferrer">10.2165/00003088-199528050-00004</a>
Clinical use of methadone
Humans; Analgesics; Drug Interactions; Therapeutic Equivalency; Half-Life; Drug Administration Schedule; Pain/drug therapy; Receptors; Biological Availability; Opioid/adverse effects/pharmacokinetics/therapeutic use; Dosage Forms; Kidney Diseases/metabolism; Liver Diseases/metabolism; Methadone/adverse effects/pharmacokinetics/therapeutic use; Opioid-Related Disorders/drug therapy; Opioid/agonists; Substance Withdrawal Syndrome/etiology
Methadone hydrochloride is a mu-opioid agonist that has been used for the treatment of pain and for the management and maintenance of opioid withdrawal for over 50 years. Several characteristics make methadone a useful drug. However, these same characteristics and wide interpatient variability can make methadone difficult to use safely. A MEDLINE search was conducted on publications between January 1996 and May 2001 to identify literature relevant to this subject. Those publications were reviewed, and from them, other literature was identified and reviewed. Published studies demonstrate methadone's efficacy in pain management and in opioid withdrawal. However, interpatient variability in pharmacokinetic variables of methadone produces difficulties in developing guidelines for methadone use. Clinicians should not be deterred from use of this drug which has been shown to benefit patients in both pain management and methadone maintenance, but an individualized patient approach must be taken to use methadone safely.
2002
Layson-Wolf C; Goode JV; Small RE
Journal of Pain and Palliative Care Pharmacotherapy
2002
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Journal Article
<a href="http://doi.org/10.1080/j354v16n01_04" target="_blank" rel="noreferrer">10.1080/j354v16n01_04</a>
Codeine phosphate in children: time for re-evaluation?
Child; Pain; Analgesics; Evidence-Based Medicine; infant; Human; Opioid/therapeutic use; Postoperative/drug therapy; Codeine/therapeutic use
2001
Cunliffe M
British Journal Of Anaesthesia
2001
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Journal Article
Codeine phosphate in paediatric medicine
Child; Pain; Analgesics; Non-U.S. Gov't; Human; Support; Postoperative/drug therapy; Codeine/pharmacokinetics/pharmacology/therapeutic use; Opioid/pharmacokinetics/pharmacology/therapeutic use
2001
Williams DG; Hatch DJ; Howard RF
British Journal Of Anaesthesia
2001
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Journal Article
Comparative clinical efficacy and safety of a novel controlled-release oxycodone formulation and controlled-release hydromorphone in the treatment of cancer pain
Female; Humans; Analgesics; Middle Aged; Double-Blind Method; Cross-Over Studies; Comparative Study; Neoplasms/complications; Delayed-Action Preparations; Drug Evaluation; Hydromorphone/administration & Male; Opioid/administration & dosage; Oxycodone/administration & Pain/drug therapy
BACKGROUND: The use of oxycodone to treat chronic cancer pain has been hampered by its short elimination half-life, which necessitates administration every 4 hours. This study compared the clinical efficacy and safety of a novel oxycodone formulation with that of hydromorphone in the treatment of cancer pain. METHODS: In a double-blind crossover study, 44 patients with stable cancer pain were randomized to controlled-release oxycodone or controlled-release hydromorphone, each given every 12 hours for 7 days. Pain intensity, nausea, and sedation were assessed by patients four times daily, and breakthrough analgesia was recorded. RESULTS: Thirty-one patients completed the study (18 women, 13 men; mean age, 56 +/- 3 years) and received a final controlled-release oxycodone dose of 124 +/- 22 mg per day and a final controlled-release hydromorphone dose of 30 +/- 6 mg per day. There were no significant differences between treatments in overall Visual Analogue Scale (VAS) pain intensity (VAS 28 +/- 4 mm vs. 31 +/- 4 mm), categorical pain intensity (1.4 +/- 0.1 vs. 1.5 +/- 0.1), daily rescue analgesic consumption (1.4 +/- 0.3 vs. 1.6 +/- 0.3), sedation scores (24 +/- 4 mm vs. 18 +/- 3 mm), nausea scores (15 +/- 3 mm vs. 13 +/- 3 mm), or patient preference. Two patients experienced hallucinations on controlled-release hydromorphone, but none did while receiving controlled-release oxycodone. CONCLUSIONS: Controlled-release oxycodone demonstrated excellent pharmacodynamic characteristics, analgesic efficacy, and safety as compared with controlled-release hydromorphone and represents an important new therapeutic option for cancer pain management.
Hagen NA; Babul N
Cancer
1997
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Journal Article
<a href="http://doi.org/10.1002/(SICI)1097-0142(19970401)79:7%3C1428::AID-CNCR21%3E3.0.CO" target="_blank" rel="noreferrer">10.1002/(SICI)1097-0142(19970401)79:7%3C1428::AID-CNCR21%3E3.0.CO</a>
Deaths related to the use of prescription opioids
Humans; Analgesics; mortality; Ontario/epidemiology; Opioid/poisoning; Prescription Drugs/poisoning
2009
Fischer B; Rehm J
Canadian Medical Association Journal
2009
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Journal Article
<a href="http://doi.org/10.1503/cmaj.091791" target="_blank" rel="noreferrer">10.1503/cmaj.091791</a>
Difficult pain
Humans; Analgesics; Neuralgia; Forecasting; PedPal Lit; Nervous System Diseases/complications; Methadone/therapeutic use; Analgesia/methods; Opioid/therapeutic use; Palliative Care/methods; Psychotherapy/methods; Acupuncture/methods; Pain/etiology/prevention & control
2006
Colvin L; Forbes K; Fallon M
Bmj
2006
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Journal Article
Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain
Female; Humans; Male; Neoplasms; Pain; Pain Measurement; Adult; Analgesics; Aged; Middle Aged; Fentanyl; Regression Analysis; Administration; Opioid; Cutaneous; Morphine
Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine/transdermal fentanyl (100:1 mg) daily was examined in patients with cancer pain. Patients with a 'stable and low level of cancer pain' receiving a constant dosage of sustained release morphine during a pre-study phase of 6 days were included in the study. Initial fentanyl dosage was calculated by a conversion table. The transdermal system was changed every 72 h and the dosage was adjusted to the needs of the patients according to the VAS scores and the requirement of liquid morphine, which was allowed to achieve sufficient pain relief. Regression analysis at the end of the study revealed a mean morphine/transdermal fentanyl ratio of 70:1. Pain relief during treatment with transdermal fentanyl was identical to sustained release morphine. However, significantly more patients took supplemental medication with liquid morphine during transdermal fentanyl therapy. The number of patients suffering from pain attacks did not increase with transdermal fentanyl. Constipation and medication with laxatives decreased significantly during fentanyl therapy. Other side effects and vital signs were identical. Three patients suffered from a morphine withdrawal syndrome beginning within the first 24 h of transdermal fentanyl therapy. Cutaneous reactions to the patch were rare, mild and transient. Patients and physicians reported satisfaction with the transdermal therapy. 94.7% of the patients chose to continue the transdermal fentanyl therapy at the end of the study due to better performance in comparison to oral morphine. Due to these results an initial conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 is safe and effective.
1996-03
Donner B; Zenz M; Tryba M; Strumpf M
Pain
1996
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Journal Article
<a href="http://doi.org/10.1016/0304-3959(95)00180-8" target="_blank" rel="noreferrer">10.1016/0304-3959(95)00180-8</a>
Disappearance of morphine-induced hyperalgesia after discontinuing or substituting morphine with other opioid agonists
Child; Female; Humans; Male; Adult; Analgesics; Aged; Middle Aged; Pain/complications/drug therapy; Neoplasms/complications; Delayed-Action Preparations; Methadone/therapeutic use; Narcotics/therapeutic use; Hyperalgesia/chemically induced/psychology; Meperidine/analogs & derivatives/therapeutic use; Morphine/administration & dosage/adverse effects/therapeutic use; Myoclonus/chemically induced; Opioid/therapeutic use; Sufentanil/therapeutic use
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 morphine infusion. The hyperalgesia and myoclonus disappeared when the morphine administration was discontinued and she felt comfortable on small and sporadic oral doses of methadone. The second case describes hyperalgesia occurring after a small dose of sustained-release morphine which disappeared after alternative use of oral ketobemidone. The third case describes hyperalgesia following high doses of intramuscular morphine which disappeared after alternative use of continuous subcutaneous infusion of sufentanil. The fourth case describes a boy developing hyperalgesia after high doses of oral and intramuscular morphine. The hyperalgesia disappeared after discontinuing morphine administration but withdrawal symptoms developed due to too small doses of methadone. Possible mechanisms of morphine-induced hyperalgesia are discussed.
1994
Sjogren P; Jensen NH; Jensen TS
Pain
1994
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Journal Article
<a href="http://doi.org/10.1016/0304-3959(94)90084-1" target="_blank" rel="noreferrer">10.1016/0304-3959(94)90084-1</a>
Efficacy and complications of morphine infusions in postoperative paediatric patients
Child; Female; Humans; Male; Pain; Analgesics; Follow-Up Studies; Confidence Intervals; Incidence; Acute Disease; adolescent; Preschool; infant; retrospective studies; Infusions; Intravenous; Opioid/administration & dosage/adverse effects/therapeutic use; Morphine/administration & dosage/adverse effects/therapeutic use; Postoperative/prevention & control; Respiration/drug effects; Akathisia; Analgesia/nursing; Anesthesia Recovery Period; Anoxemia/chemically induced; Arousal/drug effects; Drug-Induced/etiology; Postoperative Nausea and Vomiting/chemically induced; Pruritus/chemically induced; Urinary Retention/chemically induced
The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.
1999
Esmail Z; Montgomery C; Courtrn C; Hamilton D; Kestle J
Paediatric Anaesthesia
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1046/j.1460-9592.1999.00384.x" target="_blank" rel="noreferrer">10.1046/j.1460-9592.1999.00384.x</a>
End-of-life practices in the Netherlands under the Euthanasia Act
Female; Humans; Male; Analgesics; Questionnaires; Follow-Up Studies; Aged; Middle Aged; Netherlands; Suicide; 80 and over; cause of death; Opioid/administration & dosage; Hypnotics and Sedatives/administration & dosage; Assisted/legislation & jurisprudence/statistics & numerical data/trends; Euthanasia/legislation & jurisprudence/statistics & numerical data/trends; Withholding Treatment/statistics & numerical data/trends
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 other end-of-life practices. METHODS: We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS: In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
2007
van der Heide A; Onwuteaka-Philipsen BD; Rurup ML; Buiting HM; van Delden JJ; Hanssen-de Wolf JE; Janssen AG; Pasman HR; Rietjens JA; Prins CJ; Deerenberg IM; Gevers JK; van der Maas PJ; van der Wal G
The New England Journal Of Medicine
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/NEJMsa071143" target="_blank" rel="noreferrer">10.1056/NEJMsa071143</a>
Fast fact and concepts #107: Controlled sedation for refractory symptoms: Part II
Analgesics; Analgesia/methods; Anesthesia/methods
This fact fact will review sedation techniques.
2004
Salacz ME; Weissman DE
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Glia: novel counter-regulators of opioid analgesia
Humans; Analgesics; Animals; Opioid/administration & dosage; Drug Tolerance; Brain/drug effects/metabolism; Neuroglia/drug effects/metabolism; Neurotransmitter Agents/metabolism; Nociceptors/drug effects/metabolism; Pain/metabolism/prevention & control; Spinal Cord/drug effects/metabolism
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 bases remain unresolved. Within the past four years, a novel non-neuronal candidate has been uncovered that opposes acute opioid analgesia and contributes to development of opioid tolerance and tolerance-associated pain enhancement. This novel candidate is spinal cord glia. Glia are important contributors to the creation of enhanced pain states via the release of neuroexcitatory substances. New data suggest that glia also release neuroexcitatory substances in response to morphine, thereby opposing its effects. Controlling glial activation could therefore increase the clinical utility of analgesic drugs.
2005
Watkins LR; Hutchinson MR; Johnston IN; Maier SF
Trends In Neurosciences
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.tins.2005.10.001" target="_blank" rel="noreferrer">10.1016/j.tins.2005.10.001</a>
High dose opioids in pediatric palliative care.
Child; Female; Humans; Male; Adult; Analgesics; Age Factors; adolescent; Preschool; infant; Dose-Response Relationship; Drug; Palliative Care; Opioid/administration & dosage/therapeutic use; Pain/drug therapy
2003-05
Siden H; Nalewajek
Journal Of Pain And Symptom Management
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0885-3924(03)00071-x" target="_blank" rel="noreferrer">10.1016/s0885-3924(03)00071-x</a>