Journal of pain & palliative care pharmacotherapy
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A notable and welcome increase in palliative care research has led to a multitude of ethical issues and concerns for researchers, clinicians, patients (subjects) and their family members (who also might be subjects), granting agencies, and professional journals. This edition of "Palliative Care Pearls" summarizes the recommendations from a work group that met at the National Institutes of Health in September, 2002. The primary purpose for that meeting was to explore the unique characteristics of this research population and the ethical concerns that might require tailoring of "standard" clinical research processes. ⋯ This 62 page long monograph was published as a supplement to the Journal of Pain and Symptom Management (April, 2003). It includes six "plenary" papers, each that focuses on a distinct ethical domain of palliative care research and concludes with a set of recommendations and research questions. These might best be viewed as hypotheses that need to be tested or further explored.
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J Pain Palliat Care Pharmacother · Jan 2004
ReviewOpioid insights:opioid-induced hyperalgesia and opioid rotation.
Opioid analgesics are an irreplaceable component of pharmacotherapy of numerous pain-producing conditions. Clinicians and patients must contend with the imperfect nature of this class of drugs, trying to balance benefits and burdens on a continual basis. New literature related to evidence-based selection of opioids and the neurobiological phenomenon of opioid induced hyperalgesia are reviewed. A matrix describing critical elements in the selection of opioid analgesics, both for initial therapy and for opioid rotation, is presented.
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J Pain Palliat Care Pharmacother · Jan 2003
ReviewSymptom management in cancer: pain, depression and fatigue: State-of-the-Science Conference Statement.
NIH Consensus Statements are prepared by a nonadvocate, non-Federal panel of experts, based on (1) presentations by investigators working in areas relevant to the consensus questions during a 2 day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. ⋯ Thus, it provides a "snapshot in time" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.
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J Pain Palliat Care Pharmacother · Jan 2003
ReviewAddiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients.
Pain is among the most common complaints for which people seek medical care; yet pain is also among the most undertreated patient complaints. Reasons for this include reluctance by clinicians to prescribe and support the use of opioids, often due to a fear of addiction. ⋯ The first mission of the LCPA was to formulate precise definitions of the terms addiction, physical dependence, and tolerance. This report explains these definitions and discusses how they apply to clinical practice.
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J Pain Palliat Care Pharmacother · Jan 2003
ReviewPotential cardiovascular effects of COX-2 selective nonsteroidal antiinflammatory drugs.
The newly developed nonsteroidal antiinflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2), are effective against pain and inflammation and appear to have less gastrointestinal toxicity than conventional NSAIDs. Their COX-2 selectivity, however, has raised concerns regarding their cardiovascular safety, since they do not inhibit COX-1, the isoform of the enzyme that is active in thrombosis and vasoconstriction. ⋯ Renal effects, edema and hypertension appear to be similar between conventional NSAIDs and COX-2-selective inhibitors. Aspirin is still required for patients with cardiovascular risk who are prescribed a COX-2-selective inhibitor.