Journal of pain and symptom management
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Physician education in cancer pain management is seriously deficient. Many problems occur with opioids simply because of therapeutic ignorance. Opioid side effects are best prevented by using morphine as the drug of first choice for severe pain. ⋯ Physicians need to be aware of how to transfer patients from one opioid to another or from one route of administration to another. Side effects common in clinical practice are constipation, nausea/vomiting, dry mouth, and sedation. The importance of the issues of tolerance, dependence, and respiratory depression have been exaggerated.
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J Pain Symptom Manage · Oct 1990
Ambulatory infusion devices in the continuing care of patients with advanced diseases.
Until recently, patients who required hydration or parenteral administration of narcotics or antiemetics remained in hospitals until death. The period of admission, which varied between days and months, resulted in a decreased quality of life for the patient and family. With the development of portable infusion pumps, patients with these needs can now be safely discharged home for long periods of time, thereby significantly reducing the cost of medical care and improving quality of life for patients and families. ⋯ The high cost of portable pumps and supplies are a major obstacle for the establishment of large programs for home parenteral drug administration. More research is needed to better characterize the pharmacokinetics of different drugs when administered subcutaneously, and to develop simpler and more effective portable infusion devices. The results of this research will have a major impact on the quality of life of patients and their families.
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Respiratory symptoms are a common cause of distress in patients with advanced cancer. Optimal palliative therapy requires careful assessment and the appropriate use of symptomatic measures in conjunction with specific antitumor treatments. The etiology and management of the three major respiratory symptoms, dyspnea, cough and hemoptysis, are described. The indications for antitumor treatments and surgical procedures are briefly outlined, and symptomatic treatments, including drug and nondrug measures, are discussed in detail.
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J Pain Symptom Manage · Aug 1990
New method for measuring young children's self-report of fear and pain.
The purposes of this paper are (a) to describe the conceptual development of the Children's Global Rating Scale (CGRS), a technique for measuring young children's self-report of such constructs as pain and fear that was designed to address the methodological limitations of existing techniques, and (b) to report the findings of a study investigating the convergent and predictive validity of the CGRS in a sample of children undergoing an invasive medical procedure. Anticipatory procedural distress in 145 children between the ages of 4 and 8 was assessed in outpatient phlebotomy using three independent rating sources: children, parents, and a trained clinical observer. Phlebotomists' ratings as to whether or not children's distress during the actual procedure extended the time it usually takes to perform the procedure was used as the outcome criterion in a discriminate analysis in determining the degree to which anticipatory ratings would predict actual clinical distress during the medical procedure. Results provide preliminary support for the convergent and predictive validity of the CGRS revealing significant correlations with the other independent measures of children's anticipatory distress and also revealed that the CGRS was one of the significant variables in predicting children who extended and did not extend the medical procedure.
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J Pain Symptom Manage · Aug 1990
Clinical TrialPostoperative patient-controlled analgesia with alfentanil: analgesic efficacy and minimum effective concentrations.
Forty ASA I-III patients recovering from major abdominal or orthopedic operations were investigated in an open clinical study to evaluate analgesic efficacy and threshold plasma concentrations of alfentanil during the early postoperative period using patient-controlled analgesia (PCA) by means of the On-Demand Analgesia Computer. Alfentanil demand dose was 212 micrograms, continuous infusion rate 25 micrograms/hr, hourly maximum dose 1.5 mg/hr; the lockout time was set to 1 min. The duration of PCA was 18.1 +/- 5.2 hr (mean, SD) during which time 23.8 +/- 14.2 demands per patient were recorded, resulting in an average alfentanil consumption of 4.99 +/- 3.03 micrograms/kg/hr. ⋯ Based on our own earlier PCA experience with other opiate analgesics, alfentanil proved to be about 1/15th as potent an analgesic as fentanyl and about 6-7 times more potent than morphine if both intensity and duration of effect were considered. Minimum effective alfentanil plasma concentration (MEC) varied greatly and could be best described by a lognormal distribution (range 0.6-99.2 ng/mL, median 14.9 ng/mL). Intraindividual MEC variability was consistently lower than intersubject variability (37.0% vs 65.2%).