Morphine is considered the gold standard of therapy for treatment of acute and chronic pain. In regards to intrathecal drug therapies, most physicians will trial their patients on morphine and subsequently institute appropriate measures.

In conditions where morphine is not acceptable or is not yielding the desired clinical effects, clinicians will consider changing to fentanyl citrate. When doing so, it is important to carefully consider both potency and characteristics.

Fentanyl differs from morphine both in regard to clinical response as well as pharmacological characteristics. Morphine is hydrophilic, and fentanyl is very lipophilic, and there is the issue of potency. There is concern among clinicians about changing from morphine to fentanyl because of the fact that fentanyl is demonstrably more potent: in acute pain 100 times more potent and 50 times more potent for chronic pain than morphine. 

Due to fentanyl's lipophilic properties, the distribution of this drug is more focal as related to the catheter tip.  Tissues within the intrathecal space are very (dense in fat, fat saturated, fatty), with a great capacity for absorbing fentanyl, consequently, fentanyl does not travel significantly within the intrathecal space.

Once the decision has been made to change therapies, I recommend a 1 to 25 conversion rate. Although the "textbook" conversion recommendation for chronic pain is 1 to 50, I consider that to be too conservative, based upon the comparative characteristics of the drugs themselves. A 1 to 25 rate is still conservative...but I strongly suggest that physicians achieve their own comfort zone as they gain experience with the conversion process. And, of course, weigh the individual differences and concerns of each patient when determining what conversion level will best serve.

In the matter of Hartley Business Manager Stacy Cancino, the jury (comprised of her co-workers and contacts) has reached a verdict:

"Name a problem, she'll solve it."

Further assessments run the gamut from "Stacy has done every job - she can relate to employees and help them be successful" to "Always steps up to do anything" and "She's a SUPERWOMAN."

Ask Stacy, she'll put it yet another way...

"We work together to make sure that all aspects of the company are on track and on target."

A Los Angeles native, Stacy came to Hartley in 2004 with a background in pharmacy tech and a PTCB certification. In two years, she was promoted from Distribution Coordinator to Executive Assistant, and in two more years she rose to her current position. She is now responsible for managing all aspects of office organization, productivity, and administrative support - including (but not limited to) Human Resources, Accounting, Production, and Motivation.

That last one is key, because Stacy is that rare individual tasked with ensuring that employees are motivated to help customers and address their needs, while also ensuring that Hartley clients remain Hartley clients.

At Hartley we have chosen to hang our collective hat on consummate customer service. Stacy sees to that at all levels. She is the poster woman for multi-tasking and every-stage accountability. She's a good listener, a quick study, a trusted source of strength for all to draw upon...and she knows how to make the decisions that have to be made.

Stacy diligently embraces the daily demands of her position with confidence, knowledge, equanimity and empathy...always challenging herself and her co-workers to rise to a new level of excellence.

Thanks, Stacy. You're the standard that drives our standards.