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Gabriela P Peirano, Guillermo P Mammana, Mariela S Bertolino, Tania Pastrana, Gloria F Vega, Jorgelina Russo, Gabriela Varela, Ernesto Vignaroli, Raúl Ruggiero, Arnaldo Armesto, Gabriela Camerano, Graciela Dran
PURPOSE: The use of methadone for cancer pain is limited by the need of expertise and close titration due to variable half-life. Yet, it is a helpful palliative strategy in low-resources countries given its long-acting effect at low cost and worth additional study. Our aim was to describe the prescription and outcomes of methadone as a first-line treatment for cancer pain in a tertiary palliative care unit (PCU) in Argentina. METHODS: Retrospective review of medical records of patients with moderate to severe cancer pain seen at the PCU in 1-year period, who initiated strong opioids at the first consultation...
August 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Elias Veizi, Melissa Tornero-Bold, Salim M Hayek
INTRODUCTION: Intrathecal therapy [IT] has become an important modality for treatment of intractable cancer and noncancer pain although adverse events limit its effectiveness. OBJECTIVE: The purpose of this case series was to report and discuss the lower limb edema from IT hydromorphone and morphine therapy and its resolution or nonrecurrence upon rotating the IT solution to fentanyl. METHODS: Case series. RESULTS: Five patients, 4 women and 1 man, 55 to 67 years old implanted with IT delivery device systems [IDDS] were treated with continuous infusion of hydromorphone [4 subjects] at 95 ± 40 mcg/24 hours and morphine [1 subject] at 0...
July 2016: Pain Practice: the Official Journal of World Institute of Pain
Agnieszka M Jurga, Ewelina Rojewska, Anna Piotrowska, Wioletta Makuch, Dominika Pilat, Barbara Przewlocka, Joanna Mika
Accumulating evidence indicates that microglial TLR2 and TLR4 play a significant role in nociception. Experiments were conducted to evaluate the contribution of TLR2 and TLR4 and their adaptor molecules to neuropathy and their ability to amplify opioid effectiveness. Behavioral tests (von Frey's and cold plate) and biochemical (Western blot and qRT-PCR) analysis of spinal cord and DRG tissue were conducted after chronic constriction injury (CCI) to the sciatic nerve. Repeated intrathecal administration of LPS-RS (TLR2 and TLR4 antagonist) and LPS-RS Ultrapure (TLR4 antagonist) attenuated allodynia and hyperalgesia...
2016: Neural Plasticity
Nobushige Yabe, Shinji Murai, Yoko Harada, Takahiro Yokose, Takamichi Yokoe, Ippei Oto, Takahisa Yoshikawa, Kenjiro Kitasato, Hirotomo Shimizu, Hiromitsu Jinno, Yuko Kitagawa
A 51-year-old woman had previously received treatment for breast cancer at another hospital but had refused early and aggressive treatment. Therefore, she was treated with symptomatic therapy. As her disease progressed, the patient wished to receive palliative care, and was transferred to a palliative care hospital. However, based on her general condition, it was determined that aggressive treatment should not be abandoned, and she was referred to our hospital for treatment. During her initial visit, the patient was found to have left breast cancer with chest wall invasion, right breast metastasis, multiple liver and lung metastases, left pleural effusion accompanied by pleural dissemination, and left upper limb edema...
November 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Jeffrey Gudin, Jeffrey Fudin, Srinivas Nalamachu
Levorphanol is a potent opioid analgesic that was first approved for use in the United States in 1953. Levorphanol is approved for use in moderate to severe pain where an opioid analgesic is appropriate. Levorphanol has a wide range of activities including mu opioid agonism, delta agonism, kappa1 and kappa3 receptor agonism, N-methyl-d-aspartate receptor antagonism and reuptake inhibition of both norepinephrine and serotonin. This multimodal profile might prove effective for pain syndromes that are refractory to other opioid analgesics, such as central and neuropathic pain and opioid-induced hyperalgesia...
January 2016: Postgraduate Medicine
Jayne Pawasauskas
Opioid rotation is a practice used when patients with chronic pain have insufficient analgesia, experience unwanted opioid-related adverse reactions, or other pharmacologic challenges with their current opioid. Methadone is an opioid with unique pharmacological properties, which render it clinically distinct from other opioids. The drug's potential clinical benefits in treating nociceptive and neuropathic pain are coupled with risks of serious, life-threatening adverse reactions. Its unique pharmacokinetic profile contributes added complexity; therefore, clinicians should be experienced with its dosing and monitoring...
September 2015: Journal of Opioid Management
Veronica Carullo, Ingrid Fitz-James, Ellise Delphin
Opioids are utilized frequently for the treatment of moderate to severe acute pain in the perioperative setting, as well as in the treatment of cancer-related pain. When prescribing chronic opioid therapy to patients with chronic pain, it is crucial for the practitioner to be aware not only of the issues of tolerance and withdrawal, but also to have knowledge of the possibility for opioid-induced hyperalgesia (OIH). An understanding of the differences between tolerance and OIH when escalating opioid therapy allows the titration of opioid as well as nonopioid analgesics in order to obtain maximum control of both chronic and acute pain...
2015: Journal of Pain & Palliative Care Pharmacotherapy
Akhila Reddy, Supakarn Tayjasanant, Ali Haider, Yvonne Heung, Jimin Wu, Diane Liu, Sriram Yennurajalingam, Suresh Reddy, Maxine de la Cruz, Eden Mae Rodriguez, Jessica Waletich, Marieberta Vidal, Joseph Arthur, Carolyn Holmes, Kimmie Tallie, Angelique Wong, Rony Dev, Janet Williams, Eduardo Bruera
BACKGROUND: Transdermal fentanyl (TDF) is 1 of the most common opioids prescribed to patients with cancer. However, the accurate opioid rotation ratio (ORR) from other opioids to TDF is unknown, and various currently used methods result in wide variation of the ORR. The objective of this study was to determine the ORR of the oral morphine equivalent daily dose (MEDD) to the TDF dose when correcting for the MEDD of breakthrough opioids (the net MEDD) in cancer outpatients. METHODS: The records of 6790 consecutive patients were reviewed at the authors' supportive care center from 2010 to 2013 to identify those who underwent rotation from other opioids to TDF...
January 1, 2016: Cancer
Hyun-Jun Kim, Young Saing Kim, Se Hoon Park
BACKGROUND: For cancer patients with inadequate pain relief, a switch to an alternative opioid is the preferred option for symptomatic improvement. However, multiple opioids are often simultaneously administered for anecdotal reasons. This prospective study evaluated pain response to either opioid rotation or combination in patients with uncontrolled cancer pain. METHODS: Patients suffering with uncontrolled cancer pain despite dose titration were randomly assigned to opioid rotation group or opioid combination group...
September 16, 2015: BMC Palliative Care
Doralina L Anghelescu, Jennifer M Snaman, Luis Trujillo, April D Sykes, Y Yuan, Justin N Baker
BACKGROUND: Patient controlled anesthesia (PCA) is increasingly used to manage pain in pediatric cancer patients and is important in the treatment of escalating pain at the end of life. The description of the use of opioid PCA in this population has been limited. PROCEDURE: This retrospective chart review of the last 2 weeks of life addressed the following objectives: (1) to describe the patient population treated with opioid PCA; (2) to describe the morphine-equivalent doses (MED) (mg/kg/day); and (3) to describe the pain scores (PS)...
July 2015: Pediatric Blood & Cancer
Jesús González-Barboteo, Xavier Gómez-Batiste Alentorn, Felipe A Calvo Manuel, Vicente Alberola Candel, M Amalia Palacios Eito, Isabel Sánchez-Magro, Marta Neira Álvarez, F Javier Pérez Martín, Josep Porta-Sales
OBJECTIVE: To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR. SETTING: Thirty-nine tertiary hospital services. PATIENTS: Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics. INTERVENTION: Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (NRS) of 0-10. Average pain (AP) intensity in the last 24 hours, breakthrough pain (BTP), and the number of episodes of BTP on the days before and 1 week after OR were assessed...
November 2014: Journal of Opioid Management
Stephan A Schug, Chandani Chandrasena
INTRODUCTION: Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. AREAS COVERED: The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based...
January 2015: Expert Opinion on Pharmacotherapy
Tsubasa Sasaki, Izumi Kawagoe
Since the launch of pure oxycodone injections in May 2012, it has been possible to use oxycodone without opioid rotation. Although an extremely important step showing progress, very few studies regarding the use of pure oxycodone injections have been performed. In this study, we evaluated the safety and efficacy of pure oxycodone injections in 31 terminally ill cancer patients receiving home care. The difficulty in oral oxycodone intake was the main reason for changing to pure oxycodone injections. The mean administered period of subcutaneous pure oxycodone was 5...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Howard S Smith, John F Peppin
Patients requiring chronic opioid therapy may not respond to or tolerate the first opioid prescribed to them, necessitating rotation to another opioid. They may also require dose increases for a number of reasons, including worsening disease and increased pain. Dose escalation to restore analgesia using the primary opioid may lead to increased adverse events. In these patients, rotation to a different opioid at a lower-than-equivalent dose may be sufficient to maintain adequate tolerability and analgesia. In published trials and case series, opioid rotation is performed either using a predetermined substitute opioid with fixed conversion methods, or in a manner that appears to be no more systematic than trial and error...
2014: Journal of Pain Research
Akhila Reddy, Sriram Yennurajalingam, Hem Desai, Suresh Reddy, Maxine de la Cruz, Jimin Wu, Diane Liu, Eden Mae Rodriguez, Jessica Waletich, Seong Hoon Shin, Vicki Gayle, Pritul Patel, Shalini Dalal, Marieberta Vidal, Kimberson Tanco, Joseph Arthur, Kimmie Tallie, Janet Williams, Julio Silvestre, Eduardo Bruera
PURPOSE: Cancer pain management guidelines recommend initial treatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients. PATIENTS AND METHODS: We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids...
November 2014: Oncologist
Joseph Arthur, Sriram Yennurajalingam, Linh Nguyen, Kimberson Tanco, Gary Chisholm, David Hui, Eduardo Bruera
OBJECTIVE: There is no standardized and universally accepted pain classification system for the assessment and management of cancer pain in both clinical practice and research studies. The Edmonton Classification System for Cancer Pain (ECS-CP) is an assessment tool that has demonstrated value in assessing pain characteristics and response. The purpose of our study was to determine the relationship between negative ECS-CP features and some pain-related variables like pain intensity and opioid use...
October 2015: Palliative & Supportive Care
Takahiro Hayashi, Saori Ikehata, Haruna Matsuzaki, Kimio Yasuda, Toshiyasu Makihara, Akihiko Futamura, Yuki Arakawa, Rika Kuki, Kumiko Fukuura, Hiroshi Takahashi, Naoharu Mori, Takashi Higashiguchi, Shigeki Yamada
Morphine, oxycodone, and fentanyl are commonly used to control cancer pain. Because these drugs have differences in receptor affinity or pharmacokinetic parameters, changing the opioid formulation may result in an unexpected outcome, depending on the patient's condition. This study investigated whether low serum protein levels influence the effectiveness of opioid rotation by determining the impact of serum albumin levels on the analgesic effect before and after opioid rotation from morphine or oxycodone to fentanyl in cancer patients...
December 1, 2014: Biological & Pharmaceutical Bulletin
Sriram Yennurajalingam, Eduardo Bruera
PURPOSE OF REVIEW: Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects. RECENT FINDINGS: Only two placebo-controlled double-blinded randomized studies on corticosteroid for symptoms that met the inclusion criteria were published recently, despite the criteria being extended beyond 2012 and 2013...
December 2014: Current Opinion in Supportive and Palliative Care
Chi Wai Cheung, Qiu Qiu, Siu-Wai Choi, Brendan Moore, Roger Goucke, Michael Irwin
BACKGROUND: Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. STUDY DESIGN: Review and summary of practice guidelines available on PubMed and Cochrane databases as well as on the Internet on chronic opioid therapy from June 2004 to June 2013. OBJECTIVE: To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence...
September 2014: Pain Physician
Spencer Dorn, Anthony Lembo, Filippo Cremonini
Opioids affect motor and sensory function throughout the gastrointestinal tract, and are frequently associated with a number of gastrointestinal symptoms including constipation, which impairs the quality of life and may limit the dose of opioid or result in discontinuation altogether. Patients with opioid-induced constipation should be assessed by careful history and physical examination, and in some cases where the diagnosis is unclear with select diagnostic tests. Few clinical studies have been conducted to assess the efficacy of various treatments...
September 10, 2014: American Journal of Gastroenterology Supplements (Print)
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