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https://www.readbyqxmd.com/read/29123358/chronic-cancer-pain-diagnostic-dilemma-and-management-challenges
#1
Deepti Ahuja, Sachidanand Jee Bharati, Seema Mishra, Sushma Bhatnagar
A 32-year-old female, diagnosed case of neuroendocrine tumor of pancreas, was admitted to the pain and palliative care unit with complaints of diffuse abdominal pain which was severe in intensity with score on numerical rating scale-9/10. Pain was not relieved even after taking tablet morphine immediate release 360 mg every 4 hourly, paracetamol 500 mg 6 hourly, and gabapentin 300 mg 8 hourly. She had undergone distal pancreatectomy with splenectomy and also received multiple lines of chemotherapy. After making a diagnosis of opioid-induced hyperalgesia, opioid rotation from morphine to fentanyl was done...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28913486/the-switch-from-buprenorphine-to-tapentadol-is-it-worth
#2
REVIEW
Adriana Miclescu
Opioid analgesia continues to be the primary pharmacologic intervention for managing acute pain and malignant pain in both hospitalized and ambulatory patients. The increasing use of opioids in chronic nonmalignant pain is more problematic. Opioid treatment is complicated with the risks raised by adverse effects, especially cognitive disturbance, respiratory depression but also the risk of tolerance, opioid abuse and drug-disease interactions. Despite the growing number of available opioids within the last years, adequate trials of opioid rotation are lacking and most of the information is anecdotal...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28731784/response-to-the-article-overall-survival-among-cancer-patients-undergoing-opioid-rotation-to-methadone-compared-to-other-opioids
#3
Marieke H J van den Beuken-van Everdingen, Sander M J van Kuijk, Elbert A Joosten
No abstract text is available yet for this article.
November 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28711751/the-conversion-ratio-from-intravenous-hydromorphone-to-oral-opioids-in-cancer-patients
#4
Akhila Reddy, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Sara Dost, Ann Nguyen, Yvonne Heung, Simeon Kwan, Angelique Wong, Imelda Pangemanan, Ahsan Azhar, Supakarn Tayjasanant, Edenmae Rodriguez, Jessica Waletich, Kyu-Hyoung Lim, Jimin Wu, Diane Liu, Janet Williams, Sriram Yennurajalingam, Eduardo Bruera
CONTEXT: The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients. OBJECTIVES: We aimed to determine the CR and ORR from IV hydromorphone to oral hydromorphone and MEDD (obtained from oral morphine and oxycodone). METHODS: A total of 4745 consecutive inpatient palliative care consults during 2010-14 were reviewed for conversions from IV hydromorphone to oral hydromorphone, morphine or oxycodone...
September 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28700116/an-integrative-literature-review-exploring-the-clinical-management-of-delirium-in-patients-with-advanced-cancer
#5
REVIEW
Hayley Lawley, Alistair Hewison
AIM: The aim of this paper is to present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer. BACKGROUND: Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However the research into the effectiveness of treatments for delirium in people with advanced cancer is limited...
July 12, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28635354/the-effects-of-food-on-opioid-induced-nausea-and-vomiting-and-pharmacological-parameters-a-systematic-review
#6
REVIEW
Robert B Raffa, Robert Colucci, Joseph V Pergolizzi
Opioids remain the standard of care for treating moderate to severe pain resulting from surgery or injury in cases of acute pain, and are recommended for patients who have not responded to nonopioid analgesics. Effective management of pain has an impact on clinical course and often depends on achieving an acceptable balance between opioid efficacy, safety, and tolerability. Common opioid-related adverse events such as nausea and vomiting are associated with an overall lower achievement of effective pain management and patient satisfaction...
September 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28595427/challenging-equipotency-calculation-for-hydromorphone-after-long-term-intravenous-application
#7
Benjamin Luchting, Banafscheh Rachinger-Adam, Nikolai Hulde, Jens Heyn, Shahnaz Christina Azad
In advanced stages, most cancer patients suffer from pain which can usually be well controlled following the World Health Organization (WHO) level scheme. While the majority of patients report adequate pain relief by strong opioids (WHO III), some require an opioid rotation. Despite the existence of conversion tables, these rotations mea lead to inadequate pain control or life threatening events. Here, we report about a patient with urothelial cell carcinoma presenting in our Department of Pain Medicine with massive pain aggravation up to NRS values of 10/10 despite administration of the highest dose of intravenously applied hydromorphone...
March 16, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28371835/effectiveness-and-safety-of-once-daily-extended-release-hydrocodone-in-individuals-previously-receiving-immediate-release-oxycodone-for-chronic-pain
#8
Joseph Pergolizzi, Maribeth Kowalski, Ellie He
Objectives. : This study evaluated the safety and effectiveness of a once-daily, single-entity, extended-release hydrocodone bitartrate (HYD) among patients with chronic noncancer and non-neuropathic pain who required opioid rotation from a previous analgesic regimen that primarily consisted of immediate-release (IR) oxycodone. Methods. : Post hoc analyses of a primary study that assessed HYD 20 to 120 mg over a 52-week period are presented. The primary study included a dose titration period (up to 45 days), a 52-week maintenance period, and an optional taper period (up to 14 days)...
March 28, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28326948/rare-presentation-of-intrathecal-morphine-withdrawal-psychosis
#9
Rohit Aiyer, Vivek Jain, Anurag Bhatia, Boris Mekinulov, Semih Gungor
We report a case of a 57-year-old male patient with intrathecal morphine pump failure who presented with psychosis as part of a clinical presentation of opioid withdrawal. The patient was being treated for chronic back pain with an intrathecal morphine pump for several years. The patient spontaneously started to experience psychotic symptoms which included disorganized thinking, delusional thoughts, paranoia, auditory and visual hallucinations. Upon interrogation of intrathecal pump, it was found not to be functioning, thereby not delivering intrathecal morphine...
February 28, 2017: Pain Management
https://www.readbyqxmd.com/read/28223843/the-use-of-rotation-to-fentanyl-in-cancer-related-pain
#10
Delia Dima, Ciprian Tomuleasa, Ioana Frinc, Sergiu Pasca, Lorand Magdo, Ioana Berindan-Neagoe, Mihai Muresan, Cosmin Lisencu, Alexandru Irimie, Mihnea Zdrenghea
Pain is commonly diagnosed with respect to cancer and heart diseases, being a major symptom in most neoplastic diseases. Uncontrolled pain leads to a decrease in the quality of life and an increase in the morbidity of the patient. Opioids represent the best analgetic supportive therapy and are frequently used in patients suffering from cancer and experiencing a high level of pain. Opioid treatment starts with a gradual titration of the dose until the minimum effective dose and the maximum tolerated dose are determined...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28162375/-153-levorphanol-another-choice-in-opioid-rotation
#11
S Nalamachu, J Gudin
No abstract text is available yet for this article.
April 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28156454/evaluating-the-prognostic-effect-of-a-pain-classification-system-in-patients-with-advanced-cancer
#12
Kimberson Cochien Tanco, Ali Haider, Courtney Maligi, Minjeong Park, Diane D Liu, Eduardo Bruera
95 Background: The Edmonton Classification System for Cancer Pain (ECS-CP) has been shown to predict pain management complexity based on five features: pain mechanism, incident pain, psychological distress, addictive behavior, and cognitive function. The main objective of our study was to explore the association between increasing sum of negative ECS-CP features and achievement of good pain control at first follow up visit at an outpatient palliative care clinic. METHODS: Initial and follow up clinical information of 409 eligible supportive care outpatients such as patient demographics, ECS-CP assessment, morphine equivalent daily dose (MEDD), opioid rotation, Edmonton Symptom Assessment Score (ESAS), and personalized pain goal (PPG) were retrospectively reviewed and analyzed...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156444/the-conversion-ratio-from-intravenous-iv-hydromorphone-to-oral-po-opioids-in-patients-with-cancer
#13
Sara Dost, Marieberta Vidal, Saneese Stephen, Karen Baumgartner, Jimin Wu, Diane D Liu, Sriram Yennu, Eduardo Bruera
197 Background: Inpatients with cancer frequently undergo conversions from IV to PO hydromorphone (HM) or opioid rotation (OR) from IV HM to another PO opioid prior to discharge. Currently used conversion ratios (CR) between IV and PO HM range from 2-5 and opioid rotation ratios (ORR) between IV HM and oral morphine equivalent daily dose (MEDD) range from 10-20. This large variation in ratios may lead to uncontrolled pain or overdosing. Our aim was to determine the accurate CR from IV to PO HM and ORR from IV HM to PO morphine and oxycodone (measured as MEDD)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27997283/overall-survival-among-cancer-patients-undergoing-opioid-rotation-to-methadone-compared-to-other-opioids
#14
Akhila Reddy, Ulrich S Schuler, Maxine de la Cruz, Sriram Yennurajalingam, Jimin Wu, Diane Liu, Eduardo Bruera
BACKGROUND: Methadone has been associated with lower overall survival (OS) in patients with chronic pain. There are no data available on the association of methadone with OS in cancer patients. OBJECTIVE: Our aim was to compare the OS in cancer outpatients undergoing opioid rotation (OR) to methadone and other strong opioids. DESIGN: Demographics, symptoms, and morphine equivalent daily dose (MEDD) were collected in patients who underwent OR from strong opioids to either methadone or other strong opioids and returned for a follow-up within six weeks...
June 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27807793/opioids-and-gi-motility-friend-or-foe
#15
REVIEW
Allen A Lee, William L Hasler
The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS)...
December 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27022964/methadone-as-first-line-opioid-treatment-for-cancer-pain-in-a-developing-country-palliative-care-unit
#16
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
https://www.readbyqxmd.com/read/26990069/resolution-of-intrathecal-hydromorphone-or-morphine-induced-peripheral-edema-by-opioid-rotation-to-fentanyl-a-case-series
#17
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...
2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/26962463/blockade-of-toll-like-receptors-tlr2-tlr4-attenuates-pain-and-potentiates-buprenorphine-analgesia-in-a-rat-neuropathic-pain-model
#18
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
https://www.readbyqxmd.com/read/26805183/-a-case-of-advanced-breast-cancer-in-which-marked-improvement-of-joint-pain-was-obtained-with-stepwise-dose-reduction-of-trastuzumab-emtansine-t-dm1
#19
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
https://www.readbyqxmd.com/read/26635068/levorphanol-use-past-present-and-future
#20
REVIEW
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
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