Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jan 2003
Palliative care in Papua New Guinea: report of the International Association of Hospice and Palliative Care Traveling Fellowship.
In June and July 2001, Dr. Nell Muirden traveled from Melbourne, Australia to Port Moresby General Hospital and Angau Memorial Hospital located in Lae, in Papua New Guinea. This visit was supported through an International Association for Hospice and Palliative Care Traveling Fellowship. ⋯ Muirden's visit greatly increased awareness about cancer pain and the importance of palliative care and pain relief in cancer and other terminally ill patients. She developed a discussion paper relating to the drugs needed for palliative care and the changes that should be made. The Pharmaceutical Advisory Committee subsequently adopted these recommendations, which will lead to a better range of medications to treat pain becoming available throughout Papua New Guinea.
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J Pain Palliat Care Pharmacother · Jan 2003
Pain management in a long-term care facility: compliance with JCAHO standards.
An analysis of the treatment of nonmalignant pain in the elderly at a long-term facility was conducted to allow development of a pain management program that complies with both JCAHO guidelines for pain management and with the Tennessee Medicaid (TennCare) reimbursement schedule, and to determine if tramadol can meet the standards of pain management under these new guidelines. Inclusion criteria were residence in our long-term care facility; a pain intensity score > 4 on a modified Wong Baker Pain Scale; the patient having prescription orders for one or more of the following drugs: propoxyphene, meperidine, or high dosages of acetaminophen (approaching 4 g/day); suspected neuropathic or mixed nociceptive/neuropathic pain; and/or a diagnosis of diabetes, osteoarthritis, or degenerative joint disease. Exclusion criteria were history of seizures, history of opioid or alcohol abuse, and demonstrated hypersensitivity to tramadol or opioids. ⋯ Tramadol reduced the percentage of residents falling, losing weight, showing no change or decline in activities in daily living (ADLs), displaying inappropriate behavioral symptoms, suffering depression, and/or taking psychotropic medications. In the state of Tennessee, new reimbursement schedules by TennCare have allowed our hospital to comply with the JCAHO standards of "optimal achievable care" for the treatment of pain by allowing the hospital staff to treat patients with newer, safer, more effective analgesics such as tramadol. Early results from this ongoing study have shown that tramadol can provide a safe and effective treatment on non-malignant pain in a long-term care facility and improve adherence to JCAHO and TennCare standards for proper pain management.
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Pain is a complex problem, for both those who are enduring it and those trying to relieve it. Most people in the developed world have access to adequate treatment and management of pain, the availability of trained and educated doctors and nurses, feasible opioid prescribing policies, as well as ready access to appropriate medication. Often, this is not the case in developing countries such as Thailand. ⋯ The severity and frequency of pain endured by this group of individuals presented a daily challenge. Problems encountered in providing pain relief for these patients and some potential solutions are described. There is a lack of literature on pain relief in Thailand.
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J Pain Palliat Care Pharmacother · Jan 2003
COX-2 selective NSAIDs and advancing legal issues in palliative care.
The role of the cycloxygenase-2 selective NSAIDs in palliative care has not been studied, per se, but the improved adverse gastrointestinal and platelet effect profiles of these newer agents over nonselective NSAIDs offers potential advantages in patients with advanced disease. These issues are discussed. ⋯ Recent legal opinions about aggressive care of patients approaching end of life has increased this need. The clinical and ethical implications of these decisions are discussed.
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J Pain Palliat Care Pharmacother · Jan 2003
Case ReportsSymptomatic hyponatremia in patients on oxcarbazepine therapy for the treatment of neuropathic pain: two case reports.
Oxcarbazepine is an FDA approved anticonvulsant medication that has also been used clinically as a treatment for chronic neuropathic pain. Hyponatremia is occasionally seen with the older anticonvulsant carbamazepine, and oxcarbazepine is a derivative of that older drug. Two cases of hyponatremia associated with oxcarbazepine are reported and suggestions for monitoring for and managing this effect are provided.