Russell Portenoy

..With a detailed assessment, clinicians should be able to choose among the large and diverse group of options available and implement an approach, or combination of approaches, that have a high probability of improving analgesic outcomes...

..In this short-term study, FPNS was safe, well tolerated, and rapidly efficacious for BTCP...

..To evaluate the outcomes associated with the use of controlled-release (CR) oxycodone for up to 3 years in the treatment of noncancer pain...

..These findings will assist clinicians in assessing and managing this type of pain...

..In a hospice population, survival is influenced by complex factors, many of which may not be measurable. Based on these findings, concern about hastening death does not justify withholding opioid therapy...

..This double-blind, randomized, placebo-controlled study evaluated the efficacy, safety, and tolerability of FBT in opioid-treated patients with cancer-related BTP...

..FBT was evaluated for BTP in opioid-treated patients with chronic low back pain--the first such study in a population with chronic non-cancer pain...

..A second multicenter study evaluated reliability and validity. Patients (N = 308) treated by pain specialists completed ID Pain and validation measures...

..Our experience highlights an expanding scope of practice in the use of IT opioids in general and fentanyl specifically and suggests that high-dose fentanyl can be used safely in highly selected patients...

..OTFC is effective for breakthrough pain and could be particularly useful in patients with mucositis...

..Little is known about the prevalence and characteristics of chronic pain among patients with different types of chemical dependency...

..Very few studies have evaluated BTP in populations with chronic noncancer pain. Data that illuminate the impact of BTP may not generalize to other, less selected patient populations...

..The objective of this study was to describe the epidemiology of pain in this population. This information is needed to identify and address unmet clinical needs for culturally relevant interventions targeting pain and its consequences...

..However, a larger study sample will need to be investigated to determine efficacy in this type of delivery system for cancer pain relief in this population of patients undergoing radiation treatment for head and neck cancers...

..This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions...

..Approximately 30% of patients with multiple sclerosis (MS) have central pain (CP). The anticonvulsant lamotrigine has been shown to be efficacious in some types of CP, but its efficacy in MS-related CP has not been confirmed...

..e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia...

..In conclusion, methylnaltrexone relieved opioid-induced constipation at doses >or=5mg in patients with advanced illness, and did not reduce analgesia or cause opioid withdrawal symptoms...

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..Studies in noncancer populations are limited to surveys of pain clinics and patients with other advanced diseases. To better understand BTP, data are needed from less selected populations...

..This study provides the basis for the design of future placebo-controlled studies of l-carnitine supplementation for cancer-related fatigue...

..The location of pain management practices largely corresponds to census data, with the exception of underrepresentation in rural areas...

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..The pharmacodynamic implications of this profile deserve further study...

..Treatment of substance abusers with pain requires skills that complement best practices in opioid prescribing. Better approaches to the long-term treatment of these populations are needed...

..Research is needed to evaluate the phenomenology of pain and addiction in this population and the outcomes associated with varied therapeutic strategies...

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..to assess the long-term safety, tolerability, and consistency of effect of fentanyl pectin nasal spray (FPNS) in patients with breakthrough cancer pain (BTCP)...

..Further study of this systems-oriented approach to change is warranted and should include direct assessment of patient and family outcomes, as well as measures of process...

..Race and ethnicity were not independently associated with severe pain, but both minorities were more likely to possess the socioeconomic and educational characteristics that were associated...

..A national telephone survey suggests that race and ethnicity, along with other demographic and socioeconomic factors, influence access to care for chronic pain...

..To evaluate the prevalence, characteristics, and correlates of chronic pain in a population of predominantly employed, alcoholic patients attending an outpatient drug and alcohol treatment program...

..Review of these issues informs the use of opioid rotation in the clinical setting and defines key areas for future research...

..Significant dose response was observed in males on methadone <12 months (rho=0.60, P=0.02). Our study suggests that methadone may prolong the QTc interval in specific subpopulations but poses little risk of serious prolongation...

..Symptomatic interventions include specific drug treatment, modification of activity, exercise, and cognitive therapies...

..005; female caregivers, P=0.035). These results support the validity of the BASC as a brief instrument for caregiver burden...

..CONCLUSIONS: In this 6-week trial, CR oxycodone was effective for the treatment of moderate to severe pain due to diabetic neuropathy. Adverse events were typical of opioid-related side effects...

..Controlled longitudinal studies are required to further evaluate the use of ER hydromorphone in patients with discrete chronic malignant or nonmalignant pain conditions...

..Systematic symptom assessment may be useful in future epidemiological studies of symptoms and in cancer chemotherapy drug trials...

..During long-term treatment, this assessment should focus on a broad range of outcomes, each of which should be documented in the medical record...

..Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed...

..Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs examining treatment of central NP are lacking and should be a priority for future research...

..Myths and misinformation about pain and its management often lead to poor therapy for patients in pain. Nine common myths about pain and its management are described and refuted...

..Based on the best available evidence and expert opinion, consensus recommendations were developed in all these areas. The panel's conclusions may provide a foundation for clinical practice and a rational basis for new research...

..A focus on ameliorating prevalent physical symptoms and psychological distress, along with supportive measures that promote functional mobility, may lead to an improvement in the overall quality of life in this patient population...