title: A four-drug pain regimen for head and neck cancers.
abstract: Twenty patients with end-stage head and neck cancer, unresponsive to either acetaminophen with codeine or oxycodone hydrochloride, were placed on a four-drug analgesic regimen consisting of methadone hydrochloride, Trilisate or acetaminophen, a tricyclic antidepressant, and, in most cases, hydroxyzine. All drugs could be delivered through a feeding tube, making this regimen appropriate for dysphagic patients. The efficacy of this nonparenteral regimen was assessed by structured pretreatment and posttreatment interviews that addressed pain intensity, activity, and sleep levels. All of the patients showed improvement in their pain levels and 16 of the 20 had a > or = 50% improvement in all of their pain ratings (P < .01) that persisted until death (2 to 10 months later). Excellent results and ease of administration make this regimen a good choice for analgesia in terminal patients.
authors.affiliation: Pain Clinic, Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106.
authors.forename: E N
authors.initials: EN
authors.lastname: Carrol
authors.forename: E
authors.initials: E
authors.lastname: Fine
authors.forename: R L
authors.initials: RL
authors.lastname: Ruff
authors.forename: D
authors.initials: D
authors.lastname: Stepnick
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006258:Head and Neck Neoplasms / Q000503:physiopathology*; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage*; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D012890:Sleep / Q000187:drug effects
chemical_list: D000929:Antidepressive Agents, Tricyclic; D006919:Hydroxyzine; D000082:Acetaminophen; D008691:Methadone