Journal of pain and symptom management
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J Pain Symptom Manage · Feb 1994
Tolerability of ketorolac administered via continuous subcutaneous infusion for cancer pain: a preliminary report.
We evaluated the local and systemic tolerability of ketorolac administered through continuous subcutaneous infusion in ten cancer patients. The patients were monitored daily for the severity and duration of pain, and the development of other symptoms. ⋯ Mild local bleeding at the site of drug injection was observed in seven cases. No increase in the intensity of symptoms was observed during the infusion of ketorolac.
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Cancer pain treatment is well established. The World Health Organization provides clinicians an "analgesic ladder" scheme to optimize cancer pain treatment. At the beginning of the pain treatment, oral analgesic administration is preferred. ⋯ Based on this experience, the generally accepted indications for the technique appeared to be justified. Concern about spinal infection is well considered, however. Three out of those patients developed meningitis, a complication rate that is far too high.
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J Pain Symptom Manage · Feb 1994
Altered sexual function and decreased testosterone in patients receiving intraspinal opioids.
Altered sexual function has been reported in individuals addicted to opioids or on methadone maintenance, yet little literature is available regarding the effect of intraspinal opioids on libido or sex hormone levels. We evaluated sexual function and plasma sex hormone levels in six men treated with chronic intraspinal opioids. All patients had some reduction in libido and four patients had difficulty obtaining or maintaining an erection. ⋯ Serum testosterone levels and other sex hormones, including follicle-stimulating hormone, luteinizing hormone, sex-hormone-binding globulin, and prolactin, should be measured prior to and at various points during intraspinal opioid therapy. Patients should be queried regarding sexual function and should be cautioned regarding the possibility of these adverse effects prior to initiating spinal opioids. Supplemental testosterone should be considered to treat this dysfunction.
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J Pain Symptom Manage · Feb 1994
ReviewCognitive-behavioral interventions for children's distress during bone marrow aspirations and lumbar punctures: a critical review.
Children with cancer often have difficulty coping with the invasive medical procedures that are part of diagnosis and treatment. Bone marrow aspirations and lumbar punctures are painful and cause some children severe anxiety and distress. The increased risk and expense of general anesthesia and the relative ineffectiveness of sedatives and anxiolytics has prompted clinicians to examine nonpharmacologic methods for controlling pain and distress. This report critically examines intervention studies that focus on cognitive-behavioral strategies such as distraction, imagery, or hypnosis for reducing procedural distress in children with cancer.
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J Pain Symptom Manage · Feb 1994
Letter Case ReportsCervical epidural abscess following trigger point injection.