Prospective audit of short-term concurrent ketamine, opioid and anti-inflammatory ('triple-agent') therapy for episodes of acute on chronic pain
Humans; Adult; Analgesics; Prospective Studies; Aged; Middle Aged; Acute Disease; 80 and over; Oxycodone/administration & Pain/drug therapy; Analgesics/administration & dosage; Combination; Dexamethasone/administration & Drug Therapy; Hydromorphone/administration & Ketamine/administration & Ketorolac/administration & Male; Non-Steroidal/administration & Chronic Disease; Opioid/administration & Anti-Inflammatory Agents
AIM: This prospective audit was undertaken in order to document the analgesic response and adverse effects of concurrent short-term ('burst') triple-agent analgesic (ketamine, an opioid and an anti-inflammatory agent--either steroidal or non-steroidal) administration, for episodes of acute on chronic pain. The clinical hypothesis in this study is that better pain control may be obtained by simultaneous multiple target receptor blockade. METHOD: The response of 18 patients is reported. The pain and analgesic requirement data for the 24 h before starting triple-agent therapy were compared with the last 24 h on the triple-agent therapy. Patients were then classified as responders or non-responders. RESULTS : According to stringent clinical criteria, 12 out of the 18 patients were classified as responders. The response rate was highest for somatic pain (7/9) and appeared to decrease with duration of prior uncontrolled pain. Only four out of the 18 patients reported adverse effects and all of these were minor. CONCLUSIONS: The results suggest that this 'burst' triple-agent approach is safe and effective in an inpatient palliative care population during episodes of poorly controlled acute on chronic pain, and warrants further investigation to ascertain whether it gives superior results compared to the 'gold-standard' WHO ladder approach.
2005
Good P; Tullio F; Jackson K; Goodchild C; Ashby M
Internal Medicine Journal
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/10.1111/j.1445-5994.2004.00727.x" target="_blank" rel="noreferrer">10.1111/j.1445-5994.2004.00727.x</a>
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
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/(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>
Morphine and alternative opioids in cancer pain: the EAPC recommendations
Humans; Analgesics; Drug Administration Schedule; Administration; Oral; Palliative Care/standards; Injections; Intravenous; Subcutaneous; Oxycodone/administration & Pain/drug therapy; Opioid/administration & dosage/adverse effects/therapeutic use; Spinal; Chemistry; Fentanyl/administration & dosage/therapeutic use; Hydromorphone/administration & Infusions; Methadone/pharmacokinetics/therapeutic use; Morphine/administration & Neoplasms/drug therapy; Pharmaceutical
An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.
2001
Hanks GW; Conno F; Cherny NI; Hanna M; Kalso E; McQuay HJ; Mercadante S; Meynadier J; Poulain P; Ripamonti C; Radbruch L; Casas JR; Sawe J; Twycross RG; Ventafridda V; Expert Working Group of the Research Network of the European Association for Palliative Care
British Journal Of Cancer
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/10.1054/bjoc.2001.1680" target="_blank" rel="noreferrer">10.1054/bjoc.2001.1680</a>