A 44-Year-Old Woman With Severe Pain at the End of Life
JAMAPublished 26 May 1999
Kathleen M. Foley
Citations18
SJR quartileQ1
SJR score5.35
SNIP10.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
A 44-year-old woman admitted to a Boston, Mass, teaching hospital with terminal cancer complicated by severe pain is diagnosed with primary lung cancer, with presumed brain and spine metastases and her neurologic examination was significant for a flaccid left arm and minimal weakness of the left leg.
Abstract
DR PARKER: Mrs L is a 44-year-old woman admitted to a Boston, Mass, teaching hospital with terminal cancer complicated by severe pain. She lives in the greater Boston area with her husband and has managed care insurance.
Keywords
Medicine
New England Journal of MedicineThe Nature of Suffering and the Goals of Medicine
2,075 Citations1982Eric J. Cassel
European Journal of CancerThe Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress
1,543 Citations1994Russell K. Portenoy, Howard T. Thaler +9 more
High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index.
Annals of Internal MedicinePhysician Attitudes and Practice in Cancer Pain Management: A Survey From the Eastern Cooperative Oncology Group
825 Citations1993Jamie H. Von Roenn, Charles S. Cleeland +3 more
The knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions was determined to determine the methods of pain control being used by these physicians and to compare physician knowledge of and attitudes toward cancerPain with the results of a study of cancer pain.
JAMAQuality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain
802 Citations1995Mitchell B. Max
Quality improvement programs to improve treatment of acute pain and cancer pain should include five key elements, ensuring that a report of unrelieved pain raises a "red flag" that attracts clinicians' attention, and improved coordination of the process of assessing and treating pain.
CancerA validation study of the WHO method for cancer pain relief
762 Citations1987Vittorio Ventafridda, Marcello Tamburini +3 more
It is shown that a correct use of the analgesic ladder can reduce pain to a third of its initial intensity and concluded that analgesics, as proposed by WHO, are the most suitable treatment arm in controlling pain in palliative treatment for advanced cancer patients.
PainOpioid pseudoaddiction — an iatrogenic syndrome
648 Citations1989David E. Weissman, J. David Haddox
The term pseudoaddiction is introduced to describe the iatrogenic syndrome of abnormal behavior developing as a direct consequence of inadequate pain management in a 17-year-old with leukemia, pneumonia and chest-wall pain.
New England Journal of MedicineSurvival of Medicare Patients after Enrollment in Hospice Programs
537 Citations1996Nicholas A. Christakis, José J. Escarce
Survival varied substantially according to diagnosis, even after adjustment for age and co-existing conditions, and it was longest for those with chronic lung disease, those with dementia, and those with breast cancer, while patients at for-profit, larger, outpatient, or newer hospices lived longer after enrollment than those in other types of hospice programs.
New England Journal of MedicinePharmacologic Treatment of Cancer Pain
484 Citations1996Michael Levy
The impact of cancer pain is magnified by the interaction of pain and its treatments with other common cancer symptoms: fatigue, weakness, dyspnea, nausea, constipation, and impaired cognition.
Journal of the American Geriatrics SocietyInfluence of Patient Preferences and Local Health System Characteristics on the Place of Death
400 Citations1998Robert S. Pritchard, Elliott S. Fisher +7 more
To examine the degree to which variation in place of death is explained by differences in the characteristics of patients, including preferences for dying at home, and by differences of local health systems, a large number of patients in the Republic of Ireland have indicated they would like to die at home.
JAMAPalliative Care in Undergraduate Medical Education
344 Citations1997J. Andrew Billings
The increasing attention to palliative care education has created major opportunities for improving education about care at the end of life, and educational programs should be rigorously evaluated to identify best educational practices.
Journal of Clinical OncologySwitching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio?
343 Citations1998Carla Ripamonti, L Groff +4 more
The results of this study confirm that methadone is a potent opioid, more potent than believed, especially in patients who are tolerant to high doses of opioids.
CancerOpioid rotation in patients with cancer pain: A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine
319 Citations1996Eduardo Bruera, José Pereira +4 more
The purpose of this study was to review the analgesic dose ratios for methadone compared with hydromorphone and propose doses ranging from 1:6 to 1:10.
New England Journal of MedicineDextroamphetamine with Morphine for the Treatment of Postoperative Pain
214 Citations1977William H. Forrest, Byron Wm. Brown +9 more
In simple performance tests, and in measures of side effects, dextroamphetamine generally offset undesirable effects of morphine (sedation and loss of alertness) while increasing analgesia.
PubMedAddressing spiritual concerns of patients: family physicians' attitudes and practices.
204 Citations1999Mark R. Ellis, Daniel C. Vinson +1 more
Family physicians in this survey had high spiritual well-being scores, however, most reported infrequent discussions of spiritual issues with patients and infrequent referrals of hospitalized patients to chaplains.
CancerPublic attitudes toward cancer pain
201 Citations1985Daniel N. Levin, Charles S. Cleeland +1 more
It was found that cancer was perceived as an extremely painful disease relative to other medical conditions and there were multiple concerns expressed about the consequences of using narcotic analgesics for pain control.
PubMedMethylphenidate associated with narcotics for the treatment of cancer pain.
182 Citations1987Éduardo Bruera, Sharon Chadwick +3 more
It is concluded that methylphenidate can increase the analgesic effect and decrease sedation of narcotics in this population of patients with chronic pain due to advanced cancer.
Annals of Internal MedicineImproving Palliative Care
181 Citations1997Diane E. Meier, R. Sean Morrison +1 more
The barriers to achieving a peaceful death are reviewed, including inadequate medical professional education on palliative care, public and professional uncertainty about the difference between foregoing life-sustaining treatment and active euthanasia, and health professionals' difficulty recognizing when patients are dying and the associated sense that death is a professional failure.
CancerOpioid 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
176 Citations1995Nathan J. Cherny, Victor T. Chang +6 more
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.
Journal of Pain and Symptom ManagementImplementing national standards for cancer pain management: Program model and evaluation
162 Citations1996Marilyn Bookbinder, Nessa Covle +10 more
The model pain management program met its goal of implementing the APS standards, educating nurses, and identifying "system" problems, and improving overall patient satisfaction.
New England Journal of MedicineCompetent Care for the Dying Instead of Physician-Assisted Suicide
151 Citations1997Kathleen M. Foley
While the Supreme Court is reviewing the decisions by the Second and Ninth Circuit Courts of Appeals to reverse state bans on assisted suicide, there is a unique opportunity to engage the public in the debate over assisted suicide.
The Primary Care Companion to The Journal of Clinical PsychiatryOxford Textbook of Palliative Medicine, 2nd ed.
149 Citations2000Scott Craig
The 2nd edition of the Oxford Textbook of Palliative Medicine is a thorough and compelling treatise on the subject of end-of-life care and should occupy a prominent place on the bookshelf of anyone who wishes to practice palliative medicine.
PubMedPatient attitudes regarding physician inquiry into spiritual and religious issues.
135 Citations1994Timothy P. Daaleman, Donald E. Nease
This study supports the use of frequency of religious service attendance as a screening variable for patients receptive to physician-directed inquiry into religious and spiritual issues and confirms that patients are accepting of physicians' referring patients to pastoral professionals (ie, clergy) for spiritual problems.
Journal of Clinical OncologyMorphine versus methadone in the pain treatment of advanced-cancer patients followed up at home.
132 Citations1998Sebastiano Mercadante, Alessandra Casuccio +4 more
Methadone is a drug of indisputable value in the treatment of cancerPain, and an unbalanced focus on the risks of inappropriate use rather than the benefits should not compromise the use of a relevant alternative to morphine in the management of cancer pain.
NeuropsychopharmacologyN-Methyl-?-Aspartate (NMDA) Receptors, Mu and Kappa Opioid Tolerance, and Perspectives on New Analgesic Drug Development
131 Citations1995Kathryn Elliott
A strategy, which utilizes efficacy as an NMDA receptor antagonist and clinical safety, provides the basis for a discussion of the clinical potential of dextromethorphan, ketamine, and felbamate as modulators of opioid tolerance in pain patients or opioid addicts.
Annals of Internal MedicineEnd-of-Life Care in Medical Textbooks
89 Citations1999Annette T. Carron, Joanne Lynn +1 more
Four widely used general medical textbooks are assessed for their coverage of nine content domains for 12 illnesses that often cause death; each domain in each disease and in each text was graded for presence and helpfulness of advice.
New England Journal of MedicineICD-9 Code for Palliative or Terminal Care
73 Citations1996C K Cassel, B C Vladeck
The Health Care Financing Administration (HCFA) has announced the approval of a new diagnosis code for palliative care, which will enable coders reviewing hospital charts to indicate that palliatives care was delivered to a dying patient during a hospital stay.
Journal of Clinical OncologyMethadone in cancer pain management: individualize dose and titrate to effect.
49 Citations1998Kathleen M. Foley, Raymond W. Houde
Hematology/Oncology Clinics of North AmericaGUIDELINES IN THE CARE OF THE DYING CANCER PATIENT
48 Citations1996Nathan I. Cherny, Nessa Coyle +1 more
The care of patients in the final stages of cancer requires a high level of clinical vigilance and skill to ensure that the passage from life to death is as free from suffering as possible.
