Potential uses of topical opioids in palliative care – report of 6 cases

Krajnik, Małgorzata; Żylicz, Zbigniew; Finlay, Ilora; Łuczak, Jacek; Sorge, Adriaan van

doi:10.1016/s0304-3959(98)00211-5

Cited by 93 publications

(52 citation statements)

References 28 publications

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“…In addition to its effects in the central nervous system, morphine can also have peripheral effects when applied on mucosal surfaces. A case series reported that the topical administration of a 0.08 % morphine gel provided pain relief in six cases of either cutaneous or oral mucosal pain [51]. Two studies, including a RCT, examined the use of a 2 % morphine mouth rinse for the management of pain due to OM in patients receiving chemoradiation for H&N cancer [21,22].…”

Section: Topical Morphinementioning

confidence: 99%

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

141

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Purpose The aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients. Methods A systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible. and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxintobramycin-amphotericin B lozenges/paste and bacitracinclotrimazole-gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence. Conclusion Additional well-designed research is needed on prevention and management approaches for OM.

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Section: Topical Morphinementioning

confidence: 99%

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Saunders

Epstein²,

Sharon

et al. 2013

Support Care Cancer

141

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show abstract

“…At present, no method has received widespread acceptance for the prevention of mucositis (11). Pain control in mucositis can be achieved with topical local anesthetics, benzidamine, doxepin (12) or morphine or other opioid drugs (13). Mucositis was not evaluated in our series, since data collection corresponded to late follow-up after initial oncological treatment.…”

Section: Discussionmentioning

confidence: 99%

Dental implications in oral cancer patients

et al. 2011

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Objectives. A study is made of the dental implications of oral cancer, with a view to avoiding the complications that appear once oncological treatment is started. Patients and Methods. The study comprised a total of 22 patients diagnosed with oral cancer according to clinical and histological criteria in the Service of Ma�illofacial Surgery (Dental Clinic of the University of Barcelona, Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona. Results. Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12 subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could not be located; these subjects were thus e�cluded from the analysis. All of the smokers had abandoned the habit. The most common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularly before the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried out in 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperative radiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, �erostomia or speech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergo regular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50% had active periodontal disease. Conclusions. Protocols are available for preventing the complications of oral cancer treatment, and thus for improving patient quality of life. However, important shortcomings in the application of such protocols on the part of the public health authorities make it difficult to reach these objectives.

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“…Sürekli opioid tedavisi kanser ağrılarında tedavinin temelini oluşturmaktadır. [20][21][22][23][24][25] Krajnik ve ark., [26] tümör infiltrasyonuna bağlı kutanöz ağrı, malign ve beningn cilt ülseri, şiddetli oral mukozit, diz artrozu ciddi tenesmoid ağrılı hastalarda topikal opioid tedavisiyle yedi-sekiz saat süren ağrı tedavisi sağlamışlardır. Ancak, kuvvetli opioidlerin kullanımı ile ilgili yeterli bilgi sahibi olunmaması, doktor ile hasta arasında iletişimin yeterli olmaması, bağımlılık yapıcı özelliklerinden kaynaklanan korku, zor temin edilebilmesi, yan etkileri gibi nedenlerden dolayı bu ilaçlardan yeteri kadar yararlanılamamaktadır.…”

Section: Gereç Ve Yöntemunclassified

Analgesic Step Ladder Treatment in Cancer Patients With Pain

Kurşun

Yıldız

Kaymaz³

et al. 2015

Agri

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Summary Objectives ÖzetAmaç: Bu çalışmada, kliniğimize başvuran 1736 hasta, özellikleri, analjezik basamak tedavileri ve tedavi yöntemleri geriye dönük olarak değerlendirildi. Gereç ve Yöntem: Ocak 1997-Aralık 2010 tarihleri arasında Fırat Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı Algoloji Bilim Dalı'na maligniteye bağlı ağrı nedeniyle başvuran 1736 hastanın 269'u çalışma dışı bırakılarak toplam 1467 hasta değerlendirilmeye alındı. Çalışmamızda hastaların %85.5'i analjezik basamak tedavisine göre tedavi edilmiştir. Basamak tedavisiyle yeterli ağrı kontrolü sağlanamayan %14.5 oranındaki olguya minimal invaziv analjezik girişim yöntemleri uygulanmıştır. Bulgular: Adjuvan ilaç olarak antidepresan, kortikosteroid, antikonvülzan, nöroleptik, benzodiazepin, lokal anestezik, bifosfanat ve kalsitonin kullanım oranları sırasıyla; %61.0, %7.1, %4.0, %4.0, %1.6, %12.3, %1.2 ve %2.8 olarak bulunmuştur. Sonuç: Sonuç olarak ağrılı kanser hastalarının ağrısının şiddetli olması; hastada ağrı tedavisini zorlaştırmaktadır. Analjezik basamak tedavisiyle tedavi edilemeyen hastalar, minimal invaziv analjezik girişim yöntemleriyle tedavi edilmektedir. Ağrı tedavisinde başarıya ulaşmak, olguların multidisipliner tıbbi uzman kadrosu ile değerlendirilmeleri ve bu ekibin hazırlayacağı tedavi planlaması ile olasıdır. Böylece hiçbir kanser hastasının kontrol altına alınamayan ağrı ile yaşamayacağı kanısındayız. Ağrı tedavisinde başarıya ulaşmak için adjuvan ilaçlara erişmek kolay olmalıdır. Adjuvan ilaçların, ağrı tedavisi yapan Algoloji hekimleri tarafından rahatça reçete edilmesi gerektiği kanısındayız.Anahtar sözcükler: Adjuvanlar; analjezik basamak tedavisi; kanser ağrısı; minimal invaziv analjezik girişim; opioid.

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Potential uses of topical opioids in palliative care – report of 6 cases

Cited by 93 publications

References 28 publications

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

Dental implications in oral cancer patients

Analgesic Step Ladder Treatment in Cancer Patients With Pain

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