Journal of pain and symptom management
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J Pain Symptom Manage · May 2010
Case ReportsChallenges associated with spinal opioid therapy for pain in patients with advanced cancer: a report of three cases.
Intraspinal opioid therapy has been increasingly used for the management of cancer pain refractory to traditional treatment. However, this approach may present challenges in patients with advanced cancer. Three cases are presented that highlight the challenges associated with using neuraxial analgesia to manage cancer pain that was felt to be "refractory" to conventional treatment. Before an invasive procedure, such as placement of a permanent intrathecal opioid delivery system, a rigorous assessment and treatment of total pain (physical, psychological, spiritual, social, and practical) by an interdisciplinary team would be prudent.
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J Pain Symptom Manage · May 2010
Randomized Controlled Trial Clinical TrialAnodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition.
Consecutive sessions of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) may be a suitable therapy to treat chronic pain, as it can modulate neural activities in the stimulated and interconnected regions. ⋯ Results confirm that five daily sessions of tDCS over the hand area of the M1 can produce long-lasting pain relief in patients with chronic pain.
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J Pain Symptom Manage · May 2010
Randomized Controlled TrialAssessing and treating pain in hospices: current state of evidence-based practices.
The aim of this study was to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index, a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of those key evidence-based practices (EBPs) that were applicable to their situations. ⋯ Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed, or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices.
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J Pain Symptom Manage · May 2010
Trends and racial differences in the use of androgen deprivation therapy for metastatic prostate cancer.
Androgen deprivation therapy (ADT) is widely used to manage the symptoms of advanced prostate cancer and has been shown to slow the progression of the disease. Previous research investigating racial differences in the use of ADT has reported inconsistent findings. ⋯ African-American men with metastatic prostate cancer were significantly less likely to receive ADT and, when treated, had a slightly longer time to receipt than white men, which has implications for patients and physicians involved in the palliative management of metastatic prostate cancer.
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J Pain Symptom Manage · May 2010
Neuropathic pain in breast cancer survivors: using the ID pain as a screening tool.
Neuropathic pain (NP) is a debilitating symptom experienced by a number of patients with cancer. We evaluated the validity of ID Pain as a screening tool for NP in breast cancer survivors using the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and a reported diagnosis of NP as criterion measures. Two hundred forty breast cancer survivors with a mean age of 58 years (standard deviation=16) participated in this survey. ⋯ Receiver operating curve analysis demonstrated that ID Pain has a predictive validity of 0.72 and 0.70 for diagnosis of NP as made by clinicians and the S-LANSS, respectively. We also found that an ID Pain score greater than or equal to 2 corresponded with the likelihood of NP in this sample, consistent with the original ID Pain development study. This study provides evidence for ID Pain as a valid screening measure for NP in breast cancer survivors.