Showing papers by "Michael I. Bennett published in 2008"

Assessment of neuropathic pain

Abstract: Neuropathic pain is initiated or caused by a primary lesion or dysfunction of the nervous system. A consensus regarding the classification and assessment of neuropathic pain has yet to be reached. The diseases responsible for neuropathic pain are diverse; the clinical presentation of pain can vary widely between individuals despite the same underlying aetiology. Common features of neuropathic pain include spontaneous and evoked pains. Investigations may help to identify evidence of nerve dysfunction but it cannot be assumed that it is necessarily the cause of their pain.

Editorial: Palliative care research in the community: it is time to progress this emerging field:

Abstract: Developing palliative care services in the community (which is sometimes now called Primary Palliative Care) is important to reach and serve the whole population, and to provide care where many people wish.1 Such services can moreover provide supportive care in primary care from diagnosis of a life-threatening illness (as recommended by the World Health Organisation), and to people with non-malignant conditions and older persons who have comparable concerns to and in some cases even greater and more prolonged unmet needs than people with cancer.2,3 Primary care clinicians have the potential to provide end-of-life care for most patients, given adequate training and support from specialist palliative care services.4 Primary care professionals share common values with palliative care specialists – holistic, patient centred care, delivered in the context of families and friends – and are thus well placed to provide palliative and supportive care to all in need from an early stage. The increased emergence and reliance on the hospice movement, especially for example in urban Australia, has possibly disempowered some primary care providers and led to a belief that only specialist palliative care can provide ‘proper palliative care’. Although it is acknowledged that some patients do require the expertise that specialist palliative care can and does provide, it must be remembered and acknowledged that the vast majority of palliative care is carried out within primary care multidisciplinary teams, who are also very well placed to provide support to those families that require it after the death of the patient. Some important initiatives are gaining momentum internationally within primary care, such as the Gold Standards Framework in the United Kingdom,5 case conferencing in Australia,6 and in the United States evolving models of chronic care delivery and reimbursement can facilitate the delivery of primary palliative services.7 However, the academic base to guide palliative care delivery in the community is underdeveloped. There is thus an urgent need for rigorous research to guide clinical services and to ensure that primary palliative care remains on the political and research agenda.

Letter to editor: transcutaneous electrical nerve stimulation (TENS) for cancer bone pain.

Abstract: Painful bone metastases remain the most common cause of cancer-related pain and are associated with a significantly reduced quality of life.1,2 Cancer bone pain can often be both severe and difficult to treat.3,4 Less than half of all patients with cancer bone pain experience significant relief of their pain with current treatments.5–7 Transcutaneous electrical nerve stimulation (TENS) is used throughout the world to manage painful conditions because it is inexpensive, non-invasive, safe and is simple to use. However, a recent Cochrane systematic review of TENS in cancer pain found insufficient evidence to make decisions on the use of TENS in this setting.8 We report the results of a small pilot study designed to assess the acceptability of TENS as an analgesic intervention in patients with cancer bone pain and assess the suitability of measuring any analgesic benefits using both uni and multidimensional pain scores. The information gathered has been used to design a randomised, controlled clinical trial. Following ethics committee approval, we prospectively recruited seven patients with cancer bone pain from St Gemma’s Hospice, Leeds, UK. Short-form McGill, Numerical Rating Scale (NRS), Verbal Rating Scale (VRS) and Visual Analogue Score (VAS) were completed at rest and during a movement which the patient found painful (either standing, walking, bending or putting on a shirt). After completing baseline pain scores, TENS was applied to the site of bone pain using an Ultima XL-A1 device (TensCare LTD, Epsom UK). A single channel with two self-adhering gel pads was used to achieve paraesthesia over the site of pain. The TENS device was adjusted to deliver a pulse width of 200 μs and a pulse frequency of 80 Hz. Intensity was increased until the sensation from TENS was ‘strong but comfortable’. After 30 min and 1 h, measurements of pain intensity and pain relief were completed at rest and while performing the painful movement. Six patients completed the TENS treatment and pain assessments. They all showed improvement in pain scores at rest and during painful movement at 30 and 60 min of TENS (Table 1). One of the six patients who completed the study reported increased lower back pain 24 h after TENS therapy to this area. Although the pain was attributed to a prolapsed lumbar disc, we cannot discount the possibility that this may have been exacerbated by the TENS application. The analgesic effects of the TENS device allowed patients to increase the range of their normally painful movement (in this case bending over) which could lead

Diagnosis and management of neuropathic pain in palliative care.

Abstract: Neuropathic pain can be distressing and difficult to treat, and remains a problem for a significant proportion of palliative care patients. This article considers the identification and assessment of neuropathic pain, and highlights some of the challenges specific to the palliative care population. Further discussion includes definitions, pathophysiology and implications for nursing practice.

Cancer pain syndromes

Abstract: Pain is commonly associated with cancer, rising in incidence with advancing disease. Cancer bone pain is the most frequent and painful of cancer pain syndromes. Underlying pain mechanisms are commonly categorized as nociceptive, neuropathic, or a mixture of both. Observational studies have shown that most cancer pain is caused by nociceptive mechanisms. Careful evaluation is necessary to prevent inappropriate treatment and to facilitate optimal management. Evaluation of pain in advanced cancer is based primarily on probability and pattern recognition. Bone pain is the most common cause of cancer-related pain. Metastases to vertebral bodies often cause midline pain. Pain from a vertebral pedicle may be associated with unilateral nerve root pain. Pathological fractures of the ribs are relatively common in cancers of the breast and prostate, and in multiple myeloma. Spinal cord or cauda equina compression manifests in about 3 percent of all cancer patients. Meningeal carcinomatosis occurs as a result of metastatic spread into the cerebrospinal fluid.

The management of neuropathic pain in cancer.

Abstract: Neuropathic pain is a common problem amongst cancer patients, yet it can be challenging to diagnose and treat successfully. The diagnosis of neuropathic pain has been helped by the identification of common descriptors and symptoms often used by patients and several screening tools now exist to identify neuropathic features. The management of neuropathic pain in cancer is a balance of pharmacological, physical and psychological interventions used skilfully in patients that are often frail and with cognitive, hepatic or renal impairment. Commonly used drugs for the treatment of neuropathic pain include opioids, antidepressants and anti-epileptics, although the evidence for their use in the cancer population is often poor. Other drugs that have shown to be of benefit include NMDA receptor antagonists and local anaesthetic agents, although side effects often limit their use. Physical interventions include intrathecal drug delivery, neurolytic sympathetic plexus blockade and spinal cord stimulation. T...