Opioid dosing strategies for acute pain differ from strategies for chronic pain management. The basic principles of effective, safe dosing are rapid titration to the onset of analgesia followed by maintenance infusions based upon the titrated dose. This article presents guidelines and case histories for safe and effective dosing.
McCarberg BH, Barkin RL: Long-acting opioids for chronic pain: Pharmacotherapeutic opportunities to enhance compliance, quality of life, and analgesia. Am J Ther. 2001; 8(3): 181-186.
2.
McQuay H: Opioids in pain management. Lancet. 1999; 353(9171): 2229-2232.
3.
Borgbjerg FM, Nielsen K, Franks J: Experimental pain stimulates respiration and attenuates morphine-induced respiratory depression: A controlled study in human volunteers. Pain. 1996; 64(1): 123-128.
4.
Kumar KS, Rajagopal MR, Naseema AM: Intravenous morphine for emergency treatment of cancer pain. Palliat Med. 2000; 14(3): 183-188.
5.
Mercadante S, Villari P, Ferrera P, et al.: Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion. Cancer. 2002; 95(1): 203-208.
6.
Walsh D: Pharmacological management of cancer pain. Semin Oncol. 2000; 27(1): 45-63.
7.
Davis M, Walsh D: Cancer pain syndromes. J Palliat Care. 2000; 7(6): 206-209.
8.
Portenoy RK: Cancer pain: Pathophysiology and syndromes. Lancet. 1992; 339: 1026-1036.
9.
Upton RN, Semple TJ, Macintyre PE: Pharmacokinetic optimisation of opioid treatment in acute pain therapy. Clin Pharmacokinet. 1997; 33(3): 225-244.
10.
Bernards CM: Clinical implications of physicochemical properties of opioids. In Stein C (ed.): Opioids in Pain Control: Basic and Clinical Aspects. Cambridge, UK: Cambridge University Press, 1999.