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Items 1 - 12 of 12 |
One page. |
Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases - an evidence-based practice guideline.
Wu JS, Wong RK, Lloyd NS, Johnston M, Bezjak A, Whelan T, Supportive Care Guidelines Group Of Cancer Care Ontario T.
BACKGROUND: This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. METHODS: A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. RESULTS: Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. CONCLUSION: For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: * Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently considered in clinical practice when applying this evidence such as the effect of primary histology, anatomical site of treatment, risk of pathological fracture, soft tissue disease and cord compression, use of antiemetics, and the role of retreatment are discussed as qualifying statements. Our systematic review and meta-analysis provided high quality evidence for the key recommendation in this clinical practice guideline. Qualifying statements addressing factors that should be considered when applying this recommendation in clinical practice facilitate its clinical application. The rigorous development and approval process result in a final document that is strongly endorsed by practitioners as a practice guideline.
PMID: 15461823 [PubMed - as supplied by publisher]
Managing metastatic bone pain.
Dewar JA.
Publication Types:
PMID: 15472239 [PubMed - in process]
American academic headache specialists in neurology: practice characteristics and culture.
Finkel AG.
Department of Neurology, University of North Carolina, Chapel Hill 27599-7025, USA. finkela@glial.med.unc.edu
Headache diagnosis and treatment is the most important focus or concentration area for practising neurologists in America. The American Headache Society, formerly the American Association for the Study of Headache, is made up predominantly of neurologists. Recognition of the importance of the teaching and practice of headache medicine, especially migraine, is still incomplete at many academic teaching institutions. Suggestions that this results from inadequate academic hierarchies and education at graduate and post-graduate levels have been made. We therefore undertook a survey of academic practitioners of headache medicine in departments of neurology with membership of the American Headache Society. Subjects and addresses were identified using the 1999-2000 membership directory of the American Headache Society. Practice characteristics and time distribution were assessed. Teaching in undergraduate and resident programmes was also assessed. Fifty-five surveys from 46 institutions in 25 states were judged as adequate for this report. Academic neurologists with interest in headache medicine spent most of their time in clinic, with less than 25% spent doing either research or teaching. Medical schools had an average of 1 h of preclinical and 2 h of clinical teaching in headache. Neurology residents received an average of 3 h of didactic instruction in headache. This report is the first of its kind to review the practice characteristics and culture of headache medicine in the setting of academic departments of neurology. It describes a clinical practice similar to those of other non-academic American neurologists.
PMID: 15196293 [PubMed - indexed for MEDLINE]
Clonidine and guanfacine-induced antinociception in visceral pain: possible role of alpha(2)/I(2) binding sites.
Sabetkasaie M, Vala S, Khansefid N, Hosseini AR, Sadat Ladgevardi MA.
Department of Pharmacology and Neuroscience Research Center, School of Medicine, Shaheed Beheshti University of Medical Sciences, P.O. Box 19835-355, Tehran, Iran.
Visceral pain is one of the most common forms of pain which is poorly understood. We now studied the influence of imidazoline/guanidinium compounds such as clonidine and guanfacine on visceral pain in the presence or absence of yohimbine and benazoline. To produce visceral pain-related behaviours, formalin (10%) was administered by inserting a fine cannula into the colon via the anus. Each experiment took 1 h. Clonidine (0.001, 0.01 and 0.1 mg/kg, i.p.) and guanfacine (2.5, 5 and 10 mg/kg, i.p.) produced analgesia dose dependently. The clonidine response was inhibited by yohimbine (0.2 mg/kg, i.p.). On the other hand, benazoline (5 mg/kg, i.p.) blocked the antinociceptive effect of guanfacine (5 mg/kg). Benazoline (2.5 and 5 mg/kg) itself also induced analgesia in inflammatory colonic pain. In this study, we used morphine to ensure that the behavioural responses were pain-related. Our results showed that morphine (2.5, 5 and 10 mg/kg, s.c.) produced a dose-dependent antinociception. The morphine (7 mg/kg, s.c.) response was reduced by naloxone (2 mg/kg, i.p.). However, we concluded that both imidazoline (I(2)) and alpha(2)-adrenoceptors may play a role in producing analgesia in visceral pain.
PMID: 15464067 [PubMed - in process]
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TRPV1 and the gut: from a tasty receptor for a painful vanilloid to a key player in hyperalgesia.
Holzer P.
Department of Experimental and Clinical Pharmacology, Medical University of Graz, Universitatsplatz 4, A-8010 Graz, Austria.
Capsaicin, the pungent ingredient in red pepper, has been used since ancient times as a spice, despite the burning sensation associated with its intake. More than 50 years ago, Nikolaus Jancso discovered that capsaicin can selectively stimulate nociceptive primary afferent neurons. The ensuing research established that the neuropharmacological properties of capsaicin are due to its activation of the transient receptor potential ion channel of the vanilloid type 1 (TRPV1). Expressed by primary afferent neurons innervating the gut and other organs, TRPV1 is gated not only by vanilloids such as capsaicin, but also by noxious heat, acidosis and intracellular lipid mediators such as anandamide and lipoxygenase products. Importantly, TRPV1 can be sensitized by acidosis and activation of various pro-algesic pathways. Upregulation of TRPV1 in inflammatory bowel disease and the beneficial effect of TRPV1 downregulation in functional dyspepsia and irritable bladder make this polymodal nociceptor an attractive target of novel therapies for chronic abdominal pain.
PMID: 15464036 [PubMed - in process]
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Potassium channels and pain: present realities and future opportunities.
Ocana M, Cendan CM, Cobos EJ, Entrena JM, Baeyens JM.
Department of Pharmacology and Neurosciences Institute, School of Medicine, University of Granada, Avenida de Madrid 12, E-18012 Granada, Spain.
Four families of potassium channels with different structures, functional characteristics and pharmacological sensitivity, are distinguished in neurons: voltage-gated (K(v)), calcium-activated (K(Ca)), inward rectifier (K(ir)) and two-pore (K(2P)) K(+) channels. During the last 15 years, numerous studies have demonstrated that the opening of some of these K(+) channels plays an important role in the antinociception induced by agonists of many G-protein-coupled receptors (alpha(2)-adrenoceptors, opioid, GABA(B), muscarinic M(2), adenosine A(1), serotonin 5-HT(1A) and cannabinoid receptors), as well as by other antinociceptive drugs (nonsteroidal antiinflammatory drugs [NSAIDs], tricyclic antidepressants, etc.) and natural products. Several specific types of K(+) channels are involved in antinociception. The most widely studied are the ATP-sensitive K(+) channels (K(ATP)), members of the K(ir) family, which participate in the antinociception induced by many drugs that activate them in both the central and the peripheral nervous system. The opening of G-protein-regulated inwardly rectifying K(+) channels (GIRK or K(ir)3), K(v)1.1 and two types of K(Ca) channels, the small- and large-conductance calcium-activated K(+) channels (SK and BK channels, respectively), also play a role in the antinociceptive effect of different drugs and natural products. Recently, drugs that open K(+) channels by direct activation (such as openers of neuronal K(v)7 and K(ATP) channels) have been shown to produce antinociception in models of acute and chronic pain, which suggests that other neuronal K(+) channels (e.g. K(v)1.4 channels) may represent an interesting target for the development of new K(+) channel openers with antinociceptive effects.
PMID: 15464034 [PubMed - in process]
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Striatal dopamine D2 receptors in modulation of pain in humans: a review.
Hagelberg N, Jaaskelainen SK, Martikainen IK, Mansikka H, Forssell H, Scheinin H, Hietala J, Pertovaara A.
Turku PET Centre, Turku University Central Hospital and University of Turku, 20520 Turku, Finland; Department of Anaesthesiology and Intensive Care, Turku University Central Hospital and University of Turku, 20520 Turku, Finland.
We review evidence indicating that the striatum and striatal dopamine D2 receptors are involved in the regulation of pain in humans. Painful stimulation produces an increase in regional cerebral blood flow in the human striatum. Pain is a common symptom in patients with nigrostriatal dopaminergic hypofunction. Positron emission tomography findings show that a low dopamine D2 receptor availability in the striatum of healthy subjects (indicating either a low density of dopamine D2 receptors or a high synaptic concentration of dopamine) is associated with a high cold pain threshold and a low capacity to recruit central pain inhibition by conditioning stimulation. Patients with chronic orofacial pain have higher dopamine D2 receptor availability than their age-matched controls. We propose that the striatal dopamine D2 receptor may be an important target for the diagnosis and treatment of chronic pain.
PMID: 15464032 [PubMed - in process]
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Psychometric update of the Functional Interference Estimate: a brief measure of pain functional interference.
Ferguson RJ, Seville J, Cole B, Hanscom B, Wasson JH, Johnson DJ, Ahles T.
Department of Psychiatry (R.J.F., J.S., T.A.), Behavioral Medicine Section; and Department of Community and Family Medicine (B.C., B.H., J.H.W., D.J.J.), Dartmouth Medical School, Lebanon, New Hampshire, USA.
The Functional Interference Estimate (FIE) is a brief, 5-item self-report measure that assesses the degree to which pain interferes with daily functioning. While the FIE has demonstrated reliability and validity with a small normative sample, not much is known about its reliability and validity with a broad sample of individuals with pain. The current study presents FIE score means, variability estimates, reliability and validity data based on a large sample (n=1, 337) of primary care patients who report problematic pain. The FIE has excellent internal consistency and appears to have strong convergent validity with other well-established measures of function (e.g., SF-36 and Dartmouth COOP Charts). Because of its brevity and flexibility, the FIE may be a useful self-report measure of pain functional interference in clinical research on pain.
PMID: 15471657 [PubMed - in process]
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A population-based evaluation of an intervention to improve advanced stage cancer pain management.
Hoffmann W, Munzinger H, Horstkotte E, Greiser E.
Institute for Community Medicine (W.H.), Ernst-Moritz-Arndt-University Greifswald; Bremen Institute for Prevention Research Social Medicine and Epidemiology (BIPSE) (H.M., E.H., E.G.); and Centre for Public Health (W.H, E.G.), University of Bremen, Bremen, Germany.
The purpose of this study was to evaluate the effect of a community-oriented intervention in one part of the Free Town of Bremen, northern Germany (population 541,000) on the prescription prevalence of World Health Organization (WHO) class III opioids for cancer patients in their final year of life. A community-oriented, multimodal intervention included information, teaching, and training modules tailored to physicians, pharmacists, nursing staff, and patients and their relatives, and the public. Prescription prevalences were calculated for the intervention region (Bremen-Nord) and a control region (Bremen-Mitte) before and after the intervention. Specifically, a population-based, controlled, quantitative assessment of opioid prescriptions for patients with cancer during their final year of life was undertaken for two time periods, prior to 1992-1993 and after 1995-1996, respectively. Prescription ascertainment was based on duplicates kept in the pharmacies. Patients comprised two anonymized complete 4-month samples who died in 1993 and 1996, respectively, with cancer as the primary or a contributory cause of death on their death certificates. A total of 1282 prescriptions were abstracted from duplicates in 109 of 119 pharmacies in Bremen-Mitte and all 31 pharmacies in Bremen-Nord (overall pharmacy participation proportion 93%) and individually matched to 856 patients with cancer in their final year of life. In 1993, 16.3% of all terminal cancer patients in Bremen-Mitte and 19.1% in Bremen-Nord had received at least one prescription for a WHO class III opioid. Corresponding numbers after the intervention were 20% and 21%, respectively. The total amount of class III opioids, however, increased 20% in Bremen-Mitte and 210% in Bremen-Nord after the intervention. In 1996, the spectrum of prescribed opioids had changed markedly toward the WHO recommendations. The proportion of prescribing physicians remained constant. These data suggest that a community-oriented intervention in one part of Bremen had a limited impact on cancer pain therapy on the population level. A measurable change of prescription practice seemed to be restricted to the minority of physicians, who had prior experience with prescribing WHO class III opioids.
PMID: 15471651 [PubMed - as supplied by publisher]
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Oral methadone for cancer pain: no indication of Q-T interval prolongation or torsades de pointes.
Reddy S, Fisch M, Bruera E.
Department of Palliative Care and Rehabilitation Medicine M. D. Anderson Cancer Center Houston, TX, USA.
Publication Types:
PMID: 15471646 [PubMed - in process]
Re: Yelland M, Glasziou P, Bogduk N, et al. Prolotherapy injections, saline injections and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9-16.
Walter D.
Publication Types:
PMID: 15454717 [PubMed - in process]
Patient-controlled deep brain stimulation can overcome analgesic tolerance.
Romanelli P, Heit G.
Department of Neurosurgery, Stanford University Medical Center, CA 94305-5327, USA.
We report a technique based on patient-controlled stimulation to restore analgesia after development of tolerance to deep brain stimulation (DBS). A 45-year-old female with neurogenic pain after cerebellar stroke underwent DBS implantation in the right ventralis caudalis (VC) thalamus with excellent stimulus-controlled analgesia for 29 months, followed by development of tolerance and loss of analgesia. Analgesia was restored when a stimulation module that allowed patient-controlled stimulation was implanted. Copyright 2004 S. Karger AG, Basel
Publication Types:
PMID: 15305078 [PubMed - indexed for MEDLINE]
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