Opioid use in palliative care of children and young people with cancer
Child; Female; Humans; Male; Great Britain; Adult; Analgesics; Questionnaires; Prospective Studies; Research Design; Longitudinal Studies; Therapeutic Equivalency; Prescriptions; adolescent; Preschool; infant; Administration; Oral; Pain/drug therapy/etiology; Palliative Care/methods; Infusions; Injections; Intravenous; Neoplasms/complications; Subcutaneous; Drug/statistics & numerical data; Opioid/administration & dosage/therapeutic use; Fentanyl/therapeutic use; Heroin/therapeutic use; Morphine/therapeutic use; Rectal
OBJECTIVE: Identify opioids prescribed, preferred routes, and doses among children with incurable cancer. STUDY DESIGN: Prospective survey with monthly questionnaires regarding patients 0 to 19 years old from oncology centers. Data were collected by professionals on each patient for 6 months or until death, and analyzed from patients who died. Impact of tumor was analyzed with Kruskal-Wallis and Mann-Whitney tests. Major opioid dosages are expressed as oral morphine equivalents. RESULTS: Of 185 children recruited, 164 (88 boys, 76 girls) died. Mean palliative care duration was 67 days. One hundred forty-seven (89.6%) received major opioids. Morphine, diamorphine, and fentanyl were prescribed in 75%, 57.9%, and 11.6%, respectively. Seventy-three (44.5%) received >1 major opioid. Median monthly maximum doses prescribed rose from 2.1 mg/kg/24 h (study entry) to 4.4 mg/kg/24 h (death) (P < .001); overall variable (0.09-1500 mg/kg/24 h, median 3.7 mg/kg/24 h). Opioids were given by the oral (117/164, 71.3%), intravenous (68/164, 41.5%), subcutaneous (40, 28%), rectal (20, 12.2%), and transdermal (18, 11%) routes. There was a shift to intravenous use as death approached. Numbers within each tumor group were too small to show significance. Children with solid tumors outside the central nervous system were likely to receive more opioids, be given multiple different opioids, and receive opioids in the last month. CONCLUSIONS: The study shows the United Kingdom practice of opioid use and provides comparator data for practice in children's palliative medicine.
2008
Hewitt M; Goldman A; Collins GS; Childs M; Hain R
The Journal Of Pediatrics
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/10.1016/j.jpeds.2007.07.005" target="_blank" rel="noreferrer">10.1016/j.jpeds.2007.07.005</a>
Patient-controlled analgesia with intravenous L-methadone in a child with cancer pain refractory to high-dose morphine
Child; Humans; Male; Pain; Analgesics; Analgesia; Treatment Failure; Infusions; Intravenous; Neoplasms/complications; Opioid/administration & dosage/therapeutic use; Patient-Controlled; Morphine/administration & dosage/therapeutic use; Intractable/drug therapy/etiology; Methadone/administration & dosage/therapeutic use
2002
Sabatowski R; Kasper SM; Radbruch L
Journal Of Pain And Symptom Management
2002
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(01)00389-x" target="_blank" rel="noreferrer">10.1016/s0885-3924(01)00389-x</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>
Use of opioids in the treatment of severe pain in terminally ill patients--dying should not be painful
Humans; Male; Pain Measurement; Terminal Care; Analgesics; Middle Aged; Analgesia; Pain/drug therapy/etiology; Infusion Pumps; Dose-Response Relationship; Drug; Opioid/administration & dosage/therapeutic use; Patient-Controlled; Morphine/administration & dosage/therapeutic use; Pancreatic Neoplasms
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 the opioids. In addition to drugs administered continually, short-acting medications must be available for "breakthrough" pain. This article reviews the principles of pain management in terminally ill patients, using a case-based demonstration.
2003
Moynihan TJ
Mayo Clinic Proceedings
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/10.4065/78.11.1397" target="_blank" rel="noreferrer">10.4065/78.11.1397</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
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/10.1016/0163-7258(95)02003-9" target="_blank" rel="noreferrer">10.1016/0163-7258(95)02003-9</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
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/s1072-7515(01)01091-2" target="_blank" rel="noreferrer">10.1016/s1072-7515(01)01091-2</a>
Opioid switch to oral methadone in cancer pain
Cross-Sectional Studies; Humans; Analgesics; Combined Modality Therapy; Administration; Oral; Pain/drug therapy/etiology; Dose-Response Relationship; Drug; Neoplasms/complications; Receptors; Opioid/administration & dosage/therapeutic use; Morphine/administration & dosage/therapeutic use; Methadone/administration & dosage/therapeutic use; N-Methyl-D-Aspartate/antagonists & inhibitors
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 morphine, has been proposed in the control of opioid-induced toxicity. Methadone is a synthetic opioid, with mu and delta receptor activity, associated with the capacity to inhibit N-methyl-D-aspartate receptors. Questions have arisen concerning its equianalgesic ratio since its rediscovery over the past few years and are certainly related to its receptor interactions. Aspects of its pharmacology, indications, and switching modalities are discussed here. Opioid rotation is a new tool in the management of cancer pain, deserving more attention.
2000
Mancini I; Lossignol DA; Body JJ
Current Opinion In Oncology
2000
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/10.1097/00001622-200007000-00006" target="_blank" rel="noreferrer">10.1097/00001622-200007000-00006</a>