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Narcotics Last Updated: July 06, 2008

New Additions
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Methadone, methadone, methadone

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The use of ketamine as adjuvant therapy to control severe pain

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Effect of Low-Dose Naloxone Infusion on Fentanyl Requirements in Critically Ill Children

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Methadone analgesia for children with advanced cancer

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Acute effects of opioids on memory functions of healthy men and women

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What Is the Maximum Safe Dose of Opioids?

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Use of patient-controlled analgesia for pain control in dying children

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Oxycodone: a review of its use in the management of pain

Prior Additions
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Morphine: A Comfort Measure For The Dying Or Pain Control For The Living?

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FDA Issues Second Safety Warning on Fentanyl Skin Patch

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Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain

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Oral Oxymorphone for Pain Management

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FAST FACT AND CONCEPT #175: Opioid Allergic Reactions

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Opioid use and survival at the end of life: a survey of a hospice population

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Toward evidence-based prescribing at end of life: a comparative analysis of sustained-release morphine, oxycodone, and transdermal fentanyl, with pain, constipation, and caregiver interaction outcomes in hospice patients

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"Broken heart syndrome" after separation (from OxyContin)

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Opioids for Chronic Non-Cancer Pain

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Fentanyl transdermal patch is an effective way to control pain in children

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Patient-controlled analgesia: optimizing the experience

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Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

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Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia

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A double-blind comparison of morphine infusion and patient controlled analgesia in children

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Pediatric patient-controlled analgesia: enhancing the self-care construct

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Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients

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New Fentanyl Warnings: More Needed to Protect Patients
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from Medscape -- this will require a login (or free registration)

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Tramadol SR Formulations: Pharmacokinetic Comparison of a Multiple-Units Dose (Capsule) versus a Single-Unit Dose (Tablet)
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from Medscape -- this will require a login (or free registration)

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Methadone as an analgesic for cancer pain management

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Retrospective analysis of kadian (morphine sulfate sustained-release capsules) in patients with chronic, nonmalignant pain

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Morphine sparing with droperidol in patient-controlled analgesia

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Pharmacologic Treatment of Opioid-Induced Sedation in Chronic Pain

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Tramadol Exposures Reported to Statewide Poison Control System

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The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia

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Treatment of noncancer pain with oral transmucosal fentanyl citrate (OTFC) (from Pain.com)

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Two Formulations of Extended-Release Oral Morphine Reach Similar Plasma Levels

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Peripheral opioids in inflammatory pain

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Enteral administration of naloxone for treatment of opioid-associated intragastric feeding intolerance

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Continuous Subcutaneous Infusion of Opiates at End-of-Life

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The bioavailability of morphine applied topically to cutaneous ulcers

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Incidence of constipation associated with long-acting opioid therapy: a comparative study

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Developmental pharmacokinetics of morphine and its metabolites in neonates, infants and young children

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Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects

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New Formulation Of Actiq (Oral Transmucosal Fentanyl Citrate) Approved By FDA

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New Perspectives on the Pharmacology of Opioids and Their Use in Chronic Pain (CME Available)

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Optimizing Analgesic Response When Pain is Uncontrolled by Oral Opioids
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This article is from Cancer Pain Release, where you can find many other similar review articles

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Opioids in cancer pain: common dosing errors

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The importance of opioid tolerance: a therapeutic paradox J.Amer Coll Surg. Feb. 2003. Vol. 196, No.2:321-4.

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Characteristics and adequacy of intravenous morphine infusions in children in a paediatric oncology setting

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Oral tramadol for the treatment of pain of 7-30 days' duration in children
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This open-label, multicenter trial was designed to determine the safety profile and analgesic efficacy of tramadol for the treatment of painful conditions lasting 7-30 days in 7-16-yr-old children. We found that tramadol 1-2 mg/kg per os every 4-6 h (maximal dose = 8 mg x kg(-1). d(-1), not to exceed 400 mg/d) is a safe and effective analgesic in this patient population.

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Clinical pharmacology of opioids for pain
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Inturrisi CE. Clin J Pain 2002 Jul-Aug;18(4 Suppl):S3-13
Department of Pharmacology, Weill Medical College of Cornell University, Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA

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Effects of intermediate- and long-term use of opioids on cognition in patients with chronic pain
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"Relatively few differences have been found when cognitive performance in these patients is compared with their performance before taking opioids, or with the performance of a comparable pain population not taking opioids. Major unresolved questions remain regarding such important issues as effects of different types of opioids, dose effects, interactions with other medications, and subject variables."

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FDA Approves Once-Daily Avinza (Extended Release Morphine) For Chronic, Moderate-To-Severe Pain

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EPERC Fast Fact and Concept #75: Methadone for Pain

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Einstein Researchers Report on Safer Narcotic Painkillers That Prevent Dependency, Withdrawal Problems

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PRN Range for Analgesic Orders

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Sufentanil: an overview of its use for acute pain management

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Strategies to manage the adverse effects of oral morphine: an evidence-based report

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Intravenous Methadone in the Management of Chronic Cancer Pain

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Pioneering Durogesic (Transdermal Fentanyl) Skin Patch:
 A Clear Choice In Chronic Pain Which Is Difficult To Treat
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May 27, 2002 -- The UK's first skin patch to offer strong pain relief (DurogesicTM - transdermal fentanyl) - has received approval from UK regulators allowing its use for the first time to treat chronic (ongoing or continued) intractable pain such as arthritis and back pain.

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Reducing Morphine Tolerance (pdf)

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An Individual Opinion on the Use of Demerol for Rigors

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Nasal Diamorphine Preferred For Children With Limb Fractures
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Seems like a great idea: 0.1 mg/kg diamorphine intranasally relieves severe fracture pain faster that an IM injection without the need for a needle. This study was performed in Great Britain. Hopefully the product will become available in the United States. This is a review of the article in the British Med Journal, with a link to the full text version.

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The Neurotoxicity of Opioids 
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This is a brief case presentation demonstrating some of the common side effects of opioid analgesics and their management.

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Methadone in the Treatment of Chronic Non-Malignant Pain-a 2-Year Review
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We are re-learning the benefits of methadone. Consider this medication in the treatment of post-herpetic neuralgia.  This is a review of the article in Pain Medicine and a link to its abstract.


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Last modified: June 18, 2008