- Email: [email protected]
Pain in far advanced acquired immunodeficiency syndrome (AIDS)
Journal
of Pain and Symptom Management
4.5
46
A PAEDIATRIC PAIN CLINIC: HOWIT FMCTIONS, A REVIEW OF ONE
PAIN IN (AIDS).
YEAR. E. PICHARD,
94800 Villejuif
A. GAUVAIN-PIQUARD. - France.
Institut
Gustave-Roussy,
This paediatric clinic was founded in January 1987 in an oncology hospital. It is quite singular in its structure, its functioning its patient recruitment and its methods (assessment, treatment, follow-up). The analysis covers the year 1987. I. ORGANIZATION, PATIENTS and METHODS A spacious consulting room is situated in the paediatric department between the day hospital and the wards. The pain team consists of 3 doctors, 1 nurse and a secretary. The oncologist presents the case of the child at the first consultation. The consultation is on a weekly basis, but children are also followed up in the wards and the case-sheet brought up to date. II.
RESULTS In 1987 72 children, with a srean aged 6 year3 (14 days to 18 years), were followed by the pain clinic. All except one had malignant tumours. Pain was related to metaatases or terminal illness in 721 of casea, to sequelae of treatment in 19.4% and to chemotherapy in 8.3%. 2/3 of the children received narcotic analgesics no matter what the stage of their illness, iF pain rendered this necessary. 113 deceased.
III.
CONCLUSION This type of unit makes the of pain in children and helps to It alhWs us to assume more fully terminal stage and to assess the are clinically effective in such
paediatric treat
it
case team aware more
effectively.
the case of patients doses of analgesics circumstances.
in the which
Vol. 3 No. 3 Sttmmt~ 1988
FAR ADVANCE0 ACQUIRED Il3’li-iNODEFICIENCY SYNDROl’lE Jerome Schofferman, M.D. Hospice of San Francisco. San Francisco. CA, USA. There is abundant information about the incidence, diagnosis, and treatment options for each of the specific problems that comprise AIDS. However little information is available about the frequency, causes, and treatment of pain in AIDS. Pain management is important during active treatment as well as in far advanced disease. Pain in AIDS may bedue to reversible or irreversible causes. Because of the high incidence of dementia, decisions must be considered early and knowledge of possible pain syndromes helps. In order to define the incidence of pain in far advanced AIDS, we are conducting a prospective survey of 100 consecutive patients admitted to our Hospice Program with AIDS. The results of the first 56 are presented. Significant pain was present in 29 patients (52%). There were 38 separate pains. Pain was due to peripheral neuropathy in 10 and was usually controlled with low dose amitriptyline, with or without narcotics. Headache without reversible cause was seen in 9 patients (14%) and proved to be the most difficult pain to treat. Three patients had headache and peripheral neuropathy. Abdominal pain was present in 7 patients and was due to adenopathy, ascites, intestinal infection or neoplasm. Often the cause was unknown. Other sites of pain were chest, joints, muscles, rectum, skin (Kaposi's Sarcoma or pressure sores), and oropharynx. Several pains were not related to AIDS. Whether to attempt to diagnose and treat the specific cause of pain must be based on the stage of illness, risk: benefit ratio, and the wishes of the patient. The presentation will focus on the causes and treatment of reversible and irreversible pain in all stages of AIDS.
47
48
IMPROVINGCANCERPAIN MANAGEUENT BY A PHAPMAC IST/ONCOLOGY NURSETEAM IN A COMMUNITYAOSPITAL. S.L. Lo, Pharm. D., Peninsula Hospital, Burlingame, CA 94010 USA
EMPLOYMENT AND INSURANCE ISSUES FOR CANCER SURVIVORS. D Mashberg, BSN, HA, L Jones, M.D., and L Lesko, M.D., Ph.D. Psychiatry Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Survival rates for acute leukemia patients have improved. There is a scarcity of data concerning these young adult patients in the work environment. Based on the work and cancer health histories of white collar, blue collar, and youths (Feldman, 1976; 1978; t9801, it was anticipated that cancer survivors would report employment and insurance discrimination. Seventy acute leukemia survivors who were one year or more post treatment; 15-40 years of age at time of diagnosis, received their diagnosis and treatment, at Memorial Sloan-Kettering Cancer Center were eligible for participation. Fifty-two (74%) agreed to participate. Preliminary findings from a pilot study revealed that acute leukemia survivors reported a minimal amount of job insurance discrimination. However, since the 24 item questiosma(re addressed employment and insurance issues on a global level, it was necessary to construct a second questionnaire that was a more sensitive The second face valid questionnaire included instrWnent. the areas of: employer’s attitudes, co-workers’ attitties, self-perceptions of cancer survivors, school personnels’ attitudes, and health and 1Ife insurance i ssues. It was anticipated that the second questionnaire would be more sensitive than the one utilized for the pilot study. Responses of 52 survivors to the second questionnaire revealed the following salient findings the major employment concerns were: loss of job, loss of health insurance. and decrease in insurance coverage. Thirty-eight percent reported health insurance problems and War&y-six percent reported life insurance problems. Possible interventions will be presented and discussed.
Prior to 1986, most cancer patient3 at our hospital with chronic pain were routinely prescribed a variety of narcotic analgesics, often in irrational combinations and at inappropriate doses and dosing intervals, without adequate relief. In early 1986, the author and our Oncology Nurse Specialist started an informal program to improve pain oontrol for these patients. Our goal ha.3 been to promote the appropriate use of narcotic analgesics and thus optimize pain c0ntrol. Beginning with a detailed patiene and family interview, we obtain a pain history, history of narcotic analgesic usage, and &e$ree of relief for each patient. We then formulate ah individual pain control program using an equianalgesic table. We use oral mxpbine sulfate solution as the narcotic analgesic of choice unless the patient has a dot-ted allergy. We divide the dose into an every four hours around the clock schedule w2th coverage for breakthrough pain. We camnuaioate our recoreaan dations to the physician, and docwent them in the patient's chart. After the program is implemented, reassessments are made every 24 hours and dose adjusted if maceseary until pain control is achieved. Weekend and holiday coverage is provided.@ either tears member, and oareful records are kept to insure continuity of 'ware on rerdarissions. Initially, many physicians were reluctant to accept our recwmsfmdations or to ask the "team" for assistance. However, our perseverance , availability, and considerable eucces* in pain management slowly won over a small number of physicians. Since that time. most physicians accept our service and recouaaendations, and some give us total responsibility for pain management of their patients.
of Pain and Symptom Management
4.5
46
A PAEDIATRIC PAIN CLINIC: HOWIT FMCTIONS, A REVIEW OF ONE
PAIN IN (AIDS).
YEAR. E. PICHARD,
94800 Villejuif
A. GAUVAIN-PIQUARD. - France.
Institut
Gustave-Roussy,
This paediatric clinic was founded in January 1987 in an oncology hospital. It is quite singular in its structure, its functioning its patient recruitment and its methods (assessment, treatment, follow-up). The analysis covers the year 1987. I. ORGANIZATION, PATIENTS and METHODS A spacious consulting room is situated in the paediatric department between the day hospital and the wards. The pain team consists of 3 doctors, 1 nurse and a secretary. The oncologist presents the case of the child at the first consultation. The consultation is on a weekly basis, but children are also followed up in the wards and the case-sheet brought up to date. II.
RESULTS In 1987 72 children, with a srean aged 6 year3 (14 days to 18 years), were followed by the pain clinic. All except one had malignant tumours. Pain was related to metaatases or terminal illness in 721 of casea, to sequelae of treatment in 19.4% and to chemotherapy in 8.3%. 2/3 of the children received narcotic analgesics no matter what the stage of their illness, iF pain rendered this necessary. 113 deceased.
III.
CONCLUSION This type of unit makes the of pain in children and helps to It alhWs us to assume more fully terminal stage and to assess the are clinically effective in such
paediatric treat
it
case team aware more
effectively.
the case of patients doses of analgesics circumstances.
in the which
Vol. 3 No. 3 Sttmmt~ 1988
FAR ADVANCE0 ACQUIRED Il3’li-iNODEFICIENCY SYNDROl’lE Jerome Schofferman, M.D. Hospice of San Francisco. San Francisco. CA, USA. There is abundant information about the incidence, diagnosis, and treatment options for each of the specific problems that comprise AIDS. However little information is available about the frequency, causes, and treatment of pain in AIDS. Pain management is important during active treatment as well as in far advanced disease. Pain in AIDS may bedue to reversible or irreversible causes. Because of the high incidence of dementia, decisions must be considered early and knowledge of possible pain syndromes helps. In order to define the incidence of pain in far advanced AIDS, we are conducting a prospective survey of 100 consecutive patients admitted to our Hospice Program with AIDS. The results of the first 56 are presented. Significant pain was present in 29 patients (52%). There were 38 separate pains. Pain was due to peripheral neuropathy in 10 and was usually controlled with low dose amitriptyline, with or without narcotics. Headache without reversible cause was seen in 9 patients (14%) and proved to be the most difficult pain to treat. Three patients had headache and peripheral neuropathy. Abdominal pain was present in 7 patients and was due to adenopathy, ascites, intestinal infection or neoplasm. Often the cause was unknown. Other sites of pain were chest, joints, muscles, rectum, skin (Kaposi's Sarcoma or pressure sores), and oropharynx. Several pains were not related to AIDS. Whether to attempt to diagnose and treat the specific cause of pain must be based on the stage of illness, risk: benefit ratio, and the wishes of the patient. The presentation will focus on the causes and treatment of reversible and irreversible pain in all stages of AIDS.
47
48
IMPROVINGCANCERPAIN MANAGEUENT BY A PHAPMAC IST/ONCOLOGY NURSETEAM IN A COMMUNITYAOSPITAL. S.L. Lo, Pharm. D., Peninsula Hospital, Burlingame, CA 94010 USA
EMPLOYMENT AND INSURANCE ISSUES FOR CANCER SURVIVORS. D Mashberg, BSN, HA, L Jones, M.D., and L Lesko, M.D., Ph.D. Psychiatry Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Survival rates for acute leukemia patients have improved. There is a scarcity of data concerning these young adult patients in the work environment. Based on the work and cancer health histories of white collar, blue collar, and youths (Feldman, 1976; 1978; t9801, it was anticipated that cancer survivors would report employment and insurance discrimination. Seventy acute leukemia survivors who were one year or more post treatment; 15-40 years of age at time of diagnosis, received their diagnosis and treatment, at Memorial Sloan-Kettering Cancer Center were eligible for participation. Fifty-two (74%) agreed to participate. Preliminary findings from a pilot study revealed that acute leukemia survivors reported a minimal amount of job insurance discrimination. However, since the 24 item questiosma(re addressed employment and insurance issues on a global level, it was necessary to construct a second questionnaire that was a more sensitive The second face valid questionnaire included instrWnent. the areas of: employer’s attitudes, co-workers’ attitties, self-perceptions of cancer survivors, school personnels’ attitudes, and health and 1Ife insurance i ssues. It was anticipated that the second questionnaire would be more sensitive than the one utilized for the pilot study. Responses of 52 survivors to the second questionnaire revealed the following salient findings the major employment concerns were: loss of job, loss of health insurance. and decrease in insurance coverage. Thirty-eight percent reported health insurance problems and War&y-six percent reported life insurance problems. Possible interventions will be presented and discussed.
Prior to 1986, most cancer patient3 at our hospital with chronic pain were routinely prescribed a variety of narcotic analgesics, often in irrational combinations and at inappropriate doses and dosing intervals, without adequate relief. In early 1986, the author and our Oncology Nurse Specialist started an informal program to improve pain oontrol for these patients. Our goal ha.3 been to promote the appropriate use of narcotic analgesics and thus optimize pain c0ntrol. Beginning with a detailed patiene and family interview, we obtain a pain history, history of narcotic analgesic usage, and &e$ree of relief for each patient. We then formulate ah individual pain control program using an equianalgesic table. We use oral mxpbine sulfate solution as the narcotic analgesic of choice unless the patient has a dot-ted allergy. We divide the dose into an every four hours around the clock schedule w2th coverage for breakthrough pain. We camnuaioate our recoreaan dations to the physician, and docwent them in the patient's chart. After the program is implemented, reassessments are made every 24 hours and dose adjusted if maceseary until pain control is achieved. Weekend and holiday coverage is provided.@ either tears member, and oareful records are kept to insure continuity of 'ware on rerdarissions. Initially, many physicians were reluctant to accept our recwmsfmdations or to ask the "team" for assistance. However, our perseverance , availability, and considerable eucces* in pain management slowly won over a small number of physicians. Since that time. most physicians accept our service and recouaaendations, and some give us total responsibility for pain management of their patients.