Opioids in Cancer Pain

by Davis, Mellar; Glare, Paul; Hardy, J. R.

• ISBN13: 9780198529439
• ISBN10: 0198529430
• Format: Hardcover
• Copyright: 2005-09-01
• Publisher: Oxford University Press

Summary

There is a great deal of interest in the effective use of opioids for cancer pain due to concerns from both clinicians and patients about addiction. When used correctly, opioids are capable of relieving pain in more than 90% of cancer patients. In reality, patients world-wide continue toendure pain usually due to irrational fears about using them. Fear of addiction is fed by outdated knowledge about opioids and the unintended effects of the war on drugs. However, new research shows that using opioids appropriately for pain management is effective, safe, and has an extremely lowpotential to produce addiction. This book provides evidence (on which guidelines can be based) from an international group of editors and contributors on opioids in cancer pain management, aimed at palliative care doctors, pharmacists, pain specialists, and oncologists. It includes information on opioid pharmacokinetics as abasis for understanding opioid analgesia, dosing schedule, polymorphisms of analgesic receptors in relationship to tolerance, and intrinsic efficacy. The main body of the book covers individual opioids. Topics within each chapter include structure, pharmacokinetics, pharmacodynamics, routes ofadministration, toxicity, drug interactions and influences of dosing and kinetics related to organ function. A chapter is dedicated to the WHO analgesic guidelines and opioid choices.

Table of Contents

Contributors	ix
List of Abbreviations	x
Introduction	1	(10)
Mellar P. Davis
Opioid receptors and opioid pharmacodynamics	11	(32)
Mellar P. Davis
Gavril W. Pasternak
Opioid pharmacokinetics	43	(10)
Kenneth C. Jackson II
Codeine	53	(6)
Janet R. Hardy
Hydrocodone	59	(10)
Mellar P. Davis
Tramadol	69	(14)
Mellar P. Davis
Dextroproxyphene	83	(8)
Paul Glare
Morphine	91	(30)
Paul Glare
Hydromorphone	121	(8)
Paul Glare
Oxycodone	129	(26)
Mellar P. Davis
The lipophilic opioids: fentanyl, alfentanil, sufentanil and remifentanil	155	(18)
Tony Hall
Janet R. Hardy
Methadone	173	(26)
Mellar P. Davis
Levorphanol	199	(8)
Mellar P. Davis
Diamorphine	207	(8)
Janet Hardy
Oxymorphone	215	(6)
Paul Glare
Choice of opioids and WHO ladder	221	(14)
Paul Glare
Opioid rotation	235	(12)
Janet R. Hardy
Opioids equianalgesia: dynamics and kinetics	247	(18)
Mellar P. Davis
Opioid dosing strategies	265	(14)
Paul Glare
Mellar P. Davis
Patient controlled analgesia	279	(16)
Mellar P. Davis
Spinal opioids in cancer pain	295	(12)
Mellar P. Davis
Opioid-resistant pain	307	(24)
Mellar P. Davis
Index	331