The journal of pain : official journal of the American Pain Society
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To be most useful, clinical trials of cancer pain treatments should use pain measures that are both reliable and valid. A great variety of measures are now available that may be used to assess cancer pain. However, there are not yet any clear guidelines for selecting one or more measures over the others. ⋯ Composite measures that combine ratings of pain intensity and pain interference into a single score appear to be both valid and reliable for describing patient populations, although their usefulness in clinical trials may be limited because they can obscure the contributions of intensity and interference to the total score. Proxy measures of cancer pain (pain ratings made by someone other than the patient) may be useful when patients are not able to provide pain ratings, but they should not be used as replacements for patient ratings when patient self-report measures are available. The discussion includes specific recommendations for selecting from among the available pain measures, as well as recommendations for future research into the assessment of cancer pain.
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Few data exist on the distribution of pharmaceutical costs for inpatient surgical procedures across different drug categories (eg, analgesia, anti-infectives). The goals of this study were to categorize pharmaceuticals administered to patients after joint replacement surgery and then to take the hospital's perspective and quantify the pharmacy cost of delivering postoperative analgesia to these patients. Two hundred ninety-eight patients undergoing unilateral hip replacement (n = 145), unilateral knee replacement (n = 121), or bilateral knee replacement (n = 32) were studied retrospectively. ⋯ Thus, analgesics accounted for approximately 31% of pharmacy costs. The pharmacy cost of delivering postoperative analgesia to patients undergoing joint replacement surgery represents 1% of the total costs of surgery. Almost two thirds of the analgesic costs were for opioids.
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Pain can begin in the first year of life for individuals with sickle cell disease (SCD) and continue in an unpredictably recurrent manner throughout their life span. Sickle vaso-occlusive pain (sickle pain) can also occur simultaneously with pain of other origins, complicating both assessment and management. Aims of this research were to describe the reliability and validity of a daily diary for data collection with children and adolescents with SCD and to describe characteristics of vaso-occlusive sickle pain episodes (VOE) and other pain reported by children and adolescents with SCD along with home pain management strategies. ⋯ Analgesic medication was taken on 85% of days of sickle pain, whereas analgesics were taken on only 60% of days with other pain. The diary used in this study is a valid and reliable self-report tool. The use of home diaries will improve the understanding of sickle pain and its management and assist in identifying other pain syndromes that may require alternative management.
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Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.
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Naturally occurring opiates (endorphins) diminish testosterone levels by inhibiting both hypothalamic gonadotrophin releasing hormone production and testicular testosterone synthesis. Heroin addicts treated with a single daily dose of methadone and nonaddicts receiving continuous intrathecal opioids quickly develop low luteinizing hormone and total testosterone levels. A similar pattern was sought in men consuming commonly prescribed oral opioids. ⋯ Either TT or E(2) level was subnormal in all 28 men consuming the equivalent of 100 mg of methadone daily and in 19 of 26 (73%) consuming smaller opioid doses. Eighty-seven percent (39 of 45) of opioid-ingesting men who reported normal erectile function before opioid use reported severe erectile dysfunction or diminished libido after beginning their opioid therapy. Commonly prescribed opioids in sustained-action dosage forms usually produce subnormal sex hormone levels, which may contribute to a diminished quality of life for many patients with painful chronic illness.