Most powerfull pain killer for terminally ill? Doctors please.?

Question

What is the most powerfull drug that can be used to treat terminal pain without puting the person into a coma? I know there are surgical procedures but im just interested in medication.

Could doctors and nurses answer this one please.

Answer 1

Hi

This type of question is so often asked and is so often answered incorrectly.

Morphine always gets mentioned - people are obsessed with Morphine!!

Morphine is the favorite strong opiate pain killer BUT it is not the strongest. Fentanyl, on a dose weight basis, is several hundred times more potent than morphine and Diamorphine (Heroin) is 4X stronger and has less side effects.

You dont always have to use pain killers, tricyclic antidepreassants are good for neuropathic pain, steroids are good for nerve compression pain, local anaesthetics can be used for nerve blocks and so on......

Also, opiates, like morphine, dont releive all types of pain.

Pain control is a complicated subject - you can get books on the subject - but in terminal care where the pain is severe the following protocol is a common one - this assumes the patient has responded well to morphine -

Start morphine 10mg/4 hourly and increase dose as needed.

Add diazepam to morphine for additional pain control if appropiate.

If pain releif poor, switch from Morphine to Diamorphine (heroin) via syringe driver - 2.5mg diamorphine = 10mg morphine.

Again, titrate up dose to optimum and add sedation/NSAIDS/tricyclics /gabapentin as needed.

If pain is still severe after optimim dose and patient is in distress, review pain releif, consider nerve blocks or ableration.

The ultimate pain killer is KETAMINE.

Ketamine is given via syringe driver with Midazolam and the Ketamine dose titrated up to the optimum.

The above is criminally simplified, but I hope it helps.

Answer 2

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Answer 3

A good Doctor has following points.. *His social or communication skills with the patients which constitutes both verbal and non-verbal (body language) communication...As our profession is a Community Service. *He should be a role model (a doctor who tells his/her patients to quit smoking should not be seen smoking outside the hospital 5 minutes after the patient leaves.. where's the intergrity in this right?) *He should be able to communicate in a way the patient understands (not going off on the properties of amino acids... etc. etc) as this may come out as arrogance *He, IDEALLY should follow up on his patients ... give them phone calls to see how they're doing *The doctor should be WILLING TO TEACH!!... this goes along very well with preventive health care. The doctor should give the patients the fishing rods, rather than the fish. If a doctor knows how to teach his/her patient what to do and what not to do, the doctor will be able to help the patient change his lifestyle for the better so that the patient doesn't have to keep coming back. *>And last but not the least he must be INTELLIGENT, UPDATED, And Most Of all ETHICAL. Dr Suraj A K

Answer 4

Fentanyl is an opioid analgesic, first synthesized by Janssen Pharmaceutica (Belgium) in the late 1950s, with a potency eighty times that of morphine. Fentanyl was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze. Fentanyl has an LD50 of 3.1 milligrams per kilogram in rats, and, 0.03 milligrams per kilogram in monkeys. The LD50 in humans is not known. In the United States, fentanyl is a Schedule II drug.

Opiates and morphinomimetics
Morphine, the archetypal opioid, and various other substances (e.g. codeine, oxycodone, hydrocodone, diamorphine, pethidine) all exert a similar influence on the cerebral opioid receptor system. Tramadol and buprenorphine are thought to be partial agonists of the opioid receptors. Dosing of all opioids may be limited by opioid toxicity (confusion, respiratory depression, myoclonic jerks and pinpoint pupils), but there is no dose ceiling in patients who tolerate this.

Opioids, while very effective analgesics, may have some unpleasant side-effects. Up to 1 in 3 patients starting morphine may experience nausea and vomiting (generally relieved by a short course of antiemetics). Pruritus (itching) may require switching to a different opioid. Constipation occurs in almost all patients on opioids, and laxatives (lactulose, macrogol-containing or co-danthramer) are typically co-prescribed.

So Choose Wisely.

Answer 5

My sister in North Ireland suffered from terminal vulva cancer Morphine driver Ora morph and paracetamol was not sufficient for pain managements . I am a RN in the USA for over 40 years. I asked the doctor if they could give my sister a Fentanyl patch or Dilaudid and she said it was exactly the same as Morphine . Either it is cost prohibitive or the Doc was not well verses in Pharmacology. All the information is on the Internet or the PDR ( Physicians desk Reference ) probably it is called something in the UK . The nurses were all efficient and caring . I was sad
Anne H.

Answer 6

It is important for the patient to receive the appropriate medication for his or her condition. Different types of pain respond to different medications. If there is bone pain, one type of medication is useful, while if there's abdominal pain from spasms, other medications may be useful. Nerve pain may respond to other medications, or even surgeries for pain management. Giving more narcotic medications is helpful with certain types of pain, while in other cases, it does not "touch" the pain.

It is amazing, in the case of a patient with abdominal spasms, to see a patient's excruciating pain respond to a simple medication made to treat that problem, when a very strong dose of morphine may not provide any relief. Increasing the dose of a medication which is not appropriate does not help, and only increases the adverse side-effects which good medical management tries to avoid.

Eventually if opiods are working there will come a time when tolerance to the medication, but not the side effects (like stopping breathing) will be reached.

Answer 7

Most narcotics will work. Technically, fentanyl and sufentanyl are extraordinarily strong, but that's on a milligram-for-milligram base, when compared to morphine, and it's a false argument, because the drugs are given in doses that will be effective. A few narcotics are not suitable. Meperidine (Demerol) won't do because of the buildup of normeperidine, a metabolite, with larger doses, but most of the schedule II (DEA class) narcotics will work, and the particular drug is largely up to the individual, with some patients tolerating the side-effects of one better than another.

Answer 8

Powerful painkillers given to terminally ill patients are any of the OPIODS- morphine is considered the strongest.

Morphine at prescribed dose does not independently cause coma but can cause some level of addiction and tolerance.

So far opiods are the stongest painkiller given to the control of cancer pains.

Answer 9

Ask your doctor about an exercise routine. Regular exercise, such as walking three times a week, may reduce neuropathy pain, improve your muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help.

Answer 10

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