Journal of pain and symptom management
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J Pain Symptom Manage · Dec 1990
Comparative Study Clinical Trial Controlled Clinical TrialDiscordance between self-report and behavioral pain measures in children aged 3-7 years after surgery.
This study examined concurrent self-reports of pain intensity and behavioral responses in 25 children aged 3-7 yr. Behavioral (Children's Hospital of Eastern Ontario Pain Scale, CHEOPS) and self-report (the Oucher and Analogue Chromatic Continuous Scale) measures of pain were obtained following major surgery. ⋯ Many children who reported severe pain manifested few of the behavioral indicators of distress used in the CHEOPS. This behavioral response pattern may occur commonly in children experiencing pain after surgery and may limit the applicability of current behavioral scales as sole measures of pain intensity in younger children.
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We report an open, uncontrolled study designed to assess the effects of subcutaneous (SC) morphine on dyspnea of terminal cancer. Twenty patients with dyspnea caused by restrictive respiratory failure received an SC dose of morphine of 5 mg (5 patients who were not receiving narcotics), or equivalent to 2.5 times their regular dose (15 patients who were receiving narcotics for pain). Dyspnea (D) and pain (15 cases) were measured before the dose and every 15 min for 150 min after the injection using a visual analog scale 0-100. ⋯ Nineteen of 20 patients (95%) reported improved dyspnea after morphine. We conclude that morphine appears to improve dyspnea without causing a significant deterioration in respiratory function in terminal cancer patients. Double-blind placebo controlled studies are needed in this population.
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Physician education in cancer pain management is seriously deficient. Many problems occur with opioids simply because of therapeutic ignorance. Opioid side effects are best prevented by using morphine as the drug of first choice for severe pain. ⋯ Physicians need to be aware of how to transfer patients from one opioid to another or from one route of administration to another. Side effects common in clinical practice are constipation, nausea/vomiting, dry mouth, and sedation. The importance of the issues of tolerance, dependence, and respiratory depression have been exaggerated.
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Respiratory symptoms are a common cause of distress in patients with advanced cancer. Optimal palliative therapy requires careful assessment and the appropriate use of symptomatic measures in conjunction with specific antitumor treatments. The etiology and management of the three major respiratory symptoms, dyspnea, cough and hemoptysis, are described. The indications for antitumor treatments and surgical procedures are briefly outlined, and symptomatic treatments, including drug and nondrug measures, are discussed in detail.
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J Pain Symptom Manage · Oct 1990
Ambulatory infusion devices in the continuing care of patients with advanced diseases.
Until recently, patients who required hydration or parenteral administration of narcotics or antiemetics remained in hospitals until death. The period of admission, which varied between days and months, resulted in a decreased quality of life for the patient and family. With the development of portable infusion pumps, patients with these needs can now be safely discharged home for long periods of time, thereby significantly reducing the cost of medical care and improving quality of life for patients and families. ⋯ The high cost of portable pumps and supplies are a major obstacle for the establishment of large programs for home parenteral drug administration. More research is needed to better characterize the pharmacokinetics of different drugs when administered subcutaneously, and to develop simpler and more effective portable infusion devices. The results of this research will have a major impact on the quality of life of patients and their families.