Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialNeurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study.
Sympathectomy is currently used as the fourth step of the modified World Health Organization (WHO) analgesic ladder. Sympathectomy can be performed early, before the second step on the ladder. ⋯ Sympathectomy before Step 2 on the WHO analgesic ladder seems to lead to better pain control, less opioid consumption, and better quality of life in cancer patients.
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialPain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.
Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. ⋯ Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialPre-emptive value of methylprednisolone intravenous infusion in patients with vertebral metastases. A double-blind randomized study.
The vertebral column is the most common site of bone metastases irrespective of the primary tumor. Vertebral metastases are a major cause of motor deficit of the lower extremities. The use of radiotherapy is the treatment of choice in these patients. A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem. Steroid infusion has well-documented neuroprotective effects. ⋯ Pre-emptive methylprednisolone infusion is an effective prophylactic agent in the prevention of radiation-induced pain flare and improves functional motor status after short-term radiotherapy in patients with vertebral metastases.
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J Pain Symptom Manage · Oct 2014
Randomized Controlled TrialCan senior volunteers deliver reminiscence and creative activity interventions? Results of the legacy intervention family enactment randomized controlled trial.
Palliative care patients and their family caregivers may have a foreshortened perspective of the time left to live, or the expectation of the patient's death in the near future. Patients and caregivers may report distress in physical, psychological, or existential/spiritual realms. ⋯ Delivery of the intervention by RSVs had a positive impact on palliative care patients' emotional symptoms and burden and caregivers' meaning in life. Meaningful prolonged engagement with palliative care patients and caregivers, possibly through alternative modes of treatment delivery such as continued RSV contact, may be necessary for maintenance of therapeutic effects.
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J Pain Symptom Manage · Oct 2014
Randomized Controlled Trial Comparative StudyClinic-based outpatient palliative care before hospice is associated with longer hospice length of service.
Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment. ⋯ Hospice patients who had clinic-based outpatient palliative consults before hospice enrollment tended, on average, to have a longer LOS in hospice than patients who did not.