Pain relief in terminally ill patients

American Family Physician,  Dec, 1989  by Edward T. Creagan,  John M. Wilkinson

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TABLE 1
Selected Oral Nonnarcotic Analgesics for Relief of Mild to Moderate
Pain in Cancer Patients
                                Equianalgesic
Drug                             dose (mg)         Duration (hours)
Aspirin                           650                 4-6
Acetaminophen                     650                 4-6
Ibuprofen (Motrin, Rufen)         400-600             4-6
Naproxen (Anaprox, Naprosyn)      250-500             12
Indomethacin (Indameth, Indocin)  25-50                8
Diflunisal (Dolobid)              500-1,000           8-12
TABLE 2
Selected Combination Analgesics
Drug                             Content
Codeine combinations
   Empirin with Codeine No. 2    Aspirin, 325 mg
                                 Codeine phosphate, 15 mg
   Empirin with Codeine No. 3    Aspirin, 325 mg
                                 Codeine phosphate, 30 mg
   Empirin with Codeine No. 4    Aspirin, 325 mg
                                 Codeine phosphate, 60 mg
   Tylenol with Codeine No. 2    Acetaminophen, 300 mg
                                 Codeine phosphate, 15 mg
   Tylenol with Codeine No. 3    Acetaminophen, 300 mg
                                 Codeine phosphate, 30 mg
   Tylenol with Codeine No. 4    Acetaminophen, 300 mg
                                 Codeine phosphate, 60 mg
Oxycodone combinations
   Percodan                      Aspirin, 325 mg
                                 Oxycodone hydrochloride, 4.5 mg
                                 Oxycodone terephthalate, 0. 38 mg
   Tylox                         Acetaminophen, 50 mg
                                 Oxycodone hydrochloride, 4.5 mg
                                 Oxycodone terephthalate, 0. 38 mg
   Percocet                      Acetaminophen, 325 mg
                                 Oxycodone hydrochloride, 5 mg
Propoxyphene combinations
   Darvocet-N 100                Acetaminophen, 650 mg
                                 Propoxyphene napsylate, 100 mg
   Darvon Compound-65            Aspirin, 389 mg
                                 Caffeine, 32.4 mg
                                 Propoxyphene hydrochloride, 65 mg
Pentazocine combination
   Talwin Compound               Aspirin, 325 mg
                                 Pentazocine hydrochloride, 12.5 mg

TABLE 3

Guidelines for the Use of Narcotic Analgesics in Pain Management

1 Start with a specific drug for a specific type of, pain

2. Know the pharmacology of the drug prescribed

a. Duration of the analgesic effect

b. Pharmacokinetic properties of the drug

c. Equianalgesic doses for the drug and its route of administration

3 .Adjust the route of administration to the patient's needs

4. Administer the analgesic on a regular basis after initial titration of the dose

5. Use drug combinations to provide additive analgesia and reduce side effects (e.g., nonsteroidal anti-inflammatory drugs, antihistamine [Hydroxyzine] and amphetamine [Dexedrine])

6. Avoid drug combinations that increase sedation without enhancing analgesia, such as a benzodiazepine (e.g., diazepam [Valium]) and a phenothiazine (e. g., chlorpromazine [Thorazine])