The management of pain in children with life-limiting illnesses
Child; Humans; Pain Measurement; Analgesics; Severity of Illness Index; Chronic disease; Methadone/therapeutic use; Hydromorphone/therapeutic use; Opioid/therapeutic use; Fentanyl/therapeutic use; Morphine/therapeutic use; Nociceptors/physiology; Codeine/therapeutic use; Ketamine/therapeutic use; Oxycodone/therapeutic use; Pain/diagnosis/drug therapy/physiopathology
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 on topics common to practitioners caring for children with lifelimiting illnesses, including a review of myths and obstacles to achieving adequate pain control, a review of the pathophysiology of pain, an overview of the use of opioids in children, an approach to the management of neuropathic pain, and a brief discussion of nonpharmacologic pain management strategies.
2007
Friedrichsdorf SJ; Kang T
Pediatric Clinics Of North America
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/10.1016/j.pcl.2007.07.007" target="_blank" rel="noreferrer">10.1016/j.pcl.2007.07.007</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
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/10.1111/j.1526-4637.2008.00461.x" target="_blank" rel="noreferrer">10.1111/j.1526-4637.2008.00461.x</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
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
Morphine is not the only analgesic in palliative care: Literature review
Humans; Analgesics; Palliative Care/methods; Pain/drug therapy; Neoplasms/complications; Methadone/therapeutic use; Opioid/therapeutic use; Fentanyl/therapeutic use; Morphine/therapeutic use; Ketamine/therapeutic use; Analgesics/therapeutic use
BACKGROUND: No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses. AIM: The aim of this review is to examine the pharmaceutical alternatives to morphine use in palliative care that are currently available. METHODS: Searches were made of the CINAHL and MEDLINE databases for articles published between 1990 and 2000, using the keywords 'pain management', 'cancer pain' and 'morphine'. FINDINGS: Most evidence on the use of pharmaceutical alternatives to morphine is anecdotal, demonstrating a need for more research to be conducted in this field. Evidence presented in this review shows encouraging results following the administration of methadone, fentanyl or ketamine to patients with difficult pain problems. CONCLUSION: Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.
2004
Wootton M
Journal Of Advanced Nursing
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
<a href="http://doi.org/10.1046/j.1365-2648.2003.02936.x" target="_blank" rel="noreferrer">10.1046/j.1365-2648.2003.02936.x</a>
Methadone as treatment for iatrogenic narcotic dependency in pediatric intensive care unit patients
Female; Humans; infant; Male; Pain; Analgesics; infant; Newborn; Opioid/adverse effects/therapeutic use; Methadone/therapeutic use; Postoperative/drug therapy; Cardiac Surgical Procedures; Substance Withdrawal Syndrome/drug therapy; Substance-Related Disorders/drug therapy
1990
Tobias JD; Schleien CL; Haun SE
Critical Care Medicine
1990
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/10.1097/00003246-199011000-00024" target="_blank" rel="noreferrer">10.1097/00003246-199011000-00024</a>
Clinical efficacy of methadone in patients refractory to other mu-opioid receptor agonist analgesics for management of terminal cancer pain. Case presentations and discussion of incomplete cross-tolerance among opioid agonist analgesics
Child; Female; Humans; Male; Palliative Care; Pain; Adult; Middle Aged; adolescent; Neoplasms/physiopathology; Analgesics/pharmacology; Drug Tolerance; Intractable/therapy; Methadone/therapeutic use; mu/drug effects; Opioid; Receptors
BACKGROUND. Development of tolerance to opioid analgesics occurs often in patients with cancer-related pain. Cross-tolerance among opioid analgesics provides the physician with a major management problem. Incomplete cross-tolerance among opioid analgesics has been demonstrated to occur in animals and humans. The current study provides clinical evidence of the incomplete cross-tolerance of methadone with a number of mu-opioid agonist analgesics in patients with advanced cancer-related pain. RESULTS. Patients presented in the current study had cancer-related pain refractory to other mu--opioid receptor agonist analgesics as evidenced by inadequate analgesia despite escalation of opioid dose. All patients were adequately managed by conversion of their opioid dose to methadone. Additionally, the dose of methadone required to establish and maintain analgesia in these patients was modest compared with previous opioid dose requirements. CONCLUSIONS. Methadone is a potent opioid analgesic that demonstrates incomplete cross-tolerance with other mu-opioid receptor agonist analgesics. Conversion of the opioid-tolerant patient with cancer-related pain to methadone may represent an important therapeutic option in the management of patients with this difficult problem.
Crews JC; Sweeney NJ; Denson DD
Cancer
1993
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/10.1002/1097-0142(19931001)72:7%3C2266::aid-cncr2820720734%3E3.0.co" target="_blank" rel="noreferrer">10.1002/1097-0142(19931001)72:7%3C2266::aid-cncr2820720734%3E3.0.co</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
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/10.1016/0304-3959(94)90084-1" target="_blank" rel="noreferrer">10.1016/0304-3959(94)90084-1</a>
Oral methadone for the treatment of severe pain in hospitalized children: a report of five cases
Child; Female; Male; Analgesics; Parents; Treatment Outcome; Analgesia; Preschool; Administration; Oral; Neoplasms/therapy; Human; Case Report; Opioid/therapeutic use; Patient-Controlled; Wounds; Hospitalization; Palliative Care/methods; Burns/therapy; Methadone/therapeutic use; Nonpenetrating/therapy; Osteopetrosis/therapy; Pain/physiopathology
OBJECTIVE: Pain relief is still inadequate in many hospitalized patients, especially children in whom suboptimal use of analgesic drugs is still common. In the past 2 years, oral methadone has been used extensively in our institution for treating children with persistent pain from cancer, burns, or trauma who were capable of oral intake and whose pain was not relieved by nonopioid medications. SETTING: Tertiary university hospital. PATIENTS: Of the 70 children treated thus far with oral methadone, five are described in the present report. MAIN OUTCOME MEASURE: Pain relief, acceptability, and side effects of oral methadone in children with pain. RESULTS: Treatment with oral methadone (0.1% in 10% glucose, dose range of 0.2-0.6 mg/kg/day) for time periods of up to 6 weeks resulted in a rapid onset and stable pain relief, with no major side effects. No adverse responses were encountered after discontinuation of treatment. In three of the children, a parent-controlled analgesia regimen was successfully employed. CONCLUSIONS: Oral methadone can be recommended for babies and children who have severe pain that is not alleviated by nonopioid medications and who are capable of oral intake.
1998
Shir Y; Shenkman Z; Shavelson V; Davidson EM; Rosen G
Clinical Journal Of Pain
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 href="http://doi.org/10.1097/00002508-199812000-00013" target="_blank" rel="noreferrer">10.1097/00002508-199812000-00013</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
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/10.1200/jco.1996.14.10.2836" target="_blank" rel="noreferrer">10.1200/jco.1996.14.10.2836</a>