Pediatric sedation with analgesia
Child; Intensive Care Units; Analgesics; Drug Therapy; Time Factors; Clinical Protocols; Anesthetics; Pediatric; Preschool; infant; Comparative Study; retrospective studies; Human; Opioid/therapeutic use; Adolescence; Fentanyl/therapeutic use; Combination; Propofol/therapeutic use; Analgesia/adverse effects/methods; Conscious Sedation/adverse effects/methods; Intravenous/therapeutic use
Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia procedures from January 1994 through August 1995 were randomly chosen for descriptive retrospective review and analysis. Four minor complications from the procedures were identified, and recovery was complete in all cases. One medication combination (fentanyl 1 microg/kg with propofol 1.5 to 2 mg/kg, followed by an infusion of 150 microg/kg/min) provided the shortest mean time to dismissal (17.8 minutes v 38 minutes) when compared with other combinations used. No episodes of respiratory depression, hypotension, or nausea and vomiting occurred in the fentanyl/propofol group. These results show that fentanyl/propofol was superior to other medications used during this study period for pediatric sedation with analgesia. Prospective comparison of this medication combination with other short-acting agents in patients undergoing both elective and emergency procedures is necessary.
1999
Bauman L; Kish I; Baumann RC; Politis GD
American Journal of Emergency Medicine
1999
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Journal Article
Pain and symptom control in terminally ill children
Child; Palliative Care; Pain Measurement; Adult; Analgesics; Antidepressive Agents; Preschool; infant; Comparative Study; Human; Opioid/therapeutic use; Tricyclic/therapeutic use; HIV Seropositivity/psychology; Anesthetics/therapeutic use; Depression/drug therapy/etiology; Gastrointestinal Diseases/therapy; Histamine H1 Antagonists/therapeutic use; Neoplasms/complications/psychology; Pain/diagnosis/drug therapy/etiology; Terminally Ill/psychology
The management of pain in terminally ill pediatric patients has incalculable benefits to patients, their families, and physicians and nurses. A therapeutic management plan is dependent on a thorough understanding of the causes of pain in these patients, on pain assessment, and on the myriad drugs and drug strategies that are essential in pain treatment. Aggressive symptom control of treatment- related side effects can ensure successful implementation of such a plan.
2000
Galloway KS; Yaster M
Pediatric Clinics Of North America
2000
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Journal Article
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
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>
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>
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
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Journal Article
<a href="http://doi.org/10.1097/00002508-199812000-00013" target="_blank" rel="noreferrer">10.1097/00002508-199812000-00013</a>
Pain control by immune-derived opioids
Humans; Analgesics; Biomarkers of Pain; Receptors; Opioid/therapeutic use; Neuropeptides/therapeutic use; Opioid/drug effects/immunology; Pain/drug therapy/immunology; Peripheral Nervous System/drug effects
1. The nervous and immune systems communicate with each other by use of cytokines and neuropeptides. 2. Interactions between immune cell-derived opioid peptides and opioid receptors located in peripheral inflamed tissue lead to endogenous analgesia. 3. In addition to their immunological functions, immunocytes are involved in intrinsic pain inhibition. This provides new insights into pain associated with a compromised immune system, as in AIDS or in cancer. 4. The activation of opioid production and release from immune cells may be a novel approach to the development of peripherally acting analgesics. Because such drugs would be targeted towards events in peripheral injured tissue, these analgesics should lack unwanted central side effects typically associated with opioids.
2000
Machelska H; Stein C
Clinical And Experimental Pharmacology & Physiology
2000
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Journal Article
<a href="http://doi.org/10.1046/j.1440-1681.2000.03287.x" target="_blank" rel="noreferrer">10.1046/j.1440-1681.2000.03287.x</a>
Judging the effectiveness of analgesia for children and adolescents during vaso-occlusive events of sickle cell disease
Child; Female; Humans; Male; Analgesics; Anemia; adolescent; P.H.S.; Research Support; U.S. Gov't; Interviews; Pain/physiopathology; Opioid/therapeutic use; Analgesia/standards; Nalbuphine/therapeutic use; Sickle Cell/complications; Vascular Diseases/etiology/physiopathology/therapy
The effectiveness of analgesia during sickle cell crisis was examined in this descriptive, exploratory study. Pain scores (using the African-American Oucher and the Adolescent Pediatric Pain Tool) and analgesics administered were examined during a 2-hour observation/interview in the hospital while children/adolescents with sickle cell disease (SCD) experienced a vaso-occlusive episode (VOE). A convenience sample of twenty-one 6- to 16-year olds with SCD was included. Evidence indicated that 15 of the 21 children in the sample were in moderate to severe pain during their interviews, indicating that the analgesics did not effectively control their pain. Most participants (17) had received nalbuphine as the primary analgesic by intravenous infusion drip and/or patient-controlled analgesia pump. Many reasons were identified for the inadequate analgesia. The results suggested that the pain of SCD is very complex, requiring continuous adjustment of comfort measures, especially analgesics. More research is needed to examine pain control in children with SCD.
2000
Beyer JE
Journal Of Pain And Symptom Management
2000
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Journal Article
<a href="http://doi.org/10.1016/s0885-3924(99)00134-7" target="_blank" rel="noreferrer">10.1016/s0885-3924(99)00134-7</a>
Massive opioid resistance in an infant with a localized metastasis to the midbrain periaqueductal gray
infant; Male; Analgesics; Non-U.S. Gov't; Newborn; Dose-Response Relationship; Drug; Human; Case Report; Palliative Care; Mesencephalon; Periaqueductal Gray; Brain Neoplasms/congenital/drug therapy/pathology/secondary; Drug Resistance; Hypnotics and Sedatives/therapeutic use; Morphine/therapeutic use; Opioid/therapeutic use; Rhabdoid Tumor/congenital/drug therapy/pathology/secondary; Support
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 sulfate/h, i.v.) were required to achieve adequate analgesia. The behavior of the infant, interpreted as being representative of a response to pain, may have been an aversive reaction due to the location of the lesion in the dorsal PAG. We propose that the lesion in the PAG impaired the responsiveness of this infant to the effect of opioids. This report is to alert clinicians to the possible role of the PAG in impaired opioid responsiveness in patients with terminal malignancy, as well as the possibility that pain-like signs (e.g., tachycardia, tachypnea, vocalization, facial grimacing) may indicate an aversive reaction rather than pain in non-verbal patients.
1995
Collins J J; Berde CB; Grier HE; Nachmanoff DB; Kinney HC
Pain
1995
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Journal Article
<a href="http://doi.org/10.1016/0304-3959(95)00094-9" target="_blank" rel="noreferrer">10.1016/0304-3959(95)00094-9</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>
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
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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>
Recommendations for using opioids in chronic non-cancer pain
Humans; Analgesics; Drug Administration Schedule; Psychology; Chronic disease; Biomarkers of Pain; Pain/drug therapy; Quality of Life/psychology; Opioid/therapeutic use; Patient Education
1. The management of chronic pain should be directed by the underlying cause of the pain. Whatever the cause, the primary goal of patient care should be symptom control. 2. Opioid treatment should be considered for both continuous neuropathic and nociceptive pain if other reasonable therapies fail to provide adequate analgesia within a reasonable timeframe. 3. The aim of opioid treatment is to relieve pain and improve the patient's quality of life. Both of these should be assessed during a trial period. 4. The prescribing physician should be familiar with the patient's psychosocial status. 5. The use of sustained-release opioids administered at regular intervals is recommended. 6. Treatment should be monitored. 7. A contract setting out the patient's rights and responsibilities may help to emphasize the importance of patient involvement. 8. Opioid treatment should not be considered a lifelong treatment.
2003
Kalso E; Allan L; Dellemijn PL; Faura CC; Ilias WK; Jensen TS; Perrot S; Plaghki LH; Zenz M
European Journal Of Pain
2003
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Journal Article
<a href="http://doi.org/10.1016/S1090-3801(02)00143-X" target="_blank" rel="noreferrer">10.1016/S1090-3801(02)00143-X</a>
Opioids in renal failure and dialysis patients
Humans; Analgesics; Pain/drug therapy; Opioid/therapeutic use; Chronic/complications/therapy; Kidney Failure; Peritoneal Dialysis
This article reviews the literature pertaining to the metabolism of several of the commonly used opioids, and the known activity of their metabolites. The effect of renal failure on the pharmacokinetics of these drugs and metabolites is then reviewed. Finally, the effect of renal dialysis on opioid drugs and metabolites is reviewed. Based on the review, it is recommended that morphine and codeine are avoided in renal failure/dialysis patients; hydromorphone or oxycodone are used with caution and close monitoring; and that methadone and fentanyl/sufentanil appear to be safe to use. Note is made that the "safe" drugs in renal failure are also the least dialyzable.
2004
Dean M
Journal Of Pain And Symptom Management
2004
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Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2004.02.021" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2004.02.021</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
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
New and lingering controversies in pediatric end-of-life care
Child; Humans; Analgesics; Data Collection; Attitude of Health Personnel; Medical Futility; Medical Staff; Withholding Treatment; Life Support Care; Medical; Practice Guidelines; ICU Decision Making; Pain/drug therapy; Opioid/therapeutic use; Specialties; Terminal Care/psychology; Nurses/psychology; Hospital/psychology
OBJECTIVES: Professional societies, ethics institutes, and the courts have recommended principles to guide the care of children with life-threatening conditions; however, little is known about the degree to which pediatric care providers are aware of or in agreement with these guidelines. The study's objectives were to determine the extent to which physicians and nurses in critical care, hematology/oncology, and other subspecialties are in agreement with one another and with widely published ethical recommendations regarding the withholding and withdrawing of life support, the provision of adequate analgesia, and the role of parents in end-of-life decision-making. METHODS: Three children's hospitals and 4 general hospitals with PICUs in eastern, southwestern, and southern parts of the United States were surveyed. This population-based sample was composed of attending physicians, house officers, and nurses who cared for children (age: 1 month to 18 years) with life-threatening conditions in PICUs or in medical, surgical, or hematology/oncology units, floors, or departments. Main outcome measures included concerns of conscience, knowledge and beliefs, awareness of published guidelines, and agreement or disagreement with guidelines. RESULTS: A total of 781 clinicians were sampled, including 209 attending physicians, 116 house officers, and 456 nurses. The overall response rate was 64%. Fifty-four percent of house officers and substantial proportions of attending physicians and nurses reported, "At times, I have acted against my conscience in providing treatment to children in my care." For example, 38% of critical care attending physicians and 25% of hematology/oncology attending physicians expressed these concerns, whereas 48% of critical care nurses and 38% of hematology/oncology nurses did so. Across specialties, approximately 20 times as many nurses, 15 times as many house officers, and 10 times as many attending physicians agreed with the statement, "Sometimes I feel we are saving children who should not be saved," as agreed with the statement, "Sometimes I feel we give up on children too soon." However, hematology/oncology attending physicians (31%) were less likely than critical care (56%) and other subspecialty (66%) attending physicians to report, "Sometimes I feel the treatments I offer children are overly burdensome." Many respondents held views that diverged widely from published recommendations. Despite a lack of awareness of key guidelines, across subspecialties the vast majority of attending physicians (range: 92-98%, depending on specialty) and nurses (range: 83-85%) rated themselves as somewhat to very knowledgeable regarding ethical issues. CONCLUSIONS: There is a need for more hospital-based ethics education and more interdisciplinary and cross-subspecialty discussion of inherently complex and stressful pediatric end-of-life cases. Education should focus on establishing appropriate goals of care, as well as on pain management, medically supplied nutrition and hydration, and the appropriate use of paralytic agents. More research is needed on clinicians' regard for the dead-donor rule.
2005
Solomon MZ; Sellers DE; Heller KS; Dokken DL; Levetown M; Rushton C; Truog RD; Fleischman AR
Pediatrics
2005
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Journal Article
<a href="http://doi.org/10.1542/peds.2004-0905" target="_blank" rel="noreferrer">10.1542/peds.2004-0905</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>
What we still don't know about treating chronic noncancer pain with opioids
Humans; Practice Guidelines as Topic; Analgesics; Chronic disease; Pain/drug therapy; Opioid/therapeutic use
2010
Chou R
Canadian Medical Association Journal
2010
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Journal Article
<a href="http://doi.org/10.1503/cmaj.100548" target="_blank" rel="noreferrer">10.1503/cmaj.100548</a>
Pain management: a fundamental human right
Humans; Analgesics; Chronic disease; Opioid/therapeutic use; Human Rights/legislation & jurisprudence; Pain/epidemiology/therapy; Drug and Narcotic Control/legislation & jurisprudence; World Health Organization
This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the Study of Pain (IASP) Chapters-, International Association for the Study of Pain- and World Health Organization-sponsored "Global Day Against Pain," where it was adopted as a central theme. We survey the scope of the problem of unrelieved pain in three areas, acute pain, chronic noncancer pain, and cancer pain, and outline the adverse physical and psychological effects and social and economic costs of untreated pain. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. The biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Strategies currently applied for improvement include framing pain management as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. The role of the World Health Organization is discussed, particularly with respect to opioid availability for pain management. We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.
2007
Brennan F; Carr DB; Cousins M
Anesthesia & Analgesia
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/10.1213/01.ane.0000268145.52345.55" target="_blank" rel="noreferrer">10.1213/01.ane.0000268145.52345.55</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>
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>