Friday, March 2, 2007

Opioids and heart disease freak out; Research issues; Morphine & hastened death

A few quickies before the weekend...

The American Heart Association is releasing guidelines on pain management in patients with coronary artery disease which places opioids in front on NSAIDs & COX-2 inhibitors as preferred agents (Guidelines here--both BMJ & Medscape have good news articles about them). (Medscape articles are available with a free registration.) The Medscape one has a good discussion of the already rough-and-tumble fight that is breaking out due to the prominence opioids get. From BMJ:

"First line drug choices include paracetamol (acetaminophen), aspirin, tramadol, and short term use of other narcotic analgesics. If these fail to achieve adequate pain control, the next option is non-acetylated salicylates, such as naproxen."

First line. As you can imagine there is going to be general freaking-out about this. The fight is going to be, it seems, over whether naproxen should be considered before or after "narcotic analgesics." Anyway I welcome this--it is another event main-streaming opioids as effective analgesics with relatively well-defined risk:benefit profiles, and whose risk:benefit profiles happen to be, per the AHA, more favorable than NSAIDs and COX-2's for most heart disease patients.

BMJ also has a qualitative article on research barriers to studying the quality of terminal care. It's based on focus groups with end of life researchers & clinicians and covers most of the usual suspects: trouble identifying dying patients; perceptions that researching dying patients does them harm; informed consent issues, etc.

There's also a letter about the case I mentioned a while back about the woman going to court in order to receive...something...which sort of sounds like assisted death. Anyway the letter is about one of my favorite topics: the myth (or at least the overselling) of morphine and hastened death.

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