Journal of pain and symptom management
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J Pain Symptom Manage · Dec 1998
ReviewPeak plasma concentrations after oral morphine: a systematic review.
We performed a systematic review of 69 studies with information on 2146 subjects (454 patients and 1692 healthy volunteers) to examine the maximum plasma concentration (Cmax) and the time taken to reach maximum concentration (Tmax) for different oral morphine formulations, and to clarify factors contributing to variability. Data from healthy volunteers reflected that seen for patients but was less variable. There was minimal difference between single and multiple doses, suggesting no accumulation of morphine. ⋯ For controlled-release formulations, little difference was observed between brands. Only for once-daily formulations was there any difference in absorption between fed and fasted, with a Tmax for fed subjects considerably longer than for fasted. There was no evidence for any difference between values obtained by radioimmunoassay (RIA) or high-performance liquid chromatography (HPLC).
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J Pain Symptom Manage · Sep 1997
ReviewClinical realities and economic considerations: patient selection in intrathecal therapy.
Chronic nonmalignant pain, persisting more than 6 months, affects 15%-30% of the United States population. The majority of chronic pain patients respond to a combination of physical modalities and non-opioid analgesics. However, approximately 20% do not derive sufficient pain relief from traditional measures (back surgery, oral drugs, etc.). ⋯ Because pain is a biopsychosocial phenomenon, psychological and social assessment are essential along with adequate trials of opioid responsiveness. There are several valid approaches to conducting trials of intraspinal pain therapy including epidural and intrathecal trials. Other important issues concern trial length, the utility of placebo trials, and drug selection in cases where morphine alone provides insufficient analgesia.
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J Pain Symptom Manage · Sep 1997
ReviewClinical realities and economic considerations: economics of intrathecal therapy.
The estimated annual cost of medical management of chronic back pain is $25 billion. Such management is often ineffective and overly costly. Most physicians who have employed intrathecal pain therapy attest to its efficacy in the management of intractable chronic pain. ⋯ Clinical data demonstrate that for cancer patients whose expectancies exceed 3 months, the overall costs of intrathecal pain therapy may be less than those of tunneled epidural catheters or external infusion devices. In nonmalignant pain, intrathecal therapy appears to be cost effective compared to conventional medical management at 22 months. Further debate and fine tuning of these economic models from all perspectives are required.
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J Pain Symptom Manage · Sep 1997
ReviewNurses' knowledge of pain assessment and management: how much progress have we made?
Undertreatment of pain and lack of knowledge about pain management have been evident for approximately two decades. Because nurses are often the cornerstone of pain management, nurses' knowledge in this area is especially important. This paper explores indications of progress in the level of nursing knowledge about basic aspects of pain management. ⋯ Nevertheless, results of current knowledge surveys of nurses suggest that educational efforts probably have been beneficial and should continue. To maximize the impact of educational efforts, content in basic and continuing education courses should be prioritized and critically evaluated for relevance and accuracy, especially content related to addiction. Early in the education of nurses, responsibility for pain assessment and use of analgesics must be instilled.
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J Pain Symptom Manage · Sep 1997
ReviewClinical realities and economic considerations: efficacy of intrathecal pain therapy.
Studies of analgesia in cancer patients have revealed that intrathecal administration of opioids can deliver potent analgesia with fewer systemic side effects than equivalent doses of systemic opioids. In addition, several trials have examined the safety and efficacy of this modality in patients with pain of nonmalignant origin. In one survey of 35 physicians involving 429 patients treated with intrathecal therapy, physician reports of global pain relief scores were excellent in 52.4% of patients, good in 42.9%, and poor in 4.8%. ⋯ In both studies, patients reported significant improvement in activities of daily living, quality of life measures, and satisfaction with the therapy. Constipation, urinary retention, nausea, vomiting, and pruritus are typical early adverse effects of intrathecal morphine and are readily managed symptomatically. Other potential adverse effects include amenorrhea, loss of libido, edema, respiratory depression, and technical issues with the intrathecal system.