Journal of pain and symptom management
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J Pain Symptom Manage · May 1997
Randomized Controlled Trial Comparative Study Clinical TrialTransdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. The TTS-Fentanyl Comparative Trial Group.
Cancer patients requiring strong opioid analgesia (n = 202; mean age, 61.5 years; range, 18-89 years; 55% men) were recruited from 38 United Kingdom palliative care centers into a randomized, open, two-period, crossover study comparing transdermal fentanyl with sustained-release oral morphine. Patients received one treatment for 15 days followed immediately by the other for 15 days. Daily diaries were completed. ⋯ Of those patients who were able to express a preference (n = 136), significantly more preferred the fentanyl patches (p = 0.037). We conclude that, in this study, transdermal fentanyl provided pain relief that was acceptable to cancer patients and was associated with less constipation and sedation than morphine. These reduced side effects may contribute to patients preference for the patches.
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J Pain Symptom Manage · May 1997
Comparative Study Clinical TrialA prospective, within-patient, crossover study of continuous intravenous and subcutaneous morphine for chronic cancer pain.
The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. ⋯ Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.
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J Pain Symptom Manage · May 1997
Cost-effectiveness analysis of spinal cord stimulation in treatment of failed back surgery syndrome.
This article presents an analysis of the medical costs of spinal cord stimulation (SCS) therapy in the treatment of patients with failed back surgery syndrome (FBSS). We compared the medical costs of SCS therapy with an alternative regimen of surgeries and other interventions. Externally powered (external) and fully internalized (internal) SCS systems were considered separately. ⋯ We found that by reducing the demand for medical care by FBSS patients, SCS therapy can lower medical costs. On average, given current screening and efficacy rates, SCS therapy pays for itself within 5.5 years. For those patients for whom SCS therapy is clinically efficacious, the therapy pays for itself within 2.1 years.
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Children's strategies for coping with the pain and distress of venipuncture were examined in this descriptive study. Eighty-five children (aged 5-13 years) were interviewed prior to and following blood collection. Prior to the procedure, children reported pain expectations and coping strategies that might be used. ⋯ Direct Efforts to Maintain Control was the most frequently used category. Age and gender differences were observed in both number and type of strategies reported by the children. Further research is needed to examine the observed relationship between the type of coping strategies generated and the children's pain experience.
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J Pain Symptom Manage · May 1997
Spinal cord stimulation: a valuable treatment for chronic failed back surgery patients.
Spinal cord stimulation (SCS) has been used in the treatment of "chronic failed back surgery syndrome" for many years. To evaluate long-term results and cost effectiveness of SCS, we interviewed 69 patients treated during a period of 13 years. Twenty-six patients stopped using SCS; there was no clear explanation for this unsatisfactory result in 10. ⋯ Eleven patients have returned to work. In our center, the application of SCS costs on average $3660 per patient per year. Although this seems expensive, it may be a cost-effective treatment if other therapies fail.