Survivor pain: Experience at an oncology palliative care clinic.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 260-260
Author(s):  
Cristian Zanartu ◽  
Lisa Emond ◽  
Ann Wojtaszczyk
Keyword(s):  
Palliative Care ◽  
Cancer Survivors ◽  
Risk Mitigation ◽  
Opioid Analgesics ◽  
The United States ◽  
Care Clinic ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Opioid Medications

260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.

scholarly journals An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care

2021 ◽  
pp. 104990912098612
Author(s):  
Alycia A. Bristol ◽  
Sobaata Chaudhry ◽  
Dana Assis ◽  
Rebecca Wright ◽  
Derek Moriyama ◽  
...  
Keyword(s):  
Palliative Care ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Stage Iv ◽  
The United States ◽  
Qualitative Description ◽  
Disease Stage ◽  
Structured Interviews ◽  
Care Clinic ◽  
Clinical Model

Objectives: The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. Methods: Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. Results: We identified 2 themes: “Communication addressing the emotional and physical aspects of disease” and “Filling gaps in care”; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. Significance of Results: Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.

scholarly journals The effectiveness of red ginger extract to decreasemenstrual pain level in adolescent at Al Husna 2 Islamic Boarding School Kediri year 2016

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Rochmanita Sandya Afindaningrum ◽  
Rahma Kusuma Dewi
Keyword(s):  
Pain Score ◽  
Boarding School ◽  
Wilcoxon Test ◽  
Distribution Data ◽  
P Value ◽  
Menstrual Pain ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Red Ginger

Dismenorea is menstrual problems that is oftenexperienced adolescent and is caused by the occurence of uterine contractions due to increased prostaglandin. The content of gingerol in ginger red can overcome dysmenorrhoea by blocking prostaglandin. The purpose of this study was to know the effect of red ginger drink to the decline in the level of menstrual pain (in adolescent at Boarding school Al Husna 2 Kediri. Pre-experimental research design used by the approach of one group pretest posttest design. The population of this study was all students who experience dismenorea. Sample of adolescents who experience dismenoreawere 17 people with accidental sampling. The average pain score before treatment was 2.53, after treatment average pain score was 1, 59 based on the description, it shows that there was a decrease in pain scores of 0.94 or 37.1%. Normality test is known that the distribution of data in pain scores before being treated distribution is not normal with a p-value of <0.05 while after treated with distribution data is not normal P <0.05, making the results statistically using the Wilcoxon test showed the value of P = 0.000 (p <α = 0,05). There is an influence of red ginger drink to the decline in the level of menstrual pain (dysmenorrhoea) in adolescent at Boarding school Al Husna 2 Kediri. Respondents are advised to drink red ginger when dysmenorrhoea.

Time Series Analysis of the Pain Diary Data Obtained during the Multicenter Study for Hydroxyurea (MSH) Clinical Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3807-3807 ◽  
Author(s):  
William F. McCarthy ◽  
Robert L. Bauserman ◽  
Bruce A. Barton ◽  
Nan Guo ◽  
Samir K. Ballas ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Time Series ◽  
Pain Score ◽  
Multicenter Study ◽  
Pain Diary ◽  
Diary Data ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Daily Pain

Abstract The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) was a randomized double-blind placebo-controlled trial to test whether hydroxyurea could reduce the rate of painful crises in adult patients who had at least three painful crises per year. Daily pain diaries were collected biweekly for 299 MSH patients. Patients rated daily pain on a linear scale 0 through 9. The daily pain data was collected to provide useful information regarding the efficacy of hydroxyurea in reducing the rate of painful crises. The objective of this analysis was to determine if there was an underlying time series pattern associated with the MSH pain diary data, especially one indicative of a calendar or seasonal association. An Unobserved Component Model (UCM) was used to determine, based on empirical data, if there was a cycle and/or trend associated with the time series. The times series started on December 1991 and ended on December 1994. The series was equally spaced and univariate. The equal spacing was a monthly interval. The average pain score for each two- week diary period was used to create each unit of analysis. This analysis considered three groupings of patients: all patients, hydroxyurea patients and placebo patients. The results of the modeling indicated that there was indeed both a cycle and a trend associated with the MSH pain diary data. This is the case for each group of patients considered. All three groups had a cycle pattern that seemed to show a seasonal behavior of average pain scores (the changing of the season seemed to show an approximate transition from trough (Spring) to peak (Fall/Winter) and peak to trough). There was a downward trend in average pain scores for both the all patientsgroup and the hydroxyurea patientsgroup. However, there was an upward trend in average pain score for the placebo patientsgroup. This may reflect the result shown in the MSH Clinical Trial, that HU usage reduced the average pain scores reported by patients.

Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy

2013 ◽  
Vol 4 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Jarkko Kalliomäki ◽  
Bror Jonzon ◽  
Karin Huizar ◽  
Michael O’Malley ◽  
Anita Andersson ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Score ◽  
Chemokine Receptor ◽  
Plasma Levels ◽  
Analgesic Efficacy ◽  
Treatment Groups ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Ccr2 Antagonist

AbstractBackground and aimsPreclinical data suggest that the chemokine receptor 2 (CCR2) is involved in the pathophysiology of neuropathic pain through modulation of neuronal excitability, synaptic transmission and activation of spinal cord microglia. CCR2-antagonists have shown to be effective in preclinical models of neuropathic pain. The aim of this study was to evaluate the analgesic efficacy, safety and tolerability of a novel CCR2-antagonist, AZD2423, in patients with painful diabetic neuropathy (PDN).MethodsThis was a double-blind, randomized, parallel-group, multi-center study in patients with symmetric distal sensory polyneuropathy due to type 1 or 2 diabetes and duration of neuropathic pain between 3 months and 5 years. Concomitant treatment with neuropathic pain medications (e.g. anticonvulsants, tricyclic antidepressants, serotonin-noradrenaline uptake inhibitors, opioids, topical lidocaine or capsaicin) was not allowed. 134 patients with PDN were equally randomized to 28 days oral administration of 20 mg AZD2423,150 mg AZD2423, or placebo. The primary efficacy variable was the change of average pain score from 5-days baseline to the last 5 days of treatment, measured with numerical rating scale (NRS, 0–10). The secondary efficacy measures included NRS worst pain scores, patient global impression of change, pain interference on sleep and activity, and neuropathic pain symptom inventory (NPSI).ResultsThe change of NRS average pain score was not significantly different between treatment groups (AZD2423 20mg: –1.50; AZD2423 150 mg: –1.35; placebo: –1.61). The NPSI total score and three out of five subscores (evoked pain, pressing/deep pain and paresthesia/dysesthesia) tended to be reduced more by AZD2423 150 mg than by placebo. No other secondary efficacy variables differed between treatment groups. The frequency and type of adverse events for AZD2423 were similar to placebo. The achieved plasma levels of AZD2423 in the two dose groups were in line with predictions from pharmacokinetic data previously obtained in healthy volunteers. Dose-dependent increase of plasma levels of the ligand of CCR2 (CCL2; chemokine ligand 2) and decrease of the mean levels of monocytes (–27% by AZD2423 150 mg) suggested that the administrated doses of AZD2423 interacted with the CCR2 target.ConclusionThe CCR2-antagonist AZD2423 showed no analgesic efficacy in PDN based on NRS average pain scores and global and functional pain outcome measures. The NPSI data suggested possible effects on certain sensory components of pain. There were no major safety or tolerability concerns.ImplicationsTreatment with a CCR2-antagonist does not have a clinically important analgesic effect in an overall PDN population.

Regular use of a verbal pain scale improves the understanding of oncology inpatient pain intensity.

1994 ◽  
Vol 12 (12) ◽  
pp. 2751-2755 ◽  
Author(s):  
E Au ◽  
C L Loprinzi ◽  
M Dhodapkar ◽  
T Nelson ◽  
P Novotny ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Pain Perception ◽  
Assessment Tool ◽  
Pain Scale ◽  
Oncology Patients ◽  
Educational Effort ◽  
Pain Scores ◽  
Pain Status ◽  
Average Pain ◽  
Average Pain Score

PURPOSE This study was undertaken to determine if the daily use of a verbal pain scale could improve the correlation of pain perception between hospitalized oncology patients and their caregivers. PATIENTS AND METHODS Hospitalized oncology patients were asked to rate verbally their average pain over the past 24 hours on a scale ranging from 0 to 10. The patients' primary-care physicians and nurses were asked the same question on the same morning after they had evaluated their patients. RESULTS During a baseline study, only 64% of caregivers' pain scores were within two points of the respective patient's score. Caregivers tended to underestimate patients' pain scores. Caregivers were alerted to these poor results and then requested to ask each patient daily for the average pain score and record this score on the patient's medical record. Nonetheless, correlation between patients' and caregivers' pain scores remained poor (68% within two points of each other) during a second study. The major reason for the poor results appeared to be because caregivers did not routinely ask patients for pain scores. Subsequently, a renewed, more intensive educational effort was undertaken and a third study was conducted. During the third study, 85% of caregivers' and patients' pain scores were within two points of each other (P = .001 when compared with baseline). CONCLUSION The enforced use of a simple verbal pain assessment tool appears to improve caregiver's understanding of the pain status of hospitalized oncology patients.

scholarly journals Opioid Prescription Trends Among Patients With Cancer Referred to Outpatient Palliative Care Over a 6-Year Period

2017 ◽  
Vol 13 (12) ◽  
pp. e972-e981 ◽  
Author(s):  
Ali Haider ◽  
Donna S. Zhukovsky ◽  
Yee Choon Meng ◽  
Joseph Baidoo ◽  
Kimberson C. Tanco ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Care Providers ◽  
Performance Status ◽  
Symptom Assessment ◽  
The United States ◽  
Cancer Type ◽  
Care Providers ◽  
Opioid Prescription ◽  
Care Clinic ◽  
Opioid Dose

Introduction: In the United States, opioid regulations have become increasingly stringent in recent years. Increased regulatory scrutiny, in part, is related to heightened awareness through literature and a recent media blitz on the opioid prescription epidemic. These regulations have the potential to impact prescription trends by health care providers. Our objective was to evaluate changes in the type and dose of opioid prescriptions among patients who are referred by oncologists to an outpatient palliative care clinic. Materials and Methods: We reviewed the electronic health records of 750 patients who were seen as new consultations at MD Anderson Cancer Center’s outpatient palliative care clinic between January 1 and April 30 each year from 2010 through 2015. Data collected included demographics, cancer type and stage, symptom assessment, performance status, opioid type, and opioid dose defined as the morphine equivalent daily dose (MEDD). Results: Median age was 59 years (interquartile range [IQR], 51 to 67), 383 (51%) were female, 529 (70%) were white, and 654 (87%)of patients had advanced cancer. In 2010, median MEDD before referral was 78 mg/d (IQR, 30 to 150); however, by 2015, the MEDD had progressively decreased to 40 mg/d (IQR, 19 to 80; P = .001). Hydrocodone was the most common opioid prescribed between 2010 and 2015; however, after its reclassification as a schedule II opioid in October 2014, the use of tramadol, a schedule IV opioid, increased ( P < .001). Conclusion: During the past several years, the MEDD prescribed by referring oncologists has decreased. After hydrocodone reclassification, the use of tramadol with less stringent prescription limits has increased.

Pharmacist-Delivered Patient Care in an Interdisciplinary Team-Based Institutional Palliative Care Clinic, 2012 to 2018

2019 ◽  
pp. 082585971986961 ◽  
Author(s):  
Lindsey E. Dayer ◽  
Elizabeth R. McDade ◽  
Sarah Harrington
Keyword(s):  
Palliative Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Palliative Care Service ◽  
Interdisciplinary Team ◽  
The United States ◽  
Care Clinic ◽  
Care Services ◽  
Palliative Care Setting ◽  
Palliative Care Services

Palliative care services offered in the United States have grown substantially since the year 2000. These types of services have been shown to improve a patient’s quality of life when presented with a serious or life-threatening disease or illness. An important characteristic of a quality palliative care service is the presence of an interdisciplinary team to utilize different areas of expertise to address multiple aspects of patient care. An important member of this team is the pharmacist. The services presented in this interprofessional education and practice guide describe pharmacist-delivered palliative care services offered in an institutional ambulatory palliative care setting from 2012 to 2018.

SP2.2.2Analgesia prescribing in acute surgical admissions - dual-centre cross-sectional study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alexei Makhort ◽  
Ana Gavrila ◽  
Frances Hill
Keyword(s):  
Subjective Wellbeing ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Moderate Pain ◽  
Sectional Study ◽  
Cross Sectional ◽  
Pain Scores ◽  
Average Pain ◽  
Average Pain Score ◽  
Perception Of Care

Abstract Aim Pain is a common presenting complaint of acute surgical inpatients and has a great impact on their subjective wellbeing and the perception of care they receive if not addressed promptly and efficiently. It is also a common cause of patients’ complaints if not properly addressed. We set out to evaluate if analgesia is prescribed locally in accordance with WHO analgesia ladder and NICE CKS analgesia guidelines for mild-to-moderate pain. Method We performed cross-sectional studies of adults aged 16 and over, admitted under general or vascular surgery in two DGHs (2018-2020) with complaints of pain on admission. 30 patients were included in both studies with an average age 53/56 years. We undertook notes review, checked observation charts and drug charts for pain grading and analgesia prescribing following initial clinical assessment. Results In the first study, average pain score of 6 was obtained. Only 19/30 patients (63%) had regular analgesia prescribed. Only 2/30 (6%) were started on regular weak opioids, with further 8/30 (26%) on as required/PRN weak opioids. 17/30 (56%) patients had PRN Oramorph prescribed. Only 2/30 (6%) were started on PRN NSAIDs despite only 46% having cautions/contraindications. 5/30 patients with pain scores of 9-10 not had any regular analgesia prescribed. Comparable results were achieved in the second hospital we audited. Conclusions This study shows significant under-prescribing of analgesia, especially regular analgesia for surgical patients with moderate-severe pain, and skipping of weaker opioids/NSAIDs in favour of Oramorph. There is significant scope for improvement following educational session implementation.

Opioid Prescribing Patterns Before and After an Inpatient Palliative Care Consultation

2019 ◽  
Vol 37 (9) ◽  
pp. 738-742
Author(s):  
Mohammad Zafir Al-Shahri ◽  
Abdulrahman Abdullah ◽  
Ameena Alansari ◽  
Mahmoud Sroor
Keyword(s):  
Palliative Care ◽  
Prescribing Patterns ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Pain Scores ◽  
Palliative Care Consultation ◽  
King Faisal Specialist Hospital ◽  
Before And After ◽  
Average Pain ◽  
Numeric Scale

Background: To the best of our knowledge, the change in opioid prescription patterns upon referral to a palliative care team (PCT) was not previously investigated in the Middle East. Objective: This study aimed to explore the change in the pattern of opioid prescription and the pain scores before and after referring inpatients to a PCT. Methods: We conducted a retrospective review of patients’ records including all inpatients ≥15 years newly referred to the PCT over a period of 21 months at King Faisal Specialist Hospital and Research Center, Riyadh. Results: Of 631 patients, 52.3% were females, the median age was 54 years, and 96.7% had cancer. The proportion of patients on opioids before referral (83.4%) increased to 93.3% in the postreferral period, P < .0001. Patients receiving opioids on a regular basis increased from 31.9% before referral to 49.9% after referral to the PCT, P < .0001. Morphine was the most commonly prescribed opioid on a regular basis pre- and postreferral. Upon referral, the administration of opioids through the subcutaneous route increased from 3.7% to 10.9%, P < .0001. On average, pain scores were reduced by 1 point on a 0 to 10 numeric scale within 48 hours of seeing a patient by the PCT, P < .0001. Conclusion: Patients referred to a PCT are likely to get their opioid prescription optimized and pain scores improved shortly after the PCT involvement. Patients with cancer-related pain requiring opioids should be referred to a PCT as early as possible.

scholarly journals Pain and Opioid Consumption and Mobilization after Surgery: Post Hoc Analysis of Two Randomized Trials

2021 ◽  
Author(s):  
Eva Rivas ◽  
Barak Cohen ◽  
Xuan Pu ◽  
Li Xiang ◽  
Wael Saasouh ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Enhanced Recovery ◽  
Early Mobilization ◽  
Opioid Consumption ◽  
Pain Scores ◽  
Unit Increase ◽  
Average Pain ◽  
Lower Pain ◽  
Average Pain Score ◽  
Recovery Pathways

Background Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications. Methods The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing. Results A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009). Conclusions Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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