Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2003
Review Comparative StudyComparative efficacy and safety of long-acting oral opioids for chronic non-cancer pain: a systematic review.
Opioids have been endorsed as appropriate treatment for refractory chronic non-cancer pain when used according to published guidelines. They are widely used for this indication. However, there appear to be gaps in our understanding of the efficacy and safety of individual long-acting opioids compared to each other or as a class compared to short-acting opioids. ⋯ There was insufficient evidence to prove that different long-acting opioids are associated with different efficacy or safety profiles. There was also insufficient evidence to determine whether long-acting opioids as a class are more effective or safer than short-acting opioids. A subgroup of three studies on long-acting versus short-acting oxycodone was more homogeneous and provided fair evidence that these formulations are equally effective for pain control.
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J Pain Symptom Manage · Nov 2003
Clinical Trial Controlled Clinical TrialA phase II trial of Reiki for the management of pain in advanced cancer patients.
This trial compared pain, quality of life, and analgesic use in a sample of patients with cancer pain (n=24) who received either standard opioid management plus rest (Arm A) or standard opioid management plus Reiki (Arm B). Participants either rested for 1.5 hr on Days 1 and 4 or received two Reiki treatments (Days 1 and 4) one hour after their first afternoon analgesic dose. Visual analogue scale (VAS) pain ratings, blood pressure, heart rate, and respirations were obtained before and after each treatment/rest period. ⋯ Quality of life was assessed on Days 1 and 7. Participants in Arm B experienced improved pain control on Days 1 and 4 following treatment, compared to Arm A, and improved quality of life, but no overall reduction in opioid use. Future research will determine the extent to which the benefits attributed to Reiki in this study may have been due to touch.
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J Pain Symptom Manage · Nov 2003
Clinical TrialThe effect of donepezil on sedation and other symptoms in patients receiving opioids for cancer pain: a pilot study.
Opioid-induced sedation is a major complication in patients with cancer pain. This study assessed the effectiveness of donepezil in opioid-induced sedation and related symptoms in patients with cancer pain. Twenty-seven patients who were receiving strong opioids for pain and reported sedation were enrolled. ⋯ Overall, however, the treatment was well tolerated. Donepezil appears to improve sedation and fatigue in patients receiving opioids for cancer pain. Randomized controlled trials of this agent are justified.
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J Pain Symptom Manage · Nov 2003
Patient perceptions of an outpatient palliative care intervention: "It had been on my mind before, but I did not know how to start talking about death...".
Little is known about whether introducing palliative care to seriously ill outpatients continuing to pursue treatment of their disease is acceptable or beneficial to patients. Intervention patients in a trial of outpatient palliative care consultation completed structured exit interviews as part of a qualitative study. Participants had advanced heart or lung disease or cancer, and a life expectancy between 1 to 5 years as estimated by their primary care physician (PCP). ⋯ Most patients reported improved satisfaction with family caregivers (85.7%), PCPs (80%), and the medical center (65.7%). Most patients (68.6%) would have wanted the intervention even earlier in the course of their illness. Seriously ill outpatients found palliative care acceptable and helpful, reporting increased satisfaction and decreased health care utilization.
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J Pain Symptom Manage · Nov 2003
Clinical TrialValidation of a modified Rotterdam Symptom Checklist for use with cancer patients in the United States.
The Rotterdam Symptom Checklist (RSCL) is a well-known instrument for the assessment of symptom-related distress among cancer patients. Despite its broad application, the utility of the RSCL with patients of some cancers is hindered by the omission of several important physical symptoms and methodological limitations of previous validation studies. ⋯ A total of 1,005 male and female cancer patients from two midwestern states completed the RSCL-M and several other self-report instruments. Results indicated that the RSCL-M is a reliable and valid instrument for use with cancer patients in the United States and is sensitive to differences in physical distress across groups expected to have distinct symptom-related distress profiles.