Pain control in the continuity of care.

As cancer is earlier diagnosed and its treatments improve, palliative care is increasingly playing a vital role in the oncology population. The concept and the timing of application of palliative care have evolved in the last decades. The WHO pain ladder and the greater understanding of appropriate multimodal pain control treatments have dramatically improved the management of cancer pain. Integration of palliative care, which appears crucial for a proper management of patients, can be defined as the provision of palliative care both during curative cancer treatment and after curative treatment has ceased. Clinical assistance should be delivered by specialized physicians in different fields, psychologists and nurses, and should include all aspects of advanced cancer care, from diagnosis to the treatment of symptoms. A further aspect of integration of palliative care concerns the role of the continuity of care in acute or emergency contexts both for out- and inpatients. Further improvements in the management of cancer pain are needed. First, the WHO ladder should be modified with further steps, like those of interventional pain control procedures and techniques, with the aim of being effective also for the small proportion of nonresponsive patients. Second, more research is needed to find out which interventions aiming to improve continuity of care of cancer patients are beneficial to improve patient, provider and process of care outcomes and to identify which outcomes are the most sensitive to change. Of crucial importance would be the development of a standardised instrument to measure the continuity of care in cancer patients. This article is a brief overview on the management of cancer pain, from the pharmacological treatments reported by WHO ladder, to the need for integration and continuity of care

Il braekthrough pain (Dolore Episodico Intenso) - un case report

Il braekthrough pain (Dolore Episodico Intenso) - un case report; il trattamento del DEI in una paziente oncologica

Staging patients with chronic Low Back Pain: a first step in stratified pain treatment.

Abstract Background: The Mainz Pain Staging System (MPSS) is a multi-dimensional measure of pain chronicity stage (I-III). Staging Low Back Pain (LBP) patients may contribute for outcome prediction and may allow patients and professionals to formulate a management plan and to identify referral patients for pain treatment facilities. Aims: to analyze the characteristics of LBP patients at different chronicity-stage and to verify whether the MPSS stage may predict their outcome. Methods: we enrolled consecutive n=242 patients with LBP who were followed for ~60 days at 20 days interval being T1 the admission day and T4 the 60th day after admission. The MPSS was administered at T1 while the BPI from T1 to T4. Measures for analysis were patients' demographics, MPSS stage and BPI item scores. \uf0632 analysis was used to assess associations between chronicity and independent variables; T-student test was used for BPI scores comparisons. Results: MPSS stage (I-III) proportions were: 7,9%, 41,3% and 50,8%, respectively. Statistically significant associations were found between MPSS-III stage and females; and, between MPSS-I and young adults and tall patients. Among MPSS-II/III patients, pain interference with most Quality of Life items significantly decreased over time while some scores of pain intensity in the past 24h significantly decreased only among MPSS-I/II patients. Conclusions: caregiver may expect poor pain relief among LBP MPSS-III patients. However, continuous multidisciplinary approach significantly improves these patient's quality of life. Outcome prediction using the MPSS may have wide implications for public health initiatives through identifying risk for poor prognosis and screening referral patients