Lose Dose morphine Vs other non opiods in cancer patients

Low-Dose Morphine vs Weak Opioids in Moderate Cancer Pain

Journal of Clinical Oncology

  This is one of the most vexing issue in patient cancer ; adequate physician knowledge  as to what works best and how to treat narcotic requiring pain. First is to not to fear use of a narcotics  if the pain is of that severity .Second , there are weak, moderate and strong narcotics and each has a long dose response curve, each can be addictive – usually not why a patient is in pain and stops when not, each works better with other mechanism of action pain meds  and each when taken  chronically , will develop tolerance and need more. The duration of the pain relief effect also MUST be known. OF COURSE the conclusion is that low dose morphine was superior- but it combined with an NSAID and maybe other meds ( no narcotic) would be better yet, allow less use of morphine and have lower sid effects The other giant mistake is not teaching the patient about the tolerance, how they are not an addict or will become one and that pain is a vital sign , must always be reported and a moving target. Finally pain meds given BEFORE the pain gets to a bad level end up not with John Wayne but with a patient who typically is much more pain free and uses less total narcotics. Bowel regimens of stool softeners and gentle laxative preemptively are very wise – it is much easier to slow them down then have someone in agonizing narcotic induced constipation due to narcotic receptors in the bowels. Finally there are long acting version of many of these meds and often a combination of 2 or three pain meds works wonderfully Dr Ryan {Pain Specialist



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