Have you heard about topical cocaine for mucositis? Can morphine be used transdermally? Can IV lidocaine be administered for neuropathic pain? These and other novel approaches to complicated pain management cases were discussed by Dr. Judith Paice, Research Professor of Medicine, and Mr. Patrick Coyne, Clinical Director of the Thomas Palliative Care Service at Virginia Commonwealth University, at the ONS Connections Conference in Phoenix, Ariz.
Dr. Paice and Mr. Coyne returned to an old therapeutic use for cocaine as a vessel constrictor and a therapeutic tool against oral mucositis pain. They recommended no more than a 4 percent concentration up to 5ml to be used every 6 hours as needed.
They demonstrated evidence of their own research that showed morphine, unlike fentanyl, cannot be absorbed transdermally and that perhaps some of the placebo effect shown in studies of topical morphine administration to date had to do with its application over a pressure point (e.g., the wrist).
IV lidocaine is showing promise in the fight against neuropathic pain. Dr. Paice and Mr. Coyne recommended 0.5 to 2mg/kg/hr IV or SC with a maximum dose of 100mg in 30 minutes. IV lidocaine cannot be used in seizure patients. It is now being tested for effectiveness in patients with Sickle Cell Anemia.
Have you used any of these novel approaches to pain management? What was your experience with them? Is there anything else used in your facility to treat complex pain in cancer patients?
If you’d like to read more about some of the information above, here are selected references from their very informative presentation:
Ferrini, R., & Paice, J.A. (2004). How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. Journal of Supportive Oncology, 2(1), 90-94. Retrieved from http://jso.imng.com/jso/journal/articles/0201090.pdf.
Newport, K., & Coyne, P. (2010). Topical cocaine for relief of mucosal pain. Journal of Pain and Palliative Care Pharmacotherapy, 24(2), 149-151. doi:10.3109/15360281003743294.
Paice, J.A., Von Roenn, J.H., Hudgins, J.C., Luong, L., Krejcie, T.C., & Avram, M.J. (2008). Morphine bioavailability from a topical gel formulation in volunteers. Journal of Pain and Symptom Management, 35(3), 314-320. doi:10.1016/j.jpainsymman. 2007.04.016.