Pain medicine : the official journal of the American Academy of Pain Medicine
-
To review strategies for treating patients with breakthrough pain (BTP). ⋯ Breakthrough pain can often be successfully treated by tailoring opioid therapy based on the subtype of BTP. These characteristics of BTP will determine the most appropriate opioid compound (i.e., hydrophilic vs lipophilic) and most effective mode of drug delivery.
-
Randomized Controlled Trial
Can patient coaching reduce racial/ethnic disparities in cancer pain control? Secondary analysis of a randomized controlled trial.
Minority patients with cancer experience worse control of their pain than do their white counterparts. This disparity may, in part, reflect more miscommunication between minority patients and their physicians. Therefore, we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a randomized controlled trial. ⋯ Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control. Larger studies are needed to validate these findings and to explore possible mechanisms.
-
This article reviews the literature on patient-provider interactions among patients with chronic pain conditions with an emphasis on shared medical decision making. ⋯ Treatment of chronic pain is often complex and may be further complicated when patients and health care providers have differing goals and attitudes concerning treatment. Difficulties in engaging in collaborative treatment decision making may result. Efforts to enhance patient-provider communication as well as to systematically examine nonspecific treatment factors are likely to promote effective management of chronic pain.
-
To review major clinical issues related to recognition and diagnosis of breakthrough pain. ⋯ Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients.
-
Clinical Trial
Assessment of dosing frequency of sustained-release opioid preparations in patients with chronic nonmalignant pain.
Many patients with moderate to severe chronic nonmalignant pain require dosing of long-acting opioids more frequently than recommended by the product's manufacturer. To accurately quantitate opioid dosing in clinical practice, daily dosing was prospectively assessed in pain clinic patients. ⋯ Many patients taking common long-acting opioids for chronic nonmalignant pain require dosing more frequently than recommended by product labeling, and take an additional 3-4 daily doses of rescue opioid, yet they continue to report moderate to severe pain. Newer opioid formulations that can provide sustained analgesia with convenient dosing are needed as well as a better understanding of the many additional factors that may influence opioid use patterns in patients with chronic pain.