Abstract:
:The effects of opioids usually parallel the plasma concentrations but with a temporal shift. This temporal shift differs between opioids. It is small with alfentanil or remifentanil and very long with the active metabolite of morphine, morphine-6-glucuronide (M6G). The mathematical and experimental techniques for modeling these pharmacokinetic-pharmacodynamic (PK/PD) relationships were developed in the late 1970s. The delay between plasma concentrations and effects is accounted for by the introduction of a hypothetic effect compartment, which is linked to the plasma compartment by a first-order transfer function with a rate constant k(e0). The effects are then linked to the concentrations at effects site by standard pharmacodynamic models such as sigmoid ("E(max)") models or power models, depending on the actual effect measure. These principles were first applied to the opioids fentanyl and alfentanil in 1985. Since then, PK/PD of opioids have been repeatedly assessed, using EEG derived parameters, pupil size, and experimental and clinical pain as effect measures. The opioids of the fentanyl group, methadone, morphine, and piritramid, are today well characterized with respect to their PK/PD properties. Alfentanil and remifentanil are very fast equilibrating opioids with equilibration half-lives between plasma and effect site of about 1 minute. They are followed by fentanyl and sufentanil, each with equilibration half-lives of about 6 min. Methadone equilibrates with a half-life of about 8 min. Morphine, in contrast, equilibrates with a half-life of 2-3 h. The slowest opioid with respect to plasma-effect site transfer is M6G, with an equilibration half-life of about 7 h. PK/PD modeling has advanced the understanding of the time course of the clinical effects of opioids after various dosing regimens. It may provide a rational basis for the selection of opioids in clinical circumstances. PK/PD modeling of opioids may also be employed for the design and the interpretation of experiments addressing clinical effects of opioids.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Lötsch Jdoi
10.1016/j.jpainsymman.2005.01.012subject
Has Abstractpub_date
2005-05-01 00:00:00pages
S90-103issue
5 Suppleissn
0885-3924issn
1873-6513pii
S0885-3924(05)00038-2journal_volume
29pub_type
杂志文章,评审abstract:CONTEXT:Substantive discussions between loved ones are necessary for effective advance care planning. Although multiple tools are currently in use for promoting conversations, the content and clinical relevance of the conversations they stimulate is unknown. OBJECTIVE:To describe the content and clinical relevance of ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2016.03.021
更新日期:2016-11-01 00:00:00
abstract:CONTEXT:Cancer therapy-induced cognitive impairment adversely affects the quality of life of patients with cancer but cannot be detected by neuropsychological tests. OBJECTIVES:This study aimed to validate a Japanese version of the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) version 3, which ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2019.09.027
更新日期:2020-01-01 00:00:00
abstract::Cancer is one of the major causes of death in Cuba, and in current practice, patients are not usually informed of their diagnosis. Palliative care is an emerging discipline in this country. Cuban cancer patients with advanced disease completed the Palliative Outcome Scale (POS), and the researcher elicited patients' k...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2008.02.015
更新日期:2009-03-01 00:00:00
abstract:CONTEXT:Since Canada decriminalized medical assistance in dying (MAID) in 2015, clinicians and organizations have developed policies and protocols to implement assisted dying in clinical practice. Five years on, there is little consensus as to what constitutes high-quality care in MAID. OBJECTIVES:To describe MAID cli...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2020.08.018
更新日期:2020-08-21 00:00:00
abstract:CONTEXT:Dyspnea is one of the most distressing symptoms in patients with cancer, and often worsens with breakthrough episodes on exertion. We hypothesized that fentanyl given prophylactically may alleviate breakthrough dyspnea. OBJECTIVES:To determine the feasibility of conducting a randomized trial of subcutaneous fe...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2013.03.017
更新日期:2014-02-01 00:00:00
abstract::Patients with advanced cancer often do not receive high-quality pain and symptom management or support with coordination of care, communication, and decision making. Implementing quality indicators that are reflective of the scope of care, feasible to implement, and supported by evidence might help to identify areas a...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/j.jpainsymman.2009.04.024
更新日期:2009-12-01 00:00:00
abstract:CONTEXT:Cancer patients have impaired humoral and cellular immunity, and are more susceptible to infections; their immunological response is expected to be less effective than that of healthy people. OBJECTIVES:To assess the immune response to influenza vaccine in terminally ill cancer patients in a home palliative ca...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2010.05.016
更新日期:2011-02-01 00:00:00
abstract::After years of second-class status, supportive care is increasingly being recognized for its importance. Included in this recognition is a concern for making more explicit the long-held conviction within medicine that no goal can logically be more important than optimal patient functioning and well-being. This effort ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/0885-3924(94)90129-5
更新日期:1994-04-01 00:00:00
abstract:CONTEXT:Standardized outcomes that define successful advance care planning (ACP) are lacking. OBJECTIVE:The objective of this study was to create an Organizing Framework of ACP outcome constructs and rate the importance of these outcomes. METHODS:This study convened a Delphi panel consisting of 52 multidisciplinary, ...
journal_title:Journal of pain and symptom management
pub_type: 共识发展会议,杂志文章
doi:10.1016/j.jpainsymman.2017.08.025
更新日期:2018-02-01 00:00:00
abstract:CONTEXT:As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. OBJECTIVES:To determine the effect of communication training interventions for generalist palliative care providers...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jpainsymman.2017.04.007
更新日期:2017-09-01 00:00:00
abstract::Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and th...
journal_title:Journal of pain and symptom management
pub_type: 共识发展会议,杂志文章
doi:10.1016/j.jpainsymman.2007.04.004
更新日期:2007-07-01 00:00:00
abstract::This report describes a pharmacokinetic study and a clinical study of three different formulations of oral tramadol: once-daily tramadol tablets 150 and 200 mg, and normal release tramadol capsules 50 mg 8-hourly. The randomized, open-label, crossover pharmacokinetic study included 22 subjects. The three treatments sh...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0885-3924(02)00642-5
更新日期:2003-02-01 00:00:00
abstract::To evaluate the relationship between personal values and individual quality of life (iQoL) in palliative care patients, 75 patients with advanced cancer or amyotrophic lateral sclerosis (ALS) were asked to complete a self-report questionnaire concerning personal values and a semi-structured interview on their iQoL. Si...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2005.02.012
更新日期:2005-08-01 00:00:00
abstract::Placebo and nocebo effects are known to contribute significantly to the response to symptom control, including analgesia. Clinical trial methodologies using placebo controls are designed to identify the magnitude of these effects in the research context. An adequately powered, randomized, double-blind, placebo-control...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2012.12.005
更新日期:2013-11-01 00:00:00
abstract:CONTEXT:Older and seriously ill Australians are often admitted to hospital in the last year of their life. The extent to which these individuals have considered important aspects of end-of-life (EOL) care, including location in which care is provided, goals of care, and involvement of others in decision making, is uncl...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2019.09.003
更新日期:2020-02-01 00:00:00
abstract:CONTEXT:High body mass index (BMI) is linked to an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those receiving palliative chemotherapy, the impact of BMI on survival has not been investigated fully. OBJECTIVES:To assess changes in BMI during the course o...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2013.08.017
更新日期:2014-07-01 00:00:00
abstract::Forty married patients with metastatic cancer, who were receiving opioid medication for cancer pain, were interviewed for this study. They were asked about their pain and its treatment, their beliefs regarding cancer pain, their concerns about opioid analgesics, their mood state, and the nature of their interaction wi...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/0885-3924(92)90119-3
更新日期:1992-02-01 00:00:00
abstract:CONTEXT:Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. OBJECTIVES:To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2017.04.013
更新日期:2017-12-01 00:00:00
abstract:CONTEXT:Chronic pain impacts one-third of the U.S. population, and its effects are debilitating for individuals and costly to the medical system. Although opioids are commonly prescribed to address chronic pain, they confer risk for misuse and addiction in some patients and may not fully restore life function-particula...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2014.03.006
更新日期:2014-12-01 00:00:00
abstract::The purpose of this randomized, controlled, home care intervention was to test the effectiveness of two nurse-targeted, e-mail-based interventions to increase home care nurses' adherence to pain assessment and management guidelines, and to improve patient outcomes. Nurses from a large urban non-profit home care organi...
journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jpainsymman.2004.08.018
更新日期:2005-05-01 00:00:00
abstract:CONTEXT:Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates. OBJECTIVES:To compare the accuracy of estimates of potential recruitment from a retrospective consecutive cohort audit of actua...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jpainsymman.2015.11.022
更新日期:2016-04-01 00:00:00
abstract:CONTEXT:Undertreatment of cancer pain among outpatient cancer patients needs to be addressed to enhance care and improve patients' quality of life (QoL). OBJECTIVES:This prospective, cross-sectional, patient-focused study aimed to explore the prevalence of pain and undertreatment of cancer pain in outpatients in Taiwa...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpainsymman.2017.02.018
更新日期:2017-07-01 00:00:00
abstract::A significant proportion of health care resources are consumed at end of life. As a result, decision and policy makers seek cost savings to enhance program planning. Most literature, however, combines the cost of all dying patients and, subsequently, fails to recognize the variation between trajectories of functional ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2009.04.007
更新日期:2009-07-01 00:00:00
abstract:CONTEXT:Clinicians often rely on documentation to relay information, and this remains the mainstay of interprofessional communication regarding patient care. However, there has been scant research focused on clinicians' documentation of dying in hospital and how this is communicated to other team members in patient cha...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2018.05.013
更新日期:2018-09-01 00:00:00
abstract::The effectiveness of docusate for constipation has not been studied in the terminally ill. Controversy also exists concerning its effectiveness in the chronically ill. Because chronically ill patients and terminally ill patients have several risk factors for constipation in common, we undertook a systematic review of ...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析
doi:10.1016/s0885-3924(99)00157-8
更新日期:2000-02-01 00:00:00
abstract:CONTEXT:Few studies have evaluated outcomes of combined chemoradiotherapy for Stage III-IV head and neck squamous cell carcinoma in terms of the use of nutritional support by means of percutaneous endoscopic gastrostomy (PEG). OBJECTIVES:To compare nutritional status and treatment interruption because of acute toxicit...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2011.01.009
更新日期:2011-10-01 00:00:00
abstract::Women dying of ovarian cancer vary considerably in their complications and in the types of health care they receive. The objective of this study was to describe the complications of ovarian cancer, other than pain, and their treatment at the end of life. This study used a cohort of 421 enrollees in three nonprofit man...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2006.11.011
更新日期:2007-09-01 00:00:00
abstract::Approximately 65% of women report hot flashes (HFs) during or following breast cancer treatment. However, few studies have compared the occurrence of vasomotor symptoms according to the type of adjuvant treatment received, and little is known about other risk factors for HFs among this population. This longitudinal st...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2008.04.010
更新日期:2009-04-01 00:00:00
abstract::Alternative routes of drug delivery have particular relevance for use in chronic pain. When the pain experience is constant or nearly constant, a continuous infusion of drug is an ideal way to achieve effective pain relief. Early experience with the transdermal application of fentanyl in chronic cancer pain suggests t...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/0885-3924(92)90051-i
更新日期:1992-04-01 00:00:00
abstract:CONTEXT:Using mortality rates to measure hospital quality presumes that hospital deaths are medical failures. To be a fair measure of hospital quality, hospital mortality measures must take patient-level factors, such as goals of care, into account. OBJECTIVES:To answer questions about how hospital mortality rates are...
journal_title:Journal of pain and symptom management
pub_type: 杂志文章
doi:10.1016/j.jpainsymman.2010.07.005
更新日期:2010-12-01 00:00:00