Journal of pain and symptom management
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Pain is an understudied problem in frail elderly patients, especially those with cognitive impairment, delirium, or dementia. The focus of this study was to describe the pain experienced by patients in skilled nursing homes, which have a high prevalence of cognitive impairment. A random sample of 325 subjects was selected from ten community skilled nursing homes. ⋯ However, 83% of subjects who had pain could complete at least one of the scales. We conclude that cognitive impairment among elderly nursing home residents present a substantial barrier to pain assessment and management. Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.
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J Pain Symptom Manage · Nov 1995
Randomized Controlled Trial Clinical TrialRandomized evaluation of controlled-release codeine and placebo in chronic cancer pain.
Codeine is widely used in combination with acetaminophen and aspirin for the management of mild to moderate pain. However, there are few controlled clinical trials of single-entity codeine in chronic cancer pain. The purpose of this study was to evaluate the clinical efficacy and safety of controlled-release codeine given every 12 hr in patients with cancer pain. ⋯ Both patients and investigators preferred CR codeine to placebo (80% versus 3%, P = 0.0014 and 73% versus 7%, P = 0.0160, respectively). These data indicate that CR codeine, given every 12 hr results in significant reductions in pain intensity and the use of "rescue" acetaminophen-plus-codeine in patients with cancer pain. CR codeine provides the benefits of a flexible single entity codeine formulation and the convenience of 12-hr duration of action, which allows patients uninterrupted sleep and improved compliance.
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J Pain Symptom Manage · Nov 1995
Use of patient-controlled analgesia for pain control for children receiving bone marrow transplant.
We report 2 years' experience managing 39 preteen (ages 4-12 years) children with patient-controlled analgesia (PCA) for pain associated with bone marrow transplantation (BMT). We prescribed morphine or hydromorphone PCA (starting bolus 20 micrograms/kg morphine or 2 micrograms/kg hydromorphone) with or without continuous infusion (CI), for a period of 6-74 days. The duration of PCA use (median 19 days) depended upon severity of mucositis or other painful conditions. ⋯ Ninety-five percent of children successfully mastered PCA to control pain associated with BMT. We observed no instances of drug misuse, parental tampering, accidental overdose, or difficulty weaning from opioids. We conclude that opioid PCA, with or without CI, over several days or weeks is safe and effective for preteen children suffering BMT-related pain.
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In advanced cancer patients close to death, delirium, multifocal myoclonus, and restlessness may occur. Multi-organ failure and related metabolic changes are mostly responsible for these symptoms. A pharmacologic approach to manage the delirium is necessary in the majority of cases. ⋯ After a loading dose of 20 mg, an infusion of 50-70 mg per hr was started. The patient died peacefully after 8 hr of propofol infusion, without requiring opioids. Propofol seems to be a promising drug in treating the terminal agitated state that can be associated with the dying process.
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Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. ⋯ Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.