Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2006
A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria.
Palliative care is often offered only late in the course of disease after curative measures have been exhausted. To provide timelier symptom management, advance care planning, and spiritual support, we propose a simple set of prognostic criteria that identifies persons near the end of life. In this retrospective cohort study of five prognostic indicators, the CARING criteria (Cancer, Admissions > or = 2, Residence in a nursing home, Intensive care unit admit with multiorgan failure, > or = 2 Noncancer hospice Guidelines), logistic regression modeling demonstrated high sensitivity and specificity for mortality at 1 year (c statistic > 0.8). A simple set of clinically relevant criteria applied at the time of hospital admission can identify seriously ill persons who have a high likelihood of death in 1 year and, therefore, may benefit the most from incorporating palliative measures into the plan of care.
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The Cancer Dyspnea Scale (CDS) is a multidimensional measure of dyspnea experience, with three subscales related to sense of effort, sense of anxiety and sense of discomfort, and a total score. In this study, we evaluated the validity and reliability of a Swedish version, the CDS-S, in 99 patients with advanced lung cancer who were not receiving curative or life-prolonging treatments. Criterion-related validity was demonstrated by significant group differences in CDS-S scores when patients were stratified by dyspnea intensity, as measured by a visual analogue scale (VAS-D). ⋯ Internal consistency of the CDS-S scales was confirmed by Cronbach's alpha coefficients ranging from 0.81 to 0.90. The CDS-S was well received by the patients and completed in 2 minutes. This study supports the CDS as a valid and reliable instrument to measure dyspnea experience in a palliative setting, well suited for use in research as well as in clinical practice.
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Spinal cord stimulation emerged as a spin-off from the classical gate-control theory, which, however, does not suffice to explain its clinical effects. Whether or not nociceptive forms of pain may be attenuated remains a controversial issue. Previous experimental studies aiming at elucidating the underlying mechanisms were performed on intact, anesthetized animals and were therefore of limited clinical relevance. ⋯ It should be emphasized that most experimental data pertaining to the mode of action are derived from so-called animal models of neuropathic pain. However, caution must be exercised in the translation of such data from bench to bedside, because some behavioral signs interpreted as "pain" in such models may be misleading. We still need animal studies to generate basic data but these findings should also be confirmed in humans.
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J Pain Symptom Manage · Apr 2006
Review Meta AnalysisSpinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection.
Patients suffering from inoperable critical leg ischemia (CLI) ultimately face a major amputation. Spinal cord stimulation (SCS) has been introduced as a possible treatment option. This paper presents the best available evidence from a systematic review on the effectiveness of SCS in these patients and discusses the indications for SCS therapy. ⋯ These positive effects have to be weighed against the higher costs and (generally minor) complications of SCS. TcpO(2) measurements were found to be useful in selecting the most respondent patients, yielding a 12-month limb salvage up to 83%. Hence, SCS should be considered as a possible treatment option in patients with CLI, particularly if their foot TcpO(2) is between 10 and 30 mmHg.
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J Pain Symptom Manage · Apr 2006
ReviewComplex regional pain syndrome: manifestations and the role of neurostimulation in its management.
The hallmark of complex regional pain syndrome (CRPS) is excruciating pain (aching, burning, pricking, or shooting). Diagnosis should be established as soon as possible, as response to treatment is adversely affected by any delay. Treatment of CRPS is aimed at improving function, using an interdisciplinary, time-dependent, patient-dependent approach that encompasses rehabilitation, psychological therapy, and pain management. ⋯ SCS has been shown to be highly effective in the treatment of CRPS type I, resulting in a significant, long-term reduction in pain and improvement in quality of life. SCS is particularly effective at helping to restore function in affected extremities, especially if applied early in the course of the disease. SCS is also cost effective and improves health-related quality of life.