The findings have implications for the management of postoperative pain by highlighting the need for more accurate pain assessment. Further research is required to elucidate the way in which nurses and patients conceptualize pain and to understand better the process of pain assessment in clinical nursing practice.
Purpose: Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients.Clinical features: Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization.Conclusion: Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some inpatient populations.
Conclusion : Étant donné ses propriétés analgésiques et son remarquable profil d'innocuité, nous croyons que la méthadone pourrait s'ajouter à l'arsenal thérapeutique des patients hospitalisés. Elle peut aussi servir d'opioïde de premier choix chez certains patients hospitalisés.NDERTREATMENT of pain is common in hospitalized patients, children and adults. 1 , 2 It is estimated that 50% of in-patients suffer substantial pain at some time. 2 Although patients undergoing surgical procedures are more likely to suffer pain during hospitalization, more than 20% of non-surgical patients report substantial pain while in hospital. 2 , 3 Opioids are the mainstay of therapy for pain due to malignancy and an important adjuvant in patients with pain of non-cancerous etiology. Nevertheless, almost 50% of in-patients that do receive opioids for their pain report moderate to severe pain. 4 Methadone is a potent, highly lipid soluble and protein bound synthetic opioid, with a rapid onset of analgesia, large volume of distribution and prolonged half-life. 5 While its analgesic effect during chronic treatment does not exceed 12 hr, its plasma half-life could be as long as 72 hr. 6 Although favourable results REGIONAL ANESTHESIA AND PAIN
Oral methadone can be recommended for babies and children who have severe pain that is not alleviated by nonopioid medications and who are capable of oral intake.
Cannabinoids have been used for pain relief for centuries and recent studies have investigated their analgesic and anti-inflammatory mechanisms, as well as clinical efficacy, in treating chronic pain. We report an open-label study addressed to evaluate the effect and adverse events of orally administered Delta-9-tetrahydrocannabinol (Delta-9-THC) in 13 patients with chronic nonmalignant pain (CNMP) unresponsive to conventional pharmacotherapy. The effect of the treatment was assessed on an eight-item HRQoL questionnaire. Five out of 13 patients reported adequate response to the treatment while eight patients reported inadequate or no response. Seven patients did not experience any adverse events (AEs), six patients reported AEs, two of which discontinued the treatment. We conclude that oral THC may be a valuable therapeutic option for selected patients with CNMP that are unresponsive to previous treatments, though further research is warranted to characterize those patients.
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