scholarly journals Hurdles in successful treatment of cancer pain caused by primary healthcare

2010 ◽  
Vol 18 (3) ◽  
pp. 65-70
Author(s):  
Erzebet Patarica-Huber ◽  
Nedeljka Boskov
Keyword(s):  
Side Effects ◽  
Cancer Pain ◽  
Successful Treatment ◽  
Primary Healthcare ◽  
Great Influence ◽  
Daily Practice ◽  
Further Education ◽  
Cancer Pain Therapy ◽  
The Individual ◽  
Guidelines And Recommendations

Background: The aim of this study is to envisage the hurdles set by physicians in primary healthcare that can cause, or contribute to unsatisfactory cancer pain management. Methods: The study has been carried out as a prospective open non-randomized one (based on a questionnaire). It comprised 283 physicians in primary healthcare from 21 institutions of primary healthcare in Serbia. The choice of physicians was done at random, and the completion of questionnaires was voluntary. The questionnaire comprised 12 questions. Among other issues the questions covered the most important characteristics of the analgesics in their opinion, the individual doses of drugs they most often prescribe, maximum daily doses of these drugs they prescribe (tramadol, fentanyl TD, hydromorphone, methadone, IR morphine); whether they introduce opioids and/or increase the dose autonomously or only upon a specialist?s recommendation; and what is preventing them to successfully treat cancer pain; what side effects they fear and others. Results: Tramadol was favored in the previous year (82.3%), in the last month the physicians prescribed NSAID as therapy in 63.4% of the cases, tramadol was given to 13.60%; fentanyl TD to 13.40%; hydromorphone to 2.7%; IR morphine to 3.80%. Efficiency was marked by 89.80% of physicians as the most important characteristic, tolerability by 82.3%, and duration of effects by 77.4%. Tramadol is most often the choice of therapy in their daily practice although they said it to be less efficient, less tolerable, with shorter analgesic effect, less user friendly, and more expensive compared to fentanyl TD and the other opioids. They said the side effects they fear the most were respiratory depression and sedation. 23.70% of the physicians in the primary healthcare introduce and/or increase the dose of opioids (34.6%) into the therapy autonomously, and 76.30% of them introduce these drugs and/or increase the dose (65.4%) only upon a specialist?s recommendation. Conclusion: Barriers have a great influence on successful treatment of cancer pain. There is a burning need for further education which has to encompass raising awareness of the current guidelines and recommendations in the cancer pain therapy, their acquisition and utilization in everyday practice through interactive workshops with case studies because there is still an alarming lack of knowledge, level of prejudice and apparent opiophobia.

scholarly journals ‘Was it worth it?’ Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers

2017 ◽  
Vol 32 (1) ◽  
pp. 287-293
Author(s):  
Nishi Patel ◽  
Melanie Huddart ◽  
Helen Makins ◽  
Theresa Mitchell ◽  
Jane L Gibbins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Drug Delivery ◽  
Palliative Care ◽  
Side Effects ◽  
Cancer Pain ◽  
Family Carers ◽  
Incurable Cancer ◽  
Intrathecal Drug Delivery ◽  
The Individual

Background: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. Aim: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer. Design: Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres. Setting: A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded. Results: In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal – relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best – an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? – the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life. Conclusion: Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals ‘to be themselves’. Under these circumstances, the carers judged significant side effects to be acceptable.

DYNAMIC AND COMPETENCE ASPECTS OF THE MEDIA EDUCATIONAL CONCEPT OF DEVELOPING A PERSON’S READINESS FOR LIFELONG SELF-EDUCATION

2019 ◽  
pp. 23-33
Author(s):  
S. V. Akmanova ◽  
L. V. Kurzaeva ◽  
N. A. Kopylova
Keyword(s):  
Informal Education ◽  
Great Influence ◽  
Formal Training ◽  
Life Stages ◽  
Media Technologies ◽  
Educational Concept ◽  
The Media ◽  
The Individual ◽  
Competence Models ◽  
Scientific Achievements

The harmonious existence of the individual in the modern informational era, which is overly saturated with rapidly developing media technologies, is almost impossible without the developed readiness of the individual for lifelong continuous self-education. The formation and development of this readiness can begin during the formal training at the stage of higher education of the person and continue during informal education throughout his future life. Stages of socialization and professionalization of the person have a great influence on the level nature of this readiness. Based on scientific achievements in the field of self-education of university students, national and world media education, we developed dynamic and competence models of media educational concept of developing a person’s readiness for lifelong self-education. The concept demonstrates interconnection of these two models, as well as consistency with the previously developed normative model of developing this readiness.

scholarly journals POS1391 MEASURING SUBCLINICAL INFLAMMATION IN HAND AND FOREFOOT IN PATIENTS WITH ARTHRALGIA USING 1.5T OR 3.0T MRI: DOES FIELD STRENGTH MATTER?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 978.1-978
Author(s):  
D. Krijbolder ◽  
M. Verstappen ◽  
F. Wouters ◽  
L. R. Lard ◽  
P. D. De Buck ◽  
...  
Keyword(s):  
Field Strength ◽  
Scientific Evidence ◽  
Correlation Coefficients ◽  
Daily Practice ◽  
Scientific Data ◽  
Imaging Features ◽  
Subclinical Inflammation ◽  
The Individual ◽  
3.0T Mri ◽  
Inflammation Score

Background:Magnetic resonance imaging (MRI) of small joints sensitively detects inflammation. MRI-detected subclinical inflammation, and tenosynovitis in particular, has been shown predictive for RA development in patients with arthralgia. These scientific data are mostly acquired on 1.0T-1.5T MRI scanners. However, 3.0T MRI is nowadays increasingly used in practice. Evidence on the comparability of these field strengths is scarce and it has never been studied in arthralgia where subclinical inflammation is subtle. Moreover, comparisons never included tenosynovitis, which is, of all imaging features, the strongest predictor for progression to RA.Objectives:To determine if there is a difference between 1.5T and 3.0T MRI in detecting subclinical inflammation in arthralgia patients.Methods:2968 locations (joints, bones or tendon sheaths) in hands and forefeet of 28 arthralgia patients were imaged on both 1.5T and 3.0T MRI. Two independent readers scored for erosions, osteitis, synovitis (according to RAMRIS) and tenosynovitis (as described by Haavaardsholm et al.). Scores were also summed as total inflammation (osteitis, synovitis and tenosynovitis) and total RAMRIS (erosions, osteitis, synovitis and tenosynovitis) scores. Interreader reliability (comparing both readers) and field strength agreement (comparing 1.5T and 3.0T) was assessed with interclass correlation coefficients (ICCs). Next, field strength agreement was assessed after dichotomization into presence or absence of inflammation. Analyses were performed on patient- and location-level.Results:ICCs between readers were excellent (>0.90). Comparing 1.5 and 3.0T revealed excellent ICCs of 0.90 (95% confidence interval 0.78-0.95) for the total inflammation score and 0.90 (0.78-0.95) for the total RAMRIS score. ICCs for individual inflammation features were: tenosynovitis: 0.87 (0.74-0.94), synovitis 0.65 (0.24-0.84) and osteitis 0.96 (0.91-0.98). The field strength agreement on dichotomized scores was 83% for the total inflammation score and 89% for the total RAMRIS score. Of the individual features, agreement for tenosynovitis was the highest (89%). Analyses on location- level showed similar results.Conclusion:Agreement of subclinical inflammation scores on 1.5T and 3.0T were good to excellent, in particular for tenosynovitis. This suggests that scientific evidence on predictive power of MRI in arthralgia patients, obtained on 1.5T, can be generalized to 3.0T when this field strength would be used for diagnostic purposes in daily practice.Disclosure of Interests:None declared

Symptoms and side effects in chronic non-cancer pain patients: clinical implications and development of new assessment tools

2015 ◽  
Vol 59 (8) ◽  
pp. 1060-1067
Author(s):  
T. S. Olsen ◽  
T. Jonsson ◽  
J. Højsted ◽  
P. Sjøgren ◽  
L. Christrup
Keyword(s):  
Side Effects ◽  
Cancer Pain ◽  
Assessment Tools ◽  
Clinical Implications ◽  
Pain Patients

scholarly journals Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

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.

scholarly journals Complications after Intrathecal Drug Delivery Due to the Underlying Malignancy in Two Patients with Intractable Cancer Pain

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. E107-E111
Author(s):  
Thomas Chai
Keyword(s):  
Drug Delivery ◽  
Side Effects ◽  
Cancer Pain ◽  
Systemic Absorption ◽  
Pain Patient ◽  
Drug Side Effects ◽  
Intrathecal Drug Delivery ◽  
Underlying Malignancy ◽  
History Of ◽  
Intractable Cancer Pain

Intrathecal drug delivery is a mode of analgesic delivery that can be considered in those experiencing both refractory pain and excessive side effects from opioid and adjuvant analgesic use. Delivery of analgesic agents directly to the cerebral spinal fluid allows binding of the drug to receptors at the spinal level. Therefore, a reduced analgesic dosage can be afforded, resulting in reduction of drug side effects due to decreased systemic absorption. Drug delivery into the intrathecal space provides this benefit, yet it does not eliminate the possibility of drug side effects or risks of complications. Complications from this route of administration may be seen in the perioperative period or beyond, including infection, inflammatory mass, bleeding, and catheter or pump dysfunction, among others. This may manifest as new/worsening pain or as a neurologic deficit, such as a sensorimotor change and bladder/bowel dysfunction. Urgent evaluation with a detailed physical examination, device interrogation, and other workup including imaging is called for if symptoms suspicious for device-related problems arise. For the cancer pain patient, the underlying malignancy should also be considered as a potential cause for these new symptoms after intrathecal system implantation. We present 2 such cases of complications in the cancer pain patient after intrathecal drug delivery due to progression of the underlying malignant process rather than to surgical or device-related problems. The first patient had a history of metastatic osteosarcoma who, shortly after undergoing an intrathecal drug delivery trial with external pump, presented with new symptoms of both pain and neurologic changes. The second patient with a history of chondrosarcoma developed new symptoms of pain and sensorimotor change several days after intrathecal drug delivery system implantation. Key words: Intrathecal analgesia, intrathecal drug delivery, perioperative complications, cancer pain, malignant pain, pain pump

scholarly journals A study on cancer pain and sleep parameters of cancer patıents: Hydromorphone Hydrochloride

2017 ◽  
Vol 14 (4) ◽  
pp. 4149
Author(s):  
Hayriye Baltaoğlu Alp
Keyword(s):  
Respiratory Failure ◽  
Side Effects ◽  
Cancer Pain ◽  
Sleep Disorder ◽  
Cancer Patients ◽  
Shortness Of Breath ◽  
Sleep Parameters

The ratio of painless sleep was 80% in our study.26 (52%) of the patients showed no side effects, while 10 (20%) had nausea and 6 (12%) had constipation. 8 (16%) of the patients were found to have other side effects. The frequency of those side effects was nausea, constipation, dizziness, vomiting, respiratory failure and diarrhea respectively.[table 4]Hydromorphone hydrochloride helped to eliminate sleep disorder, shortness of breath and snoring and relatively improved amount of sleep and adequacy of sleep. It was found that 90% of our patients were able to fall asleep in 1-5 minutes; however 82% did not have enough amount of sleep. 78% of patients had no feeling of dizziness during the day; 82% did not have shortness of breath; 80% reported that they slept without pain, while 41% reported that they did not sleep at all.

scholarly journals The right of the stronger: The play Sisyphus and critias

Balcanica ◽  
2004 ◽  
pp. 51-70
Author(s):  
Ivan Jordovic
Keyword(s):  
Great Influence ◽  
Negative Influence ◽  
Human Society ◽  
Law And Order ◽  
Family Ties ◽  
The Third ◽  
The Individual ◽  
The Right ◽  
Constant Interest

The Focus of this study is the standpoint of the play Sisyphus and critias the leader of the thirty towards the right of the stronger. this is a question of constant interest in scientific circles, since its answer can serve as the indicator of the influence this famous theory has had. this interest has been encouraged by the fact that critias? authorship of the play is questionable. however, the question of the author is not of primary importance for this article, because there are some arguments, among some well known ones, which were not considered and which Show that in this satire, regardless of the author and the purpose of this fragment, the right of the stronger is actually non-existant. the first argument to support this theory is that nomosphysis antithesis is nowhere explicitly mentioned although it is the crucial element of the right of the stronger. in addition there is no claim in the play that the exploitation of the strong by the week or by law accrued. the second argument is that despite the incapability of laws to prevent the secret injustice, they and their importance for the human society are depicted in a positive light. it should also be noted that, unlike callicles and glaucon, laws are created to stop the bad and not the good. the third argument is that the invention of religion is accepted as a positive achievement, which finally enables the overcoming of primeval times and lawlessness. the reflection of this argument is a positive characterization of the individual who invented the fear of gods. the fourth argument, which has not been taken into consideration so far is the way the supporters and opponents of lawlessness are described and marked as ????? and ?????? in the satire only physically strong are considered as strong as opposed to callicles, where they are also spiritually superior. intelectually superior in Sisyphus is the inventor of the fear of gods who is also in favor of law and order. the fact that the strong are described as kako? while the supporter of law are recognized as ?????? is also of great importance. in other words, this division re?ects strong influence of aristocratic set of values by which the ?????? are in every way superior to the ?????. some other indications Show that critias cannot be listed as a advocate of the right of the stronger regardless of our previous conclusion about the play. we need to bear in mind the fact that critias has only recently been linked with the theory of the right of the stronger. in the classical period there had been non attempt to explain his ruthless politics in Athens 404/403 BC by Means of the right of the stronger. what is more, no indication that he supported this theory were found. unlike xenophon and philostratus, it is very likely that Plato and Aristotle were mild to critias Due to his family ties with Plato and his friendship with Socrates. however, all the four of them would have stated that critias was an upholder of the right of the stronger if he had actually been that. that way Socrates would have been completely acquitted of the responsibility for the crimes critias had committed, because of the possible assertion that critias was misled by this theory and succumbed to the negative influence of the sophistic teachings. based on these arguments we can conclude that there is no trace of the right of the stronger in the play Sisyphus and that critias did not support this theory. this satirical play and critias were Most probably under a great influence of aristocratic beliefs, which were often scientifically misinterpreted as the reflection of the right of the stronger.

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