Articles: palliative-care.
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A great number of patients with gynaecological malignant diseases suffer from severe pain, caused, for example, by bone metastases of breast cancer or tumour infiltration of the pelvis and the lumbar plexus in uterine cancer. Several methods of treatment are available depending upon the origin of pain. It is possible to achieve pain relief by radiotherapy or by cytostatic therapy. ⋯ If possible, the oral route should be selected. If vomiting occurs, or if patients are unable to take oral medication, morphine can be given peridurally, intrathecally or by infusion. Often, an additional treatment is necessary with different medicaments like tricyclic antidepressants and corticosteroids.
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J Pain Symptom Manage · Feb 1990
Comparative StudyPalliative care in a cancer center: results in 1984 versus 1987.
We reviewed the charts of 48 consecutive patients treated by our Palliative Care Team (PCT) during 1984 and compared these results with 50 consecutive patients treated during 1987. The composition of the PCT did not change between 1984 and 1987. The median equivalent daily dose of parenteral morphine (MEDD) before referral, after initial treatment by the PCT, and at the maximum prescribed by the PCT were 43 mg, 48 mg, and 96 mg in 1984, respectively, versus 60 mg (p less than 0.03), 60 mg (p less than 0.03), and 120 mg (p less than 0.12) in 1987, respectively. ⋯ Poor pain control after the initial treatment was observed in 42% of patients in 1984 versus 26% in 1987 (p less than 0.01). Our results suggest that patients are being treated more aggressively by their physicians before referral to the PCT in 1987, that our PCT is using more aggressive initial treatment than in 1984, and that, notwithstanding these changes, there is still a significant proportion of patients in whom pain cannot be controlled before death. These results suggest that more research is necessary to better define intractable pain syndromes and develop adequate treatments for them.
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Pancreatic cancer remains an important cause of suffering among oncologic patients. Due to the current poor response to specific therapies, a palliative approach represents the main treatment for this kind of tumour. The authors present the results of a prospective study performed on 41 patients treated according to the World Health Organization guidelines for cancer pain relief; 21 of them were treated by neurolytic coeliac blockade as well. Results, even if not comparable between the two groups, show that this neurolytic technique can play an important role in palliative treatment, on condition that it is part of a multimodal continuing care system.
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Journal of neurosurgery · Feb 1990
Long-term pain relief produced by intrathecal morphine infusion in 53 patients.
The present report details the characteristics of the analgesic effects of morphine administered chronically by infusion pumps implanted in 53 patients suffering from terminal metastatic disease. The median postimplant survival time in these patients was 4 months. Patients (mean age 58 years) were characterized according to the duration of pain before pump implantation (mean 16 months), prior consumption of systemic opioids (mean one to six daily analgesic equivalents of morphine), and their response to a trial intrathecal dose of morphine (1 to 2 mg). ⋯ The maximum increase was observed in patients with a low analgesic index, and this rapid incrementation was usually correlated with an unsatisfactory overall outcome. Evidence that long-term infusion continues to yield analgesia was evidenced in six cases where there was an unanticipated loss of drug infusion and a corresponding increase in parenteral narcotic consumption. These data indicate the long-term efficacy and safety of spinal opioid infusion in patients with terminal cancer, and emphasize the advantage of assessing the sensitivity of the patient to spinal opioids by a standardized trial injection prior to pump placement as a prognostic indication of outcome.
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From 1983 to 1988 57 patients with far advanced carcinomas of head and neck received pharmacological treatment of severe cancer pain according to the scheme recommended by the WHO. The evaluation of the collected data revealed that satisfactory pain control could be achieved by administration of oral analgetics. Total relief of pain was achieved in more than 35% of the days, significant relief in more than 50%. Side effects observed during therapy and co-medications are discussed.