Journal of pain and symptom management
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J Pain Symptom Manage · Mar 1999
Randomized Controlled Trial Clinical TrialIontophoretic vincristine in the treatment of postherpetic neuralgia: a double-blind, randomized, controlled trial.
The effect of iontophoretic administration of vincristine in the treatment of postherpetic neuralgia (PHN) was investigated in a prospective, double-blind, placebo-controlled trial. Twenty patients with intercostal or lumbar PHN for more than 6 months that was unresponsive to conventional medical therapy were randomized to receive vincristine 0.01% (n = 11) or saline (n = 9), by iontophoresis over 1 hour daily for 20 days. Demographics and median duration of pain were similar in both groups. ⋯ Moderate or greater pain relief was maintained in 30% of patients with vincristine and 33% of patients with placebo at follow-up on day 90. We conclude that iontophoresed vincristine is no better than iontophoresed saline in the treatment of PHN. The maintained improvement in both groups at 3 months follow-up may reflect the natural history of PHN, or might possibly by related to a beneficial effect of iontophoresis.
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J Pain Symptom Manage · Mar 1999
ReviewInjected morphine in postoperative pain: a quantitative systematic review.
This systematic review of single-dose, placebo-controlled, randomized trials assessed pain relief from subcutaneous, intramuscular or intravenous morphine compared with placebo in postoperative pain. Pain relief or pain intensity difference over 4 to 6 hours was extracted and converted into the number of patients with at least 50% pain relief. ⋯ This meant that one of every three patients with moderate or severe postoperative pain treated with 10 mg intramuscular morphine had at least 50% pain relief, and would not have achieved this had they been given placebo. Minor adverse effects were more common with morphine (34%) than with placebo (23%) (relative risk 1.49 [1.09-2.04]), but drug related study withdrawal was rare (1.2% overall) and no different from placebo.
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Enternal feeding is indicated in patients unable to ingest sufficient nutrients but whose gastrointestinal function is adequate for digestion and absorption. Indications in palliative care include patients with radical esophageal surgery, upper gastrointestinal tract obstruction, anorexia, and dysphagia. ⋯ A number of questions must be asked before a drug is considered for enteral administration. Firstly, is the drug in a suitable dosage form for administration? If not, can a different dosage form (or drug) be substituted or can the physical form of the original product be altered? Secondly, is the drug compatible with the enteral feed? Finally, are there any complicating factors that may affect drug absorption or clearance? This review attempts to answer these questions, provide easily understood guidelines for the successful enteral administration of medications, and discuss clinical implications for palliative care.
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J Pain Symptom Manage · Mar 1999
Attitudes toward euthanasia and physician-assisted suicide among Italian primary care physicians.
The public debate about euthanasia and assisted suicide is less pronounced in Italy than in other countries, and data about this topic are lacking. The aim of this study was to investigate primary care physicians' experience in requests for and opinions about euthanasia and/or assisted suicide for terminally ill patients and the relationship between attitudes and professional variables. Three-hundred thirty-six general practitioners completed the Euthanasia Questionnaire to assess attitudes toward euthanasia and/or assisted suicide and the Maslach Burnout Inventory to examine burnout symptoms. ⋯ Only a minority of the physicians endorsed euthanasia and/or assisted suicide. Agreement with the practice of euthanasia/assisted suicide was correlated with non-Catholic religious affiliation, inexperience in treating terminally ill patients, and the burnout dimension of depersonalization. The fact that professional as well as individual factors (e.g., inexperience, non-Catholic affiliation, burnout) were associated with favorable attitudes toward euthanasia and/or assisted suicide underscores the need to examine the problem as a complex phenomenon involving the dyadic patient-doctor relationship.