Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2008
Randomized Controlled Trial Comparative StudyA pilot phase II randomized, cross-over, double-blinded, controlled efficacy study of octreotide versus hyoscine hydrobromide for control of noisy breathing at the end-of-life.
Noisy breathing at the end of life (noisy breathing ("NB") occurs in up to 90% of people. Interventions have not been systematically evaluated. There has been clinical observation coupled with a proposed mechanism of effect that supports a role for octreotide in management of NB. ⋯ There was no difference in the median time to administration of the second medication (3 hours). Two participants in each arm had a 2 category reduction of intensity after the second medication. Although feasible to consent and study this population in a way that respects autonomy and dignity even in the terminal hours of life, this pilot study suggests reconsideration of the pharmacological interventions (choice of agents, dosing, timing of dosing and pharmacokinetic profiles), standardizing of non-pharmacological care; and ways to measure directly family distress before further randomized studies for this symptom.
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The top-line findings, arranged by date, from major national pain surveys published in 2005 and 2006 are reviewed. This report supplements the report on surveys published between 1996 and 2004 that appeared in Volume 21, Number 4, of the Journal.
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J Pain Palliat Care Pharmacother · Jan 2008
Clinical TrialOpen-label, add-on study of tetrahydrocannabinol for chronic nonmalignant pain.
Cannabinoids have been used for pain relief for centuries and recent studies have investigated their analgesic and anti-inflammatory mechanisms, as well as clinical efficacy, in treating chronic pain. We report an open-label study addressed to evaluate the effect and adverse events of orally administered Delta-9-tetrahydrocannabinol (Delta-9-THC) in 13 patients with chronic nonmalignant pain (CNMP) unresponsive to conventional pharmacotherapy. ⋯ Seven patients did not experience any adverse events (AEs), six patients reported AEs, two of which discontinued the treatment. We conclude that oral THC may be a valuable therapeutic option for selected patients with CNMP that are unresponsive to previous treatments, though further research is warranted to characterize those patients.
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J Pain Palliat Care Pharmacother · Jan 2008
Roles of social workers in interdisciplinary pain management.
Social workers provide important services to chronic pain patients and are the major mental health professionals in hospice and palliative care. Examples of ways that social workers provide these services are documented though a series of queries and responses about those professionals' roles.
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J Pain Palliat Care Pharmacother · Jan 2008
Case ReportsInconsistencies in opioid equianalgesic ratios: clinical and research implications.
Cancer pain is common, occurring in up to 60% of patients and opioid conversion may be required for effective pain management. Conversion from one opioid to another can be problematic due to differences in equianalgesic ratios found in established resources. This study explores the implications of using various published equianalgesic ratios when converting to a common opioid unit. ⋯ First, this study substantiates the use of these ratios as only guidelines for treatment. Second, it supports the need for well-designed, rigorous studies to evaluate opioid conversions. Third, this study demonstrates the need for a standard reporting system of opioid equianalgesic ratios employed in clinical trials.