Articles: palliative-care.
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Br Med J (Clin Res Ed) · Mar 1981
Patient-controlled dose regimen of methadone for chronic cancer pain.
Fourteen patients with severe cancer pain participated in a trial of methadone given in a fixed dose (10 mg) but at intervals selected by the patients themselves during the loading phase. The aim was to achieve rapid pain relief while avoiding the risk of toxicity from accumulation of methadone. As expected, the dosage intervals increased gradually over the first few days of treatment, the daily dose decreasing from 30-80 mg on the first day to 10-40 mg at the end of the week. ⋯ Eleven patients reported complete or almost complete pain relief and elected to continue with methadone after the study. In no case was treatment withdrawn because of intoxication. From these findings a patient-controlled dosage regimen of oral methadone may be an effective and safe alternative to parenteral narcotic medication, adjusting both for individual variation in pain intensity and for pharmacokinetics.
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Surgical and pharmacological management of cancer pain is described and discussed according to the physiopathological mechanisms underlying this complex syndrome. The therapeutic approach is planned in three mayor phases which may be employed alone or in combination, following an accurate evaluation of the pathophysiology and the clinical pattern in every single patient. The first phase includes multifocal pharmacological therapy by nonnarcotic drugs in order to affect at different levels the physiopathological mechanisms of cancer pain. ⋯ The pharmacological treatment must be continued and associated to surgery. The third phase includes hypophysectomy, deep brain stimulation, psychosurgery and/or narcotic drug therapy, which are the last step in management of terminal cancer pain when all treatments have been ineffective. The results of this therapeutic program in 188 patients affected by pain of malignant origin are reported and discussed.
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A method is presented for the endoscopic intubation of malignant tumors of the trachea and main bronchi with a Souttar tube. This is appropriate when urgent relief of respiratory obstruction is necessary and when the tumor is unsuitable for resection. ⋯ The method failed in one patient. There were no operative deaths.
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Head and neck cancer patients who develop incurable recurrent tumors present the surgical team with unique problems dissimilar to patients with cancer of other areas. When the structures of the head and neck are violated by tumor, the dying process is slow, lingering, and painful; and the anatomic areas involved tend to be visible, difficult to shield from those in attendance, and of course, are very obvious to the patient. ⋯ Our approach includes the palliative use of surgery, radiotherapy, and chemotherapy, and the participation of members of a palliative team by which therapeutic decisions and timing can be individualized for each patient. This system of palliation offers significant advantages to the patient and to the surgeon, and is a new concept applicable to head and neck cancer patients for whom previously little could be offered.