Diagnosis and treatment of cancer breakthrough pain in opinions of physicians working in Outpatients’ Palliative Care Units and Pain Clinics

Breakthrough pain (BtP) is common among patients suffering from cancer pain. The experience, knowledge and education of palliative care physicians or pain management specialists seem to be essential for proper diagnosis and treatment of breakthrough pain. The purpose of this study was to determine the scope and assess the knowledge of physicians regarding BtP and its management. 135 physicians have participated in the study and completed special questionnaires for the period from April to July 2010. The vast majority of surveyed physicians (133 out of 135) declared that they diagnosed the BtP in their patients, usually 2 to 3 episodes a day. The time for the pain to become maximal, in the opinion of 73% of physicians, was usually between 5 to 30 minutes, the average duration of the breakthrough pain episode approximately was 15– –30 minutes. The vast majority of respondents prescribed pharmacological treatment to manage the BtP episodes, most commonly morphine, non-steroidal anti-inflammatory drugs, acetaminophen and tramadol.Breakthrough pain (BtP) is common among patients suffering from cancer pain. The experience, knowledge and education of palliative care physicians or pain management specialists seem to be essential for proper diagnosis and treatment of breakthrough pain. The purpose of this study was to determine the scope and assess the knowledge of physicians regarding BtP and its management. 135 physicians have participated in the study and completed special questionnaires for the period from April to July 2010. The vast majority of surveyed physicians (133 out of 135) declared that they diagnosed the BtP in their patients, usually 2 to 3 episodes a day. The time for the pain to become maximal, in the opinion of 73% of physicians, was usually between 5 to 30 minutes, the average duration of the breakthrough pain episode approximately was 15– –30 minutes. The vast majority of respondents prescribed pharmacological treatment to manage the BtP episodes, most commonly morphine, non-steroidal anti-inflammatory drugs, acetaminophen and tramadol

Breakthrough pain in patients with chronic cancer pain followed by palliative care and pain clinic physicians — an observational study

Background. Breakthrough pain (BtP) is common among patients suffering from cancer pain. The experience, knowledge and education of palliative care physicians or pain clinicans seems to be essential for proper diagnosis and treatment of breakthrough pain. Another key point is knowledge and behavior of patients suffering the breakthrough pain episodes. The aim of this study was to determine, whether patients suffering the cancer chronic pain are being informed by physicians working in palliative care outpatients and pain clinics about BtP occurrence and treatment, as well as how patients are utilizing the rescue medications. Material and methods. Six hundred seventy eight patients participated in the study. The common demographic (age, sex), disease-related, background pain (including mode and effectiveness of treatment) data were collected. The information about breakthrough pain occurrence, number of episodes, BtP management, frequency of rescue medications dosing and effectiveness of these medications were also collected. Results. Over 75% of them had been prescribed strong opioid and almost 25% of the patients — weak opioid. 58% had uncontrolled background pain. BtP was reported by 69,3% of these patients, most commonly one or two episodes per day. Only 3% of patients experienced more than 4 episodes a day. As a rescue medication patients usually used morphine, followed by nonsteroidal antiinflamatory drugs and paracetamol, but statistically not every time they experienced the BtP. Conclusion. This study confirmed that patients followed by palliative care outpatients and pain clinics receive information about background and breakthrough pain, and are well orientated in pain medications. The problem emerges in proper utilization of rescue medications, most commonly prescribed as oral. Adv. Pall. Med. 2011; 10, 1: 29–34Background. Breakthrough pain (BtP) is common among patients suffering from cancer pain. The experience, knowledge and education of palliative care physicians or pain clinicans seems to be essential for proper diagnosis and treatment of breakthrough pain. Another key point is knowledge and behavior of patients suffering the breakthrough pain episodes. The aim of this study was to determine, whether patients suffering the cancer chronic pain are being informed by physicians working in palliative care outpatients and pain clinics about BtP occurrence and treatment, as well as how patients are utilizing the rescue medications. Material and methods. Six hundred seventy eight patients participated in the study. The common demographic (age, sex), disease-related, background pain (including mode and effectiveness of treatment) data were collected. The information about breakthrough pain occurrence, number of episodes, BtP management, frequency of rescue medications dosing and effectiveness of these medications were also collected. Results. Over 75% of them had been prescribed strong opioid and almost 25% of the patients — weak opioid. 58% had uncontrolled background pain. BtP was reported by 69,3% of these patients, most commonly one or two episodes per day. Only 3% of patients experienced more than 4 episodes a day. As a rescue medication patients usually used morphine, followed by nonsteroidal antiinflamatory drugs and paracetamol, but statistically not every time they experienced the BtP. Conclusion. This study confirmed that patients followed by palliative care outpatients and pain clinics receive information about background and breakthrough pain, and are well orientated in pain medications. The problem emerges in proper utilization of rescue medications, most commonly prescribed as oral. Adv. Pall. Med. 2011; 10, 1: 29–3

Neuropsychiatric disorders in patient with end-of-life stage of cancer disease — a case report

Advanced cancer disease often results in many unpleasant physical and psychological symptoms. They may have an important impact on the patients’ quality of life. Acute psychotic disorders like cognitive failure, and delirium in particular, are quite common in patients referred to oncologists and palliative care units. Here we describe the case of a man, 63 years of age, with squamous cell lung cancer, treated for severe pain due to bone metastases, who developed cognitive failure and delirium. We discuss delirium, its diagnosis and treatment which may help the clinician to improve their skills. Adv. Pall. Med. 2010; 9, 1: 17–20Advanced cancer disease often results in many unpleasant physical and psychological symptoms. They may have an important impact on the patients’ quality of life. Acute psychotic disorders like cognitive failure, and delirium in particular, are quite common in patients referred to oncologists and palliative care units. Here we describe the case of a man, 63 years of age, with squamous cell lung cancer, treated for severe pain due to bone metastases, who developed cognitive failure and delirium. We discuss delirium, its diagnosis and treatment which may help the clinician to improve their skills. Adv. Pall. Med. 2010; 9, 1: 17–2

Przegląd narzędzi służących do oceny bólu neuropatycznego

Diagnoza i ocena bólu neuropatycznego u chorych na nowotwory powinna się opierać na szczegółowo zebranym wywiadzie, badaniu przedmiotowym, rysunku bólu, słownym opisie charakteru dolegliwości, kwestionariuszach/skalach oceny bólu, przeglądzie funkcji somatosensorycznych. W celu określenia pewności rozpoznania bólu neuropatycznego zaleca się stosowanie specyficznego, czterostopniowego systemu klasyfikacyjnego, w którym ocenia się obecność i neuroanatomiczną dystrybucję bólu oraz wiarygodnie potwierdza patologię układu nerwowego. Ostatnio opracowano kilka prostych narzędzi do szybkiej przesiewowej diagnostyki bólu neuropatycznego, a część z tych krótkich testów może być bardzo przydatna w przypadku pacjentów objętych opieką paliatywną. Właściwe rozpoznawanie i leczenie bólu neuropatycznego u chorych z nowotworami ciągle pozostaje ogromnym wyzwaniem. Może się to wiązać z kompleksowością zjawiska bólu u tych chorych, a także ciągle zbyt rzadko stosowanymi lekami adjuwantowymi do leczenia bólu neuropatycznego

„Adamie, gdzie jesteś?” Dialogiczna egzegeza Hugona ze św. Wiktora we fragmencie jego Super Ecclesiasten

This article contains a fragment of the Commentary on the Book of Kohelet by the master Hugh of St. Victor in Polish translation. In a short introduction, apart from a concise presentation of the work itself and the circumstances of its creation, the translator and, at the same time, the critical editor of this work, draws attention to the "dialogical" form of biblical exegesis, characteristic of the Victorine. The Super Ecclesiasten, being Hugh's last exegetical work, is the most perfect testimony to his manner of reading and explaining the Bible. The passus presented in the translation, based on the critical text currently in preparation, is a remarkable and excellent illustration of this.Artykuł zawiera fragment Komentarz do Księgi Koheleta mistrza Hugona ze św. Wiktora w przekładzie na język polski. W krótkim wstępie, poza zwięzłym przedstawieniem samego dzieła i okoliczności jego powstania, tłumacz, a zarazem wydawca krytyczny tego dzieła, zwraca uwagę na charakterystyczną dla Wiktoryna „dialogiczną” formę uprawiania egzegezy biblijnej. Super Ecclesiasten, będąc ostatnim egzegetycznym dziełem Hugona, stanowi najdoskonalsze świadectwo jego sposobu czytania i wyjaśniania Biblii. Prezentowany w przekładzie passus, oparty na będącym w przygotowaniu tekście krytycznym, jest tego wyjątkową i wyborną ilustracją

De Verbo Dei Hugona ze św. Wiktora. Wprowadzenie i przekład

The authors present the first Polish translation of the opusculum entitled De Verbo Dei, written by Hugh of St Victor (d. 1141). The writing is a valuable example of the medieval allegorical and tropological interpretation of the Bible. The exegesis of the Heb 4:12–5:2 gives rise to consideration of theological and philosophical topics such as unity of God’s Word, Hugh’s anthropology, human cognitive abilities and God’s knowledge. Hugh’s theological reflection embraces also issues such as the dialogue between God and man in the light of the doctrine of natura – gratia, Christ’s priesthood and duties of the prefecti Dei in the Church. The analysis of the treatise pertains also to Hugh’s language and its stylistic values.Niniejszy artykuł zawiera pierwszy przekład na język polski opusculum Hugona ze Św. Wiktora (zm. 1141) pt. De Verbo Dei, które stanowi cenny przykład średniowiecznej alegorycznej i tropologicznej metody interpretacji Biblii. Egzegeza Hbr 4,12–5,2, korzystająca z zasobów klasycznej sztuki retorycznej, pozwoliła Hugonowi na rozwinięcie takich filozoficznych i teologicznych wątków, jak: jedność Słowa Bożego, własna wizja antropologiczna, ludzkie możliwości poznawcze i wiedza Boga. Refleksja teologiczna dotyka także takich tematów, jak dialog, rozgrywający się między Bogiem a człowiekiem w świetle Hugonowej doktryny o naturze i łasce, kapłaństwo Chrystusa oraz obowiązki kapłanów i przełożonych w Kościele. Prócz wątków doktrynalnych przeanalizowano również środki językowe, służące wyrażeniu zamierzonych treści

Mangrove - Å utvikle en app for pengeinnsamling og reduksjon av karbonutslipp

To finalize our bachelor program at the Institute of Technology at Kristiania University College, we are doing our BAO300 bachelor assignment based on developing a solution for a real company, solving real issues and documenting our process, thoughts, research, and results. During the search for projects to work on we contacted Bouvet Norge AS about having our bachelor thesis with them. They presented a case about developing an application that improves the sales experience for the adults and kids in sports organizations that will be walking around door-to-door in order to sell trees to customers. The way they are supposed to do this is by having an app where the sports team members can do door-to-door sales by selling any amount of trees to anyone, rather than selling tickets or toilet paper

Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one

Neuropathic pain still present a major diagnostic and therapeutic challenge despite considerable progress in understanding of its mechanisms and publication of number of studies which assessed the efficacy and safety of drugs used in the symptomatic treatment. In practice, it is diagnosed less frequently than recognised in the epidemiological studies, and many patients do not achieve satisfactory outcomes of treatment. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on neuropathic pain, with special focus on the published international recommendations, and formulated recommendations on neuropathic pain diagnosis and treatment, in accordance with the principles of evidence-based medicine. The paper presents also background information on the neuropathic pain definition, epidemiology, pathomechanism and method of assessment. The diagnosis of neuropathic pain may be established based on medical history and physical examination including special assessment of the somatosensory system. First-line drugs used in pharmacological management of neuropathic pain are: tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin, opioids and lidocaine patches

Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part Two

Neuropathic pain may be caused by a variety of lesions or diseases of both the peripheral and central nervous system. The most common and best known syndromes of peripheral neuropathic pain are painful diabetic neuropathy, trigeminal and post-herpetic neuralgia, persistent post-operative and post-traumatic pain, complex regional pain syndrome, cancer-related neuropathic pain, HIV-related neuropathic pain and pain after amputation. The less common central pain comprises primarily central post-stroke pain, pain after spinal cord injury, central pain in Parkinson disease or in other neurodegenerative diseases, pain in syringomyelia and in multiple sclerosis. A multidisciplinary team of Polish experts, commissioned by the Polish Association for the Study of Pain and the Polish Neurological Society, has reviewed the literature on various types of neuropathic pain, with special focus on the available international guidelines, and has formulated recommendations on their diagnosis and treatment, in accordance with the principles of evidence-based medicine (EBM). High quality studies on the efficacy of various medicines and medical procedures in many neuropathic pain syndromes are scarce, which makes the recommendations less robust