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

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 determined morphine plasma concentrations in 6 cancer patients before and with administration of diclofenac for 5 days. The non-steroidal anti-inflammatory drug does not modify morphine bioavailability. This observation suggests that diclofenac can be used in association with morphine during cancer pain treatment, without increasing the risk of overdosage or side effects of the opiate.
Pain 1992 Mar
PMID:Diclofenac does not modify morphine bioavailability in cancer patients. 159 62

Somatostatin-14 has been reported to relieve severe cancer pain when given intraspinally. We have studied a stable analog, octreotide, which is suitable for long-term infusion by a drug pump. In preclinical trials in dogs, chronic intrathecal and intraventricular perfusion at 40 micrograms/h did not produce neurotoxicity. On the basis of these findings cancer patients with pain unrelieved by oral opiates were treated for periods of 13 to 91 days with intrathecal octreotide 5-20 micrograms/h. During octreotide infusion, pain scores were lower while oral opiate usage was reduced. No central or systemic side effects of intrathecal administration were seen. The pain relief occurred in patients who had previously not obtained satisfactory pain control with systemic or intrathecal opiates, which is consistent with a non-opiate spinal pathway. These preliminary findings, if confirmed, suggest that octreotide is a potent non-opiate analgesic appropriate for long-term intrathecal infusion.
Pain 1992 Apr
PMID:Octreotide: a potent new non-opiate analgesic for intrathecal infusion. 835 Nov 67

Cancer pain represents a high-incidence problem that requires ongoing monitoring and evaluation. The recently published American Pain Society Quality Assurance Standards for Relief of Acute Pain and Cancer Pain provides an excellent basis for developing a quality assurance (QA) program in cancer pain assessment and management. These standards contain five critical areas for monitoring and evaluation related to cancer pain. The purpose of this article is to provide a useful framework for oncology nurses to develop a QA program in cancer pain assessment and management. The Oncology Nursing Society Position Paper on Cancer Pain and the American Nurses Association/Oncology Nursing Society Standards of Oncology Nursing Practice are incorporated into the framework to develop specific monitoring criteria. Practical suggestions are provided for implementing a QA program on cancer pain in a variety of oncology practice settings, using the standards of the American Pain Society.
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PMID:Implementation of the American Pain Society Quality Assurance Standards for Relief of Acute Pain and Cancer Pain in oncology nursing practice. 159 63

Pain in a child with cancer poses significant challenges for nurses. However, little research has been conducted in the area of pediatric cancer pain to guide clinical assessments and interventions. The purpose of this paper is to present a review of the research studies conducted on pediatric cancer pain over 13-1/2 years. The review of the cancer pain research studies is organized around several concepts that include approaches to cancer pain assessment and management as well as the presentation, incidence, and etiology of pain associated with childhood malignancy. Relevant clinical findings from the review of the literature are highlighted. Emphasis is on the major nursing implications from these studies, and suggestions are made for future nursing research.
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PMID:The problem of pain in children with cancer: a research review. 159 67

Glycerine has long been used with phenol as a drug depot in control of intractable pain. However, through our literature review, glycerine has never been used to prolong the pharmacological effects of a local anesthetic, such as bupivacaine. Our study is an attempt to use the same mechanism to further extend the pharmacologic effects of a popular long lasting anesthetic in a commonly used technique. Fifteen adult patients with cancer pain received 0.125% bupivacaine via a chronically implanted epidural catheter. In a blind study of pain control: Group I, consisting of 8 patients, received 5 ml 0.125% bupivacaine in normal saline; group II, consisting of 7 patients, received the same amount of the same strength anesthetic dissolved in 50% glycerine. The pharmacological effect was assessed by evaluation of intensity and duration of sensory as well as motor blockade. Our preliminary experimental experience revealed that significant prolongation (11.8 +/- 2.3 h vs 7.6 +/- 1.8 h, p less than 0.01) of analgesia was observed with the glycerine solution as compared to the saline solution. There was no motor blockade or other adverse effects or complications. This markedly prolonged analgesic effect is attributed to the slow release of the local anesthetic agent from the glycerine base which functions as a drug depot. Other clinical applications of this novel approach in pain relief are currently under investigation.
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PMID:[Epidural administration of bupivacaine in glycerine solution can prolong analgesia]. 160 16

In 35 of 316 patients suffering from severe cancer pain, an epidural catheter was placed for continuous morphine application. Indications for epidural opiates included failure of pain relief with oral morphine, severe side effects with oral administration, and contraindications for oral morphine, e.g., ileus. METHODS. The epidural catheter was inserted in the lumbar, thoracic or cervical region, according to the main localization of pain. A silicon catheter with a Dacron cuff (4.2 F Broviac Davol, Cranston, R.I.) was connected and tunneled subcutaneously to a distant exit on the lateral chest wall (Fig. 2). A portable morphine pump (CADD-PCA Pharmacia Deltec) was connected to the externalized catheter. The morphine was infused continuously at a basic rate. It could be increased to a programmed limit by additional boli determined by the patients themselves. Thirty patients were treated as outpatients. RESULTS. The mean duration of treatment was 101 (10-333) days. The daily dose of morphine ranged from 9 to 200 (33) mg at the beginning of therapy, and from 20 to 288 (88) mg at the end of treatment. In 27 patients (77%) epidural morphine administration proved to be a valuable method of pain control (Fig. 3). Even in most cases of tolerance to oral morphine, especially in patients suffering from pain of neuropathic origin, pain control was adequate. There were no cases of continuous loss of effectiveness of continuous loss of effectiveness or development of tolerance (Fig. 5). The epidural morphine dosage depended on the character and intensity of pain and its responsiveness to epidural opiates. Technical complications were noticed in 6 patients (17%), and fairly mild side effects of epidural morphine occurred in 20% of the patients for a limited time. CONCLUSIONS. The technique described is a simple and convenient method for long-term treatment of cancer patients with epidural morphine. There was no need for more invasive procedures, such as intrathecal or intraventricular morphine administration, in this group of patients in whom no pain relief had been achieved with oral morphine administration.
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PMID:[Ambulatory epidural analgesia in patients with tumors. An outmoded technique?]. 161 20

We reviewed our experience with 14 consecutive patients with cancer pain who developed severe cognitive failure that reverted either spontaneously or after specific treatment. In 3 patients who developed a nonagitated cognitive failure episode (CFE), there was no difference in the pain intensity measured by the patient before and after the episode and that measured by the nurse during the episode. In 11 patients who developed an agitated CFE, pain intensity assessed by a nurse during the CFE was significantly higher than the patient's assessment, both before and after the CFE. Patients who developed agitated CFE received a mean of 5 +/- 2 extra doses of narcotics per day, versus a mean of 2.17 +/- 1.6 doses in the average patient in our unit (P less than 0.01). Upon complete recovery, none of the 14 patients recalled having had any discomfort during the CFE. Problematic conflict between staff and family was detected in 4 of 11 cases of agitated CFE (36%), versus an expected 13 of 260 cases (5%, P less than 0.01). We conclude that (a) patients who recover from a severe CFE have no memory of pain; (b) medical and nursing staff are likely to overestimate the level of pain of patients with agitated CFE; and (c) agitated CFE in patients with cancer pain is a major source of distress for the patients' families and staff.
J Pain Symptom Manage 1992 Jul
PMID:The assessment of pain intensity in patients with cognitive failure: a preliminary report. 162 13

In a small number of studies and isolated case reports, intrathecally administered clonidine has been reported to relieve intractable cancer pain and to prolong spinal anesthesia induced by various local anesthetics. A double-blind placebo-controlled clinical trial was carried out in order to evaluate the effect of intrathecal clonidine on pain following cesarean section. Twenty patients who underwent elective cesarean section received, 45 min after general anesthesia, either 150 micrograms (n = 10) clonidine or saline (control group, n = 10) intrathecally. Pain scores were lower in clonidine- than saline-treated patients from 20 to 120 min after intrathecal injection, as measured by a visual pain linear analog scale (P less than 0.05). Pain relief, in terms of the first supplemental analgesic request by patients, lasted 414 +/- 128 min after intrathecal clonidine and 181 +/- 169 min (mean +/- SD) (P less than 0.01) after saline. Clonidine decreased systolic, diastolic, and mean arterial pressures compared to baseline values (P less than 0.05), but heart rate and central venous pressure were unaffected (difference not significant). Maximal reduction of systolic arterial pressure was 15 +/- 9%, of diastolic arterial pressure 22 +/- 12%, and of mean arterial pressure 18 +/- 12%. Clonidine did not affect arterial hemoglobin oxygen saturation or PaCO2. Patients in the clonidine group were significantly more sedated (P less than 0.05) and more frequently reported a dry mouth (P less than 0.01) compared to the normal saline group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intrathecal clonidine as a sole analgesic for pain relief after cesarean section. 164 46

Persistent severe cancer pain should be treated with opioid drugs, principally morphine. It can be administered orally, rectally and parenterally. Morphine is metabolised in the liver mainly to glucuronides, of which morphine-6-glucuronide is a powerful analgesic. Oral morphine should be administered regularly and in individualized doses. The use of morphine is frequently accompanied by adverse effects such as constipation, nausea, vomiting and sedation. Management of these is critical for successful pain treatment. Although alternatives are available none has any clear advantage over morphine in cancer pain, and should be reserved for special situations. Oral morphine is successful in more than 90% of cancer pain patients. Slow release morphine sulphate tablets (MS Contin) are often the best choice. For the few patients who need parenteral medication, continuous subcutaneous morphine sulphate infusion is generally the most suitable. Some pains are morphine resistant, especially those due to nerve injury. In these cases pain is best treated with tricyclic antidepressants and/or anticonvulsants.
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PMID:Oral opioids in the treatment of cancer pain. 166 Jan 7


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