Codeine phosphate in paediatric medicine

Williams, Donald C.; Hatch, D. J.; Howard, Richard

doi:10.1093/bja/86.3.413

Cited by 157 publications

(87 citation statements)

References 86 publications

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“…This is related to the fact that O-demethylation of codeine to morphine is dependent on cytochrome P450 isoenzyme 2D6, which is known to exhibit genetic polymorphism. Thus, some individuals produce little or no morphine from codeine and others produce significant amounts, although the amount produced may show wide variation (156)(157)(158). Thus, for individuals with moderate to severe pain, a stronger opioid (such as morphine or oxycodone) should be chosen in the first instance, and codeine is not recommended.…”

Section: Conventional Opioidsmentioning

confidence: 99%

The Pharmacotherapy of Chronic Pain: A Review

Lynch

Watson

2006

Pain Research and Management

103

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The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date.Key Words: Anticonvulsants; Antidepressants; Cannabinoids; Chronic pain; Opioids; Pharmacotherapy; Topical analgesics La pharmacothérapie de la douleur chronique : Une analyse Les deux dernières décennies ont contribué à un vaste ensemble de travaux précliniques qui nous ont permis de mieux comprendre les mécanismes physiopathologiques sous-jacents responsables de la douleur chronique. Dans ce contexte, il est admis que le traitement efficace de la douleur est une priorité et qu'il exige souvent le recours à un agent ou à une association d'agents ayant une action analgésique. La présente analyse présente une démarche probante de la pharmacothérapie de la douleur chronique. Des recherches dans Medline ont été effectuées sur tous les agents utilisés pour le traitement classique de la douleur chronique. Les articles publiés jusqu'en juin 2005 ont été inclus. La stratégie de recherche incluait les essais aléatoires et contrôlés et, si elles étaient disponibles, les analyses systématiques et les méta-analyses. D'autres références ont été obtenues dans la partie des références des articles trouvés à l'aide de la stratégie de recherche précédente. Les agents dont aucun essai contrôlé n'étayait l'efficacité pour le traitement de la douleur chronique étaient exclus de la présente analyse, sauf si les données scientifiques précliniques étaient convaincantes, si les travaux humains initiaux étaient positifs ou si on pensait que les données scientifiques colligées jusque-là étaient intéressantes pour le lecteur.

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Section: Conventional Opioidsmentioning

confidence: 99%

The Pharmacotherapy of Chronic Pain: A Review

Lynch

Watson

2006

Pain Research and Management

103

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“…[62][63][64] The appropriate use of many, more established agents such as acetaminophen and codeine is being updated and refined. 65,66 The management of acute procedural pain often includes the use of cognitive-behavioral strategies: distraction, guided imagery, and hypnosis by trained practitioners. Intuitively, these approaches are helpful and are generally liked by children, many of whom respond positively.…”

Section: Acute Painmentioning

confidence: 99%

Current Status of Pain Management in Children

Howard¹

2003

JAMA

247

111

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“…Codeine was present in only 2% of the specimens because codeine is known to be a poor analgesic compared with other opioids and is therefore not often prescribed for chronic pain [24]. or a lack of analgesia [10,11].…”

Section: Discussionmentioning

confidence: 99%

Medication and Illicit Substance Use Analyzed Using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) in a Pain Population

Pesce¹,

Gonzáles²,

Almazan³

2012

J Anal Bioanal Techniques

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Background: Patients on chronic opioid therapy are often closely monitored to identify prescribed or nonprescribed medications and/or illicit substances and to identify medication use that may lead to adverse events. Monitoring is typically performed using a combination of clinical tools and assessment methods that often include patient medication histories, risk assessments, and medication monitoring with urine testing. The chronic pain population may be prescribed an average of three to five medications for pain and associated symptoms. In addition to prescribed therapies, this patient population often takes non-prescribed medications and/or illicit substances. Medication monitoring with Urine Drug Testing (UDT), particularly when performed using mass spectrometry, provides accurate information about medications and illicit substances present in the urine. Purpose of the study: To use LC-MS/MS analyses to describe the variety of medications and metabolites observed in urine specimens from individuals on opioid therapy.Methods: Analytical procedures were developed using LC-MS/MS that could detect and differentiate between various opioids and their metabolites, other medications commonly prescribed for pain, and certain illicit substances. This retrospective analysis used approximately 340,000 de-identified specimens tested between November 2011 and February 2012 at Millennium Laboratories. Data was sorted to determine frequency of detection and concentrations of the excreted drugs and metabolites. Results:The most frequently observed medications were hydrocodone and oxycodone, and their metabolites. The next most frequently observed medication was the benzodiazepine class followed by gabapentin, buprenorphine, and morphine. Additionally, illicit substances were detected in 15% of specimens; the most common illicit substances were cannabinoids and cocaine.Conclusions: Urine drug testing, using LC-MS/MS technology with validated cutoff values for each analyte, provides objective data for providers to use when assessing medication use, potential drug-drug interactions, potential adverse events, and possible diversion. Specific identification of both the medication or substance and the associated metabolites allows for informed interpretation of UDT results. Understanding the medications and illicit substances found in UDT specimens from the pain population helps providers optimize medication monitoring for the best possible plan for pain management.

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Codeine phosphate in paediatric medicine

Cited by 157 publications

References 86 publications

The Pharmacotherapy of Chronic Pain: A Review

The Pharmacotherapy of Chronic Pain: A Review

Current Status of Pain Management in Children

Medication and Illicit Substance Use Analyzed Using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) in a Pain Population

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