Journal of pain and symptom management
-
J Pain Symptom Manage · Jul 2012
Case ReportsA successful palliative care intervention for cancer pain refractory to intrathecal analgesia.
Intrathecal delivery of opioid medications has been increasingly used to treat cancer pain that is refractory to conventional oral opioid therapy. We present a patient with complex and refractory cancer pain who failed both oral and intrathecal opioid therapy but responded to the interdisciplinary palliative care intervention in the acute palliative care unit. His morphine equivalent daily dose decreased by 94% over a 10-day period, and he had better pain control and improved function. This case highlights the importance of addressing and treating the psychosocial distress that contributes to the total pain expression.
-
J Pain Symptom Manage · Jul 2012
Comparative StudyThe practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the U.K.: a comparative study.
Existing empirical evidence shows that continuous deep sedation until death is given in about 15% of all deaths in Flanders, Belgium (BE), 8% in The Netherlands (NL), and 17% in the U.K. ⋯ Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients' characteristics or clinical profiles. Further in-depth studies should explore whether these differences also reflect differences between countries in the quality of end-of-life care.
-
J Pain Symptom Manage · Jul 2012
Comparative StudyIdentification of cancer-related symptom clusters: an empirical comparison of exploratory factor analysis methods.
Symptom clusters, important for symptom management strategies, have been determined empirically by various analytical methods. Guidance to select methods from the options available in standard statistical packages is limited. ⋯ The most parsimonious solution resulted from principal axis factoring, but for large numbers of symptoms, AFA may be superior by identifying symptom clusters more useful for symptom management. Interpreting complex symptom relationships may lead to the investigation of pathophysiological mechanisms and intervention opportunities. Future studies should include psychological and cognitive symptoms.
-
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.
-
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.