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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A multicenter study was conducted to determine the patient and physician acceptability of transdermal fentanyl in the management of cancer-related pain. In this study, 10 cancer patients at the University of Iowa received transdermal fentanyl after discontinuing their prior opioid analgesic; 7 patients completed questionnaires before and at 2 and 4 wk following transdermal fentanyl application. There was no significant difference in visual analogue scale scores for pain or mood. Verbal pain descriptor scores improved at 2 wk (P less than .05). There was a nonsignificant tendency toward increased depression and nausea; however, patients spent less time thinking about their illness and felt their cancer was less disruptive to their closest friends/relatives. Constipation, appetite, drowsiness, and concentration were not statistically different. Patients reported improved sleep habits at 2 wk (P less than .05) and tended to require less help with eating, dressing, washing, and using the bathroom. All patients completing the study chose to continue transdermal fentanyl for their cancer pain management. In summary, these data demonstrate the analgesic efficacy of the transdermal fentanyl system and suggest that some patients with cancer-related pain could benefit from its use.
J Pain Symptom Manage 1992 Apr
PMID:Management of cancer pain with transdermal fentanyl: phase IV trial, University of Iowa. 151 36

Morphine-induced constipation can lead to therapeutic disasters by several mechanisms. It can be readily prevented by administration of appropriate laxatives, but the importance of this simple intervention is often overlooked. Problems resulting from uncontrolled constipation include not only fecal impaction and spurious diarrhea, but also pseudoobstruction of bowel causing abdominal pain, nausea and vomiting, and serious interference with drug administration and absorption. Cancer pain may also be exacerbated. All of these contribute unnecessarily to morbidity and costs of health care. A case that exemplifies many of these problems is presented and discussed.
J Pain Symptom Manage 1992 Aug
PMID:Unrecognized constipation in patients with advanced cancer: a recipe for therapeutic disaster. 151 53

One hundred mothers who delivered infants at a rural community hospital between March and July 1990 were surveyed during their postpartum hospital stay to determine their opinions and expectations concerning constipation in infancy. Thirty-eight percent of multiparous mothers reported constipation in their previous children, which resolved with all home treatments given. Only 23% of the mothers reporting constipation mentioned this to their physicians. All mothers significantly underestimated stool frequency from ages birth to one week, relative to previously published norms. Mothers overestimated stool frequency at one week to one month, but this difference was not statistically significant. The most frequent description of constipation was inability to pass stool; pain was rarely mentioned. Most mothers agreed with the statement, "Constipation is dangerous for babies." Mothers reported learning about stool habits from previous personal experience, written materials, and their own mothers; impact of health-care professionals on their knowledge was minimal. The opinions and expectations of newly delivered mothers can be used to develop patient education and anticipatory guidance material to improve teaching and relieve parental anxiety about infant stool habits.
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PMID:Infant constipation: maternal knowledge and beliefs. 154 85

In contrast to the use of opioids for the treatment of acute and chronic cancer pain, the administration of chronic opioid therapy for pain not due to malignancy remains controversial. We describe 100 patients who were chronically given opioids for treatment of nonmalignant pain. Most patients experienced neuropathic pain or back pain. We used sustained-release dihydrocodeine, buprenorphine, and sustained-release morphine. Pain reduction was measured with visual analogue scales (VAS), and the Karnofsky Performance Status Scale was used to assess the patient's function. Good pain relief was obtained in 51 patients and partial pain relief was reported by 28 patients. Only 21 patients had no beneficial effect from opioid therapy. There was a close correlation between the sum and the peak VAS values (r = 0.983; p less than 0.0001) and pain reduction was associated with an increase in performance (p less than 0.0001). The most common side effects were constipation and nausea. There were no cases of respiratory depression or addiction to opioids. Our results indicate that opioids can be effective in chronic nonmalignant pain, with side effects that are comparable to those that complicate the treatment of cancer pain.
J Pain Symptom Manage 1992 Feb
PMID:Long-term oral opioid therapy in patients with chronic nonmalignant pain. 157 87

We have evaluated the predictive value of pelvic floor dysfunction (as characterized by abnormal contraction during defaecation straining or absent balloon expulsion) and evacuation proctography on symptomatic severe idiopathic constipation after colectomy with ileorectal or colorectal anastomoses for improvement and the use of laxatives. We also determined whether there was a relationship between the age of onset of symptoms and the symptomatic outcome after surgery. Forty-four women (mean age 34 years) were studied. Twenty patients had had a preoperative evacuation proctogram. Of these, 8 evacuated completely and 12 incompletely. Of the 29 patients in whom puborectalis electromyography was performed, 19 had paradoxal contraction on straining. There was no statistical relationship between symptomatic outcome and complete or incomplete evacuation on proctography, the presence or absence of puborectalis paradox or the age of onset of constipation (before or after the age of 10 years). Twenty-five patients had a preoperative balloon expulsion test. Of these, 14 were not able to expel a 50 ml water-filled balloon, and all 14 (100%) still experienced postoperative pain; 8 (57%) were still using laxatives. Of the 11 patients who were able to expel a balloon, 6 (55%) experienced pain and 1 (11%) still required laxatives postoperatively. The differences in postoperative pain and laxative requirements between those unable and those able to expel the balloon were statistically significant. Thus the balloon expulsion test may have predictive value when considering colectomy in patients with severe idiopathic constipation.
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PMID:The value of age of onset and rectal emptying in predicting the outcome of colectomy for severe idiopathic constipation. 158 23

The purpose of this double-blind crossover study was to determine whether a sustained-release morphine sulfate (SRMS) tablet given orally every 12 hours could adequately replace immediate-release morphine sulfate solution (IRMS) given orally every 4 hours in hospitalized patients with chronic pain from advanced cancer. Of 33 patients entered, 27 completed the study and were included in the efficacy and safety analysis. Patients were initially randomized to receive either 30-mg SRMS tablets every 12 hours or IRMS at the same mg/24 hours dose, every 4 hours. After 2 days, a crossover was performed, and patients received the alternate treatment for 3 days. Pain and side effects were assessed using a standard 100 mm visual analogue scale (VAS). There were no statistically significant differences between the two treatment groups for mean VAS pain scores or scores for sleepiness, nausea, depression, and anxiety. The incidence of breakthrough pain was similar for both treatment groups, as was the incidence of confusion and constipation. The results demonstrated that SRMS is a safe, effective analgesic preparation for patients who require oral opioids for cancer pain. The data also support the conclusion that sustained-release morphine tablets administered every 12 hours can replace an immediate-release morphine solution administered every 4 hours.
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PMID:A controlled study of sustained-release morphine sulfate tablets in chronic pain from advanced cancer. 159 Feb 84

We examined gallbladder motility function after intramuscular injection of caerulein (0.2 micrograms/kg) to the cases of irritable bowel syndrome (IBS) by using ultrasonography. We measured gallbladder area pre and after caerulein injection (0' 5' 10' 15' 20' 25' 30' 40' 50' 60') and calculated contraction rate of gallbladder in each time. We applied one way analysis of variance among the four groups [diarrhea group (N = 9), alternative group (N = 8), constipation group (N = 8), control group (N = 15)]. Gallbladder contraction rate was low in diarrhea group and high in constipation group (p less than 0.05). And then we classified gallbladder contraction pattern to three groups (hyperkinetic, intermediate, hypokinetic). These three groups correlated bowel habits and biliary knocked pain. Therefore, constipation group showed hyperkinetic tendency and diarrhea group showed hypokinetic tendency (chi 2 analysis: p = 0.004 CMH analysis: p = 0.001). And biliary knocked pain significantly appeared in constipation group and hyperkinetic type of gallbladder (chi 2 analysis: p = 0.026, CMH analysis: p = 0.019). Consequently, it was suggested that bowel habits concerned with abnormality of gallbladder motility function in IBS.
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PMID:[A study of the dynamics of gallbladder contraction in irritable bowel syndrome]. 159 76

Elderly patients have beliefs that, if not incorporated into the pain assessment, can block pain management by interfering with the patient's willingness to acknowledge pain and provide complete and accurate information about the pain experience. Patient beliefs that can block pain management include beliefs about self-concept and the aging process; the patient role; health professionals; pain; and consequences of treatment, including addiction, xerostomia, falls, constipation, and sexual and personality problems. Optimal pain management in the elderly is based on a complete assessment of pain, which may take several patient-nurse visits. Patients tend to reveal more information about health problems with succeeding visits, even if the patient is seen by a different person each time.
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PMID:Elder beliefs: blocks to pain management. 160 11

Bowel resection for idiopathic megarectum and megacolon does not always predictably relieve symptoms and has a significant morbidity. We have therefore evaluated the results of stoma formation in this condition. All patients had a bowel frequency of less than one per week, and all had a dilated rectum or colon. Eight patients, six of who had had a previous unsuccessful operation for their constipation, had a colostomy--this relieved the constipation and the need for laxatives in all six patients with rectosigmoid dilatation, although one patient could not tolerate his stoma. Two patients with dilatation of the whole colon were not helped. An ileostomy was formed in four patients with previous colonic resection, with relief of constipation in all. However pain and abdominal distension were common persistent symptoms in both groups. Four patients with a colostomy and all four patients with an ileostomy felt subjectively improved with a stoma. Stoma formation is a viable alternative to more major surgery, either as a primary procedure or after previous surgery has failed.
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PMID:Results of stoma formation for idiopathic megarectum and megacolon. 161 99

Constipation is a common and often perplexing problem for elderly people. The prevalence of self-reported constipation and factors associated with constipation were investigated in 3,166 people over age 65. Twenty-six percent of women and 15.8% of men reported recurrent constipation (p less than 0.0001). There was a significant increase in reported constipation with increasing age (p less than 0.0001). Multiple factors were found to correlate with self-reported constipation. A logistic regression model revealed 13 factors of significance in predicting constipation. The most important factors were age, sex, total number of drugs taken, pain in the abdomen, and hemorrhoids (p less than 0.0001). Specific drugs do not appear to be important factors in constipation in the elderly. Elderly people who report the use of multiple drugs, pain in the abdomen, and hemorrhoids are at increased risk for constipation.
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PMID:Correlates of constipation in an ambulatory elderly population. 161 39


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