Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2003
Pain and palliative care in the Cochrane Library: Issue Number 4 for 2002.
The Cochrane Library of systematic reviews is published quarterly. Issue 4 for 2002 contains 2655 reviews of which 1519 are completed and in full text. Nine of those are directly relevant to pain management and palliative care. Annotated bibliographies for those nine reviews are provided.
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Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. ⋯ Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.
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J Pain Palliat Care Pharmacother · Jan 2003
Pain management in a long-term care facility: compliance with JCAHO standards.
An analysis of the treatment of nonmalignant pain in the elderly at a long-term facility was conducted to allow development of a pain management program that complies with both JCAHO guidelines for pain management and with the Tennessee Medicaid (TennCare) reimbursement schedule, and to determine if tramadol can meet the standards of pain management under these new guidelines. Inclusion criteria were residence in our long-term care facility; a pain intensity score > 4 on a modified Wong Baker Pain Scale; the patient having prescription orders for one or more of the following drugs: propoxyphene, meperidine, or high dosages of acetaminophen (approaching 4 g/day); suspected neuropathic or mixed nociceptive/neuropathic pain; and/or a diagnosis of diabetes, osteoarthritis, or degenerative joint disease. Exclusion criteria were history of seizures, history of opioid or alcohol abuse, and demonstrated hypersensitivity to tramadol or opioids. ⋯ Tramadol reduced the percentage of residents falling, losing weight, showing no change or decline in activities in daily living (ADLs), displaying inappropriate behavioral symptoms, suffering depression, and/or taking psychotropic medications. In the state of Tennessee, new reimbursement schedules by TennCare have allowed our hospital to comply with the JCAHO standards of "optimal achievable care" for the treatment of pain by allowing the hospital staff to treat patients with newer, safer, more effective analgesics such as tramadol. Early results from this ongoing study have shown that tramadol can provide a safe and effective treatment on non-malignant pain in a long-term care facility and improve adherence to JCAHO and TennCare standards for proper pain management.
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Pain is a complex problem, for both those who are enduring it and those trying to relieve it. Most people in the developed world have access to adequate treatment and management of pain, the availability of trained and educated doctors and nurses, feasible opioid prescribing policies, as well as ready access to appropriate medication. Often, this is not the case in developing countries such as Thailand. ⋯ The severity and frequency of pain endured by this group of individuals presented a daily challenge. Problems encountered in providing pain relief for these patients and some potential solutions are described. There is a lack of literature on pain relief in Thailand.
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J Pain Palliat Care Pharmacother · Jan 2003
COX-2 selective NSAIDs and advancing legal issues in palliative care.
The role of the cycloxygenase-2 selective NSAIDs in palliative care has not been studied, per se, but the improved adverse gastrointestinal and platelet effect profiles of these newer agents over nonselective NSAIDs offers potential advantages in patients with advanced disease. These issues are discussed. ⋯ Recent legal opinions about aggressive care of patients approaching end of life has increased this need. The clinical and ethical implications of these decisions are discussed.