Browse Items · Pediatric Palliative Care Library

Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital

Context: More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST…

Tags: 2022, Analysis, Article, CARE, Carpenter AT, Casas JA, Child, Clinical, Coleman RD, coronary, Crawford CA, data, Drug, erratum, experiment, Female, guideline, Health, Hospital, Human, intensive, Journal of Pain and Symptom Management., Life, Major, Male, Neonatal, Palliative, Pediatric, Perception, Practice, Qualitative, Quality, quantitative, Sawyer K E, September 2022 List, Software, study, sustaining, Therapy, Treatment, Tume SC, Unit, Withdrawal

Inhibition of inflammatory pain by CRF at peripheral, spinal and supraspinal sites: involvement of areas coexpressing CRF receptors and opioid peptides

There is conflicting evidence on the antinociceptive effects of corticotropin-releasing factor (CRF) along the neuraxis of pain transmission and the responsible anatomical sites of CRF's action at the level of the brain, spinal cord and periphery. In…

Sedation for children with metachromatic leukodystrophy undergoing MRI

BACKGROUND: Metachromatic leukodystrophy (MLD) is a lysosomal storage disease with infantile and juvenile onset with a poor prognosis and magnetic resonance imaging (MRI) plays a fundamental role in its diagnosis. Procedural sedation is needed 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…

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…

Safety and efficacy of rosuvastatin therapy for the prevention of hyperlipidemia in adult cardiac transplant recipients

BACKGROUND: Hyperlipidemia after orthotopic heart transplantation (OHT) is associated with immunosuppression. Many OHT patients have increased lipid levels above published guidelines despite treatment with high doses of statins. Treatment with…

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…

Oral methadone for chronic noncancer pain: a systematic literature review of reasons for administration, prescription patterns, effectiveness, and side effects

OBJECTIVE: To assess the indications, prescription patterns, effectiveness, and side effects of oral methadone for the treatment of chronic noncancer pain. METHODS: We conducted searches of several electronic databases, textbooks and reference lists…

Safer prescribing for children

2005

Tags: 2005, Backlog, Bmj, Child Consumer Product Safety Drug Therapy/adverse effects Humans Medication Errors/prevention & control Physician's Practice Patterns Prescriptions, Drug, Journal Article, Marcovitch H, 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

Control of inflammatory pain by chemokine-mediated recruitment of opioid-containing polymorphonuclear cells

Opioid-containing leukocytes can counteract inflammatory hyperalgesia. Under stress or after local injection of corticotropin releasing factor (CRF), opioid peptides are released from leukocytes, bind to opioid receptors on peripheral sensory neurons…

Tags: 2004, Analysis of Variance, Animals, Antibodies/pharmacology, Backlog, Brack A, Cell Count/methods, Cell Movement/physiology, Chemokines, Chemokines/immunology/physiology, Comparative Study, Corticotropin-Releasing Hormone/therapeutic use, CXC/immunology/metabolism, Dose-Response Relationship, Drug, Drug Administration Routes, Enzyme-Linked Immunosorbent Assay/methods, Flow Cytometry/methods, Freund's Adjuvant, Gene Expression Regulation/physiology, Immunohistochemistry/methods, Intercellular Signaling Peptides and Proteins/immunology/metabolism, Interleukin-8B/metabolism, Journal Article, Leder K, Machelska H, Male, Mousa SA, Naloxone/pharmacology, Narcotics/metabolism, Neurogenic Inflammation/chemically induced/complications/therapy, Neutrophils/metabolism, Non-U.S. Gov't, Pain, Pain Measurement, Pain Threshold/drug effects, Pain/etiology/therapy, Rats, Receptors, Research Support, Rittner HL, Schafer M, Stein C, Wistar

High dose opioids in pediatric palliative care.

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…

Use of bisphosphonate therapy for osteoporosis in childhood and adolescence

Congenital and acquired forms of osteoporosis in childhood and adolescence can result in morbidity from fracture and pain in childhood, and place an individual at significant risk for problems in adult life. A range of therapies exist for the…

Increased numbers of opioid expressing inflammatory cells do not affect intra-articular morphine analgesia

BACKGROUND: Both locally expressed beta-endorphin (END) and low doses of morphine relieve pain within inflamed knee joints. Here we examined whether enhanced inflammation and END expression within the synovial tissue of patients undergoing…

The bisphosphonate pamidronate is a potent inhibitor of Ewing's sarcoma cell growth in vitro

The MTT assay was used to measure the effects of pamidronate, clodronate and mevastatin on the cell viability of Ewing's sarcoma cell lines 6647, CADO-ES-1, ES-2, ES-3, RD-ES, SK-ES-1, STA-ET-2.1 and VH-64. Treatment of these cells with pamidronate…

Melatonin treatment for sleep disorders in children with neurodevelopmental disorders: an observational study

The study aim was to quantify melatonin-associated improvement in sleep by means of a parent-completed sleep diary during routine outpatient activity. An investigation into sleep disturbance was made at neurology outpatient appointments. Those…

Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle

Peripheral N-methyl-d-aspartate (NMDA) receptors are found in deep tissues and may play a role in deep tissue pain. Injection of the endogenous NMDA receptor agonist glutamate into the masseter muscle excites deep craniofacial afferent fibers in rats…

Uses of drugs not described in the package insert (off-label uses)

New regulatory initiatives have been designed to ensure that new drugs and biologicals include adequate pediatric labeling for the claimed indications at the time of, or soon after, approval. However, because such labeling may not immediately be…

Use of opioids in the treatment of severe pain in terminally ill patients--dying should not be painful

Pain is a common symptom at the end of life. The vast majority of pain can be readily managed if simple principles of practice are followed. Chronic pain requires continuous analgesia, and severe pain requires use of strong analgesics, most commonly…

Oral opioid therapy for chronic peripheral and central neuropathic pain

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

The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions

In recent years, the observation that the response of patients to opioid drugs may be influenced by properties inherent in the pain or pain syndrome, such as its pathophysiology, has evolved into the belief that certain types of pain, e.g.,…

Peripheral opioid receptors mediating antinociception in inflammation. Activation by endogenous opioids and role of the pituitary-adrenal axis

This study investigated the involvement of endogenous opioid peptides in mediating cold water swim (CWS) stress-induced antinociception (SIA) in rats with unilateral hind paw inflammation induced by Freund's complete adjuvant (FCA). Following 0.5, 1…

Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine

BACKGROUND. When a change of opioid is considered, equianalgesic dose tables are used. These tables generally propose a dose ratio of 5:1 between morphine and hydromorphone. In the case of a change from subcutaneous hydromorphone to methadone, dose…

Massive opioid resistance in an infant with a localized metastasis to the midbrain periaqueductal gray

We report the case of a 4-month-old infant with terminal malignancy who had systemic metastases and a localized metastasis to the dorsal midbrain periaqueductal gray (PAG). Extraordinary doses of opioids (dose equivalent of 2680 mg morphine…

Bisphosphonates: a review of their pharmacokinetic properties

Bisphosphonates are a unique class of drugs. As a family, they are characterized pharmacologically by their ability to inhibit bone resorption, whereas, pharmacokinetically, they are classified by their similarity in absorption, distribution, and…

Tags: 1996, Animals, Backlog, Biological Availability, Blood Proteins/metabolism, Bone, Clodronate, Diphosphonates/pharmacokinetics/urine, Dose-Response Relationship, Drug, Humans, Intestinal Absorption/physiology, Journal Article, Lin JH, Protein Binding, Structure-Activity Relationship, Tissue Distribution/physiology

Massive opioid requirements in children with disseminated central nervous system disease

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…

Methionine-enkephalin-and Dynorphin A-release from immune cells and control of inflammatory pain

We have previously shown that beta-endorphin (END) is contained and released from memory-type T-cells within inflamed tissue and that it is capable to control pain (J Clin Invest 100(1) (1997) 142). Methionine-enkephalin (MET) and Dynorphin-A (DYN)…

Effects of high dose opioids and sedatives on survival in terminally ill cancer patients

Concerns that high dose opioids and sedatives might shorten patient survival could contribute to insufficient symptom alleviation for terminally ill cancer patients. To examine the effects of opioids and sedatives prescribed in the final 48 hours on…

A randomized, controlled trial of intravenous clodronate in patients with metastatic bone disease and pain

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…

Interleukin 1 beta and corticotropin-releasing factor inhibit pain by releasing opioids from immune cells in inflamed tissue

Local analgesic effects of exogenous opioid agonists are particularly prominent in painful inflammatory conditions and are mediated by opioid receptors on peripheral sensory nerves. The endogenous ligands of these receptors, opioid peptides, have…

Tags: 1994, Analysis of Variance, Animals, Antibodies/pharmacology, Backlog, beta-Endorphin/immunology/physiology, Biomarkers of Pain, Carter L, Corticotropin-Releasing Hormone/administration & dosage/pharmacology/therapeutic use, Cyclosporine/pharmacology, Dose-Response Relationship, Drug, Dynorphins/immunology/physiology, Endorphins/immunology/physiology/secretion, Enkephalin, Humans, Inflammation/immunology/physiopathology, Injections, Interleukin-1/administration & dosage/pharmacology/therapeutic use, Journal Article, Leucine/analogs & derivatives/pharmacology, Male, Methionine/immunology/physiology, Naloxone/pharmacology, Pain/immunology/physiopathology/prevention & control, Proceedings Of The National Academy Of Sciences Of The United States Of America, Rats, Recombinant Proteins/pharmacology/therapeutic use, Regression Analysis, Schafer M, Somatostatin/analogs & derivatives/pharmacology, Stein C, Wistar

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…

Opioid switch to oral methadone in cancer pain

The occurrence of undesirable side effects due to opioids (delirium, confusion, myoclonus, nausea, emesis) is one of the major complications in the management of pain, especially in chronic cancer pain states. Methadone, as an alternative to…

Epidural analgesia for postoperative pain control in children

Ninety-eight continuous postoperative epidurals were administered to 87 children. The patients were divided into two groups: group I included 63 cases in which a 0.0625-0.25% solution of bupivacaine was continuously administered; group II included 35…

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…

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…

Opioid analgesics: comparative features and prescribing guidelines

The term 'opioid' is a generic term for naturally occurring, semisynthetic and synthetic drugs which combine with opioid receptors to produce physiological effects and which are stereospecifically antagonised by naloxone. For clinical purposes,…

Tags: 1996, Analgesics, Backlog, Cherny NI, Comparative Study, Drug, Drugs, Humans, Journal Article, Opioid/administration & dosage/adverse effects/therapeutic use, Pain/drug Therapy, Prescriptions

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…

Occurrence of withdrawal in critically ill sedated children

OBJECTIVES: To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. DESIGN: Retrospective data collection…

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