Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2015
Opioid-induced hyperalgesia (OIH): a real clinical problem or just an experimental phenomenon?
Although opioid-induced hyperalgesia (OIH) is mentioned as a potential cause of opioid dose escalation without adequate analgesia, true evidence in support of this notion is relatively limited. Most studies conducted in the context of acute and experimental pain, which seemingly demonstrated evidence for OIH, actually might have measured other phenomena such as acute opioid withdrawal or tolerance. ⋯ Thus far, with the exception of a few clinical case reports on OIH in patients with cancer pain and one prospective study in patients with chronic neuropathic pain, evidence for OIH in patients with chronic or cancer-related pain is lacking. Whether experimental pain models are necessary for establishing the clinical diagnosis of OIH, and which specific model is preferred, are yet to be determined.
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Thirst is a pervasive, intense, and distressing symptom in intensive care unit (ICU) patients. Although thirst may be avoided and/or treated, scant data are available to help providers identify patients most in need. ⋯ Thirst presence was predicted by selected medications (e.g., opioids). Thirst intensity and/or thirst distress were predicted by other treatments (e.g., mechanical ventilation) and medical diagnoses (e.g., GI). This is one of the first studies describing predictors of the multidimensional characteristics of thirst. Clinicians can use these data to target ICU patients whose thirst might warrant treatment.
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J Pain Symptom Manage · Mar 2015
ReviewWhich treatment is better? Ascertaining patient preferences with crossover randomized controlled trials.
The difference in patient-reported outcomes between study arms can often be difficult to ascertain in randomized controlled trials (RCTs) using a parallel design because of wide interindividual variations in baseline characteristics and how patients interpret the outcome measures. Furthermore, the minimal clinically significant difference is often not available for many outcomes, and even when available, not individualized for each patient. Crossover RCTs are designed for intraindividual comparisons, which can address these issues by asking patients to directly compare the interventions with regard to effectiveness, adverse effects, and ease of use and to provide an overall choice. ⋯ By facilitating intraindividual comparisons and eliciting patient preferences, crossover studies can provide unique information on the superior intervention. Crossover designs should be considered for selected palliative care studies.
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J Pain Symptom Manage · Mar 2015
Randomized Controlled TrialDoctors' decisions when faced with contradictory patient advance directives and health care proxy opinion: a randomized vignette-based study.
Sometimes a written advance directive contradicts the opinion of a health care proxy. How this affects doctors' decision making is unknown. ⋯ Contradictions between advance directives and proxy opinions result in a weak preference for abstention from treatment and increase the difficulty of the decision.
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J Pain Symptom Manage · Mar 2015
Comparative StudyWhat is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.
Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described. ⋯ Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia.