Aging clinical and experimental research
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Multicenter Study Clinical Trial
Controlled-release oxycodone tablets after transdermal-based opioid therapy in patients with cancer and non-cancer pain.
Several publications and guidelines stress the efficacy and safety of opioid-based therapy for cancer and non-cancer pain management. The first point of the World Health Organization (WHO) guidelines recommends that, if possible, analgesics should be given by mouth. This advice fully matches the European Society for Medical Oncology (ESMO) guidelines, which advise that opioids should be titrated to take effect as rapidly as possible. The European Association for Palliative Care (EAPC) guidelines specify that transdermal fentanyl should be administered only in patients with stable analgesic requirements. The aim of this study was to assess the efficacy and influence on the quality of life of controlled- release (CR) oxycodone in patients who had obtained no or only partial pain relief after transdermal (TTD)-based opioid therapy. ⋯ Switching from transdermal opioid to oxycodone CR treatment is effective and leads to patients' improved satisfaction and quality of life.
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Case Reports
Spinal anterior epidural hematoma in an elderly man with unrecognized lupic anticoagulant taking warfarin.
Spinal epidural hematoma (SEH) is a rare acute condition defined as a hematoma occurring at spinal epidural level. It is defined as "spontaneous" (SSEH) when possible causes have been ruled out; in other cases, clotting disorders and systemic lupus erythematosus have been associated with SEH. If identified rapidly, SEH can be completely cured, with complete recovery in about 50% of cases. ⋯ Following a rehabilitation program, the patient had complete neurological recovery. Although the epidural lesion might have been a true case of SSEH, anticoagulation therapy and AL may have played a role in the pathogenesis, spread and spontaneous resolution of SEH. In cases of acute thoracic pain, associated with signs and symptoms of spinal cord compression, the diagnosis of SEH, which is a potentially devastating condition, must be carefully investigated by clinicians.