Journal of pain and symptom management
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Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. The content is also available on www.palliativedrugs.com and will feature in future editions of the Hospice and Palliative Care Formulary USA and its British and Canadian counterparts. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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J Pain Symptom Manage · Sep 2010
ReviewA review of the literature on the multiple dimensions of chronic pain in adults with sickle cell disease.
Sickle cell disease (SCD) is a major health care and societal problem that affects millions of people worldwide. In Nigeria, 45,000 to 90,000 babies are born each year with SCD. In the United States, SCD is the most common genetic disorder, affecting more than 80,000 people, the majority of whom are African American. ⋯ The primary purpose of this literature review was to summarize the findings from studies that evaluated the characteristics of chronic pain in adults with SCD. Each of the studies included in this review was evaluated to determine if it provided data on the following multidimensional characteristics of chronic pain: occurrence, number of pain episodes, duration, pattern, quality, location, intensity, aggravating factors, relieving factors, and impact of pain on function. A secondary purpose was to identify gaps in knowledge and directions for future research on the multiple dimensions of chronic pain in adults with SCD.
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J Pain Symptom Manage · Sep 2010
In-clinic use of electronic pain diaries: barriers of implementation among pain physicians.
The aim of this study was to examine barriers to the use of electronic diaries within the clinic setting and determine outcome differences between patients who used electronic diaries to monitor their progress with summary data feedback and patients who monitored their progress with paper diaries without summary data feedback. ⋯ In general, treating physicians were positive about the use of electronic diaries, although they admitted that they did not regularly incorporate the summary data in their treatment decision making because either they forgot or they were too busy. Future studies in understanding barriers to physicians' and patients' use of diary data to impact treatment outcome are needed to improve care for persons with chronic pain.
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Altered mental status and reduced level of consciousness are common among patients admitted to palliative care units. However, nonconvulsive status epilepticus (NCSE) has rarely been considered as a possible cause, and electroencephalographic confirmation of the epileptic status is sparse. The clinical presentation of patients with NCSE varies from altered mental status to coma, with no or only minimal convulsions. ⋯ Nine of 15 patients could be effectively treated with anticonvulsants and regained communication ability before death. NCSE appears to be an important, often unrecognized, and potentially treatable cause of altered mental status in palliative care patients. Pharmacological treatment might restore communicative abilities even in severely ill patients.
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J Pain Symptom Manage · Sep 2010
Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis.
There is little evidence on the symptoms experienced by those with advanced (Stage 5) chronic kidney disease (CKD), managed without dialysis, as they approach death. As palliative care extends to noncancer illnesses, understanding symptom prevalence and severity close to death will clarify which symptom interventions are most needed and which elements of (largely cancer-driven) models of palliative care best translate into end-of-life care for this population. ⋯ Stage 5 CKD patients have clinically important physical and psychological symptom burdens in the last month of life, similar or greater than those in advanced cancer patients. Symptoms must be addressed through routine symptom assessment, appropriate interventions, and with pertinent models of end-of-life care.