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

A questionnaire concerning the treatment of cancer pain was sent to 10% and 5% random samples of Finnish physicians in 1985 and in 1990, respectively. The physicians were asked about their current practice in the treatment of pain in their cancer patients, and about their main clinical problems when treating pain. Three simulated patient cases were presented, and the adequacy of the suggestions for therapy was evaluated. The results indicated that Finnish physicians had adopted a more rational and effective analgesic therapy during the 5-year period. Treatment suggestions for the simulated patient cases had improved both in terms of daily doses of analgesics and of dose intervals, but the doses of opioids were still below those commonly used in chronic cancer pain. The clinical difficulties experienced by the physicians had changed: instead of being frustrated by the inefficacy of their treatment as in 1985, physicians were now working on the problem of finding a suitable preparation and dosage. The results suggest that the voluntary activity of patient organizations, a few pain clinics, and a few clinicians interested in pain treatment have been able to improve the practising physicians' theoretical knowledge in 5 years. In contrast to the improvement in the knowledge and skills, changing attitudes takes much longer. As many as 39% of physicians who see cancer patients at least occasionally, reported that they still had not acquired the prescription sheets necessary to prescribe opioids to outpatients.
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PMID:Treatment of terminal cancer pain in Finland: a second look. 137 34

Treatment of intractable pain with parenteral, subarachnoid, or epidural narcotics is often unsatisfactory due to tolerance and other systemic complications that accompany increasing dosages of these drugs. Other disadvantages include the potential infections with implantable pumps and the inconvenience of repeated narcotic administration. During the past several years, studies at the author's laboratory indicated that transplantation of adrenal medullary tissue or isolated chromaffin cells into the spinal subarachnoid space can significantly reduce pain in several rodent models without resulting in development of tolerance. Adrenal medullary chromaffin cells were selected because they produce high levels of both opioid peptides and catecholamines, agents that independently, and possibly synergistically, reduce pain when injected locally into the spinal subarachnoid space. The adrenal medullary transplants survive for prolonged periods, and continue to produce high levels of both catecholamines and met-enkephalin. These transplants reduce pain in two rodent chronic pain models, an arthritis model and a peripheral neuropathy model, both of which closely resemble human chronic pain syndromes. The success of the animal studies has led to initiation of human clinical trials in patients with chronic cancer pain; results are promising.
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PMID:Chromaffin cell transplants for alleviation of chronic pain. 137 36

Cancer pain remains a major cause of suffering. Improvements in its management have made unrelieved cancer pain unacceptable. While pharmacotherapy is the mainstay of cancer pain treatment, other options such as radiotherapy, nerve blocks, etc., have to be considered as well. A comprehensive approach must also address psychosocial issues. A successful pharmacotherapy programme for cancer pain requires careful assessment of the origin and cause of the pain. The selection of analgesics has to be rationalised using a sequential approach such as the WHO stepladder. Oral application by the block in an individually titrated dosage is recommended. Although morphine remains the most useful opioid, it should be used in combination with nonopioids. Co-analgesics, which contribute to analgesia without being classical analgesics, should be used to treat pain of specific origin. Here membrane-stabilizers, antidepressants and steroids play an often underestimated role in the treatment of neurogenic pain. Anxiolytics and major tranquillisers should be avoided because they cause sedation without improving quality of analgesia. Calcitonin, diphosphonates and spasmolytics are of minor importance in this regard. Finally, concomitant medication to treat side effects of the therapy may be necessary in formulating a comprehensive treatment plan.
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PMID:Pharmacological management of cancer pain. 137 59

We report 4 patients who developed organic hallucinosis while receiving opiate analgesics for cancer pain. In all patients, the symptoms rapidly responded to haloperidol and change in the type of opiate. The hallucinations were exclusively visual. Cognitive status, determined by the Mini-mental State Questionnaire (MMSQ), was normal in all patients. Organic hallucinosis occasionally occurs in patients receiving opiates and can be a major source of distress for patients and their families.
Pain 1992 Mar
PMID:Organic hallucinosis in patients receiving high doses of opiates for cancer pain. 137 22

Although it is widely appreciated that patients can demonstrate highly variable responses to different opioid drugs, there have been few detailed descriptions of this phenomenon. To illustrate this variability, we present 5 patients, 4 with cancer pain and 1 with non-malignant pain, who underwent dose titration with more than 1 opioid and developed markedly different responses to each. In every case, dose escalation led to successful treatment with 1 opioid and to intolerable side effects without adequate relief with others. The existence of this individual variability in the response to different opioids has important implications for both clinical practice and current understanding of opioid pharmacology in man. It contradicts the view that any opioid is inherently more efficacious than any other, suggests that patients who fail to obtain adequate pain relief at maximally tolerated doses of 1 opioid may benefit from an alternative drug, and underscores the potential importance of genetic factors as a determinant of opioid response.
Pain 1992 Apr
PMID:Individual variability in the response to different opioids: report of five cases. 137 28

Pain from cancer is said to be poorly relieved. To examine the relevance of this statement in our hospital we registered morphine consumption used for cancer pain relief from 1983 to 1990. The use of morphine increased 20-fold during this period, corresponding to a 12-fold increase per patient. A probable explanation of this development is that cancer pain now receives more attention and use of morphine has become more acceptable. New methods such as subcutaneous continuous morphine administration from portable pumps, and the introduction of slow-release morphine, have improved and simplified the treatment. Probably several Norwegian hospitals still lag behind in this respect. Consequently much pain remains unrelieved. We suggest that hospitals evaluate their pain relief programmes. If these are found inadequate, the service should be reinforced. This would probably lead to earlier rehabilitation and improved quality of life for the patient.
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PMID:[Is cancer pain therapy insufficient?]. 137 55

One of the World Health Organization's (WHO) top priorities is cancer pain relief. Simple guidelines for assessing and relieving pain have been developed, published, and field tested. WHO has concluded that there is enough knowledge currently to permit an approach to cancer pain relief that can be implemented on a worldwide basis. This information, when used correctly, allows pain control in 75% or more of patients with cancer pain. However, numerous barriers prevent the application of this knowledge and the achievement of cancer pain relief. Assessing the patient's cancer pain and effective use of analgesic drugs, especially opioid agents, are hampered by a lack of education of health-care professionals and the fact that the pain sensation is entirely subjective. Unfortunately, these factors often result in pain management being determined on the basis of personal opinion rather than scientific knowledge. This leads to inconsistent and often inadequate care of patients with cancer pain. The extent of the cancer pain problem and the WHO analgesic-ladder approach to cancer pain relief are reviewed along with recommendations from the American Pain Society. Lack of education of health-care professionals is discussed, focusing on pain assessment, underuse of oral and rectal routes of administration, fears of addiction, and titration of doses of opioid drugs. Simple strategies for beginning to correct these problems are presented.
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PMID:Pain control. Barriers to the use of available information. World Health Organization Expert Committee on Cancer Pain Relief and Active Supportive Care. 138 Aug 84

In this open, uncontrolled trial, 15 patients with severe incident cancer pain receiving regular opiates were administered 10 mg oral methylphenidate (MP) at 08.00 h and 15 mg at 12.00 h in order to antagonize opiate-induced sedation. The daily dose of opiate was increased by 30% 24 h after starting MP, followed by a 10% increase twice a day until maximal tolerated dose. In 14 evaluable patients, pain (VAS 0-100 mm), sedation (VAS), and mean equivalent daily dose (MEDD) of morphine were 55 +/- 17, 65 +/- 18 and 248 +/- 150 48 h before MP, versus 38 +/- 12 (P less than 0.01), 42 +/- 12 (P less than 0.01), and 405 +/- 130 (P less than 0.01) 48 h after MP, respectively. After 48 h of treatment, 12 of 14 patients felt better on MP, 2 of 12 patients felt no difference, and no patients felt worse (P less than 0.05). We conclude that the addition of MP allowed for an increase in the MEDD of morphine and increased pain control. Controlled double-blind trials should be performed.
Pain 1992 Jul
PMID:The use of methylphenidate in patients with incident cancer pain receiving regular opiates. A preliminary report. 138 Oct 72

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. Forty patients survived more than 2 months; the maximum survival time was 560 days (mean survival time, 80 days with a port system, 100 days with a manual DDS). Patients still alive at the time of this study, i.e., with unknown survival time, were excluded. The initial mean daily dose was 8.5 mg in lumbar ports, 2.75 mg in lumbar DDS, and 0.2 mg with intraventricular application. Dose change patterns disclosed no alteration of the initial dose in 18 of 26 port patients, an initial increase in 4, a preterminal increase in 3, and a single intermittent increase in 1 patient. Of 40 lumbar DDS patients, 13 showed a constant dose, 9 an initial, 3 a preterminal, and 5 an intermittent increase. 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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PMID:Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain. 138 67

The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.
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PMID:Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use. 139 84


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