Against a backdrop of the growing scrutiny of appropriate dosages, this textbook takes a fresh, new approach to helping health professionals strengthen care to and possibly save the lives of patients living with pain. This easy-to-understand and often humorous book is the most comprehensive to-date on opioid calculations for pain management and palliative care. It carefully walks clinicians through a five-step process for performing opioid conversion calculations in the real-world situations they often see. The book has case examples, simple charts and tables, and practice problems throughout. It is a must for clinicians at all levels: hospice and palliative care physicians, physician s assistants, nurses, nurse practitioners, and pharmacists. Clinicians will come away with more confidence in doing the calculations, and higher service levels from the improvement in care.

Review:

I once wrote that pain and symptom control must come first, as it is not possible to have a meaningful conversation about psychosocial or spiritual issues with a patient with unrelieved pain. This book is about optimising pain control with opioid drugs for those with moderate or severe pain. In a very clear and practical way, it describes the use of opioids, changing to different routes of administration, changes to different opioids, the treatment of breakthrough pain, the difficulties that can be experienced with methadone, and the challenges of transdermal fentanyl and neuraxial opioids. It is written in an almost conversational manner, sometimes humorous, with lots of case anecdotes and highlighted clinical Pearls and clinical Pitfalls. Having been through the exercise, I think that these are important, for to present all this information in a dry, prescriptive manner is enough to narcotize the keenest reader. For someone with some experience with opioid therapy, I am not sure this book is concise enough for day-to-day use in the ward, but it would certainly be very useful for postgraduate courses in medical and nursing palliative care, where the finer detail of opioid therapy is sometimes overshadowed by matters related to psychosocial and spiritual concerns. I have to say that it warmed my heart to read about the author spending a fair amount of time banging my head on the desk restling with the limited, yet frequently conflicting, information published on opioid conversion calculations . The scientific basis of what we do in the clinic is incomplete, but I think this book provides sound and common sense advice where the science is lacking. --Dr. Roger Woodruff, International Association for Hospice & Palliative Care Newsletter, November 2010

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