Friday, July 17, 2009


My dear friend is dealing with enormous post-op pain following a prolonged surgery for a bowel blockage. She's still in the IV drip phase of pain control, snowed under by varying doses of ketamine, hydromorphone, and methadone. The surgical team has called in anesthesia and the pain team to help manage her case, so we are once again dealing with multiple docs who, we hope, are more than less keeping in touch with one another.

Ways to control pain that don't require swallowing pills are important to surgical pain control as well as in situations where oral meds aren't tolerated or aren't enough. I was interested, therefore, to learn today about Onsolis, newly approved by the FDA, as an entirely new approach to the problem. Onsolis uses BioErodible MucoAdhesive (BEMA®) drug delivery technology to deliver Fentanyl across the tissues of the inner cheek into the bloodstream. Up until now, Fentanyl has been available as a skin patch which sometimes causes local irritation and occasionally results in overdose if patients apply heat to the body area on which the patch is stuck.

Gotta be careful with these heavy duty narcotics though, they are not for the uninitiated or narcotic naive patient whose liver is not muscled up for processing these drugs. I once had a patient with dreadful arthritis in her neck. She was prescribed morphine for pain control, and in an effort to be painfree, took way more than she tolerated and died in respiratory arrest. For patients like my friend, however, who have been using narcotic analgesia for some time and cannot reliably use or absorb oral meds, this little patch may be a great boon to their comfort.

1 comment:

kenju said...

Someone in my neighborhood almost did that a month ago. She was having severe hip pain and also has a torn rotator cuff. Her pain meds (taken 6 months or so) finally reached her limit, and her husband woke to her gasping for air and not making any sense. Luckily, she was taken to the hospital quickly.