Sharon M. Weinstein

Controlled-release oxycodone compared with controlled-release morphine in the treatment of cancer pain: a randomized, double-blind, parallel-group study.

Controlled‐release oral formulations of oxycodone and morphine are both suitable analgesics for moderate to severe pain. They were compared in cancer‐pain patients randomized to double‐blind treatment with controlled‐release oxycodone (n = 48) or controlled‐release morphine (n = 52) every 12 h for up to 12 days. Stable analgesia was achieved by 83% of controlled‐release oxycodone and 81% of controlled‐release morphine patients in 2 days (median). Following titration to stable analgesia, pain intensity (0/none to 3/severe) decreased from baseline within each group (p≤ 0.005), from 1.9 (0.1) to 1.3 (0.1), mean (SE), with controlled‐release oxycodone, and from 1.6 (0.1) to 1.0 (0.1) with controlled‐release morphine (no significant between‐group differences). Typical opioid adverse experiences were reported in both groups. Hallucinations were reported only with controlled‐release morphine (n = 2). Visual analog scores (VAS) for ‘itchy’ and ‘scratching’ were lower with controlled‐release oxycodone (p≤ 0.044), as was peak‐to‐trough fluctuation in steady‐state plasma concentration (p = 0.004). The correlation between plasma concentration and dose was stronger (p = 0.026) for oxycodone (0.7) than morphine (0.3). The relationship between pain intensity (VAS) and plasma concentration was more positive for oxycodone (p = 0.046). There was a positive relationship between morphine‐6‐glucuronide concentrations and urea nitrogen and creatinine levels (p = 0.0001). Controlled‐release oxycodone was as effective as controlled‐release morphine in relieving chronic cancer‐related pain, and as easily titrated to the individuals need for pain control. While adverse experiences were similar, controlled‐release oxycodone was associated with less itching and no hallucinations. Controlled‐release oxycodone provides a rational alternative to controlled‐release morphine for the management of moderate to severe cancer‐related pain.

Combined administration of opioids with selected drugs to manage pain and other cancer symptoms initial safety screening for compatibility

Cancer patients suffer multiple symptoms and require numerous drug therapies. Parenteral administration of multiple medications from a single container can simplify drug regimens for patient self-administration. This simplification reduces drug preparation costs and risk of infection. Therapeutic options are limited by the lack of published information on the compatibility of opioids and adjuvant drugs. We report the results of a study evaluating the physical compatibility of injectable opioids with selected drugs for pain and symptom management. Fentanyl citrate, hydromorphone hydrochloride, methadone hydrochloride, and morphine sulfate solutions were physically compatible with 14 of 15 supportive care drugs tested through visual examination using a high intensity light beam and through measured examination using a turbidimeter over a range of times up to 48 hr. Phenytoin sodium was the only drug found to be incompatible with all opioid solutions tested. This compatibility information will assist clinicians in selecting the most efficient, safe, and cost-effective supportive care drug regimen.

New pharmacological strategies in the management of cancer pain.

Introduction The majority of cancer patients experience pain during the course of their disease, especially in the advanced stages. Pain may be directly related to tumor or result from cancer therapy. Unrelieved pain impairs functional status, compromises quality of life, and may interfere with antineoplastic treatment. The World Health Organization (WHO) has stated that relief of pain and other symptoms should be of high priority in the care of cancer patients (1,2). The WHO three-step analgesic ladder is a medication titration protocol that has been demonstrated to be effective in relieving 75-90% of cancer pain (3-5). Yet many cancer patients suffer with unrelieved pain due to a number of factors. Poor assessment of pain (6,7), professional knowledge deficits, and regulatory interference with the prescription of opioid analgesics (8) all contribute to the problem. Much progress has been made to overcome these educational and social barriers.

Current Pediatric Palliative Care

psychiatry, neurosurgery, physical medicine and rehabilitation, palliative care, oncology, and Chinese medicine. This extensive section aids the reader in developing a global approach to the treatment and management of pain. Although comprising numerous strengths, the text’s greatest attribute is its easy readability, logical transitions, and concise language. In addition, summary diagrams are present throughout the text, which are useful for quick reference and highlighting key ideas. These features, along with a focus on clinical practice, make it ideal for medical trainees preparing for subspecialty or board examinations in pain medicine. Although the book provides a thorough overview of the specialty of pain, it was not designed as an all-encompassing text. As examples, some intricate details of interventional techniques and aspects of patient management by highly specialized modalities are not included. There are some minor revisions that would increase the text’s effectiveness. For instance, although the discussion of peripheral nerve blocks is well done, including additional common procedures would have been beneficial (e.g., femoral nerve and ankle blocks). Similarly, the text would have been enhanced by a more detailed discussion of interventional central neuraxial analgesia techniques. By compiling and summarizing the most recent, pertinent, and accepted research and clinical data in a clear and concise text, the authors have created an excellent basic reference text for health professionals who want a good introduction to the field of pain medicine as it should be practiced today. Although not detailed enough for experienced pain medicine specialists, medical personnel of any specialty and from different backgrounds will find this text useful.