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

Morphine and hydromorphone infusions of 6 or more (average 25.75) days in duration were used with increasing frequency (up to 7%) by our oncology inpatients. Eighty-six percent of the 135 inpatients we reviewed realized good pain control with dose rates up to 700 morphine-equivalent (ME) mg/h. Local toxicity occurred on only 10 occasions. Systemic side effects secondary to the infusion were reported 75 times and were generally readily reversed. Myoclonus was seen in 11% of our patients at dose rates as low as 60-90 ME mg/h. Adjuvant therapies were not used as frequently as might be warranted. We believe that narcotic infusions, particularly subcutaneous ones, are safe and effective. Further prospective trials are needed to clarify how they should be combined with other therapies to control cancer pain that is poorly responsive to narcotics, and to better understand the etiology and management of serious side effects.
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PMID:Inpatient narcotic infusions for patients with cancer pain. 169 50

In the cancer population, the term breakthrough pain typically refers to a transitory flare of pain in the setting of chronic pain managed with opioid drugs. The prevalence and characteristics of this phenomenon have not been defined, and its impact on patient care is unknown. We developed operational definitions for breakthrough pain and its major characteristics, and applied these in a prospective survey of patients with cancer pain. Data were collected during a 3 month period from consecutive patients who reported moderate pain or less for more than 12 h daily and stable opioid dosing for a minimum of 2 consecutive days. Of 63 patients surveyed, 41 (64%) reported breakthrough pain, transient flares of severe or excruciating pain. Fifty-one different pains were described (median 4 pains/day; range 1-3600). Pain characteristics were extremely varied. Twenty-two (43%) pains were paroxysmal in onset; the remainder were more gradual. The duration varied from seconds to hours (median/range: 30 min/1-240 min), and 21 (41%) were both paroxysmal and brief (lancinating pain). Fifteen (29%) of the pains were related to the fixed opioid dose, occurring solely at the end of the dosing interval. Twenty-eight (55%) of the pains were precipitated; of these, 22 were caused by an action of the patient (incident pain), and 6 were associated with a non-volitional precipitant, such as flatulence. The pathophysiology of the pain was believed to be somatic in 17 (33%), visceral in 10 (20%), neuropathic in 14 (27%), and mixed in 10 (20%). Pain was related to the tumor in 42 (82%), the effects of therapy in 7 (14%), and neither in 2 (4%). Diverse interventions were employed to manage these pains, with variable efficacy. These data clarify the spectrum of breakthrough pains and indicate their importance in cancer pain management.
Pain 1990 Jun
PMID:Breakthrough pain: definition, prevalence and characteristics. 186 74

This report is a prospective study of 223 patients with intractable cancer pain who were offered continuing care during the year 1988 at the Pain Relief Unit, Kidwai Memorial Institute of Oncology, Bangalore, India, with a minimum follow-up of 4 months and a maximum follow-up of 16 months. A high percentage of pain relief was attained within a mean duration of 4 days, which on follow-up was maintained at a steady level in most patients (91.1%). Oral morphine could not be continued in three patients because of vomiting. The main side effects noticed were nausea and vomiting, itching, and constipation. At any time during the first 140 days, only 30% of patients had side effects and appropriate medication successfully managed these side effects. During the rest of the study period, the side effects were minimal. Oral morphine used with proper adjuncts offers the best pain palliation in most patients, with minimal side effects.
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PMID:Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center. 169 28

From 1983 to 1988 57 patients with far advanced carcinomas of head and neck received pharmacological treatment of severe cancer pain according to the scheme recommended by the WHO. The evaluation of the collected data revealed that satisfactory pain control could be achieved by administration of oral analgetics. Total relief of pain was achieved in more than 35% of the days, significant relief in more than 50%. Side effects observed during therapy and co-medications are discussed.
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PMID:[Pain-relieving therapy for 57 patients with malignancies in the head and neck area]. 170

In Pakistan, 70% of cancer patients with daily pain were found to be suffering severe pain. Cancer pain could be largely prevented by such inexpensive drugs as acetylsalicylic acid, codeine, and oral morphine.
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PMID:Cancer pain can be relieved. 170 71

We treat cancer pain patients at their homes, in collaboration with their relatives and primary physician. Assistance is free. Our team is monodisciplinary and trained volunteers are the liaison between team and patients. In 118 patients treated with our model between October 1987 and December 1988, we assessed the symptoms that moved them to seek assistance, their previous therapies, and the effectiveness of our intervention. The data obtained suggest that (a) in our country, the majority of cancer patients do not obtain effective pain and symptom control; (b) our model yields satisfactory pain control and improvement in quality of life; and (c) there is a need for centers that teach and practice terminal care; our model may be useful as a working outline for such centers.
J Pain Symptom Manage 1991 Jan
PMID:Argentina's WHO Cancer Pain Relief Program: a patient care model. 170 99

To compare the safety and efficacy of subcutaneous and intravenous infusion of opioid analgesics, a randomised, double-blind, crossover trial was carried out in inpatients. 15 patients with severe cancer pain received two 48 h infusions of hydromorphone--one subcutaneously and one intravenously in randomly allocated order. The study was made double-blind by the use of two infusion pumps throughout; during the active subcutaneous infusion the intravenous pump delivered saline and vice versa. Serial measurements of pain intensity, pain relief, mood, and sedation by means of visual analogue scales showed no clinically or statistically significant difference between the two infusion routes. Side-effects were slight, and the mean number of morphine injections for breakthrough pain did not differ significantly between the routes (4.8 [SD 4.5] for intravenous vs 5.3 [5.6] for subcutaneous). Plasma hydromorphone concentrations measured at 24 h and 48 h of infusion showed stable steady-state pharmacokinetics; the mean bioavailability from subcutaneous infusion was 78% of that with intravenous infusion. Because of the simplicity, technical advantages, and cost-effectiveness of continuous subcutaneous opioid infusion into the chest wall or trunk, intravenous opioid infusion for the management of severe cancer pain should be abandoned.
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PMID:Comparison of continuous subcutaneous and intravenous hydromorphone infusions for management of cancer pain. 171 29

The pharmacological management of paediatric pain is an area which is undergoing considerable development. Improvements in pain management are coming from appreciation of the special problems of children, increased knowledge of drug pharmacology and the development of better methods of drug delivery. Traditional methods of postoperative analgesia such as intramuscular injections are disliked by children and are being replaced by intravenous infusions, patient-controlled analgesia (PCA) and epidural opioids. Local anaesthetic blocks offer the benefit of fewer side effects and for certain procedures can provide complete pain relief in the immediate postoperative period. Inhaled analgesics such as nitrous oxide can be adapted for use in children and provide excellent analgesia for short painful procedures. The pain from needles is reduced considerably by the use of local anaesthetic creams. There has been greater appreciation of the benefits of drug combination, particularly with cancer pain management, and the importance of providing long term analgesia for these patients and patients with burns. Considerable scope exists for future developments such as transmucosal and transdermal drug delivery systems and other methods of drug delivery which are suited to the special needs of children.
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PMID:Paediatric analgesia. Which drug? Which dose? 170 87

Treatment of cancer pain with opioids through an epidural catheter, with a portable infuser has been recorded in 20 patients retrospective. In general there was a good acceptance of the treatment, which often could liberate the patients from close contacts to the pain clinic. There were not recorded adverse effects in relation to the infuser treatment. One patient had systemic adverse effects because of a very high daily opioid dose. The Pharmacia Deltec infuser employed has proven very secure and easy to handle.
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PMID:[Continuous epidural treatment of cancer pain using a portable infusion pump]. 171 93

Suggestions of percutaneous cervical cordotomy in treatment of advanced cancer pain, limits in treatment of terminal patients (needing pain therapy and total assistance), results and complications of the latest 64 procedures (part of 110 operations performed) are discussed.
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PMID:[Percutaneous cervical cordotomy in cancer pain. Preliminary experience]. 171 90


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