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Query: UMLS:C0596240 (cancer pain)
 3,066 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cancer treatment is increasingly being provided in outpatient settings, requiring many of the responsibilities for patient care to be undertaken by family caregivers. Pain is one of the most frequent and distressing symptoms experienced by cancer patients and is a primary concern for the family caregiver. Caregivers struggle with many issues that lead to inadequate management of cancer pain. The purpose of this study was to determine pain management knowledge and examine concerns about reporting pain and using analgesics in a sample of primary family caregivers of cancer patients receiving homecare. The Barriers Questionnaire and the Family Pain Questionnaire were administered to 46 primary caregivers. Between 46% and 94% of the caregivers reported having at least some agreement with the various concerns that are barriers to reporting pain and using analgesics, and up to 15% reported having strong agreement. The areas of greatest concern were about opioid-related side effects, fears of addiction, and the belief that pain meant disease progression. Results showed that caregivers with higher pain management knowledge had significantly fewer barriers to cancer pain management, supporting the importance of increasing caregiver's knowledge of management of cancer pain.
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PMID:Knowledge of and barriers to pain management in caregivers of cancer patients receiving homecare. 1723 17

With the rapid improvement in living standards and health care delivery in Saudi Arabia, people are expected to live longer, patterns of illness will change, and the chronic illnesses which now dominate medical care in the West will develop here. Among these is cancer, which is already the third most common cause of death in Bahrain and Kuwait. Many cancer patients experience considerable distress, particularly pain. Management of symptoms in advanced cancer is now a medical and nursing specialty called palliative care. The most common and most feared symptom in advanced cancer is pain, which can only be effectively relieved with morphine in 60% of such patients. Prescribing narcotics such as morphine for cancer pain in Saudi Arabia has been severely restricted legally because of the fear of addiction, but there is no evidence that the medicinal use of morphine for treating cancer pain causes addiction. This paper describes a review carried out at King Faisal Specialist Hospital and Research Center, one of the few centers in the Kingdom that can prescribe morphine to outpatients, to review the appropriateness and effectiveness of morphine usage, and to monitor any misuse. The review confirms that morphine usage was appropriate and effective, but that procurement of adequate narcotic supplies from year to year causes severe problems due to the stringency of both national and international regulations. Also, better monitoring of patients on morphine and recording of their level of pain control is required. In general, this survey shows that morphine usage in this hospital is appropriate and that limitations on supplies could be improved by changes to the Ministry of Health regulations.
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PMID:Pain control with morphine: Evaluation of prescriptions for oral morphine for outpatients at King Faisal Specialist Hospital and Research Centre. 1737 44

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the "principle of balance" may justify that "...efforts to address abuse should not interfere with legitimate medical practice and patient care." Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients' function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients' rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of "producing good for the patient and protecting from harm," so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain.
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PMID:Opioid analgesia: perspectives on right use and utility. 1752 83

This study assessed and compared residents' beliefs and concerns about using opioids for treating pain in patients with cancer and noncancer low back pain (NLBP). Participants included 72 Internal Medicine and Medicine-Pediatrics residents who completed a survey questionnaire. Based on a scale of 0 = "No concern" to 10 = "Very concerned," residents expressed greater concern that treating NLBP with opioids, compared with cancer-related pain, causes addiction (6.01 vs 1.15), abuse (5.57 vs 1.39), and side effects (4.76 vs 2.87); limits other treatments (5.36 vs 1.30); draws criticism from faculty (4.33 vs 0.88); or risks sanctioning (state board 4.12 vs 1.12, legal 4.06 vs 1.17); p < 0.001 for each (paired t-tests). They had more comfort (8.94 vs 4.31) and more empathy (9.09 vs 6.79) using opioids to treat for cancer pain than NLBP and would give whatever doses necessary for pain control (8.41 vs 3.66); p < 0.001 for each. Our findings show that residents are far more concerned about using opioids to treat NLBP than cancer-related pain.
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PMID:Medical residents' beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: a pilot study. 1755 77

Recent case reports have raised concerns about the potential for methadone to prolong the QTc interval (QT corrected for heart rate) and predispose patients to torsade de pointes (TdP), a life-threatening arrhythmia. We present a case report that describes the successful use of parenteral and oral methadone in a patient with uncontrolled cancer pain and a history of QTc prolongation. We describe an approach to the use of methadone in this patient and review both case reports and recent prospective studies that have evaluated the risk of TdP and the long-term outcome with respect to the development of TdP in patients receiving methadone for chronic pain or addiction.
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PMID:The successful use of parenteral methadone in a patient with a prolonged QTc interval. 1761 30

The Agency for Health Care Policy and Research Pain Guidelines of 1994 recognized pain as a critical symptom that impacts quality of life (QOL). The barriers to optimum pain relief were classified into three categories: patient, professional, and system barriers. A prospective, longitudinal clinical trial is underway to test the effects of the "Passport to Comfort" innovative intervention on pain and fatigue management. This article reports on preintervention findings related to barriers to pain management. Cancer patients with a diagnosis of breast, lung, colon, or prostate cancer who reported a pain rating of >/=4 were accrued. Subjects completed questionnaires to assess subjective ratings of overall QOL, barriers to pain management, and pain knowledge at baseline and at one- and three-month evaluations. A chart audit was conducted at one month to document objective data related to pain management. The majority of subjects had moderate (4-6 on a 0-10 numeric rating scale) pain at the time of accrual. Patient barriers to pain management existed in attitudes and knowledge regarding addiction, tolerance, and not being able to control pain. Subjects who were currently receiving chemotherapy were reluctant to communicate their pain with health care professionals. Professional and system barriers were focused around screening, documentation, reassessment, and follow-up of pain. Lack of referrals to supportive care services for patients was also noted. Several well-described patient, professional, and system barriers continue to hinder efforts to provide optimal pain relief. Phase II of this initiative will attempt to eliminate these barriers using the "Passport" intervention to manage cancer pain.
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PMID:Overcoming barriers to cancer pain management: an institutional change model. 1761 36

The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. Cancer was once an explosive, typically terminal disease and became the prototype for end-of-life opioid pain treatment. However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse.
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PMID:Opioid misuse in oncology pain patients. 1768 91

Opioids are given for acute intra- and postope-rative pain relief or for chronic cancer pain. In the literature there are only rare and contradictory reports on the oral administration of opioids for chronic non-malignant pain. However, there is no reason to withhold strong analgesics for patients with severe pain. When all other thrapeutic measures fail to control pain, patients with non-malignant pain can also be treated by opioids. We report 70 patients with severe pain who were given opioids as the ultima ratio in pain therapy: 50 received buprenorphine sublingual tablets, 13 received morphine sustained release tablets and the remaining 7 were treated with other opioids. The mean daily dose was 1.45 mg buprenorphine or 87.6 mg morphine. The dosage increased in 12 of the 50 patients treated with buprenorphine while 5 of the 13 morphine patients needed increasing dosage. The other patients had a constant dosage after the initial period of dose-finding. In more than 50% the pain could be effectively controlled by oral opioids. The general performance status (Karnofsky) increased from 63.6% to 74.1%. The typical side effects were constipation and nausea. Prophylaxis of constipation is most important during opioid therapy. No case of respiratory depression or opioid addiction was registered. Our results show that patients with musculo-skeletal and deafferentation pain respond better to opioids than patients with headache. Negative results were observed in some patients with neuropathic pain. The results of the study show that opioids are justifiable for the treatment of non-malignant pain and can be given without danger over a long period of time. Side effects are controlled by additional medication. The principle of opioid administration is prophylaxis of pain -therefore, they should be given "by the clock". Opioids are not only indicated in malignant illness, but also according to severity of pain and by the failure of other measures to control pain.
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PMID:[Oral opioids in patients with non-malignant pain.]. 1841 9

Anxieties and emotional disturbances associated with cancer often cause pain therapy to be unsuccessful. When psychological support is required it is mostly aimed at supporting cancer patients in attempts to cope with their disease so as to improve the efficiency of pain therapy. In our study we focused on the barriers to cancer pain management that lie in patient's beliefs about pain and their coping behavior. A pilot study was designed to examine the subjective experience of pain and coping strategies. In a sample of 146 cancer outpatients with pain we found moderate pain intensity levels and good physical conditions (Karnofsky), but an extensive impact on mood and vegetative symptoms associated with "constant or daily pain" and/or attribution of pain to cancer. Coping was characterized by stoicism, "being brave", comparison with others and self-encouragement, but seldom by communication, requests for help or such strategies as distraction, enjoyment and relaxation. Only one third of the pain patients communicated their pain. Women and the patients who had higher pain intensity levels were more likely to suffer in silence, but those who communicated had better acceptance levels of pain intensity than those who did not. In a second study we focused on two questions. What do patients think about pain therapy? Can patients' attitudes on pain and pain management be changed by an information brochure? Selected results obtained in a sample of 72 cancer pain patients are reported. From a 30-item list of statements about pain and pain management, which were extracted from the previous interviews, three distinct types of attitudes in pain patients were derived by cluster analysis. One group of 29 patients was characterized by "non-acceptance of analgesic pain management'. With respect to medication intake, they were afraid of subjecting themselves to physical stress, of addiction and side effects and of loss of control over the disease. They hoped their pain would disappear when the tumour therapy took effect (as with acute pain) and thought they could tolerate it stoically. These patients wanted to take medication only if tumour therapy had no effect and when death was imminent. They had a pain intensity level of 5.5 VAS (without therapy). Adequate pain therapy was given to 14.3% of the "nonacceptors", significantly less (P=0.002) than to the "acceptors" (n=31) who had pain intensity levels of 7.7 VAS (without pain therapy) and had attitudes quite opposed to those of the first group. Adequate pain therapy was given to 58.6% of this group. The third group of patients (n=12) was characterized by "ambivalence toward analgesic pain management". They were similar to the acceptors insofar as they did not fear addiction and side effects of medication, but they were similar to the non-acceptors insofar as they were afraid of losing control over the disease and of putting their body under stress. They also tended to bear pain stoically. Their pain intensity level without therapy was 6.3 VAS. With respect to coping strategies, communication was found significantly less often (P=0.001) than cognitive and behavioural coping. Those patients who used cognitive coping strategies and did not communicate often received inadequate pain therapy. Those who talked about pain but did not use any other coping strategies were mostly well treated. We have designed a brochure, "What tumour patients should know about pain" directly oriented on the above pain beliefs; this is now being evaluated with reference to its educational effect.
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PMID:[Cancer pain: Coping and communication.]. 1841 97

Analgesic pharmacotherapy represents one of the major approaches to the treatment of cancer pain, since it is used in almost every patient. A thorough evaluation of the physical and mental status of the patient and of the pain is as necessary as a sound understanding of the pharmacokinetic and pharmacodynamic characteristics of the analgesics selected. The World Health Organization (WHO) has issued a basic 3 stage progression for the treatment of cancer pain, the "WHO Analgesic Ladder". Assignment to the stages depends mainly on the intensity of the pain rather than on its specific aetiology. Mild to moderate pain is treated with non-opioid drugs; moderate to severe pain, with a combination of a "weak" opioid and a non-opioid; and "strong" opioids should be used in combination with a non-opioid in the case of severe pain. Adjuvant drugs can be added if specifically indicated. Nonopioid analgesics include non-acidic compounds, e. g. paracetamol and metamizole, and acidic non-opioids, e. g. acetylsalicylic acid and newer non-steroidal anti-inflammatory drugs (NSAID). In contrast to most of the opioid analgesics, they have a ceiling effect for analgesia. Addiction and tolerance are extremely rare concerns. Opioids can be subgrouped into "weak" (e. g., codeine, dextropropoxyphene) and "strong" opioids (e. g., morphine) and also into drugs interacting with different opioid-receptor subtypes. Whereas pure agonists (e. g., morphine) produce increasingly intense analgesia with increasing dose, partial agonists and agonist-antagonists have a ceiling effect for analgesia and therefore have only a minor role in the treatment of chronic pain in cancer patients. Adverse effects occur in most patients in a dose-dependent manner. The most common of these is constipation; nausea, vomiting and sedation occur mostly at the start and can usually be treated effectively. The appropriate dosage, route of administration and dosage scheme of analgesics needs to be worked out for each individual patient in intensive work with the patient and a close follow-up, for years if necessary. Some analgesics may not be available in some countries, or only in specific preparations.
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PMID:[Drug therapy for tumor pain I. Properties of non-opioids and opioids.]. 1841 58


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