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Azhar A, Hui D. Management of Physical Symptoms in Patients with Advanced Cancer During the Last Weeks and Days of Life. Cancer Res Treat 2022; 54:661-670. [PMID: 35790195 PMCID: PMC9296923 DOI: 10.4143/crt.2022.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Patients with advanced cancer are faced with many devastating symptoms in the last weeks and days of life, such as pain, delirium, dyspnea, bronchial hypersecretions (death rattle), and intractable seizures. Symptom management in the last weeks of life can be particularly challenging because of the high prevalence of delirium complicating symptom assessment, high symptom expression secondary to psychosocial and spiritual factors, limited life-expectancy requiring special considerations for prognosis-based decision-making, and distressed caregivers. There is a paucity of research involving patients in the last weeks of life, contributing to substantial variations in clinical practice. In this narrative review, we shall review the existing literature and provide a practical approach to in-patient management of several of the most distressing physical symptoms in the last weeks to days of life.
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Dyal BW, Powell-Roach KL, Robison J, Campbell B, Yoon SL, Wilkie DJ. Sublingual Versus Swallowed Morphine: A Comparison. Cancer Nurs 2021; 44:E13-E22. [PMID: 31895174 DOI: 10.1097/ncc.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The optimal route for immediate-release morphine administration is controversial. The known physical characteristics of morphine that allow absorption are counter to the unproven belief that sublingual morphine is absorbed more quickly. OBJECTIVE The aim of this study was to compare swallowed and sublingual morphine for effects on plasma morphine concentrations (PMCs), pain relief, and taste. METHODS Ten participants with cancer (mean age, 50 ± 12 years) received a 10-mg morphine tablet in a randomized crossover design with repeated premeasure and postmeasure for 60 minutes. Measures included PMC and visual analog scale (100 mm) scores for pain relief and taste. RESULTS Interindividual variability in maximum PMC was 25-fold (2.2-55 ng/mL). At 60 minutes, sublingual and swallowed routes were not significantly different for mean area under the curve for PMC (swallowed, 329 ± 314 ng/mL; sublingual, 314 ± 299 ng/mL) or for mean pain relief scores (swallowed, 81 ± 32; sublingual, 78 ± 31). Taste scores at 5 (P < .05), 10 (P < .04), 15 (P < .02), and 20 (P < .04) minutes after swallowed doses were significantly less unpleasant than after sublingual doses. CONCLUSION In this crossover design, between-group PMCs were similar for sublingual and swallowed morphine and resulted in a similar level of pain relief. Given the 25-fold across-participant differences in PMC after the same dose, additional research is warranted to identify the sources of this tremendous variability in PMC. IMPLICATIONS FOR PRACTICE Because of unpleasant taste, which could influence adherence and subsequent analgesia, clinicians should encourage patients to swallow their morphine doses and restrict use of sublingual morphine to individuals who are unable to swallow.
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Affiliation(s)
- Brenda W Dyal
- Author Affiliations: Department of Biobehavioral Nursing Science, College of Nursing (Drs Dyal, Powell-Roach, Yoon, and Wilkie), and Department of Community Dentistry and Behavioral Science, College of Dentistry (Dr Powell-Roach), University of Florida, Gainesville; Center for Palliative Care Research & Education (Drs Dyal, Powell-Roach, Yoon, and Wilkie), Gainesville, Florida; Multicare Deaconess Cancer and Blood Specialty Center (Dr Robison); and School of Nursing and Human Physiology, Gonzaga University (Dr Robison), Spokane, Washington; and University of Wisconsin Carbone Cancer Center (Ms Campbell), Madison
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Ripamonti C, Zecca E, De Conno F. Pharmacological Treatment of Cancer Pain: Alternative Routes of Opioid Administration. TUMORI JOURNAL 2018; 84:289-300. [PMID: 9678610 DOI: 10.1177/030089169808400302] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related pain is present in 51% of patients at various stages of the disease, and the incidence increases up to 74% in advanced and terminal stages. The World Health Organization proposed and issued very simple guidelines for the pharmacologic treatment of cancer-related pain. According to the guidelines, opioid analgesics are the mainstay of analgesic therapy, and the first choice for drug administration is considered to be the oral route. However, in some clinical situations, the oral route is not feasible, and analgesic drugs consequently have to be administered via an alternative route. For example, this is the case when the patient presents vomiting, bowel obstruction, severe dysphagia, mental confusion and when the opioid dose has to be increased drastically in order to achieve adequate pain control. This review of the literature is aimed at describing the indications, the limits and the main aspects of the pharmacokinetics and pharmacodynamics relative to the alternative routes of administration of opioids most commonly used in clinical practice. Sublingual, rectal, subcutaneous, intravenous, transdermal and spinal administration routes are examined.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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Bonomi M, Batt K. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients. Cancers (Basel) 2015; 7:1743-57. [PMID: 26404378 PMCID: PMC4586795 DOI: 10.3390/cancers7030862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/17/2022] Open
Abstract
Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients' quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies.
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Affiliation(s)
- Marcelo Bonomi
- Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical CenterBoulevard, Winston-Salem, NC 27157, USA.
| | - Katharine Batt
- Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical CenterBoulevard, Winston-Salem, NC 27157, USA.
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Meng J, Yu H, Ma J, Wang J, Banerjee S, Charboneau R, Barke RA, Roy S. Morphine induces bacterial translocation in mice by compromising intestinal barrier function in a TLR-dependent manner. PLoS One 2013; 8:e54040. [PMID: 23349783 PMCID: PMC3548814 DOI: 10.1371/journal.pone.0054040] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/07/2012] [Indexed: 01/08/2023] Open
Abstract
Opiates are among the most prescribed drugs for pain management. However, morphine use or abuse results in significant gut bacterial translocation and predisposes patients to serious infections with gut origin. The mechanism underlying this defect is still unknown. In this report, we investigated the mechanisms underlying compromised gut immune function and bacterial translocation following morphine treatment. We demonstrate significant bacterial translocation to mesenteric lymph node (MLN) and liver following morphine treatment in wild-type (WT) animals that was dramatically and significantly attenuated in Toll-like receptor (TLR2 and 4) knockout mice. We further observed significant disruption of tight junction protein organization only in the ileum but not in the colon of morphine treated WT animals. Inhibition of myosin light chain kinase (MLCK) blocked the effects of both morphine and TLR ligands, suggesting the role of MLCK in tight junction modulation by TLR. This study conclusively demonstrates that morphine induced gut epithelial barrier dysfunction and subsequent bacteria translocation are mediated by TLR signaling and thus TLRs can be exploited as potential therapeutic targets for alleviating infections and even sepsis in morphine-using or abusing populations.
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Affiliation(s)
- Jingjing Meng
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Haidong Yu
- Department of Surgery, Division of Infection, Inflammation, and Vascular Biology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Jing Ma
- Department of Surgery, Division of Infection, Inflammation, and Vascular Biology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Jinghua Wang
- Department of Surgery, Division of Infection, Inflammation, and Vascular Biology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Santanu Banerjee
- Department of Surgery, Division of Infection, Inflammation, and Vascular Biology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Rick Charboneau
- Department of Surgery, Veterans Affairs Medical Center, Minneapolis, Minnesota, United States of America
| | - Roderick A. Barke
- Department of Surgery, Veterans Affairs Medical Center, Minneapolis, Minnesota, United States of America
| | - Sabita Roy
- Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Department of Surgery, Division of Infection, Inflammation, and Vascular Biology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- * E-mail:
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Parsons HA, Shukkoor A, Quan H, Delgado-Guay MO, Palmer JL, Fainsinger R, Bruera E. Intermittent subcutaneous opioids for the management of cancer pain. J Palliat Med 2009; 11:1319-24. [PMID: 19115891 DOI: 10.1089/jpm.2008.0155] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Henrique A Parsons
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
OBJECTIVE To review strategies for treating patients with breakthrough pain (BTP). DESIGN This review is based on expert consensus recommendations for treating BTP and is supplemented by recent clinical studies and the author's clinical experience. RESULTS Breakthrough pain is severe or excruciating pain of rapid onset that can disable or even immobilize the patient. Patients with BTP should be assessed after baseline persistent pain has been stabilized with around-the-clock (ATC) analgesics. Clues about the cause and pattern of BTP may be identified from a patient history, preferably including a pain diary. Effective treatment can greatly improve the patient's quality of life and should be tailored for each patient, taking into consideration the cause and type of the BTP episodes. Short-acting opioid analgesics are the primary treatment. The absorption characteristics, onset of action, and duration of effect vary among the available opioid compounds based on their lipophilicity. The dose and/or dosing frequency of the ATC analgesic should be adjusted for patients with end-of-dose BTP. Short-acting oral opioids are useful when given preemptively in patients with predictable incident BTP, while rapid-onset transmucosal lipophilic opioids are most effective for patients with unpredictable incident or idiopathic BTP. Regardless of the subtype of BTP, nonpharmacologic strategies are often helpful in alleviating pain and anxiety and should be used to supplement pharmacologic intervention for BTP. CONCLUSION Breakthrough pain can often be successfully treated by tailoring opioid therapy based on the subtype of BTP. These characteristics of BTP will determine the most appropriate opioid compound (i.e., hydrophilic vs lipophilic) and most effective mode of drug delivery.
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Abstract
Patients with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Clinicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.
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Affiliation(s)
- Lewis M Cohen
- Renal Palliative Care Initiative, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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Cerchietti LCA, Navigante AH, Körte MW, Cohen AM, Quiroga PN, Villaamil EC, Bonomi MR, Roth BM. Potential utility of the peripheral analgesic properties of morphine in stomatitis-related pain: a pilot study. Pain 2003; 105:265-73. [PMID: 14499444 DOI: 10.1016/s0304-3959(03)00227-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To determine the potential clinical utility of peripheral opioid action using a clinical model of cancer treatment-induced inflammation and pain that allowed for topical application of morphine in the damaged tissue (oral mucosa). This pilot study followed a two blocks design. Ten patients with painful oral mucositis were enrolled in the first block (dose-response relationship finding) and randomized in two groups to receive oral rinses with 15 ml of either 1 per thousand or 2 per thousand morphine solution. Twenty-two patients were enrolled into the second block (efficacy and safety determination). Additionally, serum concentrations of morphine were measured in five representative patients. In the first block (n=10) a dose-response relationship for topical morphine was found. Rinses with 2 per thousand -morphine solution showed better pain relief (median 80%, range 70-80%) than those with 1 per thousand (median 60%, range 55-70%; P=0.0238). Therefore, subsequent patients enrolled for the second block (n=22) received oral rinses with 2 per thousand -morphine solution. In these patients the time to good (>or=50%) or to complete (100%) pain relief was 28 (+/-12)min after the first mouthwash, and the duration of relief was on average 216 (+/-25)min. Twenty patients (90%) received the successive mouthwashes every 3 h and 10% of them every 2 h. The duration of severe pain at the moment of swallowing was 5.17 (+/-1.47) days. Only six patients needed supplementary analgesia, and the time elapsed before the first supplemental analgesic was 1.18 (+/-0.8) days. The duration of severe functional impairment was 1.52 (+/-1.31) days, thus allowing us to feed the patient by mouth with liquid-food supplementation. During our experiment no systemically active detectable concentrations of morphine were found (GC-MS analysis). The most important side effect attributable to morphine mouthwashes was burning/itching sensation (very mild to mild intensity). Patients with painful chemoradiotherapy-induced stomatitis could be alleviated using topical morphine mouthwashes.
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Affiliation(s)
- Leandro C A Cerchietti
- Translational Research Unit, Angel H Roffo Cancer Institute, University of Buenos Aires, Ecuador 1573 1p 3, 1425, Buenos Aires, Argentina.
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Cerchietti LCA, Navigante AH, Bonomi MR, Zaderajko MA, Menéndez PR, Pogany CE, Roth BMC. Effect of topical morphine for mucositis-associated pain following concomitant chemoradiotherapy for head and neck carcinoma. Cancer 2002; 95:2230-6. [PMID: 12412178 DOI: 10.1002/cncr.10938] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oral mucositis is the dose-limiting toxicity for patients receiving concurrent chemoradiotherapy regimens for tumors of the head and neck area. Currently, the management of established mucositis includes the use of topical anesthetics and systemic analgesics. Based on the clinical evidence of pain alleviation by topical morphine in patients with some inflammatory and painful conditions, a clinical study was undertaken to determine this effect on mucositis-associated pain. METHODS Twenty-six patients with head and neck malignancies treated with concomitant chemoradiotherapy for head and neck carcinoma who had severe painful mucositis (World Health Organization Grade 2 or higher) were enrolled. Patients were randomly assigned to morphine mouthwash (MO; 14 patients) or magic mouthwash (MG), a mixture of equal parts of lidocaine, diphenhydramine, and magnesium aluminum hydroxide (12 patients). RESULTS The duration of severe pain was 3.5 days less in the MO group compared with the MG group (P = 0.032). The intensity of oral pain was also significantly lower in the MO group compared with the MG group (P = 0.038). No patient in the MO group required third-step opiates for alleviation of the mouth pain. There was a significant difference in duration of severe functional impairment (P = 0.017). Five patients in the MG group complained of local side effects and only one in the MO group (P = 0.007). CONCLUSIONS For patients with head and neck carcinomas receiving concomitant chemoradiotherapy, MO is a simple and effective treatment to decrease the severity and duration of pain and the duration of functional impairment.
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Affiliation(s)
- Leandro C A Cerchietti
- Supportive Care Division, Department of Medical Oncology, Angel H. Roffo Cancer Institute, University of Buenos Aires, Buenos Aires, Argentina.
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Abstract
Choice of an analgesic for gastrointestinal pain requires consideration of the cause of the pain, desired duration of pain relief, need for sedation, and potential side effects and toxicity, particularly in light of other drugs being used and effects on the gastrointestinal tract. It is imperative that close monitoring be continued to ensure that surgical lesions or worsening conditions are detected. Recent research in the field may lead to new drugs, drug combinations, and avenues of treatment that minimize the side effects of these drugs while maximizing their efficacy.
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Affiliation(s)
- Erin Malone
- Department of Clinical and Population Sciences, University of Minnesota College of Veterinary Medicine, 225 K VTH, 1365 Gortner Avenue, St. Paul, MN 55108, USA
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Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, Ripamonti C, De Conno F. Episodic (breakthrough) pain: consensus conference of an expert working group of the European Association for Palliative Care. Cancer 2002; 94:832-9. [PMID: 11857319 DOI: 10.1002/cncr.10249] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breakthrough pain is transitory exacerbation of pain that occurs in addition to otherwise stable persistent pain. The wide differences in estimation of incidence reported in literature are probably because of different settings and meanings attributed to the definition of breakthrough pain. METHODS A panel of experts met to establish the actual knowledge on breakthrough pain, according to the evidence in literature and experience. They agreed that episodic or transient pain could be a more simple and adequate term in most languages, including English, French, Italian, and Spanish. RESULTS A specific assessment and precise pain characterization are essential to plan the most appropriate treatments. Despite the relevance of this temporal pain pattern for the influence on the outcome and quality of life, few controlled studies have been performed to give evidence of a specific approach. Several experiences have reported the possible efficacy of different drugs, route of administration, and modalities of administration in different circumstances. CONCLUSIONS Prospective studies with previous treatments using similar terminologies are necessary to find the most convenient therapeutic intervention, according to the temporal pattern characteristics and the pain mechanism involved.
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Abstract
In recent years a better understanding of the pharmacologic and pharmacokinetic properties of methadone, including equianalgesic ratios has led to its increased use as a second line opioid for the treatment of pain in patients with cancer. Methadone may be an important alternative for those who have side effects related to the use of other opioids because it has no known active metabolites, is well absorbed by oral and rectal routes, and also has the advantage of very low cost. However, it has a long, unpredictable half-life, which can result in accumulation and toxicity in some patients. In addition, rotation to methadone as a second line agent is more complex than with other opioids because of its increased potency in those patients who are opioid tolerant, particularly those who have been on higher doses of other opioids. Future research should address the use of methadone as a first-line agent in the management of cancer pain, its use in patients with neuropathic pain, and in those who develop rapid tolerance to other opioids. In some patients with cancer the long half-life of methadone offers the advantage of extended dosing intervals to 12 and even 24 hours, further research is also needed in this area.
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Affiliation(s)
- Eduardo Bruera
- Department of Symptom Control and Palliative Care, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-0049, USA.
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Engelhardt T, Crawford M. Sublingual morphine may be a suitable alternative for pain control in children in the postoperative period. Paediatr Anaesth 2001; 11:81-3. [PMID: 11123737 DOI: 10.1046/j.1460-9592.2001.00598.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to compare the effects of sublingual morphine with intravenous morphine in the treatment of postoperative pain following adenotonsillectomy in children. Twenty-nine children scheduled for adenotonsillectomy were randomly assigned to group 1 (n=14) receiving 0.1 mg x kg(-1) sublingual morphine and group 2 (n=15) 0.1 mg x kg(-1) intravenous morphine followed by 1 mg x kg(-1) diclofenac rectally in both groups after induction of anaesthesia. Postoperatively, time to first eye opening, sedation score, pain score, time for further analgesia requests and incidence of nausea and vomiting were recorded. There was no statistical significant difference in any of these parameters between the two groups. The results suggest that sublingual morphine may be a suitable alternative to various other routes of opioid administration in children, but further investigations of the sublingual route of administration of opioids in children are required.
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Affiliation(s)
- T Engelhardt
- Department of Anaesthesia and Intensive Care, Aberdeen Royal Hospital Trusts, Foresterhill, Aberdeen, UK
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Abstract
Fourteen patients with advanced cancer received intermittent subcutaneous injection of morphine using an Edmonton Injector (EI). Twelve patients used the system at home. The minimal dose of morphine was 15 mg every 4 hr and the maximal dose was 90 mg every 4 hr. There were two complications: abscess and bleeding. In developing countries, the safety, low cost, and versatility of the Edmonton Injector offers an important alternative in terminally ill patients. This device is an ideal "injection pump" for use in developing countries, where costs are most important in making treatment decisions.
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Affiliation(s)
- M Pruvost
- Pain and Palliative Medicine Section, Hospital San Roque, Córdoba, Argentina
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Abstract
Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. While surgery must remain the primary treatment for malignant obstruction, it is now recognized that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. This review examines the indications for surgery, the use of nasogastric tube and percutaneous gastrostomy, and the place of drugs for symptom control.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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de Conno F, Ripamonti C, Sbanotto A, Saita L, Zecca E, Ventafridda V. The pharmacological management of cancer pain. Part II: The role of opioid drugs in adults and children. Ann Oncol 1993; 4:267-76. [PMID: 8100145 DOI: 10.1093/oxfordjournals.annonc.a058481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- F de Conno
- Palliative Care Division, National Cancer Institute, Milan, Italy
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Cancer pain assessment and treatment curriculum guidelines. Support Care Cancer 1993. [DOI: 10.1007/bf00366898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ripamonti C, De Conno F, Ventafridda V, Rossi B, Baines MJ. Management of bowel obstruction in advanced and terminal cancer patients. Ann Oncol 1993; 4:15-21. [PMID: 8435356 DOI: 10.1093/oxfordjournals.annonc.a058345] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. PATIENTS AND METHOD Patients may develop bowel obstruction at any time in their clinical history, with an incidence ranging from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or diffuse carcinomatosis. The symptoms which are almost always present are intestinal colic (reported in 72%-76% of patients), abdominal pain due to distension, hepatomegaly or tumor masses (in 92% of patients) and vomiting (68%-100%) of cases. CONCLUSION While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.
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Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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Bruera E, Schoeller T, Fainsinger RL, Kastelan C. Custom-made suppositories of methadone for severe cancer pain. J Pain Symptom Manage 1992; 7:372-4. [PMID: 1517654 DOI: 10.1016/0885-3924(92)90093-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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