Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2012
Randomized Controlled TrialDifferent mechanisms for the short-term effects of real versus sham transcutaneous electrical nerve stimulation (TENS) in patients with chronic pain: a pilot study.
Transcutaneous electrical nerve stimulation (TENS) has existed since the early 1970s. However, randomized placebo controlled studies show inconclusive results in the treatment of chronic pain. These results could be explained by assuming that TENS elicits a placebo response. ⋯ However, by comparing time courses of EPTs, it was found that EPT values outside the segment of stimulation increased for sham TENS, whereas for real TENS these values decreased. There were, however, no differences for EPT measurements inside the segment stimulated. These results illustrate the importance of including mechanism-reflecting parameters in addition to symptoms when conducting pain research.
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J Pain Palliat Care Pharmacother · Jan 2012
Oral morphine effectiveness in Nigerian patients with advanced cancer.
Oral morphine elixir in the immediate release form became available in Nigeria in the year 2006 after decades of use in the treatment of cancer pain in many other countries. In order to determine the effectiveness of oral morphine in Nigerian patients, 182 patients presenting with severe cancer pain at the Radiotherapy Clinic, University College Hospital (UCH), Ibadan, Nigeria, were recruited in a prospective descriptive observational study. Information on patient's demography, diagnosis, baseline intensity and character of pain, morphine dosages, and effects were collected using a semistructured questionnaire administered at recruitment and biweekly in the follow-up period. ⋯ The reduction in pain intensity was maintained throughout the 3 months follow-up period, with the mean 24-hour morphine consumption of 55.54 mg in the first month and 61.54 mg in the third month. Oral morphine significantly reduced cancer pain in Nigerian patients (P < .01). Increasing dose as required was found to enhance the effectiveness of oral morphine.
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Fulfilling information needs is one of the keys to success in palliative care. A comprehensive palliative care offered in continuity not only helps people in coping with the illness but also relieves pain and other distresses. ⋯ This is the gist of the narrative shared by a family member in a continuity of cancer care workshop. Perhaps the hospice team offered more than enough to adjust and accept dying in a safe environment, for which the family remained grateful forever.
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Random drug testing of people being treated for chronic pain has become more common. Physicians may drug test patients on opioid therapy as a result of concerns over prosecution, drug misuse, addiction, and overdose. However, profit motive has remained unexplored. This article suggests profits also drive physician drug-testing behavior and evidence is offered, including an exploration of Medicare reimbursement incentives and kickbacks for drug testing.
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J Pain Palliat Care Pharmacother · Jan 2012
IOM calls for transformation of attitudes toward pain and its prevention and management.
The Institute of Medicine (IOM), the most influential health policy body in the United States, has published an extensive report calling for a cultural transformation of attitudes toward pain and its prevention and management. This report summarizes the IOM publication.