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Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Tags: Frontmatter Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Tags: Frontmatter Source Type: journals

Pc-facsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Tags: PC-FACS Source Type: journals

Responding to Suffering: Providing Options and Respecting ChoiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Voluntary stopping of eating and drinking (VSED) as a legal means to hasten death has been discussed by some as an option for persons who wish to end their lives. A case is presented of a woman who elected to forgo eating and drinking to end intractable suffering. The potential for benefit and harm in physicians discussing VSED is discussed. Physicians working with terminally ill patients need to consider the discussion of VSED as a therapeutic tool in their support and care of patients with intractable suffering. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Authors: Zail S. Berry Tags: Ethical Issues in Palliative Care Source Type: journals

Validation of a Simplified Anorexia QuestionnaireEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Context: Anorexia is a common symptom in cancer and is usually assessed by multiple questions and multidimensional questionnaires. A simplified questionnaire would be less burdensome to patients and abbreviate the process.Objectives: We compared the reliability at one point in time, sensitivity to change over time, and prognostic accuracy of a two-item questionnaire with the Functional Assessment of Anorexia and Cachexia Therapy shortened 12-question version (A/CS-12).Methods: Individuals with cancer, who were cognitively intact and verbally agreed to participate, completed a two-item questionnaire and A/CS-12 in...
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Authors: Mellar P. Davis, Tugba Yavuzsen, Jordanka Kirkova, Declan Walsh, Matthew Karafa, Susan LeGrand, Ruth Lagman Tags: Original Articles Source Type: journals

Efficacy of Dexmethylphenidate for the Treatment of Fatigue After Cancer Chemotherapy: A Randomized Clinical TrialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment. Dexmethylphenidate (d-MPH; the d-isomer of methylphenidate) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment. A randomized, double-blind, placebo-controlled, parallel-group study evaluated the potential therapeutic effect and safety of d-MPH in the treatment of patients with chemotherapy-related fatigue. Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-F) total score at...
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Authors: Elyse E. Lower, Stewart Fleishman, Alyse Cooper, Jerome Zeldis, Herbert Faleck, Zhinuan Yu, Donald Manning Tags: Original Articles Source Type: journals

Attitudes of Patients with Advanced Cancer Toward ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is a great need for an improved evidence base to guide clinical practice and service provision in palliative care, yet research in palliative care has been notoriously difficult, with poor trial accrual and high attrition rates. It is therefore of vital importance to design “patient-friendly” studies that will encourage participation and improve accrual and retention. To design such trials, the views of potential participants need to be known. The systematic review by Todd et al., recently published in this journal, includes studies published up to 2007 and highlights some of the views of advanced cancer patient...
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Authors: Clare White, Janet Hardy Tags: Letters Source Type: journals

Axonal Common Peroneal Nerve Palsy and Delayed Proximal Motor Radial Conduction Block Following Infliximab TreatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 38-year-old female, treated with infliximab (3mg/kg) for a two-year history of psoriatic arthritis, was referred with a sudden onset of left foot drop. At referral, eight courses of infliximab (anti-tumor necrosis factor [anti-TNF] monoclonal antibody) had already been infused. Her past medical history was otherwise unremarkable. No familial history of hereditary neuropathies, that is, hereditary neuropathy with liability to pressure palsy, was reported. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - November 1, 2009 Category: Palliative Care Authors: Andreas A. Argyriou, Alexandra Makridou, Panagiotis Karanasios, Nicolaos Makris Tags: Letters Source Type: journals

The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy VolunteersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Morphine is usually given intravenously (IV) for the treatment of moderate-to-severe pain, but subcutaneous (SC) administration is a viable alternative for parenteral delivery. The pharmacokinetics of SC morphine may be enhanced by coadministration with a hyaluronidase product. In this Phase IV, double-blind, randomized, crossover study, 18 healthy adults received a single dose of 2mg morphine SC with 150U of recombinant human hyaluronidase (rHuPH20), SC with 0.9% normal saline, or IV on three consecutive days. The primary endpoint was time to maximum plasma morphine concentration (Tmax) for SC injection with rHu...
Source: Journal of Pain and Symptom Management - October 12, 2009 Category: Palliative Care Authors: Jay R. Thomas, Richard C. Yocum, Michael F. Haller, Jocelyne Flament Tags: Original Articles Source Type: journals

The INFUSE-Morphine Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneously Administered Morphine in Patients with Advanced IllnessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Morphine is often administered by the subcutaneous (SC) route when venous access is difficult to achieve. Hyaluronidase temporarily increases the permeability of SC connective tissues by degrading hyaluronan and has been shown to increase the dispersion and absorption of coadministered molecules. Therefore, hyaluronidase could enhance the pharmacokinetics of subcutaneous morphine. This Phase IIIB, double-blind, randomized, placebo-controlled crossover study compared the pharmacokinetics, safety, and tolerability of morphine administered SC with and without 150U of recombinant human hyaluronidase (rHuPH20) with th...
Source: Journal of Pain and Symptom Management - October 12, 2009 Category: Palliative Care Authors: Jay R. Thomas, Mark S. Wallace, Richard C. Yocum, Daniel E. Vaughn, Michael F. Haller, Jocelyne Flament Tags: Original Articles Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Tags: Frontmatter Source Type: journals

Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Tags: Frontmatter Source Type: journals

Pc-facsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Tags: PC-FACS Source Type: journals

Outpatient Continuous Interscalene Brachial Plexus Block in Cancer-Related PainEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: This case outlines the use of a continuous interscalene brachial plexus block to treat cancer-related pain. Using an elastomeric device, the patient's previously intractable pain was controlled and he was able to return home. Furthermore, the patient developed a pragmatic and effective method of balancing loss of power and sensation against pain control using the flow restrictor. This case illustrates the potential of an integrated approach to cancer pain management to obtain rapid pain relief in the acute hospital setting. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Authors: Deans Buchanan, Emma Brown, Fergus Millar, Fiona Mosgrove, Raj Bhat, Pamela Levack Tags: Palliative Care Rounds Source Type: journals

Bereaved Parents' Perceptions About When Their Child's Cancer-Related Death Would OccurEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Parents of terminally ill children with cancer frequently ask clinicians when their child will die. Such information helps parents prepare for the child's death. To identify how parents perceived when their child's cancer-related death would occur, we conducted a secondary analysis of telephone interviews with 49 bereaved parents 6–10 months after their child's death to extract their descriptions of this occurrence. The parents knew in advance that their child was going to die, but they described when their child's death would occur in three different ways: anticipated (parents observed changes that alerted the...
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Authors: Michele Pritchard, Deo Kumar Srivastava, James O. Okuma, Brent Powell, Elizabeth Burghen, Nancy K. West, Jami S. Gattuso, Sheri L. Spunt, Justin N. Baker, Javier Kane, Wayne L. Furman, Pamela S. Hinds Tags: Original Articles Source Type: journals

A Community Population Survey of Prevalence and Severity of Dyspnea in AdultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Given the progress in the symptomatic treatment of breathlessness, and the physical and psychological morbidity associated with chronic breathlessness, estimates of the size of the population that may benefit from better support become imperative. Prevalence estimates have varied widely (0.9% of clinical encounters to 32%) and have largely relied only on respondents who used clinical services. Whole-of-population approaches may be able to define better the “true” prevalence of chronic breathlessness and quantify exertion limited by breathlessness. The aim of this study was to estimate population levels of chr...
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Authors: David C. Currow, John L. Plummer, Alan Crockett, Amy P. Abernethy Tags: Original Articles Source Type: journals

Evaluating Cognitive, Emotional, and Physical Fatigue Domains in Daily Practice by Single-Item Questions in Patients With Advanced Cancer: A Cross-Sectional Pragmatic StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: To assess cancer-related fatigue (CRF), multidimensional questionnaires are required. The aim of this study was to evaluate single-item fatigue (SIF) screening questions—one for global fatigue and three for the fatigue domains (cognitive, emotional, and physical)—for their immediate use in daily oncology practice. Sixty-one fatigued patients with advanced cancer completed SIF assessments (visual analog scales for global fatigue and for fatigue in the cognitive, emotional, and physical domains, respectively), and the Brief Fatigue Inventory (BFI), the Fatigue Assessment Questionnaire (FAQ), the Hospital Anxiet...
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Authors: Florian Strasser, Iris Müller-Käser, Daniel Dietrich Tags: Original Articles Source Type: journals

Development of a Standard for Hospital-Based Palliative Care Consultation Teams Using a Modified Delphi MethodEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Although palliative care consultation teams are rapidly being disseminated throughout Japan as a result of government policy, the role of these teams has not been standardized. The aim of this study was to develop a hospital-based palliative care consultation team standard. We adopted a modified Delphi method to develop a standard. Twenty-seven multiprofessional panelists were selected according to two criteria: adequate experience as part of a palliative care consultation team and representative of 16 palliative care-related organizations. Panelists rated the appropriateness of 33 statements in a provisional st...
Source: Journal of Pain and Symptom Management - September 30, 2009 Category: Palliative Care Authors: Tomoyo Sasahara, Yoshiyuki Kizawa, Tatsuya Morita, Yuumi Iwamitsu, Junji Otaki, Hitoshi Okamura, Mikako Takahashi, Sayaka Takenouchi, Seiji Bito Tags: Original Articles Source Type: journals

Advancing Palliative Care as a Human RightEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes recent advocacy activities and explores practical strategies for the palliative care community to use within a human rights framework to advance palliative care development worldwide. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 25, 2009 Category: Palliative Care Authors: Liz Gwyther, Frank Brennan, Richard Harding Tags: Special Articles Source Type: journals

Improving Availability of and Access to Opioids in Colombia: Description and Preliminary Results of an Action Plan for the CountryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation works...
Source: Journal of Pain and Symptom Management - September 25, 2009 Category: Palliative Care Authors: Marta Ximena Leon, Liliana De Lima, Sandra Florez, Marcela Torres, Marcela Daza, Lina Mendoza, Natalia Agudelo, Laura Guerra, Karen Ryan Tags: Special Articles Source Type: journals

Morphine Inhalation by Cancer Patients: A Comparison of Different Nebulization Techniques Using Pharmacokinetic, Spirometric, and Gasometric ParametersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Despite numerous case reports suggesting the value of morphine (M) nebulization in the treatment of breathlessness, only a few clinical trials have been able to support this. The reason for this could lie in the lack of understanding of the localization of opioid receptors in the airways and the biopharmaceutics and pharmacokinetics of nebulized morphine. In the present study, we compared two different methods of pneumodosimetric nebulization: the Bronchial Control Treatment System-Sidestream (BCTS-S) and the Bronchial Control Treatment System-Micro Cirrus (BCTS-MC). The first method delivers relatively large aer...
Source: Journal of Pain and Symptom Management - September 25, 2009 Category: Palliative Care Authors: Małgorzata Krajnik, Zygmunt Podolec, Monika Siekierka, Marzena Sykutera, Ewa Pufal, Piotr Sobanski, Roman Makarewicz, Cees Neef, Nieko Punt, Zbigniew Zylicz Tags: Original Articles Source Type: journals

Associations Between Physical Activity and Quality of Life in Cancer Patients Receiving Palliative Care: A Pilot SurveyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The primary aim of this study was to examine the association between physical activity and quality of life (QoL) in cancer patients receiving palliative care. Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of 3–12 months and Palliative Performance Status Scale scores greater than 30% were recruited from an outpatient palliative care clinic and palliative home care. Participants completed a cross-sectional survey by means of face-to-face interview assessing self-reported QoL (McGill Quality of Life Questionnaire [MQOL]), self-reported physical function (Late-Life ...
Source: Journal of Pain and Symptom Management - September 24, 2009 Category: Palliative Care Authors: Sonya S. Lowe, Sharon M. Watanabe, Vickie E. Baracos, Kerry S. Courneya Tags: Clinical Note Source Type: journals

A Meta-Analysis of the Relationship Between Response Expectancies and Cancer Treatment-Related Side EffectsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Response expectancies, defined as expectations for nonvolitional responses, have been proposed to contribute to the experience of side effects of cancer and its treatment. To statistically evaluate this association, a systematic search of the published literature was conducted, resulting in 14 studies appropriate for meta-analysis. Results revealed a significant (Z=6.58, P (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - September 24, 2009 Category: Palliative Care Authors: Stephanie J. Sohl, Julie B. Schnur, Guy H. Montgomery Tags: Review Article Source Type: journals

Differences in the Use of Pain Coping Strategies Between Oncology Inpatients with Mild vs. Moderate to Severe PainEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of ≤4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n=224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had m...
Source: Journal of Pain and Symptom Management - September 24, 2009 Category: Palliative Care Authors: Inger Utne, Christine Miaskowski, Kristin Bjordal, Steven M. Paul, Gunnhild Jakobsen, Tone Rustøen Tags: Original Articles Source Type: journals

State of Consciousness During the Last Days of Life in Patients Receiving Palliative CareEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Most patients want to interact with proxies and nursing staff to be able to make clear decisions until death. In addition, to address and treat symptoms efficiently, communication is crucial. But communication can be altered because of disease progression or metabolic abnormalities, and side effects from drugs are frequently implicated in the occurrence of delirium or impaired consciousness. Common drugs that cause this effect include anxiolytic and antipsychotic agents and even opioids. Previous studies have reported that about 30% of patients were conscious until death, meaning that 70% were not. In recent years, great i...
Source: Journal of Pain and Symptom Management - September 24, 2009 Category: Palliative Care Authors: Sophie Pautex, Karine Moynier-Vantieghern, François R. Herrmann, Gilbert B. Zulian Tags: Letters Source Type: journals

Assessment of Symptoms Reported by 10- to 18-Year-Old Cancer Patients in TaiwanEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The purposes of this study were 1) to assess and describe the occurrence, frequency, severity, and distress of symptoms reported by Taiwanese pediatric cancer patients who were between 10 and 18 years of age, and 2) to use statistical analysis to determine whether the multiple dimensions (i.e., frequency, severity, or distress) of the Memorial Symptom Assessment Scale (MSAS) 10–18 alone can provide sufficient useful information for the assessment of symptoms that patients report as distressing. A total of 144 Taiwanese pediatric cancer patients and their mothers participated in this cross-sectional study. The f...
Source: Journal of Pain and Symptom Management - September 14, 2009 Category: Palliative Care Authors: Chao-Hsing Yeh, Chao-Hui Wang, Yi-Chien Chiang, Lin Lin, Lung-Chang Chien Tags: Original Articles Source Type: journals

Heart Failure: The Hidden Problem of PainEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67±11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual f...
Source: Journal of Pain and Symptom Management - September 4, 2009 Category: Palliative Care Authors: Joy R. Goebel, Lynn V. Doering, Lisa R. Shugarman, Steve M. Asch, Cathy D. Sherbourne, Andy B. Lanto, Lorraine S. Evangelista, Adeline M. Nyamathi, Sally L. Maliski, Karl A. Lorenz Tags: Original Articles Source Type: journals

Pc-facsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Source Type: journals

The Defined Trial Period in Ethical Decision MakingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: In the face of acute life-threatening illness, especially when superimposed upon chronic illness, patients and their families often face great difficulty in establishing treatment preferences and goals of care. This is especially true early in treatment when prognostication is difficult. The “defined trial period” is discussed and emphasized as a useful strategy in resolving some of these dilemmas. This strategy depends on acceptance of the moral and legal equivalency of withholding and withdrawing treatment. An unusual case is presented in which the use of a defined trial period enabled the entire care team ...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Gary A. Johanson Tags: Ethical Issues in Palliative Care Source Type: journals

Novel Use of Amantadine: To Treat HiccupsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report a complex clinical case of intractable hiccups in a patient with cancer of the pancreas and Parkinson's disease and some of the problems encountered when attempting symptom control. We also discuss a potential therapeutic response to a novel agent, amantadine, unlicensed in the treatment of hiccups. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Sarah K. Wilcox, Anne Garry, Miriam J. Johnson Tags: Palliative Care Rounds Source Type: journals

Hospice Care in the Nursing Home Setting: A Review of the LiteratureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The U.S. Medicare hospice benefit has expanded considerably into the nursing home (NH) setting in recent years. This literature review focuses on the provision of NH hospice, exploring its growth and the impact of such care on NH residents, cost and efficiency implications for NHs and government, and policy challenges and important areas for future research. Although hospice utilization is relatively modest among NH residents, its increased availability holds great promise. As an alternative to traditional NH care, hospice has been shown to provide high-quality end-of-life care and offer benefits, such as reduced...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: David G. Stevenson, Jeffrey S. Bramson Tags: Review Articles Source Type: journals

Opioid Rotation: The Science and the Limitations of the Equianalgesic Dose TableEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Opioid rotation refers to a switch from one opioid to another in an effort to improve the response to analgesic therapy or reduce adverse effects. It is a common method to address the problem of poor opioid responsiveness despite optimal dose titration. Guidelines for opioid rotation are empirical and begin with the selection of a safe and reasonably effective starting dose for the new opioid, followed by dose adjustment to optimize the balance between analgesia and side effects. The selection of a starting dose must be based on an estimate of the relative potency between the existing opioid and the new one. Pote...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Helena Knotkova, Perry G. Fine, Russell K. Portenoy Tags: Review Articles Source Type: journals

Establishing “Best Practices” for Opioid Rotation: Conclusions of an Expert PanelEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Opioid rotation is a strategy applied during opioid therapy for pain that refers to a switch from one opioid to another in an effort to improve clinical outcomes (benefits or harms). It begins with the selection of a new drug at a starting dose that minimizes potential risks while ideally maintaining analgesic efficacy. The selection of a starting dose must be informed by an estimate of the relative potency between the existing opioid and the new one. Clinically relevant estimates of relative analgesic potency have been codified in the “equianalgesic dose table,” which has been used with little modification f...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Perry G. Fine, Russell K. Portenoy, Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation Tags: Special Article Source Type: journals

Opioid Equianalgesic Tables: Are They All Equally Dangerous?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Pain is one of the most common symptoms in cancer patients. Opioids are widely prescribed for this and other purposes. Properly used, they are safe, but they have serious and potentially lethal side effects. Successful use of opioids to manage cancer pain requires adequate knowledge about opioid pharmacology and equianalgesia for the purpose of both drug rotation and route conversion. The aim of this study was to demonstrate variations in equianalgesic ratios, as quoted in equianalgesic tables and various educational materials widely available to practicing physicians. We surveyed commercially available education...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Philip E. Shaheen, Declan Walsh, Wael Lasheen, Mellar P. Davis, Ruth L. Lagman Tags: Original Articles Source Type: journals

Artificial Hydration Therapy for Terminally Ill Cancer Patients: A Nurse-Education InterventionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The Japanese Society of Palliative Medicine has developed a clinical guideline to minimize the large variation in clinical practice of artificial hydration therapy for terminally ill cancer patients. The primary aim of this preliminary study was to explore the effects of a five-hour interactive workshop based on the guideline of nurses' knowledge, confidence, self-reported practice, and nurse-perceived usefulness. The study was designed as a pre-post anonymous questionnaire survey. The nurses attended a five-hour interactive workshop based on the guideline and were asked to complete a questionnaire before and aft...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Akemi Yamagishi, Fukuko Tanaka, Tatsuya Morita Tags: Original Articles Source Type: journals

Update on Cancer Pain GuidelinesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is now 26 years since Vittorio Ventafridda, MD, organized, with the help of the Floriani Foundation and on behalf of the World Health Organization (WHO), a meeting of experts from around the world (J. J. Bonica, K. M. Foley, A. Rane, M. Swerdlow, R. Twycross, V. Ventafridda, J. Birkham, P. B. Desai, M. Martelete, F. Takeda, and R. Tiffany) to develop the first international cancer pain guidelines. These guidelines had an enormous impact on the attitudes and practices of professionals, and on patient care. Although this impact never was scientifically assessed, it was probably much more important than one can estimate fr...
Source: Journal of Pain and Symptom Management - August 31, 2009 Category: Palliative Care Authors: Augusto Caraceni, Franco De Conno, Stein Kaasa, Lukas Radbruch, Geoffrey Hanks Tags: Letters Source Type: journals

Methylnaltrexone Treatment of Opioid-Induced Constipation in Patients with Advanced IllnessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this study, patients with advanced illness and OIC on stable doses of opioids and laxatives were randomized to methylnaltrexone 0.15mg/kg (n=62) or placebo (n=71) subcutaneously every other day for two weeks. Laxation was assessed daily. Constipation distress, bowel status change, pain, laxative use, and opioid withdrawal symptoms were assessed weekly using standardized scales. Additional analyses to further characterize response to methylnaltrexone revealed that among patients with a bowel movement within four hours following the first dose, the median time to response was 0.5 hours for methylnaltrexone. Response rates...
Source: Journal of Pain and Symptom Management - August 27, 2009 Category: Palliative Care Authors: Bruce H. Chamberlain, Karen Cross, Jaron L. Winston, Jay Thomas, Wenjin Wang, Chinyu Su, Robert J. Israel Tags: Original Articles Source Type: journals

The Landscape of Distress in the Terminally IllEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Understanding the complexities of distress and knowing who is most vulnerable is foundational to the provision of quality, palliative end-of-life care. Although prior studies have examined the prevalence of symptom distress among patients nearing death, these studies have tended to largely focus on physical and, to a lesser extent, psychological challenges. The aim of this study was to use the Patient Dignity Inventory (PDI), a novel, reliable, and validated measure of end-of-life distress, to describe a broad landscape of distress in patients who are terminally ill. The PDI, a 25-item self-report, was administer...
Source: Journal of Pain and Symptom Management - August 27, 2009 Category: Palliative Care Authors: Harvey Max Chochinov, Thomas Hassard, Susan McClement, Thomas Hack, Linda J. Kristjanson, Mike Harlos, Shane Sinclair, Alison Murray Tags: Original Articles Source Type: journals

Nocturnal Hypoxemia in Patients with CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In a survey of 100 palliative care inpatients with a variety of cancers, we found that 35 experienced nocturnal hypoxemia, as defined by an oxygen saturation (SaO2) (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 26, 2009 Category: Palliative Care Authors: Andrew Wilcock, Aqdas Kazi, Abi Walton, Matthew Maddocks Tags: Letters Source Type: journals

One-Year rTMS Treatment for Refractory Trigeminal NeuralgiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Repetitive transcranial magnetic stimulation (rTMS) is emerging as an interesting tool in the relief of chronic pain. Indeed, numerous groups have independently demonstrated analgesic effects after a single session of stimulation when the rTMS coil is applied over the motor cortex. The question remains, however, whether rTMS can be used to induce long-lasting pain relief. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 26, 2009 Category: Palliative Care Authors: Soroush Zaghi, Alexandre F. DaSilva, Mariana Acar, Mariana Lopes, Felipe Fregni Tags: Letters Source Type: journals

Understanding the Association Between Employee Satisfaction and Family Perceptions of the Quality of Care in Hospice Service DeliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Families often draw their conclusions about the quality of care received by a family member during the last months of life from their interactions with professional caregivers. A more comprehensive understanding of how these relationships influence the care experience should include an investigation of the association between employee job satisfaction and family perception of the quality of care. This cross-sectional study investigated the association at a regional hospice. Using the Kendall's tau correlation, employee satisfaction scores for care teams trended toward a positive correlation with family overall sa...
Source: Journal of Pain and Symptom Management - August 25, 2009 Category: Palliative Care Authors: Grady S. York, Janet L. Jones, Richard Churchman Tags: Original Articles Source Type: journals

Development, Implementation, and Process Evaluation of a Regional Palliative Care Quality Improvement ProjectEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The delivery of optimal palliative care requires an integrated and coordinated approach of many health care providers across the continuum of care. In response to identified gaps in the region, the Palliative Care Integration Project (PCIP) was developed to improve continuity and decrease variability of care to palliative patients with cancer. The infrastructure for the project included multi-institutional and multisectoral representation on the Steering Committee and on the Development, Implementation and Evaluation Working Groups. After review of the literature, five Collaborative Care Plans and Symptom Managem...
Source: Journal of Pain and Symptom Management - August 24, 2009 Category: Palliative Care Authors: Deborah J. Dudgeon, Christine Knott, Cheryl Chapman, Kathy Coulson, Elizabeth Jeffery, Sharon Preston, Mary Eichholz, Janice P. Van Dijk, Anne Smith Tags: Original Articles Source Type: journals

Intravenous Naloxone Plus Transdermal Buprenorphine in Cancer Pain Associated with Intractable Cholestatic PruritusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The complex and unpredictable series of symptoms that comes with the terminal stage of neoplastic disease significantly compromises patients' quality of life, and poses harsh therapeutic challenges for clinicians. Good control of severe cancer-related cholestatic pruritus seems to be hard to achieve and pruritus still undermines the remaining physical and relational capabilities of seriously ill cancer patients. Its pathogenesis remains substantially unknown and its treatment mostly empirical. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 24, 2009 Category: Palliative Care Authors: Franco Marinangeli, Cristiana Guetti, Chiara Angeletti, Cristina Bonetti, Antonella Paladini, Alba Piroli, Giustino Varrassi Tags: Letters Source Type: journals

The Utility of Screening in the Design of Trials for Symptom Management in CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: Clinical trials that test interventions for symptom management must target patients whose symptoms are severe and can benefit from participation. Screening symptoms for their severity prior to trial entry may be an important element of trial design. This research describes the utility of screening for severity of symptoms prior to entry into clinical trials for symptom management in cancer. To accomplish this, 601 cancer patients undergoing chemotherapy were assessed at screening and at the initial intervention contact, using the 0–10 rating scale for severity of nine symptoms. Post-test probabilities and likel...
Source: Journal of Pain and Symptom Management - August 20, 2009 Category: Palliative Care Authors: Sangchoon Jeon, Charles W. Given, Alla Sikorskii, Barbara Given Tags: Original Articles Source Type: journals

Acute Opioid Withdrawal Precipitated by Blood Transfusion in a 21-Year-Old MaleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Cancer patients can be among the most challenging groups in which to maintain pain control. At our institution, many cancer patients are managed with patient-controlled analgesia (PCA) opioids, sometimes on an outpatient basis. These patients frequently undergo multiple surgeries as well as courses of chemotherapy and radiotherapy and, as a result, often require multiple blood product transfusions. According to the American Association of Blood Banks standard, blood transfusions should not be coadministered with any intravenous drugs or fluids apart from 0.9% sodium chloride. For many cancer patients, it is difficult or im...
Source: Journal of Pain and Symptom Management - August 20, 2009 Category: Palliative Care Authors: Roland N. Kaddoum, Laura L. Burgoyne, Lilia A. Pereiras, George B. Bikhazi Tags: Letters Source Type: journals

Analysis of Patient-Related Barriers in Cancer Pain Management in Turkish PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The purpose of this study was to evaluate the validity and reliability of the Barriers Questionnaire II (BQ-II) for Turkish patients and to define the patient-related barriers to cancer pain management in Turkey. For this, 170 patients with cancer who used or were still using analgesic medication for pain related to cancer participated in the study. It was found that patients have beliefs that may be barriers to optimal pain management, mostly in relation to addiction, and to a small extent, physical side effects. It was ascertained that male, unmarried patients, patients with cancer who also have another chronic...
Source: Journal of Pain and Symptom Management - August 19, 2009 Category: Palliative Care Authors: Gülcan Bağçivan, Nuran Tosun, Şeref Kömürcü, Nalan Akbayrak, Ahmet Özet Tags: Original Articles Source Type: journals

Screening for Psychological Distress in Palliative Care: Performance of Touch Screen Questionnaires Compared with Semistructured Psychiatric InterviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study examined the criterion validity of computer-based screening tools (Distress Thermometer [DT], Brief Symptom Inventory-18 [BSI-18], and General Health Questionnaire-12 [GHQ-12]) in detecting any form of psychological distress in palliative care patients, compared with a semistructured psychiatric interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients aged 18 years or older referred to specialist palliative care services in Leeds completed the computer-based screening tools before SCAN interview by psychiatrists who were blind to screening results. SCAN interviews generated International ...
Source: Journal of Pain and Symptom Management - August 18, 2009 Category: Palliative Care Authors: Parvez Thekkumpurath, Chitra Venkateswaran, Manoj Kumar, Alex Newsham, Michael I. Bennett Tags: Original Articles Source Type: journals

General Practitioner Awareness of Preferred Place of Death and Correlates of Dying in a Preferred Place: A Nationwide Mortality Follow-Back Study in The NetherlandsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: To improve the quality of end-of-life care, general practitioner (GP) awareness of where their patients prefer to die is important. To examine GP awareness of patients' preferred place of death (POD), associated patient- and care-related characteristics, and the congruence between preferred and actual POD in The Netherlands, a mortality follow-back study was conducted between January 2005 and December 2006. Standardized registration forms were used to collect data on all nonsudden deaths (n=637) by means of the Dutch Sentinel Network, a nationally representative network of general practices. Forty-six percent of ...
Source: Journal of Pain and Symptom Management - August 18, 2009 Category: Palliative Care Authors: Ebun Abarshi, Bregje Onwuteaka-Philipsen, Gé Donker, Michael Echteld, Lieve Van den Block, Luc Deliens Tags: Original Articles Source Type: journals

Breakthrough Pain in Advanced Cancer Patients Followed at Home: A Longitudinal StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abstract: The aim of this study was to longitudinally assess breakthrough pain (BP) in advanced cancer patients who were admitted to home palliative care. One hundred and one consecutive patients who were admitted to one of the two home care programs and were representative of the cancer population followed at home in Italy were included. Patients were excluded only if at admission they were cognitively impaired or too unwell to provide reliable answers to questions regarding data collection. At admission (T0), and one month later (T1), data were recorded about the pharmacological treatment of background pain and its effec...
Source: Journal of Pain and Symptom Management - August 18, 2009 Category: Palliative Care Authors: Sebastiano Mercadante, Benedetta Veruska Costanzo, Flavio Fusco, Valeria Buttà, Valentina Vitrano, Alessandra Casuccio Tags: Original Articles Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 31, 2009 Category: Palliative Care Tags: Frontmatter Source Type: journals