Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study

Kalso, Eija; Heiskanen, Tarja; Rantio, Merja; Rosenberg, P. H.; Vainio, Anneli

doi:10.1016/0304-3959(96)03161-2

Cited by 92 publications

(60 citation statements)

References 21 publications

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“…141 A small randomized study of 10 patients showed that a switch from the oral route to either subcutaneous or epidural administration of morphine resulted in improved pain control and a reduction in adverse effects. 142 There was no difference either in pain relief or in adverse effects between the subcutaneous and epidural routes. Route of administration can have a significant impact on opioid metabolite levels.…”

Section: Table 6 Proposed Strategies To Prevent Opioid-induced Cognitmentioning

confidence: 89%

The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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BACKGROUNDOpioids have an essential role in the management of pain in cancer patients, particularly those with advanced disease. Cognitive dysfunction is a recognized complication of opioid use. However, misconceptions and controversy surround the nature and prevalence of its occurrence. A projected increase in the aging cancer population highlights the need for a better understanding of this phenomenon.METHODSA critical appraisal of the literature evidence in relation to the pattern, pathophysiology, assessment, impact, and management of cognitive dysfunction due to opioid use in cancer pain management is given.RESULTSStudies in cancer patients with less advanced disease reveal subtle evidence of cognitive impairment, largely related to initial dosing or dose increases. In advanced cancer, opioid‐induced cognitive dysfunction usually occurs in the form of delirium, a multifactorial syndrome. The presence of both cognitive impairment and delirium frequently is misdiagnosed or missed. Potential risk factors include neuropathic and incidental pain, opioid tolerance, somatization of psychologic distress, and a history of drug or alcohol abuse. Elevation of opioid metabolites with renal impairment may contribute to cognitive dysfunction. Recognition of opioid‐related cognitive dysfunction is improved by objective screening. Successful management requires either dose reduction or a change of opioid, in addition to addressing other reversible precipitants such as dehydration or volume depletion.CONCLUSIONSOpioid‐related cognitive dysfunction tends to be subtle in the earlier stages of cancer, whereas delirium, a more florid form with behavioral disturbance is likely to be present in the advanced cancer population. In patients with advanced disease, an optimal management approach requires careful clinical assessment, identification of risk factors, objective monitoring of cognition, maintenance of adequate hydration, and either dose reduction or switching to a different opioid. Cancer 2002;94:1836–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10389

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Section: Table 6 Proposed Strategies To Prevent Opioid-induced Cognitmentioning

confidence: 89%

The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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“…Full consideration of spinal opioids is beyond the scope of this paper, but there is new evidence that it offers little advantage over parenteral administration [19].…”

Section: Alternatives To the Oral Routementioning

confidence: 98%

Problems with opiates in cancer pain: parenteral opioids

Glare¹

1997

Support Care Cancer

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Morphine is the preferred drug for the management of moderate-severe chronic cancer pain. The best route of administration is by mouth, because it is simple, safe, convenient, inexpensive and effective. Non-oral modes of administration should be only considered if (a) the oral route becomes unavailable or (b) there is documentation of failure of maximal doses of oral morphine and coanalgesic drugs. Recent developments have made new routes of morphine administration fashionable--in the absence of supportive pharmacokinetic or pharmacodynamic data--even when departure from established practice is not justified. It is important for clinicians to be familiar with the practicalities and problems that limit the utility of the non-oral routes, and the state of current understanding of these options will be reviewed.

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“…W badaniach klinicznych zarówno fentanyl, jak i buprenorfina rzadziej niż morfina powodowały zaparcie, mimo to jest to głów-ne działanie niepożądane tych leków [62][63][64][65][66].…”

Section: Rozpoznanie Zaparcia Poopioidowegounclassified

Constipation – a difficult therapeutic problem

Dzierżanowski¹,

Rydzewska²

2012

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Epidural and subcutaneous morphine in the management of cancer pain: a double-blind cross-over study

Cited by 92 publications

References 21 publications

The panorama of opioid‐related cognitive dysfunction in patients with cancer

The panorama of opioid‐related cognitive dysfunction in patients with cancer

Problems with opiates in cancer pain: parenteral opioids

Constipation – a difficult therapeutic problem

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