Intravenous high-dose methadone administered by patient controlled analgesia and continuous infusion for the treatment of cancer pain refractory to high-dose morphine.

The management of severe tumor-related pain in the patient with cancer may be problematic. Systemically administered opioids remain the cornerstone of treatment for moderate to severe cancer pain, while parenteral routes should be considered for patients who require rapid onset of analgesia, and for highly tolerant patients whose dose requirements cannot be conveniently administered. The use of intravenous methadone by patient controlled analgesia (PCA) is attractive for the management of severe, intractable cancer pain and may offer some advantages over morphine.

Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review.

The patient with a history of current opioid consumption presenting in the acute postoperative setting presents a challenge for pain management. Standard treatment dosages and strategies are often ineffective in providing pain relief. This retrospective case-control study reviews 4 years' experience of the Acute Pain Service (APS) at our institution providing care for 202 chronic pain and opioid-consuming (CPOC) patients, 6.

Drug utilization patterns in chronic pain patients.

In the population of chronic pain patients seen at multidisciplinary pain clinics, excessive and/or inappropriate medication use is a frequent problem. This study examined differences between chronic pain patients who used no addicting medication (30% of the sample of 131 patients), those who used narcotic but not sedative medications (33%) and those who used both narcotic and sedative medications (37%). Patients in the narcotic and narcotic-sedative groups had undergone significantly more pain-related hospitalizations and surgeries than those in the no addicting drugs group.

Self-reported vs. actual use of medications in chronic pain patients.

Inappropriate or excessive medication use is a commonly observed problem among patients with chronic pain. Comparing patients' self-reported drug use with actual observed drug use, this study examines the incidence, nature and magnitude of drug utilization in a selected population of pain patients and evaluates the reliability of patient estimates of their own drug use. The data support the clinical observation that patients with chronic pain tend to underestimate their medication use.