Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2006
Randomized Controlled Trial Controlled Clinical TrialA randomized, double-blind, crossover trial of the effect of oxygen on dyspnea in patients with advanced cancer.
Dyspnea is a common symptom in palliative care. Despite this, there is uncertainty regarding the role of oxygen to treat the symptom in patients with advanced illness. This randomized, double-blind, crossover trial examined the effect of oxygen versus air on the relief of dyspnea in patients with advanced cancer. ⋯ Hypoxia was corrected in 13 of 17 patients using the treatment dose of 4 L/min of oxygen. The experience of dyspnea is a complex, multifactorial phenomenon, with oxygen tension not correlating with the subjective experience. The administration of either air or oxygen via nasal prongs on average confers improvement of the symptom.
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J Pain Symptom Manage · Jul 2006
Randomized Controlled TrialEffects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease.
Self-management is crucial in people with chronic diseases, and self-efficacy has been shown to impact patients' self-management. The purposes of this study were to 1) determine the effect of intervention on self-efficacy and 2) determine the relationship between domain-specific self-efficacy, walking performance, and symptom severity in patients with chronic obstructive pulmonary disease (COPD). Subjects (n=102, forced expiratory volume in 1 second % predicted 44.8+/-14) received one of three self-management interventions. ⋯ Self-efficacy for managing shortness of breath was positively related to symptom severity (P<0.05). This study examined two types of disease-specific self-efficacy in patients with COPD and demonstrated that improving self-efficacy is an important outcome of self-management interventions. Studies in other domains of self-efficacy are needed.
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J Pain Symptom Manage · May 2006
Randomized Controlled TrialA randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain.
Safety and efficacy data from a study of slow intrathecal (IT) ziconotide titration for the management of severe chronic pain are presented. Patients randomized to ziconotide (n = 112) or placebo (n = 108) started IT infusion at 0.1 microg/hour (2.4 microg/day), increasing gradually (0.05-0.1 microg/hour increments) over 3 weeks. The ziconotide mean dose at termination was 0.29 microg/hour (6.96 microg/day). ⋯ Significant adverse events (AEs) reported in the ziconotide group were dizziness, confusion, ataxia, abnormal gait, and memory impairment. Discontinuation rates for AEs and serious AEs were comparable for both groups. Slow titration of ziconotide, a nonopioid analgesic, to a low maximum dose resulted in significant improvement in pain and was better tolerated than in two previous controlled trials that used a faster titration to a higher mean dose.
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J Pain Symptom Manage · May 2006
Randomized Controlled Trial Comparative StudyA comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain.
Concern about abuse/dependence in chronic pain patients taking opioid analgesics may lead to undertreatment of pain, yet little is known about the prevalence of abuse/dependence in these patients and how it differs among analgesic agents. The objective of this study was to assess the prevalence of tramadol abuse compared to nonsteroidal anti-inflammatory drugs (NSAIDs) and hydrocodone-containing analgesics in patients with chronic noncancer pain (CNP). The study had three arms. ⋯ The percent of subjects who scored positive for abuse at least once during the 12-month follow-up were 2.5% for NSAIDs, 2.7% for tramadol, and 4.9% for hydrocodone. When more than one hit on the algorithm was used as a measure of persistence, abuse rates were 0.5% for NSAIDs, 0.7% for tramadol, and 1.2% for hydrocodone. Thus, the results of this study suggest that the prevalence of abuse/dependence over a 12-month period in a CNP population that was primarily female was equivalent for tramadol and NSAIDs, with both significantly less than the rate for hydrocodone.
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J Pain Symptom Manage · Jan 2006
Randomized Controlled TrialMidazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer.
The mainstay of dyspnea palliation remains altering its central perception. Morphine is the main drug and anxiolytics have a less established role. This trial assessed the role of midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in terminally ill cancer patients. ⋯ Mi). During the first day, patients with BD for the groups Mo, Mi, and MM were 34.3%, 36.4%, and 21.2%, respectively (P = NS or not significant), whereas during the second day, these percentages were 38%, 38.5%, and 24%, respectively (P = NS). The data demonstrate that the beneficial effects of morphine in controlling baseline levels of dyspnea could be improved with the addition of midazolam to the treatment.