The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Nov 2009
Influence of malignancy on the decision to withhold or withdraw life-sustaining therapy in critically ill patients.
To evaluate the influence of malignancy on the decision to limit life-sustaining therapy in the intensive care unit (ICU). ⋯ Our study showed that critically ill patients with malignancy are more likely to have their life-sustaining therapy withheld or withdrawn than those without malignancy after adjusting for severity of disease. This finding may be related to a perception that critically ill patients with malignancy have worse prognosis as compared with those without malignancy.
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Am J Hosp Palliat Care · Nov 2009
Case ReportsBuprenorphine for neuropathic pain--targeting hyperalgesia.
Opioids are well known to relieve severe, acute, and chronic nociceptive pain, but neuropathic pain shows a relatively poor response to opioids. Buprenorphine, a partial mu and ORL-1-receptor agonist, kappa-delta receptor antagonist, interacts with different G proteins than potent mu agonists and hence is not cross-tolerant to standard opioids. ⋯ We present a patient with neuropathic pain and tactile allodynia in which buprenorphine alleviated the hyperalgesia to a greater extent than pain severity. We found buprenorphine to be effective in reducing hypersensitivity in neuropathic pain when pure mu agonists fail to produce a response or in individuals who are intolerant to pure mu agonists.