Opioids in Cancer Pain / Edition 2

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Opioids have become invaluable in modern medicine but it is essential that they are prescribed with an understanding of the complex pharmacology behind their effectiveness; without this, they will fail to achieve their enormous potential for pain relief, minimal side effects, and improved function. In addition, opioids can present problems, including side effects such as constipation, respiratory depression, and sedation, as well as the potential for substance abuse. Clinicians handling the complex pain problems of cancer patients must incorporate the insight of basic scientists and pharmacologists. This new edition of an already comprehensive text brings together a wealth of experience from those involved in all aspects of opioids, with a view to improving both clinical understanding and patient care.

The text includes: comprehensive coverage of the principles of opioid pharmacodynamics, pharmacokinetics, and pharmacogenetics; chapters dedicated to in-depth coverage of each of the main opioids; and chapters discussing the complex issues and debate surrounding the use of these drugs.

New to this edition:

An editor from the UK, Columba Quigley, has joined the established editor team of Mellar P. Davis, Paul Glare, and Janet R. Hardy, making the new edition even more international in scope

New chapters on opioids in paediatrics and opioids in developing countries, addressing the unique needs of these patient groups

More focused attention on the differing uses of opioids, with separate chapters devoted to dosing strategies for acute pain, and dosing strategies for chronic pain

Buprenorphine added to the list of opioids covered, reflecting its common use in Europeand the debate surrounding its use in the US

Organ failure now covered

Issues of addiction and substance abuse addressed

Strengthening of the palliative care perspective, with the role of opioids in the terminal phase now included

New studies in opioid pharmacogenetics incorporated, a topic which may have significant implications for the use of these drugs in the future

This text is the most complete and extensive work available on the use of opioids for cancer pain, and is an important reference for clinicians treating individuals with cancer; this includes palliative care doctors, oncologists, pain specialists, and pharmacists.

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Product Details

  • ISBN-13: 9780199236640
  • Publisher: Oxford University Press, USA
  • Publication date: 8/28/2009
  • Edition number: 2
  • Pages: 456
  • Product dimensions: 6.90 (w) x 9.80 (h) x 1.30 (d)

Meet the Author

Mel Davis is Director of Research at the Harry R. Horvitz Center of Palliative Medicine, Taussig Cancer Center, Division of Solid Tumor, Cleveland Clinic, USA. He also holds the positions of Editor-in-Chief of Progress in Palliative Care, and Chairman of the Palliative Section, Multinational Association of Supportive Care in Cancer. His research interests are in pain management, cancer pain, palliative medicine, symptom control and supportive cancer care.
Paul Glare is a Senior Staff Specialist Physician at Royal Prince Alfred Hospital (RPAH) in Sydney, Australia. He is Head of the Dept of Palliative Care at RPAH, and Head of Palliative Care Services for Sydney Cancer Centre and the eastern zone of Sydney South West Area Health Service (population 500,000). He is also Clinical Associate Professor of Medicine (Central Clincial School) at the University of Sydney.
Janet Hardy is the Director of Palliative Medicine for the Mater Health Services and is the Clinical Research Programme Leader for the Centre for Palliative Care Research and Education in Brisbane. She holds a chair in Palliative Medicine from the University of Queensland School of Medicine.
Columba Quigley previously held the post of Deputy Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Group. She has lectured and published in a range of areas, including opioid switching, alternative opioids, inter-individual variability in opioid responsiveness and the genetics of opioid response.

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Table of Contents

Contributors ix

List of abbreviations xi

1 Opioid receptors and opioid pharmacodynamics Mellar P. Davis Gavril W. Pasternak 1

2 Opioid pharmacokinetics Kenneth C. Jackson II Mellar P. Davis Columba Quigley 29

3 Liver disease and exogenous opioid pharmacokinetics Mellar P. Davis 39

4 Opioids in renal failure Janet R. Hardy 69

5 Codeine Janet R. Hardy Kenneth C. Jackson II 81

6 Hydrocodone Mellar P. Davis 89

7 Tramadol Mellar P. Davis Paul Glare 99

8 Dextropropoxyphene Paul Glare 119

9 Morphine Paul Glare 127

10 Oxycodone Paul Glare Mellar P. Davis 155

11 The lipophilic opioids: fentanyl, alfentanil, sufentanil, and remifentanil Anthony Hall Janet R. Hardy 175

12 Buprenorphine Mellar P. Davis 193

13 Methadone Mellar P. Davis Columba Quigley 211

14 Hydromorphone Columba Quigley Paul Glare 245

15 Levorphanol Mellar P. Davis 253

16 Diamorphine Janet R. Hardy Columba Quigley 263

17 Oxymorphone Paul Glare 269

18 Choice of opioids and the WHO ladder Paul Glare 275

19 Pharmacogenetics and opioids Joy R. Ross Columba Quigley 287

20 Opioid rotation Janet R. Hardy Columba Quigley Joy R. Ross 301

21 Equi-analgesia Mellar P. Davis Kenneth C Jackson II 313

22 Dosing strategies for acute pain Mellar P. Davis 329

23 Opioid dosing strategies for chronic pain and the management of opioid side effects Mellar P. Davis 347

24 Patient-controlled analgesia Mellar P. Davis 367

25 Spinal opioids in cancer pain Costantino Benedetti Steven Paquelet Mellar P. Davis 385

26 Opioid poorly responsive pain, physical dependence, tolerance, and opioid-induced hyperalgesia Mellar P. Davis 403

27 Opioids in special populations: developing countries MhoiraLeng 419

28 Opioids in special populations: paediatric population Ross Drake 431

29 Opioids in the terminal phase Janet R. Hardy 455

30 Cancer pain and substance abuse Kenneth L. Kirsh Tatiana D. Starr Lauren J. Rogak Steven D. Passik 461

Index 479

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