Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2003
Pain and palliative care for people living with HIV/AIDS in Asia.
Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. ⋯ These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.
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J Pain Palliat Care Pharmacother · Jan 2003
Pain relief in the developing world: the experience of hospice Africa-Uganda.
The need for high quality end-of-life care in the developing world is increasingly becoming recognized. One of the core parts of such a service is adequate pain control. Poor health care infrastructures and lack of access to opioid analgesics are common problems. ⋯ This paper discusses some of the challenges encountered and how these have been addressed. These include access to opioids, educating of health care workers and influencing policy makers. Factors that have been important in making the service a success, such as choosing an appropriate model of care, and future directions for the organization are discussed.
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Palliative care started in Hong Kong in 1982. It gradually established an increasingly important role in cancer care. Hong Kong is fortunate because analgesic drugs and expertise from various disciplines and specialties in pain management are readily available. ⋯ To promote the quality of palliative care and pain management, efforts have been made to provide training of healthcare professionals, and on formation of professional societies for palliative care doctors and nurses. In Hong Kong, palliative medicine achieved medical specialty status in 1998, with a curriculum and a structured training program designed for doctors interested in this field. Efforts are underway to further improve palliative care and pain management in Hong Kong through the formation of consultative teams in general hospitals, enhanced liaison with nursing homes, and possibly by redefining the role of traditional Chinese medicine in pain management.
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J Pain Palliat Care Pharmacother · Jan 2003
ReviewAddiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients.
Pain is among the most common complaints for which people seek medical care; yet pain is also among the most undertreated patient complaints. Reasons for this include reluctance by clinicians to prescribe and support the use of opioids, often due to a fear of addiction. ⋯ The first mission of the LCPA was to formulate precise definitions of the terms addiction, physical dependence, and tolerance. This report explains these definitions and discusses how they apply to clinical practice.
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The risk of patients receiving opioids without adequate monitoring and resulting in adverse outcomes has been noted by the Institute for Safe Medication Practices. More aggressive opioid analgesia often is clinically indicated, but it is not without risk. Adverse drug events due to opioids have increased with the recent adoption of pain management standards by the Joint Commission on Accreditation of Healthcare Organizations. The implications of this are discussed and a specific safe practice recommendation is provided.