Articles: palliative-care.
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In 1989 a Delphi study was undertaken to identify the nursing priorities in burn research. The Delphi technique is a series of questionnaires used to reach consensus. Ninety-four nurses involved in burn care completed four rounds of questionnaires containing 101 research questions. ⋯ Eleven (10%) of the 101 questions dealt with pain, whereas five were rated among the top 20 priority questions. As a category the questions concerning pain management had a mean score of 5.91 on a 0 to 7 Likert scale. The questions collectively were cited as having the most impact on the welfare of the patient with burns.
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Comparative Study
Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain.
Intrathecal morphine analgesia for the treatment of cancer pain was administered using implanted ports and drug delivery systems (DDS) in 79 patients. Effective control of the pain was achieved in nearly all patients; in only two patients was the use of the DDS discarded because of relative ineffectiveness. Fifty-three manual drug release systems (41 lumbar, 12 ventricular) and 26 lumbar ports were used. ⋯ Three patients with less than 2 months' survival time had a rather continuous increase. All long-time survivors (i.e., with more than 2 months' survival time) reached a plateau and remained there until a preterminal if any increase occurred. These findings suggest the morphine dosage to be indicative of the progress of the disease rather than of a drug tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)
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The course of pain associated with temporomandibular disorders (TMD) and other chronic pain conditions is typically episodic. Its expression may influence when a person seeks treatment, for example, when the level of pain flares up or exceeds its characteristic severity. Improvement in pain status subsequent to entering treatment may be due to: (1) specific effects of treatment; (2) non-specific effects of treatment ('placebo effects'); or (3) regression to the mean. ⋯ A control group of TMD subjects not seeking treatment showed no mean reduction in pain intensity but reported lower pain intensity at baseline than the group seeking care. When both groups of subjects were stratified on baseline VAS pain values, the reduction in pain increased as the baseline pain level increased, but no differences between comparable treated and untreated cases in the extent of improvement were observed. The before-after differences in both groups may be attributed to regression to the mean.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Ibuprofen plus codeine, ibuprofen, and placebo in a single- and multidose cross-over comparison for coxarthrosis pain.
The analgesic efficacy of 200 mg ibuprofen plus 30 mg codeine, 200 mg ibuprofen and placebo was investigated in a new analgesic evaluation model using single- and repeated-dose administration. The study was a double-blind randomized cross-over investigation in 26 coxarthrosis patients with persistent pain. After a washout period of at least 2 days with paracetamol available as rescue analgesic, each of the 3 treatments was administered in a total of 6 doses during 24 h. ⋯ The analgesic efficacy of ibuprofen plus codeine was significantly superior to that of ibuprofen which was, in turn, superior to that of placebo. In conclusion, analgesic efficacy was better differentiated after repeated-dose than after single-dose administration. The present study design was able to differentiate between 200 mg ibuprofen plus 30 mg codeine and 200 mg ibuprofen alone in a relatively small number of patients.