Management Of Chronic Cancer Pain Research Articles

Transdermal fentanyl: Long-term analgesic studies

Alternative routes of drug delivery have particular relevance for use in chronic pain. When the pain experience is constant or nearly constant, a continuous infusion of drug is an ideal way to achieve effective pain relief. Early experience with the transdermal application of fentanyl in chronic cancer pain suggests that it is a safe, noninvasive, effective method of managing pain. The first experience with the use of transdermal fentanyl in cancer pain was reported by Miser and colleagues in 5 patients. They demonstrated that steady-state blood concentrations of fentanyl were linearly related to the transdermal fentanyl dose. The terminal elimination half-life was approximately 34 hr. Zech and colleagues studied 13 patients with chronic cancer pain. Pain relief was obtained and was correlated with plasma fentanyl levels. The largest experience so far was reported in 39 patients in a multicenter trial conducted by Simmonds and colleagues. The median fentanyl dose was 100 μg/hr (range, 25–525 μg/hr). The initial dose of fentanyl from morphine conversion (6:1) was adequate in 50% of patients and titrated upward by 72 hr for the remaining 50%. Patients wore the system for a median of 84 days (range, 5–365 days). Median supplementary daily dose of morphine was 105 mg/day (range, 0–720 mg/day). The system was able to be maintained through a variety of concomitant events. This experience demonstrated the safety and clinical effectiveness of transdermal fentanyl. The transdermal therapeutic system (fentanyl) is a promising advance in achieving noninvasive, continuous drug administration for the management of chronic cancer pain.

Management of chronic cancer pain: A guideline for client-family teaching

The oncology nurse is constantly challenged to prepare the client and family for self-care in the home following active treatment, and, intermittently during the palliative phase of the cancer experience. Nurses are increasingly cognisant of the need to teach clients and families self-care. Numerous teaching aids are available to assist the nurse in carrying out teaching in relation to symptom management following either chemotherapy or radiation therapy. Aids for teaching pain management are less accessible. However, it is the challenge of controlling chronic pain in the home setting that frequently immobilises the family and necessitates hospitalisation of the client. The outline in this paper addresses the staff nurses' need for a comprehensive and succinct outline to use in planning the essential teaching to facilitate effective self-care for the client experiencing chronic malignant pain.

Chronic cancer pain management with the Du Pen epidural catheter

Chronic epidural administration of narcotics and/or local anesthetics is sometimes required in those few patients where utilization of systemic narcotics and appropriate adjuvant medications is unsuccessful in controlling intractable cancer pain. The Du Pen epidural catheter (Davol, Inc.) a silicone-based tunneled catheter modeled after the Hickman central venous catheter, has provided a safe, reliable means of long-term administration of drugs to the epidural space in over 400 patients to date. A systematic approach to the pharmacology of epidural pain control includes drug choice, bolus dosing versus infusion, volume guidelines, and titration protocols. Utilization of local anesthetics in combination with narcotics allows for enhanced pain relief in those patients refractory to narcotics as is frequently the case with neurogenic involvement. Follow-up care of patients receiving epidural narcotic with or without local anesthetic can be accomplished by a trained home cae team. Successful epidural pain management requires thorough patient and caregiver education, frequent pain assessment, and monitoring of side effects, with close collaboration between patient/family, pharmacist, home care nurse, and physician.

Keys to Effective Management of Chronic Cancer Pain

Keys to Effective Management of Chronic Cancer Pain

The combination of ibuprofen and oxycodone/acetaminophen in the management of chronic cancer pain

Thirty subjects with chronic moderate to severe pain who were receiving oxycodone/acetaminophen (oxy/APAP) for analgesia were initially evaluated for at least 7 days for oxy/APAP requirements for pain control. Each subject then received, in a randomized double-blind fashion, either 600 mg ibuprofen or placebo for an additional 7 days while hospitalized. Oxy/APAP usage was recorded daily along with efficacy and toxicity parameters. Overall global evaluations were also recorded on completion of the study. Comparison of mean differences before and after treatment with ibuprofen or placebo indicated a marked decrease in oxy/APAP use with ibuprofen (p less than 0.01) and a slight increase in use in the placebo group. Reduction in oxy/APAP usage occurred within 24 hours and maximized at 5 days. Overall global scores showed a marked preference for the ibuprofen combination over placebo (p less than 0.01). Daily pain intensity (p less than 0.05) and pain relief scores (p less than 0.05) also improved with the addition of ibuprofen. This study indicates that ibuprofen is efficacious in the management of chronic cancer pain, resulting in both enhanced analgesia and a reduction in concomitant narcotic use.

Pain assessment charts in the management of chronic cancer pain

A chart was designed for the assessment and monitoring of chronic cancer pain. A pilot study involving thirty hospital in-patients indicated that the chart was useful in 53% of cases. Problems identified in this study and initial experience with the chart enabled us to incorporate improvements in its design and also made it possible to identify patients for whom the chart may be inappropriate. The revised charts were used throughout the hospital for a trial period. Questionnaires completed by 50 nurses and patients indicated that the chartwas a valuable tool for pain assessment in 89% of cases. The factors contributing to the successful use of the chart and its possible disadvantages are discussed.

Controversy in the management of chronic cancer pain: therapeutic equivalents of IM and PO morphine.

Controversy in the management of chronic cancer pain: therapeutic equivalents of IM and PO morphine.

Spinal opioid analgesics and local anesthetics in the management of chronic cancer pain.

Abstract Spinal administration of opioid drugs and local anesthetics has been developed as an alternative method of pain control in the cancer population. This review addresses the indications for these techniques, choice of drugs, benefits and liabilities of the epidural v intrathecal route, efficacy in those with cancer pain, and risk of significant side effects. The need for applied pharmacokinetic principles in the use of these methods and the clinical controversies yet to be resolved are emphasized.

Brompton Mixture for the Management of Chronic Cancer Pain in the Terminal Stage Patient

Brompton Mixture for the Management of Chronic Cancer Pain in the Terminal Stage Patient

Brompton Mixture as Management of Chronic Cancer Pain in Terminal Stage A Pilot Study

Brompton Mixture as Management of Chronic Cancer Pain in Terminal Stage A Pilot Study

Management of Cancer Pain With Parenteral Medication

ANALGESICS are most effective in the management of cancer pain when incorporated into a comprehensive regimen of total patient care. Such a regimen includes specific therapy for the cause of pain, which may be the cancer itself, some painful complication, or a nonmalignant intercurrent illness. Measures to decrease other sources of distress and improve the patient's general emotional state are also of great importance. Oral analgesics or analgesic combinations should, when possible, be used in the management of chronic cancer pain. 1,2 Oral analgesic administration offers simplicity and economy, avoids the discomforts and potential complications of repeated injections, makes the patient less dependent on others for his care, and may even obviate the need for hospitalization in some cases. Parenteral administration is most often necessitated by the patient's inability to swallow or retain oral medication. Physicians also frequently resort to parenteral analgesics because of the apparent failure of oral medications

Tricyclic Antidepressants for Peripheral Neuropathy

To the Editor.— In their article Medical Management of Chronic Cancer Pain, Shimm et al (241:2408, 1979) speculate that the tricyclic antidepressant drugs imipramine hydrochloride and amitriptyline hydrochloride may be helpful for chronic pain because of causing direct analgesic effects, potentiating other drugs, or simply by relieving depression. We are confident that tricyclic compounds are helpful for pain and paresthesias caused by peripheral neuropathy. Although a controlled study is still in formulation, we believe that amitriptyline has been particularly helpful for patients with diabetic neuropathy. Perhaps a fourth mechanism for effects of tricyclics in treating chronic pain or neuropathy consists of affecting neuronal or axonal transmission. Such a mechanism might especially be important for pain from cancer, which may cause a painful neuropathy, and from other causes of peripheral neuropathy, like diabetes.

Medical management of chronic cancer pain

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.

Medical Management of Chronic Cancer Pain

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.