Analgesic gaps

Carr DB, Reines HD, Schaffer J, et al. The impact of technology on the analgesic gap and quality of acute pain management. RegAnesth Pain Med. 2005 30 286-291. 

Panchal and coworkers evaluated the incidence of analgesic gaps resulting from SREs for patients using the fentanyl iontophoretic transdermal system (ITS), a non-invasive PCA system, or morphine IV-PCA for post operative pain management [12]. For morphine IV-PCA, infiltration of the IV line was the most frequently reported SRE that resulted in an analgesic gap. Infiltration at the catheter site is a problem commonly encoimtered with IV-related procedures, and may result in IV line failure and/or a subcutaneous depot of opioid, leading to inadequate and ineffective delivery... 

Analgesic gaps are a significant component as to why patients are under-treated in regard to acute pain, and occur from a variety of causes. In order to mitigate this problem and improve patient outcomes, it is important for institutions to take a comprehensive approach. It is necessary to address transition issues such as patient location changes, as well as transitions from one analgesic therapy to another. This will... 

Ng A, Hall F, Atkinson A, Kong KL, Hahn A. Bridging the analgesic gap. Acute Pain 2000 3 194-199. 

Smith G, Power I. Audit and bridging the analgesic gap. Anaesthesia 1998 53 521-522. 

Ranchal SJ, Damaraju CV, Nelson WW, Hewitt DJ, Schein JR. System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controUed analgesia. Anesth Anal 2007 105(5) 1437-1441. 

However, there is still a wide gap in the understanding of the nephrotoxic effects caused by certain therapeutic agents such as cyclosporin, analgesics, and nonsteroidal anti-inflammatory agents. Several chemical substances disturb the glomerular filtration rate (GFR) and related renal functions in animals and humans. 

Pharmacologists have been unable to come up with analgesics (pain relievers) ot medium strength to fill the gap between aspirin and morphine. They have given us several derivatives of opiates that they claimed were more powerful than aspirin but safer and less addicting than morphine. If these drugs are effective at controlling pain, however, they always turn out to be attractive to opiate addicts and are likely to cause dependence. 

Large numbers of these are offered particularly to bridge the efficacy gap between paracetamol and morphine. Doctors should consider the formulae of these preparations before using them. Caffeine has been shown to enhance the analgesic effect of aspirin and of paracetamol and to accelerate the onset of effect, but at least 30 mg and probably 60 mg are needed (a cup of coffee averages about 80 mg and of tea averages about 30 mg). 

Phenacetin Spontaneous reports, time gap signai and use OTC, combined with other analgesics Poor Co-medications, disease severity, protopatic bias... 

Thirty-four patients vith advanced solid tumors were treated with CA-4-P receiving 167 infusions [47]. The drug CA-4-P was given weekly for 3 weeks followed by a gap of 1 week. Up to 40 mg/m, the only drug-related toxicity was tumor pain in 35%. Tumor pain was not considered a dose-limiting toxicity because it could be controlled by analgesics. Tumor viability and tumor blood flow were assessed by positron emission therapy (PET) and DCE-MRI. 

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