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

Pain that cannot be controlled by traditional oral and parenteral methods in those patients with advanced cancer can be alleviated by spinal administration of narcotics. Epidural and intrathecal infusion with morphine causes analgesia by blocking spinal receptors without significant long-term central nervous, gastrointestinal, and genitourinary system effects. Of the total of 33 patients, epidural catheters inserted in 20 patients then connected by a subcutaneous tunnel to a continuous infusion system. Implanted pumps were used in each of these patients. Because of the cost and limitations of the implanted pumps, epidural catheters were connected, either directly or by subcutaneous reservoirs, to external ambulatory infusion pumps in the remaining 13 patients. Patient assessment by a linear analogue scale to measure pain levels determined that 23 of the 33 total patients (70%) had excellent or good relief of pain. The delivery of spinal administration of narcotics to treat intractable cancer pain in patients is safe. Most importantly, this method of delivery can be used in community hospitals, in outpatient settings, and in home health care programs.
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PMID:Control of cancer pain by epidural infusion of morphine. 171 47

Recently, the return to everyday life and a meaningful life are the most important goals in the management of cancer pain patients who have not undergone radical therapy. The aim is therefore betterment of QOL (quality of life) of the cancer pain patients who suffer from physical and mental pain, However, one can not expect much from any kind of therapy without adequate relief of physical cancer pain. Accordingly, pain relief methods in a pain clinic are also necessary for home therapy in cancer pain. We should like to show some cases treated in our pain clinic and emphasize the efficacy of our treatment for cancer pain.
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PMID:[Home therapy in cancer pain--from the viewpoint of the pain clinic]. 172 Sep 43

Morphine consumption for medical purposes in Japan showed a 17-fold increase between 1979 and 1989, due to increased use in cancer pain management. This increase is a reflection of the improving attitude of the health care professionals and health policy makers towards narcotics use. The WHO Cancer Pain Relief Programme has ultimately become the basis for a national cancer pain relief programme. The Ministry of Health and Welfare amended the Narcotics and Psychotropics Control Law in 1990, to improve accessibility of morphine preparations to cancer patients with pain, and edited four manuals for palliative care, that include guidelines on cancer pain relief, and legislative management of narcotics use in hospital, clinic and pharmacy.
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PMID:Changing attitudes towards narcotic use in cancer pain management in Japan. 172 36

This article examines misperceptions and barriers to adequate pain relief in cancer patients. Healthcare professionals have gaps in their knowledge of opioid drugs as well as misconceptions concerning tolerance, physical dependence, and addiction that often lead to the underprescribing of these agents. The pervasiveness of the "say no to drugs" message in our society and the fear of addiction on the part of patients and their families creates yet another barrier to the legitimate use of opioids to treat cancer pain. Legal and regulatory documents filled with arbitrary and ill-defined labels meant to promote the legitimate use of these drugs and curtail their misuse may instead intimidate healthcare professionals and negatively influence prescribing habits. Increased educational efforts for pharmacists and other healthcare professionals as well as the development of clinical role models and state cancer pain initiatives are cited as means to break down these barriers in order to achieve adequate pain relief for all cancer patients.
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PMID:Misperceptions and inadequate pain management in cancer patients. 172 70

In the last 30 years antidepressant drugs have been used increasingly in the treatment of patients with chronic pain. This article reviews the results of some 40 placebo-controlled studies. It is difficult to make comparisons between the various studies because they often differ in terms of pain conditions, patient selection, antidepressant drug used, dosages, trial design, etc. However, in spite of this heterogeneity and other methodological problems it is clear that a wide range of pain conditions are responsive to antidepressant drug treatment, in particular: headache, migraine, facial pain, neurogenic pain, fibrositis, and probably arthritis and rheumatoid arthritis. More data need to be gathered in cancer pain, and in other conditions such as low back pain for which no, or very limited, effect has been shown. The beneficial effects of antidepressant drugs is in most cases of a mild to moderate degree, some time lag is necessary before it is completely manifest, and it tends to persist over time if drug treatment is continued in the long term. Strong evidence of efficacy is not evident for all the antidepressants, and there are probably significant differences in this respect between various drugs. The effect of a drug on pain does not seem necessarily to be related to its effect on mood. Further studies are needed to clarify this topic, and it will be necessary to examine specific pain conditions, compare different antidepressants, with reference to each other and to placebo, further investigate the role of drug plasma concentrations and control for the presence of concomitant psychiatric disturbances and for organic lesions responsible for the pain symptomatology.
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PMID:The use of antidepressants in the treatment of chronic pain. A review of the current evidence. 172 71

Nearly 50% of all patients with cancer will suffer from chronic pain. Aside from specific anticancer treatment these patients need an adequate analgetic drug therapy. By using the WHO analgesic ladder correctly more than 85% of cancer pain can be treated effectively. Nevertheless, there are several reasons for an unsatisfactory management of cancer pain and in practice we often make simple but relevant mistakes in dealing with analgetic drugs, especially with opioids. Non-analgetic treatment of cancer pain e.g. neurolytic or neurosurgical blocks are relatively unknown. An adequate and satisfactory care for patients with cancer pain is based on an individual comprehensive approach, including analgetic treatment, non-analgetic techniques and last but not least the consideration of psychological factors that influence and determine the severity of pain.
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PMID:[After care as a supportive measure in palliative surgery--pain therapy]. 172 98

Cancer pain in general responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment, successfully controlling pain in 70-90% of patients. The two major problem areas are pain associated with nerve damage, and 'incident' (movement-related) bone pain. Nerve damage pain tends not to respond well to morphine or other opioids. The difficulty with severe incident pain is that if the dose of opioid is titrated sufficiently to relieve the pain on weight-bearing or on movement and is then given regularly at this level, it is too much for the patient at rest. The patient may then experience excessive side-effects at rest, but still have pain on movement. Other examples of pain which may be resistant to treatment with opioid analgesics are bladder and rectal tenesmus, pancreatic pain, and pain associated with decubitus ulcers or other superficial ulcers subjected to pressure or shearing forces. Management of non-opioid-responsive pain may include a variety of treatments involving adjuvant analgesic drugs and non-drug measures.
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PMID:Opioid-responsive and opioid-non-responsive pain in cancer. 172 4

From August 1989 to December 1990, we collected 1523 cases of malignancy at Tri-service General Hospital (TSGH), and 470 cases (30.9%) of these malignancy had pain complaint. Moreover, we found that 68.1% (79/116 cases) of malignancy with bony metastasis had pain complaint. These informations were obtained from medical records. By counting the site of these 1523 cases, the leading sites in sequence were lung (207 cases), stomach (164 cases), cervix uteri (132 cases), breast (117 cases) and colon (91 cases). Regarding the incidence of cancer pain among these malignancy, bone cancer had the highest incidence (75.0%), followed by tongue (66.7%), brain (65.7%), liver (62.3%) and pancreas (60.0%). There was no difference of the incidence of cancer pain between male and female. The incidences of cancer pain in different age groups were different; the young patients had higher incidence than elderly patients. The analgesics for cancer pain used most frequently by physicians at TSGH were nonsteroid anti-inflammatory drugs and meperidine. Although the therapeutic management of cancer pain has been advancedly developed, we found that the treatments of cancer pain by physicians at TSGH were not aggressive enough. Therefore, promotion of the concept in advanced pain control and techniques is our important task in the near future.
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PMID:[The study of cancer pain and its correlates]. 175 62

The role of epidural morphine in chronic cancer pain treatment is unresolved. In a population of 1205 cancer patients, the aggressive use of systemic opiates limited the trial of epidural analgesia to 16 cases. Successful analgesia was achieved with epidural morphine alone in 6 of these 16 cases following systemic opiate failure. The addition of bupivacaine produced analgesia in all of the 10 remaining cases and was successful chronically in 6 cases. Complications occurred in 11 of the 16 cases of epidural analgesia and included dislodged or broken catheters, pain on injection, hyperesthesia from epidural morphine and bleeding or infection related to the epidural catheter. Epidural morphine is indicated only in selected cancer pain patients and, although bupivacaine extends the efficacy of epidural analgesia, these methods are accompanied by problems and limitations.
Pain 1991 Sep
PMID:Epidural opiates and local anesthetics for the management of cancer pain. 137 25

A nation-wide survey (1987) of cancer pain and analgesic methods showed that the incidence of pain in the terminal stage was in the range of 68 to 72% without any significant difference between hospital groups. Irrespective of the stage of illness, a certain analgesic effect was obtainable with oral/parenteral use of opioids. As a result of a year-to-year comparison of pain in cancer clinics, it was found that the rate of complete pain relief has increased for all stages of illness, especially in the terminal stage. Here the rate of complete pain relief steadily increased from 37.8% in 1986 to 42.7% in 1987 and 48.6% in 1988. Propagation of WHO-advocated cancer pain therapeutics has led to an improvement of the rate of pain relief in the terminal stage. Marketing of MS Contin tablets resulted in a dramatic increase in the consumption of morphine, but there was no increase in the rate of pain relief due to poor measures to counter adverse reactions, and to administration of morphine in insufficient doses. The consumption of morphine for medical use increased year by year, but a greater number of doctors experienced in the use of opioids would further improve the management of pain. To realize that, it would be necessary to incorporate terminal care into medical education programmes as soon as possible. Further efforts will be required for extensive research and propagation of analgesic methods in various fields including education in medicine, science of nursing and postgraduate education.
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PMID:The incidence of cancer pain and improvement of pain management in Japan. 175 14


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