Journal of pain and symptom management
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J Pain Symptom Manage · Sep 1996
Randomized Controlled Trial Clinical TrialResponse to intravenous lidocaine infusion predicts subsequent response to oral mexiletine: a prospective study.
The local anesthetic sodium-channel blockers lidocaine and mexiletine reduce spontaneous and evoked activity in experimental neuroma models and have been reported to relieve a variety of clinical neuropathic pain conditions. The predictive value of relief from an intravenous lidocaine infusion (IVL) for subsequent relief from a 4-week trial of oral mexiletine was assessed in a prospective study of nine subjects with chronic neuropathic pain of peripheral origin. Subjects received IVL, 2 mg/kg and 5 mg/kg, over 45 min during separate sessions in random order under double-blind conditions. ⋯ Subsequent response to oral mexiletine was significantly correlated with the average response to the two IVL. Mexiletine dose and blood levels were not correlated with pain relief. The results suggest that IVL may be a valuable tool in selecting patients for oral therapy with analogous drugs.
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J Pain Symptom Manage · Sep 1996
Comparative StudyMeasurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices.
A self-administered pain assessment tool called the Pain-O-Meter (POM) was developed for the purposes of improving assessment and management of pain in acute and chronic pain patients. The POM is a hard, white, plastic tool that measures 8-in. long by 2-in. wide and 1-in. thick. Two methods for assessing pain are located on the POM. ⋯ Correlations between the POM-WDS and the McGill Pain Questionnaire (MPQ) (r = 0.69, P < 0.001) and POM-VAS (r = 0.85, P < 0.001) supported the concurrent validity of the POM-WDS. Construct validity was also supported for the Pain-O-Meter by showing that pain scores decreased significantly for POM-WDS (t + 5.53, P < 0.001), and POM-VAS (t = 6.18, P < 0.001) after the patients were treated with pain medication. The use of a pain tool, such as the POM, could improve patient care by facilitating the documentation of pain and evaluation of pain relief measures.
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J Pain Symptom Manage · Sep 1996
Clinical TrialAttenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone.
We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. ⋯ These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.
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J Pain Symptom Manage · Sep 1996
Review Case ReportsKetorolac continuous infusion: a case report and review of the literature.
We report a case of intractable pain due to metastatic carcinoma that was effectively managed with a continuous intravenous (IV) infusion of ketorolac. Unlike previous reports of short-term continuous IV ketorolac for postoperative analgesia, this case is unique because of the etiology of the pain and the duration of treatment. The published literature on continuous administration of ketorolac by the intravenous, intramuscular, and subcutaneous routes is also reviewed.