Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2013
Placebo and nocebo effects in randomized controlled trials: the implications for research and practice.
Placebo and nocebo effects are known to contribute significantly to the response to symptom control, including analgesia. Clinical trial methodologies using placebo controls are designed to identify the magnitude of these effects in the research context. An adequately powered, randomized, double-blind, placebo-controlled trial of ketamine in cancer pain has recently been reported, which demonstrated no net clinical benefit for ketamine over and above that of placebo. ⋯ The findings of the ketamine study are analyzed in the context of a methodological discussion of placebo and nocebo effects, what is known about the biological and psychological bases for each of these, and their implications for a clinical trial design in the palliative care setting. Along with reviewing the use of ketamine after this negative trial, clinicians need to remain aware of the strength and significance of both placebo and nocebo responses in their own practices and the biopsychosocial complexity of why and how patients actually respond to pain management strategies. The results of this study strongly reinforce the importance of the therapeutic relationship and the context of care.
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J Pain Symptom Manage · Nov 2013
Living with advanced but stable multiple myeloma: a study of the symptom burden and cumulative effects of disease and intensive (hematopoietic stem cell transplant-based) treatment on health-related quality of life.
The cumulative impact of disease and treatment-related factors on health-related quality of life (HRQoL) in long-term survivors of multiple myeloma is poorly characterized. ⋯ Despite disease control and supportive care, intensively treated long-term myeloma survivors have significantly compromised HRQoL related to symptom burden. Systematic assessment is routinely indicated in advanced phase myeloma, even when disease activity is stable. Further studies should investigate the utility of interventional strategies and the relationship of cytokines with symptoms.
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J Pain Symptom Manage · Nov 2013
Targeted investment improves access to hospice and palliative care.
Availability of hospice and palliative care is increasing, despite lack of a clear national strategy for developing and evaluating their penetration into and impact on the target population. ⋯ Receipt of philanthropic funding appeared to be associated with improved access to palliative care and hospice services in NC.
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J Pain Symptom Manage · Nov 2013
New approaches to understand cognitive changes associated with chemotherapy for non-central nervous system tumors.
Researchers have described a constellation of cognitive deficits (e.g., impairments in executive functions, working memory, attention, and information-processing speed) associated with cancer treatment, and specifically chemotherapy, for non-central nervous system tumors. However, findings have been inconsistent, largely because of measurement and study design issues. ⋯ There is a need to apply new research approaches to understand the real-world functional implications of the cognitive side effects of chemotherapy to develop and implement strategies to minimize and remediate these effects before, during, and after cancer treatment.
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Providing care for patients and caring about patients should go hand in hand. Caring implicates our fundamental attitude towards patients, and our ability to convey kindness, compassion and respect. Yet all too often, patients and families experience health care as impersonal, mechanical; and quickly discover that patienthood trumps personhood. ⋯ If caring really matters, health care systems can insist on certain behaviors and impose certain obligations on health care providers to improve care tenor, empathy, and effective communication. Caregivers need to be engaged in looking at their own attitudes towards patients, their own vulnerability, their own fears and whatever else it is that shapes their tone of care. Health care professionals must set aside some time, supported by their institutions, to advance a culture of caring-now is the time to take action.