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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, September 15, 2011

Código: DOLOR

Pain Code: Get Pain Under Control Quickly
Charles F. von Gunten, MD, PhD.
From The Institute for Palliative Medicine
..."The most important fact to remember is this -- the time to pain control is the same as the time to the maximum concentration of the opioid in the blood.
So for a drug such as morphine given intravenously, the time to maximum concentration is 8 minutes. Therefore, successive doses of morphine can be given every 8 minutes. For someone whose pain is completely out of control, 10 out of 10, you want to double the dose to get that pain under control.
The point here is you're doubling the dose of the opioid at the level of the receptor. When the patient begins to describe relief, you found the dose that is controlling that person's pain.
So the key fact to remember is dose every time to maximum concentration. For morphine, for hydromorphone, and for intravenous fentanyl, that's every 8 minutes. If you are giving it subcutaneously, that would be every 30 minutes. And if you were giving it orally, it would be every hour. But the key point is dose every time to maximum concentration and double the dose until the patient reports relief..."