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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inadequately managed cancer pain continues to be a significant problem despite increased awareness, improved knowledge and understanding of pain pathophysiology, and standardized treatment guidelines of this distressing and debilitating symptom complex. Small subsets of patients who are refractory to optimal medical management because of drug toxicity or unsatisfactory analgesia may be candidates for exteriorized or implantable intrathecal drug delivery systems. By delivering opioids and other agents directly to the central nervous system, intrathecal drug administration can offer superior pain relief with less toxicity at a fraction of the systemic dose. With adjuncts such as local anesthetics and clonidine, intrathecal therapy also allows for broader therapeutic options in the most difficult of cases. In general, intrathecal therapy is underused despite evidence of its efficacy, safety, and cost-effectiveness.
Curr Pain Headache Rep 2006 Aug
PMID:Intrathecal therapy for the management of cancer pain. 1683 39

Therapeutic massage as a cancer pain intervention appears to be safe and effective. Patients who receive massage have less procedural pain, nausea, and anxiety and report improved quality of life. The use of massage in cancer care centers and hospitals is on the rise. Massage has a positive effect on biochemistry, increasing levels of dopamine, lymphocytes, and natural killer cells. Specialized training of massage therapists in caring for people with cancer is recommended. Most studies to date are small but promising. Exact methodology and best practices warrant further investigation by the industry. More randomized clinical trials and case studies must be conducted.
Curr Pain Headache Rep 2006 Aug
PMID:Massage therapy for cancer pain. 1683 41

Cancer pain is commonly believed to be a unique type of pain and dissimilar to noncancer pain; however, only limited research efforts have been directed at examining this belief. The aim of this study was to explore whether patients with chronic daily headache (CDH) and patients with chronic cancer pain (CCP) present with different pain, mood, and sleep quality profiles. Forty-seven patients diagnosed with CDH were matched by age and gender with 47 patients with CCP. The research instruments included the Brief Pain Inventory-Chinese version, the Profile of Mood States Short Form, and the Pittsburgh Sleep Quality Index-Taiwan Form (PSQI-T). Results revealed that there was no difference in pain intensity between the patients with CDH and those with CCP; however, the CCP group reported significantly higher mean levels of pain interference with daily life than did the CDH group. These two groups did not differ on the Total Mood Disturbance score; however, the CCP group reported significantly lower mean levels of vigor than did the CDH group. Moreover, there was no difference on the PSQI-T total score between these two groups; however, the CDH group reported higher mean scores of sleep disturbance, higher mean scores of use of sleep medications, lower mean scores of sleep efficiency, and lower mean scores of daytime dysfunction than did the CCP group. Despite some differences between these two groups, pain, mood, and sleep quality profiles in these two types of pain groups are similar.
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PMID:Mood state and quality of sleep in cancer pain patients: a comparison to chronic daily headache. 1719 5

The 12-member National Institute of Health Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia (1996) reviewed outcome studies on hypnosis with cancer pain and concluded that research evidence was strong and that other evidence suggested hypnosis may be effective with some chronic pain, including tension headaches. This paper provides an updated review of the literature on the effectiveness of hypnosis in the treatment of headaches and migraines, concluding that it meets the clinical psychology research criteria for being a well-established and efficacious treatment and is virtually free of the side effects, risks of adverse reactions, and ongoing expense associated with medication treatments.
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PMID:Review of the efficacy of clinical hypnosis with headaches and migraines. 1736 74

Successful management of pain in the cancer patient requires careful assessment of the components of the pain complaint and accurate diagnosis of the cause of pain. Symptomatic management of pain involves pharmacotherapeutic strategies that focus on opioid use. Factors influencing the choice of opioid in patients with cancer pain include the severity of pain, the presence of coexisting disease, response to previous analgesic therapy, pharmacokinetic factors, available formulations, and patient compliance. Long-term opioid prescription always requires individual titration of medication to adequate pain relief, which is determined on an individual patient basis and/or based on manageable adverse effects. Failure to continuously monitor opioid use generally results in overtreatment or undertreatment of pain. The cognitive and psychomotor effects of long-term opioid therapy are not well-defined and merit further study.
Curr Pain Headache Rep 2007 Aug
PMID:Clinical use of opioids for cancer pain. 1768 87

The control of cancer pain is an essential goal in the care of patients with cancer. Inadequate pain assessment by health care providers is a major risk factor for undertreatment of pain. Repeated and accurate pain assessment is required for optimal pain management. Pain assessment tools such as simple rating scales and short pain questionnaires can facilitate routine measurement of cancer-related pain in clinical and research settings. In addition to measuring pain intensity, it is important to determine the impact of pain on patients' function, mood, and quality of life. Developmental issues must be considered when assessing the pain of children and elderly individuals with cancer. Novel technologies may be used to improve accurate and timely pain measurement.
Curr Pain Headache Rep 2007 Aug
PMID:Assessment tools for the evaluation of pain in the oncology patient. 1768 88

Pain is a feared component of cancer for a patient. The patient's prior experience with cancer pain will affect how he or she deals with ongoing and acute onset new pain. Radiation therapy has been and continues to be a major component in the management of cancer pain. New technologies are rapidly becoming available that will allow more specific and accurate targeting, while limiting the dose that is received by normal tissues and thus minimizing the potential for tissue toxicity. How new techniques and technologies are incorporated into the management of cancer pain will require a better understanding of the disease process being treated.
Curr Pain Headache Rep 2007 Aug
PMID:Advances in radiation therapy for oncologic pain. 1768 90

The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. Cancer was once an explosive, typically terminal disease and became the prototype for end-of-life opioid pain treatment. However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse.
Curr Pain Headache Rep 2007 Aug
PMID:Opioid misuse in oncology pain patients. 1768 91

Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications; however, an important minority of patients (2% to 5%) suffers from severe and refractory cancer pain. For these individuals, spinal analgesics (intrathecal or epidural) provide significant hope for pain relief over months or years of treatment to help improve quality of life. Spinal analgesics have been suggested as the fourth step in the World Health Organization guidelines in the management of cancer pain, and thus the pain physician should be familiar with principles of use. Most patients achieve pain relief using spinal analgesics, with a minimum of complications that are easily managed at home. A variety of opioids, local anesthetics, clonidine, ketamine, and other analgesics are available for the spinal route of administration and should be titrated to clinical effect or intolerable side effect. This article discusses the appropriate selection of patients for spinal analgesics, reviews current recommended infusion systems and current spinal analgesics, discusses possible complications, and includes practical suggestions for patient management.
Curr Pain Headache Rep 2007 Aug
PMID:Neuraxial pain relief for intractable cancer pain. 1768 92

Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. When all other thrapeutic measures fail to control pain, patients with non-malignant pain can also be treated by opioids. We report 70 patients with severe pain who were given opioids as the ultima ratio in pain therapy: 50 received buprenorphine sublingual tablets, 13 received morphine sustained release tablets and the remaining 7 were treated with other opioids. The mean daily dose was 1.45 mg buprenorphine or 87.6 mg morphine. The dosage increased in 12 of the 50 patients treated with buprenorphine while 5 of the 13 morphine patients needed increasing dosage. The other patients had a constant dosage after the initial period of dose-finding. In more than 50% the pain could be effectively controlled by oral opioids. The general performance status (Karnofsky) increased from 63.6% to 74.1%. The typical side effects were constipation and nausea. Prophylaxis of constipation is most important during opioid therapy. No case of respiratory depression or opioid addiction was registered. Our results show that patients with musculo-skeletal and deafferentation pain respond better to opioids than patients with headache. Negative results were observed in some patients with neuropathic pain. The results of the study show that opioids are justifiable for the treatment of non-malignant pain and can be given without danger over a long period of time. Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain -therefore, they should be given "by the clock". Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.
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PMID:[Oral opioids in patients with non-malignant pain.]. 1841 9


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