Journal of pain and symptom management
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The use of spinal opioids in the management of acute pain is now widely accepted. The development of acute pain services has provided standardized approaches to the management of this modality. This article discusses technical considerations, monitoring, and benefits of this approach.
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J Pain Symptom Manage · Apr 1990
Similarities in pain descriptions of four different ethnic-culture groups.
The purpose of this study was to identify pain terms commonly used by Hispanics, American Indians, blacks, and whites to describe painlike experiences. Subjects were asked to rate the intensity of the terms pain, ache, and hurt on a Visual Analogue Scale. Following this procedure, they were given three separate copies of the McGill Pain Questionnaire and asked to choose the words that represented pain, ache, and hurt, respectively. ⋯ There was a significant difference between the intensity level of the three terms (p less than 0.001). Word descriptors that distinguished pain from ache and hurt are presented. The importance of these findings for clinical practice is discussed.
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J Pain Symptom Manage · Apr 1990
Comparative StudyTreatment of pain and other symptoms in cancer patients: patterns in a North American and a South American hospital.
The charts of 200 consecutive patients with cancer pain admitted to a major teaching hospital in Edmonton, Canada (n = 100) and in Buenos Aires, Argentina (n = 100) were reviewed to assess the differences between North American (NA) and South American (SA) facilities in patterns of treatment of pain and other symptoms. Criteria for eligibility and methods were identical in both hospitals. Characteristics of patients (age, sex, primary tumor, reason for admission) and attending staff were similar between both hospitals. ⋯ The types of narcotics and the use of adjuvant drugs were significantly different between NA and SA. Nonpharmacologic treatments, antiemetics, and laxatives were more frequently used in NA. These results suggest that there are significant differences in symptomatic management of advanced cancer between institutions in NA and SA.
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This review draws on data obtained in the cancer pain, nonmalignant pain, and addict populations to examine critically the major issues raised by the use of chronic opioid therapy in nonmalignant pain. The available evidence suggests that there is probably a selected subpopulation of patients with chronic nonmalignant pain who may obtain sustained partial analgesia without the development of toxicity or the psychologic and behavioral characteristics of addiction. Future discussions of this approach must adequately define the terminology of addiction and strive to distinguish medical considerations from the societal and regulatory influences that may affect prescribing behavior. Those who treat patients with chronic pain must actively participate in these discussions lest decisions with enormous impact on patient care be made solely by those whose primary responsibility is the elimination of substance abuse.
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J Pain Symptom Manage · Feb 1990
Relationship among cultural, educational, and regulatory agency influences on optimum cancer pain treatment.
Evidence is presented that supports the allegation that cancer pain is inadequately treated. This is true despite the existence of more knowledge about the anatomy, physiology, pharmacology, and pathology of pain; more professional organizations dedicated to expanding and disseminating information about pain; and the reputation of physicians as persons of compassion. Not all cancer patients with pain, however, fail to get adequate treatment. ⋯ The reasons these patients have a problem with treatment are, in descending order of influence on physicians' prescribing practices: (a) cultural and societal barriers to the appropriate and adequate use of opioids, (b) real and perceived pressures from government regulatory agencies, and (c) knowledge deficits among health care providers because of newer knowledge gained from pharmacologic studies of cancer pain patients. Factors in each category are discussed. Correction of the problem will require fundamental changes in cultural attitudes, which will distinguish legitimate uses of opioids from drug abuse.