Journal of pain and symptom management
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J Pain Symptom Manage · Apr 2009
Comment Letter Case Reports"Palliative" and not "terminal" sedation.
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J Pain Symptom Manage · Apr 2009
Review Meta AnalysisAcupuncture: what does the most reliable evidence tell us?
Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. ⋯ Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions.
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J Pain Symptom Manage · Apr 2009
Randomized Controlled TrialMeaninglessness in terminally ill cancer patients: a randomized controlled study.
Although recent empirical studies reveal that fostering patients' perception of meaning in their lives is an essential task for palliative care clinicians, few studies have reported the effects of training programs for nurses specifically aimed at improving these skills. The primary aim of this randomized controlled trial was to determine the effects of an educational workshop focusing on patients' feelings of meaninglessness on nurses' confidence, self-reported practice, and attitudes toward caring for such patients, in addition to burnout and meaning of life. The study was designed as a single-institution, randomized controlled trial using a waiting list control. ⋯ The change ratio of each parameter ranged from 5.6% (willingness to help) to 37% for the helplessness score and 51% on the Confidence Scale. The percentages of nurses who evaluated this program as "useful" or "very useful" were 85% (to understand the conceptual framework in caring for terminally ill patients with meaninglessness), 80% (to foster nurses' personal values), and 88% (to know how to provide care for patients with meaninglessness). This educational intervention had a significant beneficial effect on nurse-perceived confidence, practice, and attitudes in providing care for patients feeling meaninglessness, in addition to the levels of burnout and spiritual well-being of nurses.
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J Pain Symptom Manage · Apr 2009
An intravenous ketamine test as a predictive response tool in opioid-exposed patients with persistent pain.
Chronic pain patients who are treated with opioid therapy represent a significant challenge to medical professionals. When pain recurs in the face of a previously effective opioid regimen, treatment options include dose escalation, opioid rotation, drug holidays, and the addition of adjuvants. Some experts advocate the use of N-methyl-D-aspartate receptor (NMDA-R) antagonists to combat tolerance. ⋯ In contrast, a weaker correlation between ketamine and DX response was found in subjects requiring high-dose rather than low-dose opioid therapy. A significant correlation also was noted between the development of side effects for the two NMDA-R antagonists. Based on these results, we conclude that an i.v. ketamine test may be a valuable tool in predicting subsequent response to DX treatment in opioid-exposed patients. with persistent pain.