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Biomedical subjects

Judith A Paice

Publications and source records attributed to Judith A Paice.

29 records · Page 2Linked to original sources
PubMed1992

Antinociception induced by electrical stimulation of spinally projecting noradrenergic neurons in the A7 catecholamine cell group of the rat.

Recent anatomical evidence indicates that the pontine A7 catecholamine cell group provides the major noradrenergic innervation of the spinal cord dorsal horn (laminae I-IV). The experiments described in this report were designed to determine if these neurons modulate nociception at the level of the spinal cord. To this end, the antinociceptive effect of electrical stimulation applied at various sites along several tracks through the dorsolateral pontine tegmentum was determined in lightly anesthetized rats. The latency of the withdrawal response of the hind feet to noxious radiant thermal stimulation applied to the dorsal surface was used as a measure of nociception. The results indicated that the most potent and consistent antinociception was produced at sites near the A7 cell group. In addition, intrathecal injection of alpha-noradrenergic antagonists blocked the antinociception produced by electrical stimulation at sites near the A7 group. These observations indicate that the antinociception produced by stimulation near the A7 cell group was mediated by spinally projecting noradrenergic neurons. The results of these experiments provide evidence that pontospinal noradrenergic neurons located in the A7 cell group are important components of the descending neuronal system that modulates nociception.

Animals↗
PubMed1992

Octreotide: a potent new non-opiate analgesic for intrathecal infusion.

Somatostatin-14 has been reported to relieve severe cancer pain when given intraspinally. We have studied a stable analog, octreotide, which is suitable for long-term infusion by a drug pump. In preclinical trials in dogs, chronic intrathecal and intraventricular perfusion at 40 micrograms/h did not produce neurotoxicity. On the basis of these findings cancer patients with pain unrelieved by oral opiates were treated for periods of 13 to 91 days with intrathecal octreotide 5-20 micrograms/h. During octreotide infusion, pain scores were lower while oral opiate usage was reduced. No central or systemic side effects of intrathecal administration were seen. The pain relief occurred in patients who had previously not obtained satisfactory pain control with systemic or intrathecal opiates, which is consistent with a non-opiate spinal pathway. These preliminary findings, if confirmed, suggest that octreotide is a potent non-opiate analgesic appropriate for long-term intrathecal infusion.

Adult↗
PubMedDate not supplied

Palliative care at the end of life: comparing quality in diverse settings.

There is growing awareness that pain and other symptoms are often poorly managed at the end of life. The purpose of this quality improvement project was to compare the quality of care provided to a convenience sample of 195 patients who died during a six-month period, using a retrospective chart review. Quality was defined by symptom documentation, use of diagnostic and therapeutic procedures in the final 48 hours of life, and determination of advance directives. Daily and total charges incurred by these patients were also captured. Symptom distress was common, and diagnostic and therapeutic procedures were widespread. These data suggest areas for improvement in clinical practice, in palliative care units, and in all settings where end-of-life care is provided. Also, the data can guide future research into the quality of care provided to dying persons.

Adult↗
PubMedDate not supplied

Learning pain assessment and management: a goal of the End-of-Life Nursing Education Consortium.

BACKGROUND: Relief of pain for patients requires that palliative care practitioners have knowledge and skill in both pain assessment and the use of pharmacologic and complementary therapies. METHOD: Pain assessment and management and the teaching strategies suggested within the End-of-Life Nursing Education Consortium curriculum are presented. RESULTS: By addressing the pain experienced by patients with life-limiting illnesses and those at the end of life, the quality of care can be greatly improved. As a multidimensional phenomenon that relates to physical, emotional, and spiritual well-being, the relief of pain enhances the quality of life of patients and lessens the stress experienced by family caregivers. CONCLUSION: The relief of pain and suffering is consistent with the philosophy and goals of nursing as a profession and is a nursing responsibility.

Abbreviations as Topic↗
PubMedDate not supplied

Mechanisms and management of neuropathic pain in cancer.

Neuropathic pain is a common syndrome in people with cancer. The pathophysiology of such pain in cancer is not fully understood, often leading to poor management and needless suffering. Knowledge regarding the potential mechanisms of neuropathic pain, skill in appropriate history-taking and physical-assessment techniques, and awareness of the more common neuropathic pain syndromes and their etiologies, as well as familiarity with the role of new pharmacologic interventions, will allow healthcare professionals to provide better relief of neuropathic pain. At present,a variety of agents are used to treat neuropathic pain situations. Rehabilitation of persons with neuropathic pain should be part of overall management and should address functional impairment and safety factors to prevent accidents resulting from sensory loss.

Analgesics, Opioid↗
PubMedDate not supplied

Meeting the challenges in cancer pain management.

Improved life expectancy among patients with cancer has unfortunately resulted in significant increases in the number of patients experiencing chronic, intractable pain-neuropathic pain syndromes, in particular. Yet treatment for this pain is frequently suboptimal. This is due, at least partially, to the generalized nature of available therapeutics, which are often aimed toward symptom management and temporal pain properties rather than targeted directly toward the multiple mechanisms underlying the generation and propagation of pain. Although the future of pain medicine undoubtedly lies with improved formulations, kinetics, and metabolic characteristics, the current armamentarium nevertheless has proven effective in promoting beneficial outcomes and improved life quality in cancer patients with neuropathic pain. Novel, evidence-based guidelines recommend several agents for first-line consideration, including gabapentin, the lidocaine (5%) patch, tramadol hydrochloride, tricyclic antidepressants, and opioid analgesics. However, in oncology perhaps more than in any other field, pain is dynamic and ever-changing in response to a variety of factors, including chemotherapeutic, radiation, or surgical interventions. For this reason, patient-specific assessment and continual monitoring are warranted when selecting a therapeutic regimen. General considerations, particularly when an opioid agent is utilized, should include pharmacoclinical, pharmacoeconomic, and pharmacogenetic variables.

Analgesia↗