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Palliative consults us on a patient with terminal cancer wondering about other options. Currently getting ~150mg IV dilaudid every 8 hours.
I started wondering how this dose could possibly be helping her. How is ~150mg that much better than say 70mg or 40mg? I searched the SDN forum and didn't see the issue of opioid ceiling in cancer pain specifically addressed. There were some threads that touched on it. I searched pubmed for more clarification and didn't come across anything to help me figure this out. I am sure I just missed it, or didn't have the right search terms.
With an internet search I found a number of articles stating that "pure opioids have no ceiling and dose is only limited by side effects" yet there was never a citation about this.
Is there evidence that ultra high doses of opioids are more efficacious than "standard" dosing plus/versus adjuvants, multi-disciplinary care, interventions, etc.?
Thanks for any help/citations.
I started wondering how this dose could possibly be helping her. How is ~150mg that much better than say 70mg or 40mg? I searched the SDN forum and didn't see the issue of opioid ceiling in cancer pain specifically addressed. There were some threads that touched on it. I searched pubmed for more clarification and didn't come across anything to help me figure this out. I am sure I just missed it, or didn't have the right search terms.
With an internet search I found a number of articles stating that "pure opioids have no ceiling and dose is only limited by side effects" yet there was never a citation about this.
Is there evidence that ultra high doses of opioids are more efficacious than "standard" dosing plus/versus adjuvants, multi-disciplinary care, interventions, etc.?
Thanks for any help/citations.