Part 6 - Why Is Cancer Pain So Special?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Crafted GraphPart 4 – Everything We Were Taught About High Doses Was Wrong, And The Same Hand-Crafted GraphPart 5 – Why Do We Lump The Non-Cancer Pain Syndromes Together?This is Part 6, which asks the sort of inverse question toPart 5– Why Is Cancer Pain So Special?Why is cancer pain, in so many guidelines and organizational/public policies ‘exempted’ from the dosing and safety guidelines. This is not a rhetorical question – I have not actually ever read a coherent explanation as to why.One might reasonably assume there ’s all this research demonstrating the safety and efficacy of long-term opioid use in cancer patients. In reality, that research is non-existent.Guidelines like the CDC ’s accurately point out that there are essentially no data demonstrating the long term efficacy of opioids for &lsquo...
Conditions: Pain, Postoperative; Tonsillar Bleeding; Postoperative Nausea and Vomiting Interventions: Drug: Dexamethasone; Drug: Sodium chloride Sponsors: Walid HABRE; University Hospital, Geneva Not yet recruiting
Condition: Malignant Neoplasm Interventions: Drug: Fentanyl Sublingual Spray; Drug: Morphine; Other: Physical Performance Testing; Other: Placebo; Other: Quality-of-Life Assessment; Other: Questionnaire Administration Sponsors: M.D. Anderson Cancer Center; National Cancer Institute (NCI) Not yet recruiting
Condition: Insomnia Intervention: Behavioral: Su-Man formula massage oil Sponsor: China Medical University Hospital Completed
Condition: Pain, Neuropathic Interventions: Procedure: Stellate ganglion block; Procedure: Sham Stellate ganglion block Sponsors: Tanta University; Mohamad Gamal Elmawy, M.D Not yet recruiting
Conditions: D011471; D064129; D035683; D009360; D014408 Intervention: Diagnostic Test: Periodic ARV7 and miRNA evaluation Sponsor: Azienda Ospedaliero-Universitaria Careggi Recruiting
Condition: Arthritis, Rheumatoid Intervention: Drug: Golimumab Sponsor: Peking Union Medical College Hospital Recruiting
Condition: End Stage Renal Disease Intervention: Other: Presence of elbow pain in patients with end stage renal disease Sponsor: Namik Kemal University Completed
Condition: Locally Advanced Colon Cancer Intervention: Combination Product: CAPECITABINE AND OXALIPLATIN Sponsor: Universidad de León Recruiting
Condition: Patients With Metastatic Colorectal Cancer Interventions: Drug: Fluoropyrimidine; Drug: Bevacizumab Sponsor: Centre Hospitalier Universitaire Dijon Not yet recruiting
Condition: Breast Cancer Interventions: Drug: Avelumab; Drug: Aspirin; Drug: Lansoprazole Sponsors: The Christie NHS Foundation Trust; University of Manchester Not yet recruiting
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