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Managing Pain in the Terminally Ill

Author(s):  Williams Clifford L

Issue:  Mar/Apr 1998 - Pain Management
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Abstract:  The purpose of this article is to present a case that illustrates the basics of pain management. The author is a palliative-care specialist and hospice medical director. The case involves a 57-year-old man who was diagnosed with large-cell carcinoma of the lung. The patient was eventually treated with a compounded suppository of haloperidol + metoclopramide + dexamethasone until the final stages of his illness, when he was switched to hydromorphone given as a continuous subcutaneous infusion. His expiration was peaceful. The author discusses the principles of pain management applied to this case. A table provides information regarding opiate equivalents. The author concludes that barriers to the use of modern opiates and synthetic opioids derived from the poppy must be addressed at an international level. The expertise of the compounding pharmacist is needed to bring drugs together in formulations previously unavailable and also in allowing novel and innovative delivery systems to be explored.

Related Keywords: Hospice, Hydromorphone, Kadian, Oxycodone, Palliative, Percodan


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