Journal of pain and symptom management
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialPain medication management processes used by oncology outpatients and family caregivers part II: home and lifestyle contexts.
Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home. ⋯ Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and their family caregivers when cancer treatment and supportive care are provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles.
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialNeurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study.
Sympathectomy is currently used as the fourth step of the modified World Health Organization (WHO) analgesic ladder. Sympathectomy can be performed early, before the second step on the ladder. ⋯ Sympathectomy before Step 2 on the WHO analgesic ladder seems to lead to better pain control, less opioid consumption, and better quality of life in cancer patients.
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialPain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.
Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. ⋯ Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.
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J Pain Symptom Manage · Nov 2014
Randomized Controlled TrialPre-emptive value of methylprednisolone intravenous infusion in patients with vertebral metastases. A double-blind randomized study.
The vertebral column is the most common site of bone metastases irrespective of the primary tumor. Vertebral metastases are a major cause of motor deficit of the lower extremities. The use of radiotherapy is the treatment of choice in these patients. A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem. Steroid infusion has well-documented neuroprotective effects. ⋯ Pre-emptive methylprednisolone infusion is an effective prophylactic agent in the prevention of radiation-induced pain flare and improves functional motor status after short-term radiotherapy in patients with vertebral metastases.
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J Pain Symptom Manage · Oct 2014
Randomized Controlled Trial Comparative StudyClinic-based outpatient palliative care before hospice is associated with longer hospice length of service.
Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment. ⋯ Hospice patients who had clinic-based outpatient palliative consults before hospice enrollment tended, on average, to have a longer LOS in hospice than patients who did not.