How Should Opioids Be Started and Titrated in Routine Outpatient Settings?

Goldberg, Gabrielle R.; Smith, Cardinale B.

doi:10.1016/b978-1-4377-3796-7.00001-x

Cited by 5 publications

(10 citation statements)

References 30 publications

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“…For clinicians to safely and effectively manage cancer‐related pain with opioids, it is important that they understand basic opioid pharmacology, are able to titrate an immediate release or long‐acting opioid, and can anticipate and treat expected side effects of opioid therapy. Sample case scenarios can be found in Table …”

Section: Pain Management: Opioidmentioning

confidence: 99%

“…There are 3 primary opioid receptors in the body—the mu, kappa, and delta receptors—and genetic variation in receptors is one factor contributing to the various responses to opioids within or between individuals . With the exception of transmucosal immediate‐release fentanyl, a typical oral immediate‐release opioid will provide peak analgesic effect within 60 to 90 minutes and, in a patient with normal renal and hepatic function, should provide pain relief for approximately 4 hours . Helping patients understand how much pain relief they should expect with each opioid dose and preparing them for the time to peak analgesic effect can set appropriate expectations for outcomes in pain management and also can teach patients to strategically use pain medication during times when it is needed most.…”

Section: Pain Management: Opioidmentioning

confidence: 99%

“…If a single dose of immediate‐release opioid provides no pain relief and causes no side effects, then the dose may be increased by 100%. If the dose provides moderate pain relief, then the dose may be increased by 50% . The second reason pain may be uncontrolled despite access to PRN opioid is if the dosing interval is too long and the patient has breakthrough pain from end‐of‐dose failure .…”

Section: Pain Management: Opioidmentioning

confidence: 99%

“…If a long‐acting opioid is not controlling pain when used as prescribed, a patient may use additional PRN doses during the day, and then the clinician can adjust the long‐acting opioid to the desired analgesic effect. Clinicians may still need to counsel patients on the strategic use of a PRN opioid before painful activities to prevent pain from escalating to an uncontrollable level …”

Section: Pain Management: Opioidmentioning

confidence: 99%

“…Clinicians may use antiemetics if needed, but these rarely need to be given on a scheduled basis. Patients should be tolerant to the nausea within a week …”

Section: Pain Management: Opioidmentioning

confidence: 99%

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Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

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242

174

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Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182-196.

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Section: Pain Management: Opioidmentioning

confidence: 99%

Section: Pain Management: Opioidmentioning

confidence: 99%

Section: Pain Management: Opioidmentioning

confidence: 99%

Section: Pain Management: Opioidmentioning

confidence: 99%

“…Clinicians may use antiemetics if needed, but these rarely need to be given on a scheduled basis. Patients should be tolerant to the nausea within a week …”

Section: Pain Management: Opioidmentioning

confidence: 99%

See 3 more Smart Citations

Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

Self Cite

242

174

View full text Add to dashboard Cite

show abstract

Managing pain in oncology

Jain

2020

Journal of Prescribing Practice

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Pain is one of the most common symptoms in cancer and almost all patients experience pain at various stages of the disease. Despite the high prevalence of these symptoms and various international guidelines that are in place for management, there is still a gap between the pain management approaches and achieving satisfactory pain relief. A holistic approach is required for effective management, which not only includes the pain-relieving medications but should also contain various complementary procedures to treat cancer pain and improve patients' quality of life.

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A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery

Tsai

Zheng

et al. 2022

Biomedicines

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Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.

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How Should Opioids Be Started and Titrated in Routine Outpatient Settings?

Cited by 5 publications

References 30 publications

Optimal pain management for patients with cancer in the modern era

Optimal pain management for patients with cancer in the modern era

Managing pain in oncology

A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery

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