Journal of pain and symptom management
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J Pain Symptom Manage · Aug 2007
ReviewDiscrepant perceptions about end-of-life communication: a systematic review.
Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients' wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. ⋯ Patients' understanding and awareness of information received conflicted with the HPs' perceptions of patients' understanding and awareness of the information that had been given. HPs tended to underestimate patients' need for information and overestimate patients' understanding and awareness of their prognosis and EoL issues. HPs need to repeatedly check patients' understanding and preferences for information.
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J Pain Symptom Manage · Aug 2007
ReviewAntiepileptic drugs in treatment of pain caused by diabetic neuropathy.
Pain is frequent in diabetic neuropathy and is very hard to manage. Antiepileptic drugs have been used in treating pain for several decades. Their effectiveness has been described in different types of neuropathic pain, but when used as analgesics in painful diabetic neuropathy it still remains controversial. ⋯ A combined 2.33 relative risk (95% confidence interval [CI] 1.88-2.88) was obtained; this result indicated that the antiepileptic drugs studied were effective for controlling pain in diabetic neuropathy. The corresponding necessary number to treat (NNT) values were established for evaluating which antiepileptic drug was most effective as an analgesic, according to our interests; pregabalin was shown to be the antiepileptic drug having the lowest NNT (NNT=3.24 and 95% CI 2.12-6.81) for achieving greater than 50% analgesia in patients suffering from painful diabetic neuropathy. Antiepileptic drugs are frequently used in the specific case of diabetic neuropathy; the combined result of this meta-analysis has demonstrated their analgesic benefit.
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The aims of this prospective study were to determine the prevalence, characteristics, and impact of breakthrough pain in children with cancer. Twenty-seven pediatric inpatients with cancer (aged 7-18 years) who had severe pain requiring treatment with opioids and who received care in the Oncology Unit at the Children's Hospital at Westmead, Sydney, Australia participated in this study. The children responded to a structured interview (Breakthrough Pain Questionnaire for Children), designed to characterize breakthrough pain in children. ⋯ No statistical difference could be shown between children with and without breakthrough pain in regard to anxiety and depression. The most effective treatment of an episode of breakthrough pain was a patient-controlled analgesia opioid bolus dose. Further studies of breakthrough pain in children and more effective treatment strategies in this age group are necessary.
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J Pain Symptom Manage · Aug 2007
Timing of referral to hospice and quality of care: length of stay and bereaved family members' perceptions of the timing of hospice referral.
Previous research has noted that many persons are referred to hospice in the last days of life. The National Hospice and Palliative Care Organization collaborated with Brown Medical School to create the Family Evaluation of Hospice Care (FEHC) data repository. In 2005, 106,514 surveys from 631 hospices were submitted with complete data on the hospice length of stay and bereaved family member perceptions of the timing of hospice care. ⋯ Our results suggest that family members' perception of the timing of hospice referral-not the length of stay-is associated with the quality of hospice care. This perception varies substantially among the participating hospice programs. Future research is needed to understand this variation and how hospice programs are delivering high quality of care despite short length of stay.
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J Pain Symptom Manage · Aug 2007
Case ReportsA retrospective chart review of the antiemetic effectiveness of risperidone in refractory opioid-induced nausea and vomiting in advanced cancer patients.
Nausea and vomiting are distressing symptoms in advanced cancer patients. The causes of nausea and vomiting are multifactorial. Among the causes is opioid therapy, the mainstay of cancer pain management. ⋯ Complete response was observed in 50% of patients (10/20) for nausea and 64% (7/11) for vomiting. Sedation (n=2) was documented as an adverse effect. This observation suggests that risperidone can be an effective antiemetic drug in the treatment of refractory opioid-induced nausea and vomiting in advanced cancer patients.