DrugBuyers.Com: Demerol not good for pain???

While browsing, I came across the article pasted below.

The Passing of Demerol
J. David Daniels, MD
Meperidine (Demerol) has been the traditional analgesic drug for many years. Several misconceptions have lead meperidine to the established place as the standard agent for pain control. In truth, Meperidine is distinctly inferior for pain control, an irritant at the site of injection, ineffective orally, and has a dangerous toxic metabolite which can accumulate at standard doses. Serious questions must be raised about the continued use of Meperidine view of its poor effectiveness and high incidence of serious side effects.

The erroneous reasons for the use of Meperidine have been repeated so often that they have been accepted as truth. These misconceptions include: Less respiratory depression, less effect on biliary pressure, and a lower addiction potential than alternative analgesics, are the standard dogma for the use of Meperidine, All of those old teachings have been proven groundless in recent studies by experts and pharmacologists on pain control. Meperidine has been in use so long that it has less stigma than morphine and it is more readily accepted by health professionals and lay people alike.

The first disadvantage of Meperidine is a short duration of action of only 2 to 3 hours. The standard dosing schedule results in serum levels below the concentration required for pain relief for most of the dosing interval. The old teaching has alleged that a certain amount of pain is good for the healing process. Extensive research by pain experts have proven that pain prevention and continuous control decreases suffering by the patient, hastens recovery time and shortens the length of hospital stay.

The second disadvantage is that Meperidine is a toxic, local irritant, which must be given intramuscularly, and not subcutaneously. Frequent injections lead to muscle fibrosis with decreased analgesic effectiveness. Almost all patients with acute severe pain have intravenous lines and could receive analgesics by that route. Intravenous administration is better for the patient and carries a much lower Risk of needle injury for the nurse. The intramuscular route is inferior for pain control and should be abandoned.

Meperidine is a central nervous system depressant with the same side effects as other narcotics, including respiratory depression, sedation, and constipation.

Additionally, Meperidine is metabolized to normeperidine. This toxic metabolite, causes symptoms of negative mood swings, tremor and twitches, which may lead to multifocal clonus and eventually generalized seizures.

This syndrome is called "Meperidine-induced CNS Excitatory Toxicity." Other studies have demonstrated an increased incidence of post operative delirium in patients receiving Meperidine. Toxicity may occur in normal individuals at standard dose. Risk factors for seizures include larger or more frequent doses (such as for pancreatitis or advanced cancer), renal dysfunction, chronic use longer than six days, and patients with a low seizure threshold.

Normeperidine toxicity can be treated by stopping Meperidine immediately. Standard anti-seizures measures should be used. Naloxone should be avoided as it reverses the analgesic effect of Demerol but not the effects of normeperidine. Pane control can be continued with a preferred analgesic, such as morphine.

In summary, pain should be relieved, not endured. The end point of relief must be interpreted by the patient. the nurse at the bedside must constantly assess the patient's report of pain and offer sufficient medication for relief.

Analgesics, such as morphine or hydromorphone (Dilaudid, can be given for constant pain control while staying below toxic levels, Demerol is an old, lumbering dinosaur which must be taken out of use in order that effective pain control can become a reality.

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Just wondering what your thoughts were on this subject. It has always been very effective for pain for me when drugs like morphine couldn't touch it. In fact, if I got to choose my pain med it would definitely be Demerol.

Thoughts, anyone?

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