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Anesthesiology 2003 Feb;98(2):291
[Medline record in process]
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PMID: 12552183, UI: 22437766
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Cancer 2003 Feb 1;97(3 Suppl):866-73
Department of Orthopedic Surgery and Cancer Center, University of Minnesota, Minneapolis, Minnesota.
BACKGROUND: Bone cancer pain is very common, and patients with this type of pain may be difficult to treat. Development of an experimental model for studying this condition is critical to advancing an understanding of the mechanisms that cause pain in patients with malignant disease. METHODS: A murine model of bone cancer was studied. Combined analysis of the extent of tumor-induced bone destruction, pain, and neurochemical characterization of the peripheral and central nervous systems was performed to investigate bone cancer pain. Disease-induced bone destruction was assessed by radiographs and histomorphometry. Pain was assessed by spontaneous and elicited behaviors, and neurochemical analysis involved immunohistochemical detection of hyperalgesic peptides and neurochemical markers. RESULTS: Mice with distal femoral sarcomas exhibited behavioral and neurochemical measures of pain. The pain condition created by malignant bone disease was distinct neurochemically from inflammatory and neuropathic pain states. Experimental evidence indicated that both disease-induced osteolysis and tumors themselves contributed to the generation of pain and that peripheral and central sensitization of the nervous system was present. CONCLUSIONS: Malignant bone disease creates a unique pain state that involves sensitization of the nervous system. Major contributors to the pain state within the bone tissue are osteoclastic bone resorption and the malignant disease itself. Cancer 2003;97(3 Suppl):866-73. Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11144
PMID: 12548588, UI: 22434870
Clin J Pain 2002 Jul-Aug;18(4 Suppl):S76-82
Pain Trials Center, Brigham and Women's Hospital, Boston, Massachusetts, USA. NatPaulKatz@aol.com
Recognition is growing that self-report of drug use, prescribed or otherwise, among patients with chronic pain treated with opioids is often unreliable. This fact is well known to the addiction management community. Patients may inaccurately report use of prescribed medications, fail to report use of nonprescribed medications or medications prescribed by other physicians, or fail to report use of illicit drugs. Although there are yet no accepted diagnostic criteria for addiction or other forms of medication misuse in the patient with chronic pain, most clinicians would agree that awareness of a patient's inappropriate use of nonprescribed medications or illicit drugs is relevant to proper patient management. The use of external sources of information, therefore, such as testing of biologic material (e.g., urine), interviews with spouses, review of medical records, or input from prescription monitoring programs, may improve patient management. Of these methods, urine toxicology testing has by far the largest experience. Urine toxicology testing may reveal the presence of illicit drugs, such as heroin or cocaine, or controlled substances not prescribed by the physician ordering the test (e.g., hydromorphone in a patient prescribed oxycodone). The authors review the use of urine toxicology testing in monitoring patients with chronic pain, including laboratory aspects. They also present evidence from recent studies that suggests that monitoring the behavior alone of patients on chronic opioid treatment will fail to detect potential problems revealed by urine toxicology testing. The authors conclude that, although further research is urgently needed, at this time it is appropriate to conduct routine urine toxicology testing in patients with chronic pain treated with opioids.
PMID: 12479257, UI: 22366772
Clin J Pain 2002 Jul-Aug;18(4 Suppl):S70-5
Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, California 95817, USA. smfishman@ucdavis.edu
Opioid contracts are widely used but not well studied. Despite the widespread use of the opioid contract or agreement, there is no standard approach. Some studies have found both considerable variability between opioid contracts as well as consistent core themes. While an opioid contract may be an appealing tool for obtaining informed consent, providing education, or otherwise overcoming some of the problems associated with chronic opioid therapy for noncancer pain, its efficacy is not well established. This article will consider many of the significant factors that impact clinicians and patients using a contract or agreement for chronic opioid therapy.
PMID: 12479256, UI: 22366771
Eur J Pharmacol 2003 Jan 24;460(2-3):109-16
Department of Pharmacology, NeuroSearch A/S, 93 Pederstrupvej, DK-2750, Ballerup, Denmark
We have tested for anti-nociceptive effects of the anticonvulsant KCNQ channel opener, N-(2-amino-4-(4-fluorobenzylamino)-phenyl)carbamic acid ethyl ester (retigabine), in rat models of experimental pain. In the chronic constriction injury and spared nerve models of neuropathic pain, injection of retigabine (5 and 20 mg/kg, p.o.) significantly attenuated (P<0.05) mechanical hypersensitivity in response to pin prick stimulation of the injured hindpaw. In contrast, retigabine had no effect on mechanical hypersensitivity to von Frey stimulation of the injured hindpaw in either model. Cold sensitivity in response to ethyl chloride was only attenuated (P<0.05) in the chronic constriction injury model. In the formalin test, retigabine (20 mg/kg, p.o.) attenuated flinching behaviour in the second phase compared with vehicle (P<0.05), and this effect was completely reversed by the KCNQ channel blocker 10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone (XE-991; 3 mg/kg, i.p.). Neither retigabine nor XE-991 administration affected the latency to respond to noxious thermal stimulation of the tail in control animals. These results suggest that retigabine may prove to be effective in the treatment of neuropathic pain.
PMID: 12559370, UI: 22447048
J Pain Symptom Manage 2002 Dec;24(6):620-1
Bruce H. Chamberlain, MD, FACP is the Chief Medical Officer, VistaCare Hospice, Lehi, UT, USA
PMID: 12551814, UI: 22439993
J Pain Symptom Manage 2002 Dec;24(6):598-602
Hayward House Macmillan Specialist Palliative Care Unit, Nottingham City Hospital NHS Trust, Nottingham, United Kingdom
Breakthrough pain in patients with cancer is common, often unpredictable, and can rapidly become severe. Treatment using the oral administration of opioids is not optimal due to the slow onset of pain relief. Nasal administration of analgesics potentially offers more rapid pain relief. This study investigates the tolerability and efficacy of a novel morphine-chitosan formulation. Twenty episodes of breakthrough pain were observed in 14 patients with cancer who received 5-80 mg of nasal morphine-chitosan. Nasal symptoms, sedation, giddiness, nausea, and other volunteered symptoms, along with pain scores (pain intensity and pain relief), were recorded at baseline and at regular intervals up to 4 hours after administration, together with an overall satisfaction rating. The formulation was acceptable to patients, generally well tolerated, and had an onset of pain relief 5 minutes after dosing. This formulation warrants further study.
PMID: 12551810, UI: 22439989
J Pain Symptom Manage 2002 Dec;24(6):586-92
Public Health Department, Groupe Hospitalier Pitie Salpetriere, Paris, France
To measure the prevalence and intensity of pain in hospitalized patients and to assess the quality of pain management, an exhaustive cross-sectional study was conducted in every department in a university hospital. Patients hospitalized for 24 hours or more completed an anonymous self-report questionnaire. Among the 1,475 inpatients, 998 completed the questionnaire. During the 24-hour period prior to our survey, 55% experienced pain. On 100 mm pain intensity measures, the median maximum pain experienced in the 24 preceding hours was 60 mm and the median pain intensity at the time of the survey was 30 mm. Although pain measured at the time of survey disappeared in only 16% of patients, 79% were satisfied with pain management. Despite a high satisfaction level, the prevalence and intensity of pain were very high. This study provided baseline data on pain in a French hospital and led to the implementation of a program for improving pain management.
PMID: 12551808, UI: 22439987
J Pain Symptom Manage 2002 Dec;24(6):578-85
Pain Expertise Center, Groningen, The Netherlands
Phantom pain has been given considerable attention in literature. Phantom pain reduces quality of life, and patients suffering from phantom pain make heavy use of the medical system. Many risk factors have been identified for phantom pain in univariate analyses, including phantom sensations, stump pain, pain prior to the amputation, cause of amputation, prosthesis use, and years elapsed since amputation. Multivariate analyses are lacking in the literature and, therefore, no estimation of an overall risk for phantom pain can be made. The aim of this study was to analyze risk factors in a multivariate analysis in 536 subjects (19% upper limb amputees and 81% lower limb amputees). These subjects filled out a questionnaire in which the following items were assessed; side, date, level, and reason of amputation, pre-amputation pain, presence or absence of phantom pain, phantom sensations and or stump pain, and prosthesis use. The prevalence of phantom pain was 72% (95% CI: 68 to 76%) for the total group, 41% (95% CI: 31 to 51%) in upper limb amputees and 80% (95% CI: 76 to 83%) in lower limb amputees. The most important risk factors for phantom pain were "bilateral amputation" and "lower limb amputation." The risk for phantom pain ranged from 0.33 for a 10-year-old patient with a distal upper limb amputation to 0.99 for a subject of 80 years with a bilateral lower limb amputation of which one side is an above knee amputation.
PMID: 12551807, UI: 22439986
J Pain Symptom Manage 2002 Dec;24(6):562-71
Departments of Health Care Sciences and Prevention and Community Health, George Washington University Medical Center and School of Public Health, Rockville, MD, USA
To assess the utility of relatives' assessments of pain in cognitively impaired nursing home residents, the internal consistency of these assessments, and their relationship to other assessments of pain, was examined in a correlational study of 79 residents of a large suburban nursing home. The cohort was 85% female and had an average age of 87 years. The sample included moderately and severely cognitively impaired residents, some of whom were taking pain medication. The results demonstrated that relatives were less likely to rate the pain of the resident when the resident's cognitive level was more impaired and when they had a longer stay in the nursing home. The internal consistency of the relatives' ratings were good and, when only relatives who visited at least once a week were included, correlated significantly with most Minimum Data Set (MDS), resident, physician, and nursing staff ratings. They also correlated significantly with frequency of visits, higher cognitive function, type of relationship with the resident, and with a shorter stay in the nursing home. Relatives' ratings of pain and of past sources of pain may prove useful in the detection of pain in cognitively impaired persons. However, relative's pain ratings are only useful when relatives visit regularly. Like other informants, relatives have more difficulty rating pain when the resident is severely cognitively impaired.
PMID: 12551805, UI: 22439984
J Pain Symptom Manage 2002 Nov;24(5):543-5
Department of Anesthesia and Critical Care Medicine, Iwaki Kyoritsu General Hospital, Iwaki, Fukushima, Japan.
Oral viscous lidocaine is useful for the treatment of symptoms induced by oral inflamed mucosa, such as radiation- or chemotherapy-induced mucositis. The toxic reactions associated with an accidental overdose have been reported in pediatric cases. We report a case of lidocaine toxicity in a 22-year-old man during frequent viscous lidocaine use for severe painful tongue ulcer. The toxic symptoms developed when the amount of oral viscous lidocaine exceeded 240 ml per day. The serum lidocaine concentration associated with this use was 6.7 microg/ml. The toxic symptoms continued in spite of the serum lidocaine concentration below the toxic level after the start of a diluted preparation, which contained a half-dose lidocaine. It is speculated that lidocaine metabolites might have contributed to the toxic symptoms. Clinicians should consider the risk of lidocaine toxicity in cases of frequent viscous lidocaine use, and determine the serum concentrations of lidocaine and its metabolites.
PMID: 12547053, UI: 22435968
J Pain Symptom Manage 2002 Nov;24(5):526-42
Center for Behavioral Research and Program Evaluation, Lyle S. Hallman Institute, University of Waterloo, Waterloo, Ontario, Canada
Poor pain assessment is cited as one barrier to the adequate treatment of cancer pain. The identification of relevant psychosocial factors may improve the assessment of chronic cancer pain. This article presents: 1) a critical review of the evidence for an association between chronic cancer pain and psychological distress, social support, and coping; 2) clinical implications of the findings; and 3) recommendations for future research. Fourteen of the 19 reviewed studies on psychological distress found a significant association between increased pain and increased distress. Seven of the eight studies on social support found significant association between higher levels of pain and decreased levels of social activities and social support. Three of the four studies that examined coping strategies found that increased catastrophizing was significantly associated with more intense pain. Based on several criteria, the evidence is considered Strong for psychological distress, Moderate for social support, and Inconclusive for coping. This review suggests that comprehensive chronic pain assessment should include routine screening for psychological distress.
PMID: 12547052, UI: 22435967
J Pain Symptom Manage 2002 Nov;24(5):517-25
Department of Anesthesiology and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
The European Association of Palliative Care recommends the Brief Pain Inventory questionnaire (BPI) as a pain assessment tool in clinical studies. After translation into Norwegian, we administered the BPI to 300 hospitalized cancer patients. Cronbach's alphas were computed to assess reliability, and factor analysis was utilized to ascertain construct validity. The BPI interference and pain severity scales were validated against items on pain intensity and pain influence on daily function in the European Organization for Research and Therapy of Cancer (EORTC) QLQ-C30 questionnaire. In total, 235 patients (78%) were able to complete the BPI questionnaire, but 82 (35%) of these questionnaires had one or more missing items. Cronbach's alphas were 0.87 for the pain severity and 0.92 for the interference scales. A factor analysis identified three factors; pain intensity, interference with physical function, and interference with psychological functions/sleep. These three factors explained 82% of the variance. The correlation between BPI pain severity index and the EORTC QLQ-C30 item on pain intensity was 0.70 (P < 0.001). The correlation between BPI interference index and the EORTC QLQ-C30 item on pain influence on daily living was 0.62 (P < 0.001). We conclude that BPI has satisfactory psychometric properties, but is not completed by a significant proportion of patients. Further research is needed to establish pain assessment tools for patients unable to answer a comprehensive pain questionnaire, to establish routines for analysis of missing values, and to investigate if pain interference items also reflect disease-related impairment.
PMID: 12547051, UI: 22435966
J Pain Symptom Manage 2002 Nov;24(5):506-16
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
To explore the factors that patients with malignant and nonmalignant pain consider when deciding whether to enroll in pain research studies, determine whether their views are different, and determine whether willingness to enroll in research is associated with pain severity, semi-structured interviews were conducted with 80 patients (cancer pain: n = 40; chronic nonmalignant pain: n = 40). The risks and potential benefits that were important to patients with cancer were the same as those that were important to patients with chronic pain. Willingness to enroll in research was associated with pain severity (Spearman rho = 0.33; P = 0.041) in patients with chronic pain, but not in patients with cancer pain. Patients with cancer pain do not have different concerns than chronic pain patients do. Although chronic pain patients' willingness to enroll in research was related to pain severity and a desire for better pain management, cancer patients' willingness to enroll was not.
PMID: 12547050, UI: 22435965
J Pain Symptom Manage 2002 Nov;24(5):494-505
Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ, USA
We measured pain outcomes in a cohort of patients with cancer pain in a general hematology/oncology setting at a Veterans Administration Medical center (VA). The outcomes included pain relief, pain severity, changes in pain severity, interference scores, symptom distress, quality of life (QOL), and satisfaction. Seventy-four (74) consecutive patients with worst cancer-related pain equal to or greater than 4/10 were recruited. Cancer pain diagnoses were made and the cancer pain management guidelines of the United States Agency for Health Care Policy and Research were followed. Patients were followed weekly using the Brief Pain Inventory (BPI), medication diary, satisfaction questionnaire, visual analogue quality of life scale (VASQOL) and record of side effects for 3 weeks. The Functional Assessment of Cancer Therapy (FACT-G) and Memorial Symptom Assessment Scale Short Form (MSAS-SF) were used at initial and final interviews. The mean initial worst pain severity was 8.3 (range 4-10) and mean pain relief was 40% (range 0-100). By week 1, the majority of patients achieved pain relief of >/=80%, with a corresponding decrease in worst pain severity and pain interference scores. Pain continued to decrease over three weeks. At week 3, there was a significant improvement in the MSAS-SF psychological symptom distress subscale (P = 0.02). The average number of opioid-related side effects was 5 and remained steady over time. Most patients felt "quite a bit" or "very much" satisfied at all weeks. There was a significant improvement in VASQOL (P < 0.005) and in FACTG SUMQOL scores (P = 0.007). This experience demonstrates that cancer pain management can result in measurable and significant changes in pain relief, pain severity, pain interference scores, psychological symptom distress, and QOL scores.
PMID: 12547049, UI: 22435964
J Pain Symptom Manage 2002 Nov;24(5):456-7
Hospice di Abbiategrasso, Milan, Italy
PMID: 12547044, UI: 22435959
Lancet 2003 Jan 18;361(9353):225-6
Burnet Institute, Centre for International Health, PO Box 2284, Victoria 3001, Melbourne, Australia. dhoy@burnet.edu.au
In a baseline assessment of 30 rural villages surrounding Shigatse City, Tibet, many people, especially women, identified low back pain as a serious health problem. Consequently, we aimed to establish the prevalence of such pain and to develop appropriate interventions. We did a cross-sectional study of the prevalence of low back pain and related functional disability using two-stage random cluster sampling. We included 499 adults aged at least 15 years from 19 villages. The point prevalence of low back pain was 34.1% (95% CI 27.9-40.3% [170 people]); the 12-month prevalence was 41.9% (35.5-48.3% [209 people]). 100 (20%) villagers had substantial functional disability associated with low back pain. Low back pain is likely to be an important and under recognised problem in rural societies like Tibet.
PMID: 12547548, UI: 22436054
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N Engl J Med 2003 Jan 23;348(4):319-32
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston 02115, USA.
PMID: 12540646, UI: 22429018
Support Care Cancer 2003 Feb;11(2):114-9
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo Colli 312, 90146 Palermo, Italy, terapiadeldolore@la-maddalena.it
Palliative care in Italy was provided solely on a home care basis until a couple of years ago. In recent years different realities have been created according to personal experience, quite apart from new resources provided by the National Health System. The first Pain Relief and Palliative Care Unit in Sicily, the largest region in Italy, was established in March 1999. Most members of the regular staff of this Unit have a background in anesthesiology. Activity in the Unit has grown progressively, with 460 admissions in the last year. The characteristics of the first 1,000 patients admitted, the principal protocols for diagnostic and therapeutic procedures, such as those for hitherto intractable pain, nutrition and hydration, interventional procedures for symptom control, and emerging problems, a project called "Island with no pain," and activities in the fields of formation and research are described.
PMID: 12560940, UI: 22448328