Monday, June 20, 2005

This month's Journal of Pain and Symptom Management

This month's Journal of Pain & Symptom Management is out & as usual has some very good articles. Highlights of this month's issue are...
Two articles on the Palliative Care Advanced Disease clinical pathway for the inpatient care of imminently dying patients (both articles showed some improvement on quality measures). Both were pilot studies & conclude more research is needed. We all know, however, that to really get PCAD implemented studies will be needed to show that it saves hospitals or payors money.
Extended-release oral hydromorphone is compared to immediate release and is essentially found to be equivalent in pain control and potency. This may become available in the US (as the Orwellian "Pallidone") in the not too distant future. The reaction to it, given the OxyContin controversies, will be interesting. I vaguely remember reading a NY Times article, years ago when I was in med school, about the development of ER hydromorphone in which one of the physician interviewees lamented ER hydromorphone and said something like "Dilaudid is the number one prescription drug of abuse amongst addicts." I imagined a family member at a hospice sitting at the bedside of her dying mother on a hydromorphone drip reading that zinger and wondering what the hell the doctors were doing to Mom.
Finally there's an article comparing subcutaneous with nebulized morphine for dyspnea relief in patients with cancer. They too are essentially found to be equivalent but the n was small (11 in each arm), the subjects had relatively mild dyspnea to begin with, & the effect of either subcutaneous or nebulized morphine was modest at best. This is the sort of article that's neither going to motivate people to try nebulized morphine, nor dissuade those that are already using it.

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