By F. De Conno MD, A. Caraceni MD (auth.), F. De Conno MD, A. Caraceni MD (eds.)
This handbook covers easy details which may still allow the profitable analysis and remedy of ninety according to cent of sufferers with soreness because of melanoma. Our objective has been to not trivialize the matter, which continues to be advanced and on occasion tricky to resolve, yet to aid all overall healthiness care execs all in favour of the care of melanoma sufferers who're now not ache experts, to appreciate and be ready to deal with lots of the events they see of their scientific perform.
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Extra resources for Manual of Cancer Pain
An opioid (morphine and hydromorphone) can be combined with several other drugs (metoclopramide, dexamethasone, haloperidol, scopolamine, midazolam) in the same infusion (107, 108). To set up an opioid infusion the total daily opioid consumption should be calculated and converted to parenteral morphine equivalents (using a 1:3 ratio for parenteral versus oral morphine). The resulting dose can be chosen to start the infusion and can be adapted to the situation: increased in case of poor pain control, decreased when changing the opioid drug according to guidelines for opioid rotation.
In a cross-over study between SCI and PCA using hydromorphone for 25 patients, pain relief was comparable between the two methods; however, all patients required extra doses (mean =6) when treated with SCI. At the end of the study, some patients preferred PCA while others preferred SCI (113). A modified application of PCA is one in which a continuous infusion of opioids is integrated with the possibility of self administering extra boli at preestablished intervals and doses. This approach can be used very successfully with the main indication of treating breakthrough pain (103).
2 days (mean ± SO) and it can be improved by the use of Teflon cannulae (l00). Tolerance probably develops in all forms of opioid treatment. Portenoy and co-workers (101) described three typical patterns in opioid infusion: 1) relatively stable doses with good pain control; 2) rapidly increasing doses with good analgesia; and 3) insufficient analgesia despite the fast rate of dose increase. The last case could be the result of a relatively opioid-resistant pain syndrome (l02). Doses employed vary widely across case series and largely depend on patient selection and previous opioid exposure.
Manual of Cancer Pain by F. De Conno MD, A. Caraceni MD (auth.), F. De Conno MD, A. Caraceni MD (eds.)