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By Nathan E Goldstein MD, R. Sean Morrison MD
Evidence-Based perform of Palliative Medicine is the purely publication that makes use of a practical, question-and-answer approach to deal with evidence-based selection making in palliative drugs. Dr. Nathan E. Goldstein and Dr. R. Sean Morrison equip you to evaluate the on hand facts alongside of present perform directions, so that you can provide optimum deal with sufferers and households who are facing severe illness.
- Confidently navigate scientific challenges with chapters that discover interventions, review suggestions, therapy modalities, concepts / directions, and to be had resources - all with a spotlight on sufferer and family-centered care.
- Build a context for top practices from fine quality facts collected through a number of best authorities.
- Make trained judgements efficiently with therapy algorithms incorporated in the course of the book.
- Access the total, absolutely searchable contents online at www.expertconsult.com.
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The rectal route cannot be used in patients with diarrhea, hemorrhoids, anal fissures, or neutropenia, and it is not meant for long-term use. Suppositories can be uncomfortable for patients, and the potential for expulsion of the suppository by a bowel movement further complicates drug absorption. Many patients and caregivers may simply prefer to avoid the rectal route of delivery. The oral mucosal route of delivery offers several advantages. The oral mucosa is highly permeable— 20 times more permeable than the skin—and is highly vascularized.
This pain escalation must be distinguished from episodic or breakthrough pain. 6 The pharmacokinetics of opioids must also be considered when treating breakthrough pain. When patients need a rapid intervention, the intravenous route provides the best drug availability from a pharmacokinetics point of view. When comparing pain relief in the intravenous and oral groups, Elsner and colleagues7 found that 87% of the patients in the intravenous group reported at least sufficient pain relief after 1 hour, whereas only 26% in the oral group reached similar results after 1 hour.
Continued research is required to increase the evidence base for the majority of the treatment recommendations provided in this chapter. REFERENCES 1. Moryl N, Coyle N, Foley KM. ” JAMA. 2008;299(12):1457–1467. 2. Ripamonti C, Bandieri E. Pain therapy. Crit Rev Oncol Hematol. 2009;70(2):145–159. 3. Webster LR. Breakthrough pain in the management of chronic persistent pain syndromes. Am J Manag Care. 2008;14(5 suppl 1): S116–S122. Sinatra R. Causes and consequences of inadequate management of acute pain.