pain relief in pancreatic cancer

soapynurse@adel · Apr 24, 2005

Before I would even begin to offer any suggestions, I would want to know if the person is on any long acting narcotics and what do they have for breakthrough pain. Maybe it could be time for a clysis. Is the patient eating, ambulatory, having BM's?

Alice in VA

Limegreen · Apr 24, 2005

Before I would even begin to offer any suggestions, I would want to know if the person is on any long acting narcotics and what do they have for breakthrough pain. Maybe it could be time for a clysis. Is the patient eating, ambulatory, having BM's?
Alice in VA

He lives at home, recent diagnosis of Pancreatic cancer. He was using a Duragesic patch incorrectly--on 3 days, leaving off for 3 days and Vicodin tab1 at H.S.When he entered Hospice, increased patch to 50mcg, and at this time is using Morphine 10mg tabs 1-2 prn breakthrough pain. Knowing that it takes the patch a few days to become fully effective,encouraged him to take the Morphine and Tylenol on a regular basis which he did for one day with total relief of the pain, but the medicine is clouding his thinking which he doesn't like. I hope this effect wears off as he becomes accustomed to the Duragesic and then may be able to back off on the Morphine, or may need to increase the Duragesic. He is ambulatory, has little appetite. Using Glycolax daily for constipation. His pain is at the L waist goes around to the L flank rates from 0 to 8. 79 yrs. old.

soapynurse@adel · Apr 25, 2005

He lives at home, recent diagnosis of Pancreatic cancer. He was using a Duragesic patch incorrectly--on 3 days, leaving off for 3 days and Vicodin tab1 at H.S.When he entered Hospice, increased patch to 50mcg, and at this time is using Morphine 10mg tabs 1-2 prn breakthrough pain. Knowing that it takes the patch a few days to become fully effective,encouraged him to take the Morphine and Tylenol on a regular basis which he did for one day with total relief of the pain, but the medicine is clouding his thinking which he doesn't like. I hope this effect wears off as he becomes accustomed to the Duragesic and then may be able to back off on the Morphine, or may need to increase the Duragesic. He is ambulatory, has little appetite. Using Glycolax daily for constipation. His pain is at the L waist goes around to the L flank rates from 0 to 8. 79 yrs. old.

Sounds like you're on the right track. Yes, I think he'll get over the side effects, but he probably doesn't realize that. Duragesic can make some people very fuzzy. He'll decide when it's necessary to take the breakthrough med. when he needs it. Some people, though, are very stoic about their pain and resistant to additional meds.

Keep up the good work. Wish I was still doing it.

Alice

Cindarella · Apr 25, 2005

Sounds like you're on the right track. Yes, I think he'll get over the side effects, but he probably doesn't realize that. Duragesic can make some people very fuzzy. He'll decide when it's necessary to take the breakthrough med. when he needs it. Some people, though, are very stoic about their pain and resistant to additional meds.
Keep up the good work. Wish I was still doing it.
Alice

Alice,

New register here, but thought I would just drop in. I am currently working for hospice. Here we use a lot of componds made by various pharmacies here. We often use scopolamine 0.25mg/3mls that is rubbed into the pacreatic area. It works as a smooth muscle relaxor and we have had wonderful results with it. We also use it often with liver cancer. Just thought I would see if you have ever used and had any good results.

Cheryl :rolleyes:

Limegreen · Apr 25, 2005

Alice,
New register here, but thought I would just drop in. I am currently working for hospice. Here we use a lot of componds made by various pharmacies here. We often use scopolamine 0.25mg/3mls that is rubbed into the pacreatic area. It works as a smooth muscle relaxor and we have had wonderful results with it. We also use it often with liver cancer. Just thought I would see if you have ever used and had any good results.
Cheryl

This sounds very interesting, we use scop patches for tracheal congestion, but haven't heard of it used this way. I'm going to bring this up at our next IDT meeting. Thank you.

Cindarella · Apr 26, 2005

This sounds very interesting, we use scop patches for tracheal congestion, but haven't heard of it used this way. I'm going to bring this up at our next IDT meeting. Thank you.

You are welcome, we also use for congestion the same way...just rubbed into the tracheal area. Hope you can use it....

Cheryl :uhoh3:

saribeth · May 1, 2005

Alice,
New register here, but thought I would just drop in. I am currently working for hospice. Here we use a lot of componds made by various pharmacies here. We often use scopolamine 0.25mg/3mls that is rubbed into the pacreatic area. It works as a smooth muscle relaxor and we have had wonderful results with it. We also use it often with liver cancer. Just thought I would see if you have ever used and had any good results.
Cheryl

Hi Cheryl this sounds really interesting...is it very expensive???? Wish we could get into the componding but it just ends up in the black hole! :uhoh3: Thanks Janie

Cindarella · May 10, 2005

Hi Cheryl this sounds really interesting...is it very expensive???? Wish we could get into the componding but it just ends up in the black hole! Thanks Janie

It's really not all that much more than the po forms here. It depends on the componding pharmacist and your relationship with them. It really is great to work with componds and so much better for the patients. We use a number of them...ativan plo gel, phenergan plo gel, etc.. Our pharmacist can compond just about anything we need. Hope you can find a way to get it.

See ya

Cheryl

oncalllorraine · May 2, 2006

just had such a case! we had him on morphine subcutaneous, but his pain was intractable. in retrospect i feel he would have obtained more relief with a dilaudid drip. there are always those few pts.who's pain is worsenend by morphine, and they are always the GI types.

doodlemom · May 2, 2006

Methadone, methadone, methadone! Well, the conversation lately seems to always go back to methadone (mainly because I bring it up)...and I have to say that methadone is the best thing out there that I have seen for pain. It works better than anything else that is long acting and is usually better tolerated as far as the "fuzzy headedness" goes. Duragesic does not actually take several days to acheive maximum result. The drug reaches steady state after about 18 hours. We don't use duragesic anymore unless the pt's physician insists on it. It's very expensive and really doesn't work very well in this population. About the only good thing I can say about duragesic is that it is convenient.

abnerRN · May 2, 2006

He lives at home, recent diagnosis of Pancreatic cancer. He was using a Duragesic patch incorrectly--on 3 days, leaving off for 3 days and Vicodin tab1 at H.S.When he entered Hospice, increased patch to 50mcg, and at this time is using Morphine 10mg tabs 1-2 prn breakthrough pain. Knowing that it takes the patch a few days to become fully effective,encouraged him to take the Morphine and Tylenol on a regular basis which he did for one day with total relief of the pain, but the medicine is clouding his thinking which he doesn't like. I hope this effect wears off as he becomes accustomed to the Duragesic and then may be able to back off on the Morphine, or may need to increase the Duragesic. He is ambulatory, has little appetite. Using Glycolax daily for constipation. His pain is at the L waist goes around to the L flank rates from 0 to 8. 79 yrs. old.

I have a couple of suggestions: First with pancreatic cancer, the patient tends to be very thin..if this is the case the Duragesic doesn't work properly, 2. We use MSContin extended release given every 12 hours, with MSIR for breakthrough pain with really good results. 3. If and when the pain becomes intractible, Dilaudid around the clock or Morphine Sulfate sub q around the clock is effective. Also with the Duragesic, try on for 48 hours, then change instead of 72 hours.