Pain in ovarian cancer patients. Prevalence, characteristics, and associated symptoms.

Background: The prevalence, characteristics, and impact of pain and other symptoms have not been studied systematically in women with ovarian cancer. Anecdotally, pain has been associated with the onset of the disease and is a common problem among those with advanced cancer; symptoms other than pain appear to be highly prevalent. Given the profound influence of pain and other symptoms on quality of life, the evaluation of these phenomena could provide data relevant to the clinical management of these patients and advance quality of life research in the area of symptom assessment.

Symptom prevalence, characteristics and distress in a cancer population.

Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and outpatients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 evaluable patients was 55.

Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms: a combined analysis of controlled, single-dose studies.

We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAR) score.

Subcutaneous opioid infusions at home.

The ability to provide subcutaneous infusions in the home has had a major impact on patient care. The main indication for this approach in the cancer population is the need for prolonged parenteral administration of an opioid drug. Successful administration begins with proactive consideration of patient selection; choice of pump, drug, mode of infusion, and dosing schedule; the resources of the family and community health-care system; and cost and insurance coverage.

Management of common opioid side effects during long-term therapy of cancer pain.

For most patients with cancer pain, the primary goal of opioid pharmacotherapy is a satisfactory balance between analgesia and side effects. Consequently, the assessment and treatment of opioid side effects is a fundamental aspect of therapy, which may increase the likelihood of a favourable treatment outcome, potentially allow higher and more efficacious opioid doses, and improve quality of life by reducing other uncomfortable symptoms. This review describes the presentation, assessment and management of adverse neuropsychological and gastrointestinal effects due to opioid drugs.

Tolerance to opioid analgesics: clinical aspects.

Tolerance is a complex phenomenon with important therapeutic implications. Understanding of its clinical aspects has been hampered by inadequate communication between clinicians, who have acquired striking observations relevant to the stability of the dose-response relationship in patients with pain, and investigators who have extensively studied animal models or drug effects in former addicts. In the clinical setting, it is now clear that the loss of analgesic effects over time has a differential diagnosis, only one component of which is tolerance.

Delirium as a contributing factor to "crescendo" pain: three case reports.

Cancer patients occasionally experience periods of rapidly escalating pain--"crescendo" pain--that may present a challenge in assessment and management. Although these episodes are often associated with progressive neoplasm, any of a variety of other processes may be involved. Delirium is a potentially treatable and frequently unrecognized factor.

The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.

The Memorial Symptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life.

Cancer pain management. Current strategy.

Pain is among the most prevalent symptoms experienced by cancer patients. A strategy for the management of cancer pain is now widely accepted, and when well implemented, is usually effective. Unfortunately, many oncologists are ill-prepared for the task of pain assessment and management, and the outcomes achieved in clinical practice are often suboptimal.

Cancer pain management.

Pain can be adequately relieved in most cancer patients through the application of widely accepted management approaches. Current therapeutic guidelines emphasize ongoing patient assessment and optimal pharmacotherapy with opioid and nonopioid analgesics.

Evaluation of back pain caused by epidural neoplasm.

Back pain is a common symptom in the cancer population. For some patients, the complaint reflects a process independent of the underlying disease, such as myofascial pain, discogenic disease, or osteoporosis. Many patients, however, experience pain as the first indication of a spinal neoplasm, and this possibility increases the diagnostic challenge.

Pharmacotherapy of Cancer PainA Practical Guide.

Chronic pain is experienced by approximately one-third of all cancer patients and as many as 70 to 90% of those with advanced disease.1 Although established pharmacotherapeutic strategies have been demonstrated to benefit most patients, undertreatment remains common.1 This unacceptable situation must be remedied; relief of cancer pain is an ethical imperative and it is incumbent upon clinicians to maximize the knowledge, skill, and diligence needed to attend to this task.

Transdermal fentanyl for cancer pain. Repeated dose pharmacokinetics.

Background: The transdermal therapeutic system (fentanyl), or TTS(fentanyl), continuously delivers fentanyl for up to 72 h. The transdermal therapeutic system (fentanyl)-100 delivers approximately 100 micrograms/h. The repeated dose pharmacokinetics of this drug using the recommended dosing interval have not been evaluated previously and were determined in the present study.

A novel morphine sulphate preparation: clinical trial of a controlled-release morphine suspension in cancer pain.

In order to determine the efficacy of a novel controlled-release morphine suspension, we performed two prospective sequential open-label studies in patients with pain due to cancer. The studies were identical except for the duration of treatment (three days and 30 days respectively). Sixty-nine patients with a variety of advanced cancers and associated pain participated.

Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy.

The authors retrospectively reviewed 50 episodes of spinal epidural tumor that occurred in 42 patients with metastatic prostate cancer and were treated with external-beam radiation. Treatment response was evaluated in terms of symptoms, neurologic status, and, in most cases, reduction of tumor on repeat myelography. At the completion of therapy, 92% of treated patients experienced pain relief and 67% had significant to complete improvement on neurologic examination.