Ann Acad Med Singap
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Ann Acad Med Singap · Mar 1994
Review Case ReportsPalliative care in acquired immunodeficiency syndrome (AIDS): problems and practicalities.
The World Health Organisation estimates that over 1.5 million human immunodeficiency virus (HIV) infections have occurred to date in South and South East Asia. As most of these patients will develop acquired immunodeficiency syndrome (AIDS) in the coming decade, health services in the region face a major challenge in meeting their needs. ⋯ Based on the author's experience with the Central Sydney Area Palliative Care Service in Sydney, Australia, this paper discusses the problems and practicalities involved in palliative care for adult patients with advanced AIDS, such as clinical decision making, pain and other symptom control, psychosocial issues and terminal care. Representative case histories are described to illustrate how the palliative care physician can start to approach some of the dilemmas created by this demanding yet growing area of palliative care.
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In common with any medical problem, careful assessment and an analytical approach are the keystones to effective symptom control in advanced cancer. When dealing with such symptoms the multi-faceted pathophysiology must be considered, and due attention paid to the affective component of pain and other symptoms. ⋯ The importance of explanation to the patient cannot be overstated and is an integral part of any treatment and the sole component of many. This paper reviews the management of common symptoms in advanced cancer (dyspnoea, nausea and vomiting, constipation, anorexia-cachexia syndrome, hypercalcaemia, confusion, insomnia and depression.
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Ann Acad Med Singap · Mar 1994
ReviewCurrent approaches to the management of cancer pain: a review.
Pain, which is among the most prevalent symptoms experienced by cancer patients, can be effectively treated. Patient assessment, the use of anticancer therapies and systemically administered non-opioid and opioid analgesics are pivotal. Practical aspects of opioid pharmacology include both drug selection, methods of analgesic administration: selection of the appropriate route, dose titration, and an understanding of the management of side effects. ⋯ Finally, the use of sedation in the management of patients with pain that is refractory to other interventions is addressed. This approach can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine to address these difficult problems.
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Ann Acad Med Singap · Mar 1994
ReviewDyspnoea in advanced malignancies: a palliative care approach.
The incidence of dyspnoea in advanced malignancies varies from 48-78.6% in different studies. A systematic approach enables the clinician to separate non-malignant causes from those due to complications of malignancy. ⋯ Nebulised anaesthetics are alternatives, while the value of other drugs is uncertain. Oxygen therapy and treatment of anxiety are important components.
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Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. ⋯ It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.