Journal of pain and symptom management
-
J Pain Symptom Manage · Feb 1992
Case Reports Clinical TrialLong-term oral opioid therapy in patients with chronic nonmalignant pain.
In contrast to the use of opioids for the treatment of acute and chronic cancer pain, the administration of chronic opioid therapy for pain not due to malignancy remains controversial. We describe 100 patients who were chronically given opioids for treatment of nonmalignant pain. Most patients experienced neuropathic pain or back pain. ⋯ The most common side effects were constipation and nausea. There were no cases of respiratory depression or addiction to opioids. Our results indicate that opioids can be effective in chronic nonmalignant pain, with side effects that are comparable to those that complicate the treatment of cancer pain.
-
J Pain Symptom Manage · Nov 1991
Case ReportsContinuous intrathecal fentanyl infusion for postoperative analgesia.
Following inadvertent dural puncture during epidural catheter placement, a 20 gauge polyethylene catheter was placed in the intrathecal space, and continuous spinal anesthesia with hyperbaric bupivacaine was administered intraoperatively to supplement general anesthesia. Following surgery, a continuous intrathecal fentanyl infusion (0.2 mcg/kg/hr) was administered to provide postoperative analgesia. The child was awake and comfortable throughout this time and required no supplemental analgesic agents. Although epidural catheters are still our preferred method of analgesia, intrathecal fentanyl infusion is one alternative when inadvertent dural puncture occurs.
-
J Pain Symptom Manage · Nov 1991
Childbirth in Kuwait: the experiences of three groups of Arab mothers.
The aims of the present study were to characterize the childbirth experiences of three groups of Arab mothers delivering in Kuwait and to evaluate the use of visual analog scales (VAS) for assessing their pain (N = 301). Kuwaiti, Palestinian, and Bedouin women who were expected to have an uncomplicated vaginal delivery were studied. 73% of the women described their maximum labor pain as "unbearably painful," and more than one-half reported that they were "very frightened" or "terrified." The deliveries of Bedouin mothers were remarkable for the absence of pain behaviors; yet their VAS reports indicated that they experienced no less pain. Painful menstruation and fear of childbirth emerged as risk factors for a painful labor. Among the issues discussed are the validity of the VAS data, the difficulties of managing Bedouin mothers' pain, and the importance of excluding physical factors before cultural differences in pain perception are assumed.
-
J Pain Symptom Manage · Oct 1991
Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life.
The efficacy of the World Health Organization's guidelines for cancer pain relief was examined in 401 dying patients. At the time of death, only 3% of the patients experienced severe or very severe pain; whereas 52% had no pain at all, 24% experienced only mild or moderate pain, and 20% were unable to rate their pain intensity. Analgesic drugs were the mainstay of therapy during the last 24 hr of life, being administered by mouth in 47% and parenterally in 44% of the patients. ⋯ Additional adjuvant drugs to treat special types of pain or other symptoms were prescribed in 90% of the patients. Nonpharmacological measures, such as radiotherapy, nerve blocks or neurosurgery played only a very minor role at this stage of the disease. This study shows that cancer pain can be treated satisfactorily until death.