1 (edited by PCL1029 Mon, 15 Aug 2011 11:15:43)

Topic: Information about Cancer Pain Management- Part II- the Use of Opioids.

Pharmacological Management:   the use of opioids(ie: codeine, oxycodone, hydrocodone,morphine,hydromorphone,fentanyl and methadone).

2.Opioids are  the first-line and widely used for moderate to severe chronic  cancer pain.Due to the side effects such as constipation, nausea,sleepiness or drowsiness,mental confusion,itching,perceptual disorders,hallucinations etc.are common in the course of long term use ,choosing the appropriate opioid and route of administration will prevent or minimize the problem. Here are some of the information on this topic.

Most patients start with oral administration of acetaminophen and hydrocodone or oxycodone combination formulations such as Vicodin,Lorcet,Norco,Percocet and Tylox etc  or ibuprofen with hydrocodone(Vicoprofen) or  aspirin with hydrocodone (Damason-P) every 4-6 hour and adjust upward;or morphine  such as MS Contin for twice daily use or Avinza extended capsule for once daily use. For breakthru pain morphine oral solution can be used every 1-2 hours as needed.
Morphine is the standard for comparison for opioids; multiple routes are  available as tablets , rectal suppository,enteral liquid and parenteral infusion such as in PCA dosage form given intravenously.
For patients with difficulty in swallowing or oral mucositis or severe nausea, SOME of the modified release morphine capsules(eg.Avinza,Kadian) can be opened and sprinkled on food without changing the delivery characteristics (ie:the frequency of administration-once or twice daily)through feeding tube. Ask your doctor or pharmacist when in doubt about which one can be used in this way. In general, opioids controlled-release , sustained- release or extended- release dosage form (ie: tablet,capsule )  should never be crushed because of acute toxicity and should not take with alcohol because alcohol can dissolve the matrix in which the drug is embedded for modified-release.

Hydromorphone(Dilaudid) is more often used in intravenous such as in PCA (patient- controlled analgesia) dosage form or subcutaneous administration but it also comes as oral dosage forms such as liquid,immediate release tablet,extended release tablet(Exalgo) for once  daily use.For patients have renal insufficiency or relatively high doses are needed, hydromorphone is preferred.

Fentanyl can be given as  IV bolus intravenously for  almost immediately relief of pain as compare to morphine,IV bolus,which may require 15-30 minutes to reach the peak onset of pain relief. Fentanyl also comes  as transdermal system(patch) for topical use of up to 48-72 hours; as oral lozenge (ACTIQ), sublingal  tablet(Abstral)buccal tablet (Fentora)  and a buccal soluble film (Onsolis) for rapid onset of  cancer-related breakthru pain relief. The Fentanyl patch may be preferred over orally administered opioid for  patients of poor GI absorption or having difficulty in swallowing,or if constipation or renal insufficiency is an issue.
Experience in the use of Levorphanol is very limited in the US,but it should be viewed as another option for the treatment of cancer pain.
Methadone is challenging to use and clinicians should seek assistance from a consultant before prescribing methadone.It has the highest risk of among opioids of overdosage.
Codeine and Meperidine(Demerol) are  not preferred for cancer pain management .
Rectal absorption of opioids is variable and the relative potency and effectiveness are difficult to predict .
Intrathecal and intraspinal administration(ie:epidural) of opioids yielded better pain control and fewer side effects.

There is no evidence that anyone of the commonly used,long-acting formulations (including morphine,hydromorphone,oxycodone , oxymorphine and fentanly) is more likely to be effective than any other.Selection usually is determined by the patient's prior experience with opioids,the doctor's experience,cost , availability and formulations.

Management of poorly responsive pain options such as opioid rotation(switching between opioids)required clinical judgment and should be based upon specific patient characteristics as well.- summarization of cancer pain management articles(May,2011) from uptodate.com .

For more  info. about pain go to    www.stoppain.org ,click the bottom left box"pain medicine" for more in depth information about pain management.(I did not read that much on this web site.but it looks like a good place to learn.)
God bless

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Information about Cancer Pain Management- Part II- the Use of Opioids.

Percy....thanks so much for this.  It is of incredible benefit to those patients in need of pain control. 
Thanks again,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Information about Cancer Pain Management- Part II- the Use of Opioids.

Hi,Marion,
You do more than I do for this web site. Thanks to you too.
God bless

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Information about Cancer Pain Management- Part II- the Use of Opioids.

Oh Percy....don't you just wish we would have reached our goal....FACILITATING RESEARCHERS AND PHYSICIANS IN FINDING THE CURE?
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

5 (edited by PCL1029 Mon, 22 Aug 2011 21:47:39)

Re: Information about Cancer Pain Management- Part II- the Use of Opioids.

Hi,Marion,
Of course,that is why I volunteer  for what I am doing now here;same as for many people on this web site contribute  their  time and energy for what they can to help others.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.