Journal of pain and symptom management
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J Pain Symptom Manage · Aug 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of subcutaneous morphine and fentanyl in hospice cancer patients.
This study compares subcutaneous (s.c.) morphine and fentanyl with respect to pain control and side effects using a 6-day randomized, double-blind, cross-over design. Results were obtained from 23 patients (12 males and 11 females: mean age of 70.5 years) who could tolerate morphine. Thirteen patients were randomized to receive morphine for the first 3 days followed by fentanyl; 10 received fentanyl first followed by morphine. ⋯ Patients had more frequent bowel movements during days 4-6 while on the fentanyl arm [t-test, df (22), P = 0.015]. Other measures for nausea, delirium, and cognitive function showed no differences between the two drugs. This study highlights the need to further assess the role of various opioids in hospice patients, and emphasizes the requirement for sensitive and simple cognitive tests in this population.
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J Pain Symptom Manage · Aug 1999
Clinical Trial Controlled Clinical TrialThe use of the Rotterdam Symptom Checklist in palliative care.
The Rotterdam Symptom Checklist (RSCL), which measures both physical and psychological aspects of quality of life (QOL), was given to all new patients admitted to a palliative care unit who were thought capable of filling out a questionnaire as an outcome measure of symptom control. Assessments were obtained from 52 patients at baseline (week 1). This represented only 53% of the new patients admitted to the unit. ⋯ In these selected patients, the median overall RSCL scores were 57, 52, and 49 at weeks 1, 2, and 3. There was a significant improvement in QOL scores across the three measurements with a significant difference between weeks 1 and 3 (P = 0.05) but not between weeks 1 and 2. Primarily because of the inability of many patients to complete the questionnaire and the high attrition rate, the appropriateness of this tool as a symptom control measure in palliative care patients is questioned.
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J Pain Symptom Manage · Aug 1999
Case ReportsMorphine-induced ventilatory failure after spinal cord compression.
We describe a patient who required large doses of parenteral morphine for severe pain secondary to epidural spinal cord compression caused by metastatic cancer. The pain improved suddenly after neurological progression to a complete cord compression. ⋯ The dose of morphine was then physiologically excessive once the neurologic damage was completed and the pain had been relieved. We advise caution in patients receiving high doses of opioids in which a change in disease status or a pain-relieving intervention may produce rapid pain relief.
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J Pain Symptom Manage · Aug 1999
Comparative Study Clinical Trial Controlled Clinical TrialDifferences in the ratios of morphine to methadone in patients with neuropathic pain versus non-neuropathic pain.
The use of methadone in the treatment of cancer pain is becoming more attractive mainly because of its known efficacy, lack of active metabolites, and low cost. Methadone also blocks the n-methyl-D-aspartate (NMDA) receptor, and this property may result in other clinical advantages. ⋯ We found that the ratio of morphine subcutaneous equivalent dose to methadone is between 5 and 7, which is different from previously described dose ratios. However, our study failed to show a difference in the ratios of patients with neuropathic or non-neuropathic pain syndromes.
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J Pain Symptom Manage · Aug 1999
Clinical TrialCharacteristics of postradical neck pain syndrome: a report of 25 cases.
The postradical neck pain syndrome has been briefly described in the literature, but detailed characterization has not been reported. To further define this syndrome, 25 patients with persistent pain for at least 1 month following neck dissection were evaluated. The sample consisted of 13 men and 12 women with moderate to severe pain ranging from 1 month to 27 years in duration. ⋯ Local anesthetic injection of the SCP temporarily eliminated all neuropathic pain in the 17 patients who underwent the procedure. The 10 patients who also had myofascial pain reported temporary relief of their somatic pain following myofascial trigger point injections (TPI). Criteria for the postradical neck pain syndrome are proposed: (1) persistent, nonprogressive neuropathic pain involving one or more branches of the SCP, which may be accompanied by (2) regional nonprogressive somatic pain associated with myofascial pain trigger points in head and neck muscles.