Journal of pain and symptom management
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As the United States continues its "War on Drugs," physicians who prescribe opioids for the purpose of pain control must recognize that legal issues are an important part of the prescription process. Physicians who do not correctly prescribe opioids may mark their patients as drug abusers and themselves as misprescribers. Efforts are under way to characterize appropriately the conditions under which opioids should be prescribed for the management of pain. ⋯ Physicians must be aware that once a patient has been diagnosed an addict, it is not legal to prescribe opioids for the purpose of maintaining or detoxifying that patient; treatment of pain is still permissible, however. It is clear that new standards of care must be developed to reduce the liability of legitimate prescribers from sanctions in either criminal or civil settings. With new standards of care, prescriptions for opioids written in good faith for the treatment of pain should survive legal scrutiny.
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J Pain Symptom Manage · May 1993
Case ReportsContinuous intravenous infusion of fentanyl: case reports of use in patients with advanced cancer and intractable pain.
The use of continuous intravenous infusion of opioids may be efficacious in managing pain related to advanced cancer. Short-acting opioids, such as morphine and hydromorphone, are commonly used. We describe the use of a fentanyl infusion in four cases. This experience suggests that fentanyl may be considered an alternative drug for infusion in the treatment of refractory cancer pain.
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J Pain Symptom Manage · May 1993
Case ReportsCase studies outlining use of nebulized morphine for patients with end-stage chronic lung and cardiac disease.
This article describes the use of nebulized morphine in the management of dyspnea in two patients with end-stage chronic lung disease, and two patients with end-stage heart failure. All four patients had relief of breathlessness. Arterial blood gas results and vital signs were monitored pre- and postnebulized morphine in two of the patients and demonstrated little change. Nebulized morphine appears to be well tolerated in this patient population.
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A short form of the McGill Pain Questionnaire (SF-MPQ) was previously developed. It was found to correlate highly with and demonstrate differences due to treatment in a manner similar to the long form of the McGill Pain Questionnaire (LF-MPQ). The LF-MPQ was previously found to be a valid measurement of pain in the cancer population. ⋯ Both the long and short total scores correlated highly with the visual analogue scale (VAS) and present pain intensity (PPI) scale. The SF-MPQ demonstrated changes over time in a manner similar to the LF-MPQ in this patient group. These observations support the value of the SF-MPQ as a tool for studying interventions in patients with chronic pain due to cancer.
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A variety of evidence suggests a link between migraine and the female sex hormones. Women with migraine outnumber men by at least a 2:1 ratio and definite patterns of development and attacks are noted at menarche and throughout the period of menses, related to trimester of pregnancy, and again at menopause, although it may also regress. Hormonal replacement with estrogen can exacerbate migraine; oral contraceptives can change the character and frequency of migraine headache. This article will cover approaches to the therapy of hormone-related headaches associated with the menstrual cycle, menopause, and oral contraceptives.