Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2003
ReviewPotential cardiovascular effects of COX-2 selective nonsteroidal antiinflammatory drugs.
The newly developed nonsteroidal antiinflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2), are effective against pain and inflammation and appear to have less gastrointestinal toxicity than conventional NSAIDs. Their COX-2 selectivity, however, has raised concerns regarding their cardiovascular safety, since they do not inhibit COX-1, the isoform of the enzyme that is active in thrombosis and vasoconstriction. ⋯ Renal effects, edema and hypertension appear to be similar between conventional NSAIDs and COX-2-selective inhibitors. Aspirin is still required for patients with cardiovascular risk who are prescribed a COX-2-selective inhibitor.
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The 10th World Congress on Pain, the triennial meeting of the International Association for the Study of Pain, continued the series' tradition as one of the premier international meetings for pain clinicians and scientists. At this meeting, held in August 2002 in San Diego, California, a broad spectrum of topics was presented, with substantial representation in both the clinical and basic science realms. Increased understanding of basic pain mechanisms, potential new targets for drug treatment of pain, ethical issues, and psychological interventions for pain were all areas of considerable interest.
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The Kansas Living Initiatives for End-of-Life Care (LIFE) project was formed in 1999 by over 70 Kansas organizations, agencies and associations to further the cause of dignified, comfortable and peaceful end of life in terminally ill patients. LIFE developed a module on end-of-life care that was added to the Kansas year 2000 Behavioral Risk Factor Surveillance system, convened meetings of partners including health professional licensing boards, reviewed state laws and regulations, and published a joint policy statement of the Kansas Boards of Healing Arts, Nursing and Pharmacy on the use of controlled substances for pain management. Activities of Project LIFE and outcomes are described.
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Spiritual care is an essential component of palliative care because spirituality is an important part of suffering and the relief of pain and suffering. It is especially important in the developing world where medical and comfort resources are limited. ⋯ The role of spiritual resources in end-of-life care are described in the context of taking a spiritual inventory. The importance of all palliative care clinicians understanding these concepts is emphasized.
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Concern about controlled substance diversion and overview of prescribers by legal and regulatory officials is growing. The article is designed to increase health professionals' awareness of the methods of diversion and to provide guidance on how diversion can be foiled. This paper also should help healthcare practitioners to better understand the regulations governing prescribing of controlled substances. ⋯ Some behaviors of persons illegitimately seeking controlled substances from prescribers are described. Strategies to lessen the possibility of prescriptions being altered are discussed. Federal and state laws and regulations pertaining to controlled substances are described.