Journal of pain & palliative care pharmacotherapy
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A decade ago a North Carolina jury awarded millions of dollars in damages because of a healthcare institution's failure to provide appropriate pain relief to a dying patient. In 2001, a California jury found a physician guilty of elder abuse for his failure to properly manage the pain of a cancer patient. ⋯ These cases dramatically illustrate a significant and persistent gulf between the lay public and the health professions with regard to the moral significance they attach to the duty to relieve suffering. Measures to insure that all patients receive effective assessment and management of their pain must take into account this disparity, and endeavor to achieve congruence by reconnecting the health professions to their ancient and core value--the relief of suffering.
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J Pain Palliat Care Pharmacother · Jan 2002
ReviewOpioid treatment of chronic pain in patients with addiction.
Patients with a history of drug or alcohol addiction may present to physicians with pain complaints. The medical literature is weak on the treatment of pain with opioids in patients in recovery or active addiction. This is because inconsistent criteria were used to define addiction and the types of chronic pain. ⋯ A way to distinguish between these conditions is by giving the patient appropriate pain medication and observing the pattern of behavior to determine which is causing the drug-seeking behavior. Safe prescribing of medications with abuse potential includes use of a medication agreement, setting goals with the patient, giving appropriate amounts of pain medication, monitoring with pill counts and drug screens, and careful documentation. Even patients with a history of addiction can benefit from opioid pain medications if monitored appropriately.
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An international panel of pain specialists including physicians and health policy scholars met to discuss the impact of fear of opioids on the clinical use of these strong analgesics. Recognizing potential risk from opioids, the panel members concluded that irrational fear of the drugs often impedes their appropriate use. The need for education among clinicians was recognized and the panel concluded that while progress has been made, much remains to be done to correct unfounded fears and misconceptions that impede provision of opioid analgesia when it is indicated.
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This paper introduces a new series in the Journal that will address Outcomes Research and Pharmacoeconomics in Pain & Palliative Care. The goal of the series is to provide an overview of the field of outcomes research that will be geared to clinicians, and to review the outcomes literature in the area of Pain and Palliative Care. ⋯ There are a lot of misconceptions about the field including some who look at outcomes research as not really science and not adding to our knowledge about drugs and drug use. To the contrary, outcomes research is a powerful tool, but like many others it has limitations and it is important to understand both what outcomes research is, and what it isn't.
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J Pain Palliat Care Pharmacother · Jan 2002
Comparative StudyPatient-specific factors affecting patient-controlled analgesia dosing.
A study was conducted to evaluate the effect of characteristics patients' gender, age, weight, height, and body surface area, as well as the concurrent or recent use of opioids, ethanol and tobacco, on opioid dose requirements during administration of patient-controlled analgesia (PCA). Data were collected retrospectively from the medical records of 150 patients who underwent open cholecystectomies during an 18 month period at one institution. ⋯ The results of the study demonstrate that during the first 48 hours of PCA therapy, patient age, height, weight, body surface area, gender, smoking, alcohol use, and preoperative opioid use may have significant influence on opioid analgesic use (p < 0.05). The data support the hypothesis that patient-specific factors may contribute to the variability observed in patients' PCA analgesic dose requirements, and these factors should be considered when selecting a proper demand (bolus) dose for PCA therapy.