Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2007
Low use of durable medical equipment by chronically disabled elderly.
Assistive devices are a common effective approach to mitigating the effects of chronic disability. The Medicare Durable Medical Equipment (DME) benefit is intended to provide patients with equipment to meet the challenges of health-related disability; the penetrance of benefit among the disabled is unclear. ⋯ Fewer than half the chronically disabled, and less than one-quarter of the newly disabled, received any DME from Medicare. These data suggest underuse of the benefit by the disabled elderly.
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J Pain Symptom Manage · Mar 2007
Randomized Controlled TrialSymptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial.
The level of evidence for the use of acupuncture and massage for the management of perioperative symptoms in cancer patients is encouraging but inconclusive. We conducted a randomized, controlled trial assessing the effect of massage and acupuncture added to usual care vs. usual care alone in postoperative cancer patients. Cancer patients undergoing surgery were randomly assigned to receive either massage and acupuncture on postoperative Days 1 and 2 in addition to usual care, or usual care alone, and were followed over three days. ⋯ Participants in the intervention group experienced a decrease of 1.4 points on a 0-10 pain scale, compared to 0.6 in the control group (P=0.038), and a decrease in depressive mood of 0.4 (on a scale of 1-5) compared to +/-0 in the control group (P=0.003). Providing massage and acupuncture in addition to usual care resulted in decreased pain and depressive mood among postoperative cancer patients when compared with usual care alone. These findings merit independent confirmation using larger sample sizes and attention control.
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J Pain Symptom Manage · Mar 2007
ReviewMultimodal approaches to the management of neuropathic pain: the role of topical analgesia.
Because of their localized activity and low systemic absorption, topical analgesics have a favorable safety profile and a low risk for drug-drug interactions. There is a growing body of evidence on the efficacy and safety of these agents in a variety of pain disorders, including the most prevalent neuropathic pain conditions. The molecular basis for the usage of peripheral analgesics in neuropathic pain and the available clinical trial evidence for a wide variety of topical agents are reviewed.
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J Pain Symptom Manage · Mar 2007
Comparing hospice and nonhospice patient survival among patients who die within a three-year window.
There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients' lives. We studied the difference of survival periods of terminally ill patients between those using hospices and not using hospices. ⋯ Mean survival was not significantly different (statistically) for hospice vs. nonhospice patients with breast or prostate cancer. Across groups studied, hospice enrollment is not significantly associated with shorter survival, but for certain terminally ill patients, hospice is associated with longer survival times. The claims-based method used death within three years as a surrogate for a clinical judgment to recommend hospice, which means our findings apply to cases where a clinician is very sure the patient will die within three years, and it points to the need to validate these findings.
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J Pain Symptom Manage · Mar 2007
Hospital deaths in Sweden: are individual socioeconomic factors relevant?
As the proportion of deaths in hospital falls, it is important to ensure that social disadvantage has no role in determining place of death. This study investigated the association between individual sociodemographic factors and deaths in hospitals for the population of Stockholm County, Sweden, using linked population registers. In 2002, 14,517 (87%) of the 16,617 adult decedents in Stockholm County had contact with health services in the three years before they died. ⋯ Decedent characteristics associated with higher chance of hospital death included older age, being married, diagnosis of heart disease, and contact with ambulatory services (not family practitioners) in the three years before death. Cancer patients were no more or less likely than those without cancer to die in hospital. In health systems wishing to reduce an already low proportion of deaths in acute hospitals, enhancing palliative and social support for older patients and people with noncancer diagnoses may merit attention.