The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Dec 2008
Management of neuropathic cancer pain following WHO analgesic ladder: a prospective study.
Cancer pain treatment according to the guidelines of World Health Organization (WHO) is effective and safe in majority of patients. 818 neuropathic cancer pain patients were enrolled in the study and pain was managed according to WHO analgesic ladder and followed up to six months. Main adjuvant drugs used were amitryptaline (29.9%), gabapentin (29.9%) and gabapentine with dexamethasone in (19.9%) and dexamethasone alone in (20.2%) patients. ⋯ At the end of six months 53.2% patients had no pain and 41.9% of patients had mild pain as compared to 0% and 10.2% patients respectively at the first visit. 4.9% of patients had moderate pain even after the treatment. Neuropathic cancer pain can be relieved by multimodal treatment following WHO guidelines as majority of cancer patients suffered multiple types of pain.
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Am J Hosp Palliat Care · Dec 2008
Case ReportsHigh-dose propofol drip for palliative sedation: a case report.
Oftentimes, patients at the end of life may present with challenging symptoms refractory to conventional therapies. Agitation and terminal restlessness, 2 common symptoms encountered in the hospice population, are frequently managed using benzodiazepines or typical antipsychotics. In clinical scenarios that either preclude their use or in which they prove ineffective, alternative pharmacotherapy must be considered. ⋯ Here, the authors present a hospice patient admitted to the general medical floor of a small community hospital for pain and symptom management. A history of polysubstance abuse contributes to rapidly escalating doses of opioids and midazolam. Failure to control her symptoms resulted in the initiation and successful titration of propofol.
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Am J Hosp Palliat Care · Dec 2008
Word choices of advanced cancer patients: frequency of nociceptive and neuropathic pain.
The purpose of this study was to determine if nociceptive and/or neuropathic pain in advanced cancer patients could be identified by word selections made on the McGill Melzack Pain Questionnaire. Theoretical definitions for nociceptive and neuropathic pain provided a framework for categorizing the word descriptors in the McGill Melzack Pain Questionnaire's sensory and miscellaneous dimensions. A description study design was used to group word frequencies by primary site and pain type. ⋯ Individuals with colon and liver cancer selected words that described 2 types of nociceptive (visceral, somatic) pain, while those with prostate cancer noted somatic pain. A set frequency was not reached by individuals with breast, pancreatic, gastric, and other advanced cancers. This study provided evidence that advanced cancer patients select words that describe nociceptive and neuropathic pain types.
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Am J Hosp Palliat Care · Oct 2008
Review Case ReportsOral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.
An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. ⋯ After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.
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Although hospice care to assist the dying is widely available, palliative care, which focuses on living with chronic and life threatening illness and preparing the living for dying, is poorly understood. Only recently, palliative care has been mandated by the Joint Commission on Accreditation of Healthcare Organizations as a necessary intervention for facilities. ⋯ No specific Medicare reimbursement exists for palliative care in hospitals, and hospital administrators are generally not supportive of programs where no reimbursement exists. Developing a model palliative care program using a cost aversion financial model to quantify benefits of a palliative care programs is one strategy to address the reimbursement shortcomings.