Wednesday, September 7, 2005

Current controversies in pain management

Lancet Oncology has a provocative article about current controversies in pain management .  It covers many questions (should morphine remain the opioid of choice, COX-2s, bisphosphonates for malignant bone pain).  Using strong opioids in combination/partial opioid switching--a practice I wasn't really aware of (other than adding low dose methadone to another opioid)--is addressed as well & is cautioned against outside of trials.  When to use spinal opioids is mentioned also & much of literature in the last several years is criticized.  They conclude with this:

     Spinal opioids necessitate intense monitoring in patients with progressive disease and reduced ability to attend the clinic.  Subcutaneous tunnelled catheters necessitate fixation, need bacterial filters, site protection, limited tubing changes, and at least weekly exit-site care and close monitoring for infection.  As patients become more homebound and transitioned to hospice home care, this approach becomes impractical.

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