Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2009
Preparing family caregivers for death and bereavement. Insights from caregivers of terminally ill patients.
Many family caregivers are unprepared for the death of their loved one and may suffer from worse mental health as a result. We therefore sought to determine the factors that family caregivers believe are important to preparing for death and bereavement. Focus groups and ethnographic interviews were conducted with 33 family caregivers (bereaved or current) of terminally ill patients. ⋯ Finally, preparedness had cognitive, affective, and behavioral dimensions. To prepare, some caregivers needed information tailored to their uncertainty (cognitive), others needed to "mentally" or "emotionally" prepare (affective), and still others had important tasks to complete (behavioral). In order to better prepare family caregivers for the death of a loved one, health care providers must develop a trusting relationship with caregivers, provide them with reliable information tailored to their uncertainty, and allow time for caregivers to process the information and complete important tasks.
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J Pain Symptom Manage · Jan 2009
Randomized Controlled TrialA phase II pilot study to evaluate use of intravenous lidocaine for opioid-refractory pain in cancer patients.
Opioid-refractory pain is distressing because it is notoriously difficult to treat. Relief from adjuvant therapies often occurs after a lag time. Retrospective evidence points to a role for intravenous (IV) lidocaine in this setting for pain relief. ⋯ These data demonstrate that a single IV infusion of lidocaine provided a significantly greater magnitude and duration of pain relief than placebo infusion in opioid-refractory patients with cancer pain. Side effects were tolerable. It is thus a promising modality worth investigating further to establish guidelines for its use in cancer patients with opioid-refractory pain.
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J Pain Symptom Manage · Jan 2009
Has pain management in cancer patients with bone metastases improved? A seven-year review at an outpatient palliative radiotherapy clinic.
The primary objective of this study was to determine the prevalence of underdosage of analgesics for pain associated with bone metastases in outpatients referred to the Rapid Response Radiotherapy Program at the Odette Cancer Centre from 1999 to 2006. A prospective database containing data for all patients with bone metastases who were referred to the Rapid Response Radiotherapy Program for palliative radiotherapy from 1999 to 2006 was analyzed. The database included patient demographic information, including age at referral for radiation to the bone, gender, primary cancer site, and Karnofsky Performance Status; information on treatment-related factors, such as worst pain ratings and analgesic consumption in the past 24 hours (recorded as oral morphine equivalent doses); pain intensity ratings (none [rating=0], mild [rating=1-4], moderate [rating=5-6] or severe [rating=7-10]; and analgesic consumption (rated as none, nonopioids, weak opioids [e.g., codeine] and strong opioids [e.g., morphine and hydromorphone]). ⋯ The percentages of undermedicated patients were 40% in 1999, 34% in 2000, 29% in 2001, 37% in 2003, 39% in 2004, 36% in 2005, and 48% in 2006. No appreciable decline was noted in the proportion of patients with moderate-to-severe pain who received no pain medication, nonopioids, or weak opioids during the study period. Despite the publication of pain management guidelines and the dissemination of data regarding the proportion of patients with bone metastases who are being prescribed inadequate analgesics, our findings suggest that a significant proportion of patients continue to be undermedicated.
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J Pain Symptom Manage · Jan 2009
Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale.
The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. ⋯ The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.
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J Pain Symptom Manage · Jan 2009
Randomized Controlled Trial Comparative StudyA double-blind, randomized, crossover comparison between single-dose and double-dose immediate-release oral morphine at bedtime in cancer patients.
The European Association for Palliative Care guidelines for treatment of cancer pain recommend a double dose (DD) of immediate-release morphine at bedtime instead of single doses (SD) repeated every four hours throughout the night. A previous open controlled study reported more side effects after DD than after SD. The present study was a randomized, double-blind, crossover study comparison of DD and SD of immediate-release morphine during the night, followed by an open pharmacokinetic study. ⋯ DD patients displayed higher area under the curve for morphine and morphine-6-glucuronide during the first part of the night. Although DD tended to perform slightly better than SD, a difference in average pain during the night of 0.50 has little clinical significance, and the two procedures are, therefore, clinically equivalent. It is speculated whether the initial higher exposure to morphine-6-glucuronide may have clinical significance.