Extreme doses of intravenous methadone for severe pain in two children with cancer.

We describe the effect and side effects in two children with cancer treated with intravenous methadone in extreme doses (>10 mg/kg/day) due to vincristine-induced neuropathy where surgical procedures provoked severe neuropathic pain. The maximum daily dose was 33 and 25 mg/kg/day. Methadone remained effective at adjusted doses. Few side effects were reported. No significant changes in paraclinical data were observed. Prolonged QTc-interval occurred only during concomitant treatment with fluconazole. In conclusion, methadone should be seen as a part of the armamentarium against cancer-related pain. Methadone can be used in extreme doses with appropriate monitoring by clinicians experienced in its use.

The impact of "modern telecommunication" in palliative care--the views of the professionals.

BACKGROUND: Specialized palliative care teams are typically based in larger hospitals, from where home visits, telephone consultations, and support are given directly to patients and relatives, but also to professionals working on the frontline. One of the challenges is the long distances to the patients' homes. Modern telecommunication may help overcome this, but little is known about the perceived advantages and barriers to palliative care. This study analyzed the views on modern telecommunication from specialized palliative care professionals' perspective. MATERIALS AND METHODS: This descriptive study is based on four semistructured group interviews where 17 health professionals from three different palliative care teams in the Central Denmark Region were interviewed from November 2009 to March 2010. RESULTS: We found that face-to-face communication is essential. The participants perceived a potentially added communicative value in visual telecommunication but would never let it replace face-to-face communication. Ethical and practical concerns were expressed on the implementation of "modern telecommunication" and in particular strong reservations against permanent telemonitoring in the patient's home. CONCLUSIONS: Our study underlines the necessity of face-to-face contact in optimal palliative care and that home visits were favored. The participants were generally positive toward telecommunication, although reservations and prerequisites were voiced.

[Pain audit as a tool to optimize pain treatment in hospital departments]. / Smerteaudit som et redskab til optimering af smertebehandlingen på hospitalsafdelinger.

On March 3 2011 the Department of Oncology, Aarhus University Hospital, conducted a cross-sectional pain audit. All patients present at the department were invited to complete a questionnaire about their pain experience, and their medical records were reviewed. The results indicated that patients with probable neuropathic pain reported the highest pain severity levels and experienced the greatest burden of their pain. Most patients with neuropathic pain did not receive any secondary analgesics and their general practitioners were infrequently involved in the treatment. The methods used in the present audit can be transferred to other departments for the benefit of the patients.