Articles: palliative-care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Enhancement of pain control with ketorolac tromethamine in patients with sickle cell vaso-occlusive crisis.
Twenty one patients with sickle cell disease admitted to the hospital with the pain of vaso-occlusive crisis (VOC) were treated by continuous IV infusion of ketorolac or normal saline for up to 5 days. All patients received supplemental IM injections of meperidine, 100 mg, as necessary, but not more frequently than every 3 hr. Over the 5 days the ketorolac treated patients (KT) required 33% less meperidine than did the placebo treated patients (PL), P = 0.04, and had significantly better pain relief as assessed by categorical, visual analog, and pain relief scales. ⋯ Adverse events were mainly related to the digestive system. This study showed that continuous infusion of ketorolac significantly reduced total meperidine requirement and that the analgesia produced by this combination was superior to that produced by meperidine alone. Further evaluation of this drug in the management of sickle cell VOC is warranted.
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Randomized Controlled Trial Clinical Trial
Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms: a combined analysis of controlled, single-dose studies.
We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAR) score. ⋯ We compared pain relief achieved by patients with different mechanisms, with TOTPAR adjusted for significant covariates (duration of prior opioid administration, doses of opioid administered in the previous 48 hours, pain intensity at the start of the study, BUN:creatinine ratio, and dose of administered opioid). The adjusted mean TOTPAR score of the group with any neuropathic pain was significantly lower than that of the group with nociceptive pain only (26.1 versus 20.4, p = 0.02). The score of the group with definite nociceptive pain alone (adjusted mean TOTPAR = 28.0) was significantly higher than scores of the groups with possible/probable nociceptive pain (TOTPAR = 19.9), mixed mechanisms (TOTPAR = 20.2), definite neuropathic pain alone (TOTPAR = 20.6), and possible/probable neuropathic pain alone (TOTPAR = 22.9).(ABSTRACT TRUNCATED AT 250 WORDS)
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Self-expanding metallic stents (Wallstents) were implanted in 44 ureters in 31 patients suffering from malignant ureteral obstruction. The causes of obstruction were lymph node metastases or primary tumors of the pelvis. ⋯ After 4 to 6 weeks, the stents were incorporated into the wall of the ureter. In a follow-up period from 1 to 27 months, tumor-associated hydronephrosis was prevented in all patients by implantation of the Wallstents.
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Ugeskrift for laeger · Apr 1994
Case Reports[Treatment of cancer pain with continuous opioid via spinal catheters].
Continuous intrathecal morphine treatment of cancer pain is reviewed on the basis of a literature search. Clinical, pharmacological and technical aspects are described, and the indications and potential complications are discussed. Three case histories illustrate the practical conduct and problems. The authors conclude that continuous intrathecal morphine treatment offers significant therapeutical advantages, when pain relief is not provided by conventional methods.
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Ugeskrift for laeger · Apr 1994
Case Reports[Continuous subcutaneous morphine to patients with terminal cancer. Analgesia at home].
Since 1992 it has been possible for cancer patients in the county of Southern Jutland to receive terminal care in their own homes. An essential part of this management is effective pain relief; more than 60% of cancer patients have chronic pain. ⋯ The patient may be treated in this latter manner for long periods of time. A case story is described where a cancer patient was treated with continuous subcutaneous morphine in his home for more than 257 days without complications or major side-effects.