Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2012
Older adults' experiences of transitions between care settings at the end of life in England: a qualitative interview study.
Providing care that is shaped around the needs of patients, carers, and families is a challenge in the last months of life, as moves between home and institutions may be frequent. Despite this, there have been few studies of end-of-life transitions in the U.K. ⋯ Qualitative study of transitions provides valuable insights into end-of-life care, even in countries where there are few financial barriers to services. This study has highlighted a need for continued attention to basic aspects of care and communication between professionals and with patients.
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J Pain Symptom Manage · Jul 2012
Causal attributions for fatigue by older adults with advanced cancer.
Fatigue is a prevalent, debilitating, and often disruptive symptom for cancer patients. Yet, it remains inadequately understood and managed, especially among late middle-aged and older patients with advanced disease. Few studies have explored fatigue qualitatively, and almost none have focused on patients' attributions for this subjective and multidimensional symptom. ⋯ Patients' causal attributions for fatigue had a profound effect on their physical and psychological well-being, their communication with providers, and their integration of the symptom into their lives.
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J Pain Symptom Manage · Jul 2012
Insights into the reluctance of patients with late-stage cancer to adopt exercise as a means to reduce their symptoms and improve their function.
Exercise reduces cancer-related disablement and adverse symptoms, yet patients' attitudes toward exercise remain largely unexamined. ⋯ Effective use of exercise and activity modification to ameliorate cancer-related symptoms appears to require a linkage to a patient's usual and past activities, proactive negotiation of potential barriers, education regarding symptoms and exercise, and the positive support of their oncologist.
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J Pain Symptom Manage · Jul 2012
Topical morphine for oral mucositis in children: dose finding and absorption.
Systemic opioids for painful chemotherapy-induced oral mucositis in children often result in unsatisfactory pain relief and a high frequency of side effects. Opioids applied topically can produce analgesia by binding to opioid receptors on peripheral terminals of sensory neurons. These receptors are upregulated during inflammation, for example, in oral mucositis. ⋯ No obvious dose-response effect was found for topical morphine doses of 0.025-0.400mg/kg, and topically applied morphine was not absorbed in clinically relevant doses. However, this study was limited by the small number of patients and the allowance of a systemic opioid as rescue medication. Thus, randomized controlled studies are needed to further investigate the analgesic properties of topical morphine.