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BMJ 2002 Feb 2;324(7332):300
[Medline record in process]
Publication Types:
PMID: 11936135, UI: 21931899
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Cancer 2002 Mar 15;94(6):1836-53
Edmonton Palliative Care Program and Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada. plawlor@ualberta.ca
BACKGROUND: Opioids have an essential role in the management of pain in cancer patients, particularly those with advanced disease. Cognitive dysfunction is a recognized complication of opioid use. However, misconceptions and controversy surround the nature and prevalence of its occurrence. A projected increase in the aging cancer population highlights the need for a better understanding of this phenomenon. METHODS: A critical appraisal of the literature evidence in relation to the pattern, pathophysiology, assessment, impact, and management of cognitive dysfunction due to opioid use in cancer pain management is given. RESULTS: Studies in cancer patients with less advanced disease reveal subtle evidence of cognitive impairment, largely related to initial dosing or dose increases. In advanced cancer, opioid-induced cognitive dysfunction usually occurs in the form of delirium, a multifactorial syndrome. The presence of both cognitive impairment and delirium frequently is misdiagnosed or missed. Potential risk factors include neuropathic and incidental pain, opioid tolerance, somatization of psychologic distress, and a history of drug or alcohol abuse. Elevation of opioid metabolites with renal impairment may contribute to cognitive dysfunction. Recognition of opioid-related cognitive dysfunction is improved by objective screening. Successful management requires either dose reduction or a change of opioid, in addition to addressing other reversible precipitants such as dehydration or volume depletion. CONCLUSIONS: Opioid-related cognitive dysfunction tends to be subtle in the earlier stages of cancer, whereas delirium, a more florid form with behavioral disturbance is likely to be present in the advanced cancer population. In patients with advanced disease, an optimal management approach requires careful clinical assessment, identification of risk factors, objective monitoring of cognition, maintenance of adequate hydration, and either dose reduction or switching to a different opioid. Copyright 2002 American Cancer Society.
PMID: 11920548, UI: 21916639
Clin Orthop 2002 Feb;2002(395):262-72
Division of Pediatric Orthopaedics and Pathology, Valley Children's Hospital, Madera, CA, and the Departments of Surgery and Pathology, University of California at San Francisco, CA.
PMID: 11937891, UI: 21934917
Eur J Pharmacol 2002 Mar 29;439(1-3):83-92
Pain Research Group, Department of Anaesthetics, Faculty of Medicine, Imperial College, Chelsea and Westminster Hospital Campus, London, UK
Activation of cannabinoid receptors causes inhibition of spasticity, in a mouse model of multiple sclerosis, and of persistent pain, in the rat formalin test. The endocannabinoid anandamide inhibits spasticity and persistent pain. It not only binds to cannabinoid receptors but is also a full agonist at vanilloid receptors of type 1 (VR1). We found here that vanilloid VR1 receptor agonists (capsaicin and N-N'-(3-methoxy-4-aminoethoxy-benzyl)-(4-tert-butyl-benzyl)-urea [SDZ-249-665]) exhibit a small, albeit significant, inhibition of spasticity that can be attenuated by the vanilloid VR1 receptor antagonist, capsazepine. Arvanil, a structural "hybrid" between capsaicin and anandamide, was a potent inhibitor of spasticity at doses (e.g. 0.01 mg/kg i.v.) where capsaicin and cannabinoid CB(1) receptor agonists were ineffective. The anti-spastic effect of arvanil was unchanged in cannabinoid CB(1) receptor gene-deficient mice or in wildtype mice in the presence of both cannabinoid and vanilloid receptor antagonists. Likewise, arvanil (0.1-0.25 mg/kg) exhibited a potent analgesic effect in the formalin test, which was not reversed by cannabinoid and vanilloid receptor antagonists. These findings suggest that activation by arvanil of sites of action different from cannabinoid CB(1)/CB(2) receptors and vanilloid VR1 receptors leads to anti-spastic/analgesic effects that might be exploited therapeutically.
PMID: 11937096, UI: 21935078
Lancet 2002 Mar 16;359(9310):925
Department of Surgery, Prince of Wales Hospital, NT, Shatin, Hong Kong.
PMID: 11918910, UI: 21918277
Spine 2002 Feb 1;27(3):334-5
PMID: 11805707, UI: 21664583
Spine 2002 Feb 1;27(3):332-4
PMID: 11805706, UI: 21664582
Spine 2002 Feb 1;27(3):328-9
PMID: 11805703, UI: 21664579
Spine 2002 Feb 1;27(3):327
PMID: 11805701, UI: 21664577
Spine 2002 Feb 1;27(3):299-305
Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium. greet.cardon@rug.ac.be
STUDY DESIGN: A control group-designed 1-year follow-up study involving 9 to 11-year-old schoolchildren who followed back education. OBJECTIVES: To evaluate the efficacy of a back education program, consisting of six sessions of 1 hour each, in elementary school. SUMMARY OF BACKGROUND DATA: In surveys among children and teenagers during the past few years, as many as half of all children in a community report a history of low back pain. Although several authors advocate the implementation of back education in elementary school, no guidelines exist and little is known about the efficacy of such a program. METHODS: A total of 198 children (subjected to back education) and 165 controls performed a practical test, evaluating the use of back care principles while sitting, taking off shoes, picking up a pen, and handling a load and a book bag. Post-tests were performed within 1 week after the intervention, after 3 months, and after 1 year. The week prevalence of back and neck pain was evaluated at these test moments in extended samples of intervention children (n = 347) and controls (n = 349). To evaluate habit changes, a limited group of intervention pupils (n = 38) and controls (n = 31) was additionally evaluated in a candid camera observation at the last post-test. RESULTS: At all post-tests intervention pupils scored significantly higher (P < 0.001) than controls for all practical test items. Candid camera evaluation scores were higher in the intervention group sample compared with the control group sample for four of the eight evaluated items. Following back education significantly decreased the week prevalence of back and neck pain. CONCLUSIONS: Back education in elementary schoolchildren is efficacious up to 1 year. The role of early back education in preventing back pain at the adult age merits further attention.
PMID: 11805696, UI: 21664573
Spine 2002 Feb 1;27(3):291-6; discussion 297-8
RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, California 90407-2138, USA. coulter@rand.org.
SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. RESULTS: More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.
PMID: 11805694, UI: 21664571
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