What is the optimal management of paraduodenal pancreatitis? Surgery is associated with higher incidence of diabetes but similar quality of life and pain control

BACKGROUND: Osmotic release oral system (OROS®) hydromorphone is a potent, long-acting opioid analgesic, effective and safe for controlling cancer pain in patients who have received other strong opioids. To date, few studies have examined the efficacy of hydromorphone for pain relief in opioid-naive cancer patients.OBJECTIVES: A prospective, open-label, multicentre trial was conducted to determine the efficacy and tolerability of OROS hydromorphone as a single and front-line opioid therapy for patients experiencing moderate to severe cancer pain.METHODS: OROS hydromorphone was administered to patients who had not previously received strong, long-acting opioids. The baseline evaluation (visit 1) was followed by two evaluations (visits 2 and 3) performed two and 14 weeks later, respectively. The starting dose of OROS hydromorphone was 4 mg/day and was increased every two days when pain control was insufficient. Immediate-release hydromorphone was the only accepted alternative strong opioid for relief of breakthrough pain. The efficacy, safety and tolerability of OROS hydromorphone, including the effects on quality of life, and patients’ and investigators’ global impressions on pain relief were evaluated. The primary end point was pain intensity difference (PID) at visit 2 relative to visit 1 (expressed as %PID).RESULTS: A total of 107 patients were enrolled in the present study. An improvement in pain intensity of >50% (≥50% PID) was observed in 51.0% of the full analysis set and 58.6% of the per-protocol set. The mean pain score, measured using a numerical rating scale, was significantly reduced after two weeks of treatment, and most adverse events were manageable. Quality of life also improved, and >70% of patients and investigators were satisfied with the treatment.CONCLUSIONS: OROS hydromorphone provided effective pain relief and improved quality of life in opioid-naive cancer patients. As a single and front-line treatment, OROS hydromorphone delivered rapid pain control.

Download Full-text

Improving Quality of Life Through Pain Control

Clinical Journal of Oncology Nursing ◽

10.1188/13.cjon.117-118 ◽

2013 ◽

Vol 17 (2) ◽

pp. 117-118

Author(s):

Valerie Burger ◽

James T. D'Olimpio

Keyword(s):

Quality Of Life ◽

Pain Control

Download Full-text

Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

Canadian Journal of Gastroenterology ◽

10.1155/2005/836030 ◽

2005 ◽

Vol 19 (1) ◽

pp. 15-35 ◽

Cited By ~ 136

Author(s):

David Armstrong ◽

John K Marshall ◽

Naoki Chiba ◽

Robert Enns ◽

Carlo A Fallone ◽

...

Keyword(s):

Quality Of Life ◽

Reflux Disease ◽

Symptom Relief ◽

Management Strategies ◽

Consensus Conference ◽

Optimal Management ◽

Barrett’S Epithelium ◽

Barrett's Epithelium ◽

Gerd Symptoms

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially.OBJECTIVE: To develop up-to-date evidence-based recommendations relevant to the needs of Canadian health care providers for the management of the esophageal manifestations of GERD.CONSENSUS PROCESS: A multidisciplinary group of 23 voting participants developed recommendation statements using a Delphi approach; after presentation of relevant data at the meeting, the quality of the evidence, strength of recommendation and level of consensus were graded by participants according to accepted principles.OUTCOMES: GERD applies to individuals who reflux gastric contents into the esophagus causing symptoms sufficient to reduce quality of life, injury or both; endoscopy-negative reflux disease applies to individuals who have GERD and a normal endoscopy. Uninvestigated heartburn-dominant dyspepsia -- characterised by heartburn or acid regurgitation - includes erosive esophagitis or endoscopy-negative reflux disease, and may be treated empirically as GERD without further investigation provided there are no alarm features. Lifestyle modifications are ineffective for frequent or severe GERD symptoms; over-the-counter antacids or histamine H2-receptor antagonists are effective for some patients with mild or infrequent GERD symptoms. Proton pump inhibitors are more effective for healing and symptom relief than histamine H2-receptor antagonists; their efficacy is proportional to their ability to reduce intragastric acidity. Response to initial therapy - a once-daily proton pump inhibitor unless symptoms are mild and infrequent (fewer than three times per week) - should be assessed at four to eight weeks. Maintenance medical therapy should be at the lowest dose and frequency necessary to maintain symptom relief; antireflux surgery is an alternative for a small proportion of selected patients. Routine testing for Helicobacter pylori infection is unnecessary before starting GERD therapy. GERD is associated with Barrett's epithelium and esophageal adenocarcinoma but the risk of malignancy is very low. Endoscopic screening for Barrett's epithelium may be considered in adults with GERD symptoms for more than 10 years; Barrett's epithelium and low-grade dysplasia generally warrant surveillance; endoscopic or surgical management should be considered for confirmed high-grade dysplasia or malignancy.CONCLUSION: Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

Download Full-text

Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

Pain Research and Management ◽

10.1155/2020/7565962 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yinxia Wang ◽

Ligang Xing

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cancer Pain ◽

Cancer Patients ◽

Pain Control ◽

Analgesic Drugs ◽

Oxycodone Hydrochloride ◽

Radiation Esophagitis

Radiotherapy is commonly used to treat cancer patients. Besides the curable effect, radiotherapy also could relieve the pain of cancer patients. However, cancer pain is gradually alleviated about two weeks after radiotherapy. In addition, cancer patients who receive radiotherapy may also suffer from pain flare or radiotherapy-induced side effects such as radiation esophagitis, enteritis, and mucositis. Pain control is reported to be inadequate during the whole course of radiotherapy (before, during, and after radiotherapy), and quality of life is seriously affected. Hence, radiotherapy is suggested to be combined with analgesic drugs in clinical guidelines. Previous studies have shown that radiotherapy combined with oxycodone hydrochloride can effectively alleviate cancer pain. In this review, we firstly presented the necessity of analgesia during the whole course of radiotherapy. We also sketched the role of oxycodone hydrochloride in radiotherapy of bone metastases and radiotherapy-induced oral mucositis. Finally, we concluded that oxycodone hydrochloride shows good efficacy and tolerance and could be used for pain management before, during, and after radiotherapy.

Download Full-text

Palliative Gastrointestinal Surgery

Surgical Palliative Care ◽

10.1093/med/9780190858360.003.0015 ◽

2019 ◽

pp. 175-182

Author(s):

Brian Badgwell

Keyword(s):

Quality Of Life ◽

Gastrointestinal Cancer ◽

Bowel Perforation ◽

Gastrointestinal Surgery ◽

Optimal Management ◽

Critical Component ◽

Gastrointestinal Malignancies ◽

Common Diagnosis ◽

Surgical Palliation

Palliative surgical consultation is a critical component of multidisciplinary gastrointestinal cancer care. For many types of gastrointestinal malignancies, the majority of patients are not able to achieve cure and develop symptoms attributable to their advanced or incurable malignancy. The most common diagnosis is bowel obstruction, but diagnoses such as bowel perforation, hemorrhage, neutropenia and abdominal pain, and anorectal infections are also included. Safe utilization of surgical intervention can be difficult due to the increased risks of surgery, limited therapeutic options for these complex palliative care situations, and the progressive nature of incurable gastrointestinal cancer. In selected patients, surgical palliation can improve symptoms and quality of life with acceptable reported rates of morbidity and mortality. Even in situations where surgery is not offered, an understanding of the disease processes and outcomes can inform patients and other providers in the optimal management strategy.

Download Full-text

Application of quality control circle in the treatment of moderate cancer pain in inpatients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz214 ◽

2020 ◽

Vol 50 (5) ◽

pp. 581-585

Author(s):

Yehuan Liu ◽

Beibei Lin

Keyword(s):

Quality Of Life ◽

Quality Control ◽

Cancer Pain ◽

Pain Control ◽

Management Tool ◽

Control Group ◽

Observation Group ◽

Patients With Cancer ◽

Significant Difference

Abstract Context Pain is one of the most common and intolerable symptoms in cancer patients. But cancer pain control is still negative in China. Objectives This paper explores the application of quality control circle in the treatment of cancer pain in inpatients to improve the quality of life of patients with cancer pain. Method Established a quality control circle group to analyze the current status of cancer pain control in inpatients with moderate cancer pain, set goals, formulate corresponding countermeasures and implement and review them in stages. The plan-do-check-act method was cyclically applied. The Brief Pain Inventory was used to evaluate the cancer pain status of patients with cancer pain hospitalized before (January to April 2016) and after (September to December 2016) the implementation of quality control circle activities. Results The pain control effect of the observation group was significantly better than that of the control group. The mean (standard deviation) of pain severity and pain interference in the observation group were significantly lower than those in the control group (6.21 [2.86] vs 4.31 [2.25], 10.54 [4.10] vs 7.25 [3.77]). There was significant difference after the implementation of quality control circle (P < 0.01). Conclusion Quality control circle activities are used to manage patients with cancer pain, to improve the situation of pain control and to improve the quality of life of patients. This management tool and method is worthy of clinical promotion and application.

Download Full-text

Chemotherapy-Induced Nausea and Vomiting Incidence and Prevalence

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.45 ◽

2012 ◽

pp. 541-543 ◽

Cited By ~ 3

Author(s):

Steven M. Grunberg

Keyword(s):

Quality Of Life ◽

Patient Experience ◽

Nausea And Vomiting ◽

Physician Education ◽

Optimal Management ◽

Effective Management ◽

Optimal Maintenance ◽

The Impact

Overview: Although chemotherapy-induced nausea and vomiting is recognized as having been an important problem during the initial introduction of chemotherapy into the antineoplastic armamentarium, the assumption that this problem has already been solved can restrict optimal management and further advances. Underestimation of nausea and vomiting may have many causes. If these toxicities are assumed to be necessary properties of chemotherapy, then their incidence may be taken for granted. If nausea and vomiting appear after discharge from the clinic several days after chemotherapy, these toxicities may not be reported because of poor recall or because of efforts by patients to avoid unnecessary complaints. Physician education may be compromised if physicians see nausea and vomiting as population problems but not problems for their own patients. Failure to recognize nausea and vomiting as two distinct entities that may appear independently of each other can also limit understanding of the prevalence of these problems and efforts at effective management. Continued attention to the impact of nausea and vomiting on the patient experience will be necessary to insure optimal maintenance of quality of life.

Download Full-text

Pain Relief as an Integral Part of the Palliative Care

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.163 ◽

2018 ◽

Vol 6 (4) ◽

pp. 739-741 ◽

Cited By ~ 3

Author(s):

Marija Sholjakova ◽

Vesna Durnev ◽

Andrijan Kartalov ◽

Biljana Kuzmanovska

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Pain Relief ◽

Pain Control ◽

Palliative Therapy ◽

The Other ◽

Spiritual Problems ◽

Active Care ◽

Different Origin

BACKGROUND: Palliative therapy represents active care for patients whose illness has such nature that is not responding to the curative treatment. The palliative care aims to provide comfort and prevention from the suffering of the patients at the end of their life. Treatment of the pain presents an important integral part of palliative care.AIM: This article aims to discuss and answer to some of the analgesic regimes and therapeutic dilemmas.RESULTS: Pain control, in addition to the other treatments such as alleviation of psychological, sociological and spiritual problems, has a priority. The proper pain management can achieve a better quality of life for the patients and their families.CONCLUSION: It can be concluded that because of the different origin of the pain, the use of analgesic therapy should be individualised and adapted to the real need of every person. Finally, only a good organisation and institutionalisation of the palliative care in one society could permit better prevention of suffering at the end of the life.

Download Full-text