Postgraduate medical journal
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The well established use of oral morphine in the treatment of chronic cancer pain has developed empirically and a knowledge of its pharmacokinetics is not necessary in order to use the drug effectively. However recent information about the pharmacokinetics of morphine may help resolve the controversy about oral to parenteral relative potency ratios, and may also in the future shed some light on the problem of patients whose pain does not respond to morphine.
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Pain management is an integral component of comprehensive cancer care. The combined goals of optimal comfort and optimal function require a working understanding of how pain therapy interacts with cancer and cancer therapy. The two main aspects of cancer which affect pain management are the cancer's treatability and its non-pain pathophysiology. ⋯ Pain therapy can impair cancer therapy by augmenting or complicating cancer therapy's adverse effects. Pain therapy can enhance cancer therapy by improving organ function and patient performance status permitting previously limited or contraindicated cancer therapies to be given. Five case studies are presented to illustrate how effective integration of pain management into comprehensive cancer care is mandatory for optimal care of cancer patients and their families.
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Pain about the bridge of the nose is often a diagnostic dilemma. There is an important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by anaesthesia can be achieved and cure is possible by division of the anterior ethmoidal nerve. This rare cause of facial pain is presented using two illustrative cases.
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Systemic and renal haemodynamic and functional indices were measured in 15 anaesthetised pigs during systemic sepsis induced by faecal peritonitis. Five animals were assigned to maintenance of cardiac output (CO) at baseline, pre-infection values throughout the study (controls n = 5). In the remaining 10 animals, CO was increased by 25% prior to induction of sepsis and maintained at this level for the duration of the study using volume expansion with intravenous colloid and an infusion of either 20 micrograms/kg/min dobutamine (n = 5) or placebo (n = 5). ⋯ In the dobutamine group systemic oxygen uptake (VO2) increased from 173 +/- 30 to 277 +/- 73 ml/min (P less than 0.05), however this resulted in a decrease in renal DO2 (20 +/- 9 to 10 +/- 2 ml/min P less than 0.05) and there was no equivalent rise in renal VO2 (3.3 +/- 1.6 to 3.2 +/- 1.5 ml/min). There was however no significant difference in the effect on renal function of the three management protocols. Agents used to increase cardiac output during systemic sepsis may result in significantly different effects on the renal vascular bed which are not revealed by the measurement of systemic indices alone.
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The purpose of this study was to describe family factors which influence cancer pain. Previous research has focused on the patients' and professional caregivers' perspective of pain. ⋯ Findings of the study demonstrate family perceptions of pain, caregiver burden associated with pain, caregiver moods and differences in caregiver experiences of pain between three sites of care including a hospice, a community hospital and a cancer centre. Understanding the perspective of the family caregivers and their role in pain management can assist health care providers in management of the patient's pain.