Search PubMed⌕ Search

Biomedical subjects

K M Foley

Publications and source records attributed to K M Foley.

At least 19 recordsLinked to original sources
PubMed1996

Palliative medicine: providing care when cure is not possible. A roundtable discussion: Part I.

Palliative medicine describes the care of patients with advanced disease. When cure is no longer possible, the goal becomes control of pain, other symptoms, and psychological distress. In the United States, palliation has been pioneered by the hospice movement for patients with disseminated cancer and AIDS. Palliative care is also appropriate for patients with many of the chronic diseases of aging. For medical, humanitarian, financial, and legal reasons, physicians are being called on to provide palliative care when they make the diagnosis of all illness that is unresponsive to curative treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1996

A peaceful death: how to manage pain and provide quality care. A roundtable discussion: Part 2.

One of the most important components of a peaceful death is adequate control of pain and other distressing symptoms, such as dyspnea, agitation, and restlessness. Pain is an important symptom in 75 to 80% of noncancer patients in the last year of life. Opioid analgesics are often the mainstay of pain treatment for dying patients. A primary care physician also needs to know about anesthetic and neurosurgical approaches, the use of cognitive behavioral approaches, and the availability of specialized pain experts. A sizeable minority of physicians receive requests for an assisted death, which should be seen as a cry for help. The most useful function of advance directives is that they open an avenue for discussion between the doctor and the patient about a difficult subject.

Analgesics, Opioid↗
PubMed1995

Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration.

BACKGROUND: This survey documents the strategies used by pain control physicians in the selection of opioid drugs and routes of administration in the management of inpatients referred to a cancer pain service. METHODS: The following approaches were prospectively evaluated during the treatment of 100 consecutive inpatients: 1) the influence of the evaluation of the goals of care on decision making, 2) selection of opioid drugs, 3) indications for changing opioid drugs and the frequency with which this strategy is used, and 4) selection of route of administration. RESULTS: Eighty of the 100 patients underwent a total of 182 changes in drug, route, or both drug and route before discharge or death. The major reasons for change were to improve the convenience of treatment regimen in the setting of adequate pain relief (31.4%), diminish side effects in the setting of controlled pain (25.0%), reduce the invasiveness of therapy in the setting of controlled pain (19.3%), and simultaneously improve pain control and reduce opioid toxicity (17.7%). When opioid toxicity was the reason for change, physicians changed the opioid drug in 71% of cases and the route in 29%. When convenience or invasiveness were targeted, the physicians changed the route in 61% of cases and the opioid in 39%. Forty-four patients required one or more change in the opioid, and 20 required 2 or more changes (range, 2-6 changes). At the time of discharge (n = 82), morphine was more commonly selected than hydromorphone or fentanyl (39% vs. 23% vs. 17%) and the routes of administration were oral (57%), transdermal (18%), intravenous (18%), subcutaneous (5%), and intraspinal (4%). Therapeutic changes were associated with improvement in physician-recorded pain intensity and a lower prevalence of cognitive impairment, hallucinations, nausea and vomiting, and myoclonus among patients who were discharged from the hospital. CONCLUSIONS: These data illustrate the application of strategies for selections of opioid drugs and their route of administration that are recommended in current guidelines for the management of cancer pain.

Adult↗
PubMed1995

Misconceptions and controversies regarding the use of opioids in cancer pain.

The WHO has created a Cancer Pain Relief Programme and developed guidelines for the treatment of cancer pain. Implementation of the analgesic guidelines, assurance of drug availability (specifically opioids), education of healthcare professionals, and designating cancer pain as a priority for all national cancer control programmes are the major goals. Recent studies of medical students, physicians, nurses and state medical boards demonstrate a significant lack of knowledge with regard to the theoretical and practical understanding of the use of analgesic drugs, particularly opioids, in the management of cancer pain. Communication between physicians and patients about pain symptoms has also been shown to be problematic. Limited availability of opioids, their excessive regulation, and the lack of use of alternatives to systemic analgesics also prevent adequate management. Although analgesic drug therapy is the mainstay of treatment, opioid use remains a controversial issue. Some of the controversies include their role in the management of neuropathic pain, which has been suggested to be 'opioid-resistant', as well as the choice of opioid drug. A third controversy is the route of administration. The impetus for the development of novel routes has come from the goals of maximising analgesia, minimising side effects, and providing convenient dosing schedules for patients who require parenteral administration. Other important controversial issues are the development of tolerance and the relationship of pain management to patient requests for physician-assisted suicide and euthanasia.

Analgesics, Opioid↗
PubMed1995

Pain and depression in patients with newly diagnosed pancreas cancer.

PURPOSE: To evaluate the prevalence of pain and depression, their correlation, and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas (PC). MATERIALS AND METHODS: Cross-sectional pain and psychosocial distress were assessed using validated instruments, including the Memorial Pain Assessment Card (MPAC), Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and Functional Living Index-Cancer (FLIC). Patients were evaluated before their first operation for PC or first treatment with chemotherapy at a large tertiary-care cancer center. RESULTS: One hundred thirty patients with proven PC were studied: 83 before their operation and 47 before their first chemotherapy treatment. At the time of study entrance, 37% of patients had no pain and an additional 34% had pain that was mild or less severe. Only 29% of patients had moderate, strong, or severe pain. Chemotherapy patients reported significantly more intense pain than did preoperative patients (P = .02). Symptoms of depression were assessed using the BDI and BHS scales. A substantial minority of patients (38%) had BDI scores > or = 15, which suggests high levels of depressive symptoms. There was a significant correlation between increasing pain and depressive symptoms among those who experienced pain. Quality of life was assessed using the Weekly Activity Checklist (WAC) and the FLIC. Compared with patients who had no pain or mild pain, patients with moderate or greater pain had significantly impaired functional activity (P = .03) and poorer quality-of-life scores (P = .02) when compared with those with lesser degrees of pain. There were significant correlations between increasing pain and depression and between pain and depressive symptoms and impaired quality of life and function. CONCLUSION: Our results indicate that moderate or severe pain and symptoms of depression are not as prevalent in recently diagnosed PC patients as is generally believed. However, one third have inadequate pain control despite the use of oral analgesics. These patients can be identified by the use of a simple self-report instrument (the MPAC card). Quality of life and function are adversely affected by moderate or greater levels of perceived pain intensity. A simple and rapid assessment is possible and can identify high-risk patients in need of intervention that may improve quality of life.

Adenocarcinoma↗
PubMed1995

Dextromethorphan shows efficacy in experimental pain (nociception) and opioid tolerance.

The oral antitussive dextromethorphan is a clinically available N-methyl-D-aspartate receptor antagonist. Dextromethorphan has analgesic efficacy in the experimental formalin test, blocks the nociceptive activation of the immediate-early gene, c-fos proto-oncogene, and prevents and reverses the development of opiate analgesic tolerance in experimental models. These data suggest that dextromethorphan should be evaluated in a controlled clinical trial for analgesic efficacy in zoster-associated neuralgia.

Dextromethorphan↗
PubMed1994

Therapeutic and neurotoxic effects of 2-chlorodeoxyadenosine in adults with acute myeloid leukemia.

Despite expectations that 2-chlorodeoxyadenosine (2-CdA) would prove active primarily in lymphoproliferative diseases, early reports suggested unexpected high activity of this drug in heavily pretreated children with acute myeloblastic leukemia (AML) at a maximally tolerated dose of 8.9 mg/m2/day for 5 days. In view of these findings, we conducted an escalating dose trial of 2-CdA in adult patients with relapsed or resistant AML. Thirty-six patients who had received extensive prior therapy were treated at 9 dose levels of 2-CdA at daily doses ranging from 5 to 21 mg/m2 for 5 days. 2-CdA eliminated leukemic blasts from the peripheral blood in 32 of 36 cases; however, bone marrow hypoplasia was seen only at daily dose levels > or = 15 mg/m2. We observed a total of 3 complete remissions: 1 at the 15 mg/m2/d dose level and 2 at the 21 mg/m2/d dose level; these responses persisted for 3, 2, and 3 months, respectively. Although prolonged myelosuppression would have been dose-limiting at 21 mg/m2/d for 5 days, the most important adverse effect was the development of a sensorimotor peripheral neuropathy. This reaction, whose onset was substantially delayed after completion of drug treatment, was observed in 2 of 5 patients at the 19 mg/m2/d level and in 4 of 4 evaluable patients at the 21 mg/m2/d level. Pathologically, this process was characterized by axonal degeneration and secondary demyelination. Other side effects included reactivation of a posttransplant Epstein-Barr virus-related lymphoma in 1 patient and tumor lysis syndrome. We conclude that the maximally tolerable dose of 2-CdA in adult patients (17 mg/m2/d for 5 days) in approximately twofold in excess of that previously reported in children and that the limiting toxic effect is a degenerative neuropathic disorder. We confirm that this drug has definite activity in AML, but the magnitude of this effect needs to be determined in larger numbers of patients who have received less extensive therapy. This agent deserves further evaluation in patients with both AML and acute lymphoblastic leukemia at these higher doses and perhaps as part of a preparative regimen for patients undergoing bone marrow transplantation.

Adolescent↗
PubMed1994

Pain in ovarian cancer patients. Prevalence, characteristics, and associated symptoms.

BACKGROUND: The prevalence, characteristics, and impact of pain and other symptoms have not been studied systematically in women with ovarian cancer. Anecdotally, pain has been associated with the onset of the disease and is a common problem among those with advanced cancer; symptoms other than pain appear to be highly prevalent. Given the profound influence of pain and other symptoms on quality of life, the evaluation of these phenomena could provide data relevant to the clinical management of these patients and advance quality of life research in the area of symptom assessment. METHODS: Questionnaires were completed by 111 inpatients and 40 outpatients with ovarian cancer who were undergoing treatment at a cancer center. Measures included a comprehensive pain questionnaire; the Rand Mental Health Inventory, Functional Living Index--Cancer; and the Memorial Symptom Assessment Scale. RESULTS: The sample (N = 151) represented 74% of the eligible patients. The median age was 55 years (range, 23-86), 82% had Stage III or IV disease at presentation, and 69% had active disease at the time of the survey. Pain, fatigue, and psychologic distress were the most prevalent symptoms. Sixty-two percent (N = 94) described a pain syndrome that preceded the onset or recurrence of the disease, and 42% (N = 63) reported "persistent or frequent pain" during the preceding 2 weeks. The latter pain had a median duration of 2 weeks (range, less than 1 to 756 weeks) and usually was in the abdominopelvic region (80%), frequent or almost constant (66%), and moderate to severe. Most patients reported moderate or greater pain-related interference with various aspects of function, particularly activity (68%), mood (62%), work (62%), and overall enjoyment of life (61%). Performance status, inpatient status, and unmarried status were significant predictors of pain presence or intensity, and both performance status and extent of tumor were significant predictors of pain interference with function. CONCLUSIONS: Among those with ovarian cancer, greater than 40% experienced pain that substantially undetermined function in one half to two thirds of these patients. Impaired performance status is associated most strongly with pain. The onset or recurrence of disease often is heralded by a stereotypic pain syndrome.

Adult↗
PubMed1994

Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms: a combined analysis of controlled, single-dose studies.

We performed a combined analysis of the results from four controlled single-dose relative-potency studies to assess the impact of inferred pain mechanism on the response to an opioid drug. A total of 168 patients received 474 administrations of either morphine or heroin, and we assessed the analgesic response during a 6-hour period with visual analog scales. We summarized this as a total pain relief (TOTPAR) score. Two experienced pain clinicians reviewed information about pain characteristics and designated each case according to the inferred pain mechanism (neuropathic, nociceptive, or mixed) and the degree of confidence in the inferred mechanism (definite versus probable/possible). They grouped the cases as follows: nociceptive pain only (n = 205), neuropathic pain only (n = 49), and mixed (n = 220). We compared pain relief achieved by patients with different mechanisms, with TOTPAR adjusted for significant covariates (duration of prior opioid administration, doses of opioid administered in the previous 48 hours, pain intensity at the start of the study, BUN:creatinine ratio, and dose of administered opioid). The adjusted mean TOTPAR score of the group with any neuropathic pain was significantly lower than that of the group with nociceptive pain only (26.1 versus 20.4, p = 0.02). The score of the group with definite nociceptive pain alone (adjusted mean TOTPAR = 28.0) was significantly higher than scores of the groups with possible/probable nociceptive pain (TOTPAR = 19.9), mixed mechanisms (TOTPAR = 20.2), definite neuropathic pain alone (TOTPAR = 20.6), and possible/probable neuropathic pain alone (TOTPAR = 22.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Current approaches to the management of cancer pain: a review.

Pain, which is among the most prevalent symptoms experienced by cancer patients, can be effectively treated. Patient assessment, the use of anticancer therapies and systemically administered non-opioid and opioid analgesics are pivotal. Practical aspects of opioid pharmacology include both drug selection, methods of analgesic administration: selection of the appropriate route, dose titration, and an understanding of the management of side effects. Specific approaches for the management of patients unable to attain an acceptable balance between relief and side effects of opioids are described. These comprise non-invasive interventions, including the use of adjuvant analgesics, psychological therapies and physiatric techniques, and invasive interventions, such as the use of intraspinal opioids, neural blockade and neuroablative techniques. Finally, the use of sedation in the management of patients with pain that is refractory to other interventions is addressed. This approach can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should have access to specialists in pain management or palliative medicine to address these difficult problems.

Acute Disease↗