Journal of pain and symptom management
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J Pain Symptom Manage · Jun 2003
Randomized Controlled Trial Clinical TrialPilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain.
Pressure ulcer pain, a common problem among palliative care patients, does not respond well to oral analgesics. There have been case reports in the medical literature describing the successful use of topical opioids for painful skin conditions. So far, these topical opioids have not been compared to placebo. ⋯ Pain scores improved significantly after diamorphine gel application compared with placebo (P<0.05). Diamorphine gel appears to be an effective treatment for pain caused by stage II or III pressure ulcers. It is probably as safe as placebo in regards to side effects, but a larger study would be required to confirm these results.
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J Pain Symptom Manage · Jun 2003
ReviewAre opioid-dependent/tolerant patients impaired in driving-related skills? A structured evidence-based review.
Previous reviewers have concluded that opioids cause dose-related impairment in opioid-naive volunteers on psychomotor skills related to driving. Data relating to opioid-dependent/tolerant patients have not yet been reviewed. To determine what evidence, if any, exists for or against opioid-related driving skill impairment in opioid-dependent/tolerant patients, we performed a structured evidence-based review of all available studies addressing the issue of whether opioid-dependent/tolerant patients are impaired in driving-related skills. ⋯ This evidence was consistent in four out of five research areas investigated, but inconclusive in one. As such, additional controlled studies are required. Until more data are available, however, physicians may wish to consider the approach to this problem recommended in this review.
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J Pain Symptom Manage · Jun 2003
Comparative StudyPalliative care in a national cancer center: results in 1987 vs. 1993 vs. 2000.
In the last few years, palliative care for advanced and terminal cancer patients has undergone considerable evolution. We determined the characteristics of patients admitted to the 4-bed Palliative Care Unit (PCU) of the National Cancer Institute (NCI) of Milan in 1987, 1993 and 2000 to evaluate how our diagnostic and therapeutic approaches have changed over the years. We reviewed the charts of every patient admitted to the PCU in 1987, 1993, and the first ten months of 2000. ⋯ Over time, there was an increase in requests for specialist consultations, which was significant for neurological, cardiological and oncological consults (P < 0.001). Although the characteristics of the patients admitted to the PCU did not change over these years, there have been significant modifications in our therapeutic approaches, above all in the use of supportive therapy, adjuvant drugs, opioids and neurosurgical invasive procedures. Moreover, a major collaborative interaction with other specialists of the NCI took place with the aim to tailor treatment for each single patient.
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J Pain Symptom Manage · Jun 2003
Cancer pain management and the JCAHO's pain standards: an institutional challenge.
Unrelieved pain is a major medical problem. In response to this problem, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched new standards for pain management in 1999. A review was conducted in five hospitals of 117 charts of 80 inpatients and 37 outpatients with cancer who had pain documented in their medical records to determine whether application of these JCAHO standards was documented. ⋯ When pain was documented, treatment was noted in 86% of outpatients' charts and 89% of inpatients' charts. Of those patients with documented pain, reassessment after treatment was reported in 34% of the outpatient charts and 44% of the inpatient charts. Work to properly manage cancer pain needs to continue, and the JCAHO standards provide a mechanism to evaluate practice documentation in order to improve care.
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J Pain Symptom Manage · Jun 2003
Case ReportsOlanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer.
Nausea and vomiting are difficult symptoms to manage in patients with advanced cancer. Several classes of antiemetics are available, including phenothiazines, butyrophenones, substituted benzamides and selective serotonin antagonists, as well as corticosteroids. ⋯ The atypical antipsychotic, olanzapine, relieves nausea in some patients failing to respond to the usual antiemetics. Two case reports are presented and the rationale for olanzapine's benefit is discussed.