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Biomedical subjects

F De Conno

Publications and source records attributed to F De Conno.

At least 91 records · Page 5Linked to original sources
PubMed1987

Intraspinal morphine for cancer pain.

From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow-up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long-term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side-effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.

Humans↗
PubMed1985

The importance of a home care program for patients with advanced cancer pain.

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physician, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

Home Care Services↗
PubMed1985

WHO guidelines for the use of analgesics in cancer pain.

The growing incidence of cancer pathology all over the world implies not only problems of prevention and cure, but also of pain control. Pain appears in more than 50% of cancer patients, mainly because analgesic opioids are not available or adequately administered. For this reason, the World Health Organization (WHO) has created a Collaborating Centre for Cancer Pain Relief at the Division of Pain Therapy of the National Cancer Institute, Milan. Experts in pain therapy have drafted guidelines on the sequential use of analgesic drugs by identifying three steps: non-narcotics, weak narcotics, narcotics, all in association with adjuvant drugs. After a positive pilot trial, field testing will be conducted in developed and developing countries. The first step of the analgesic ladder is represented by the use of non-narcotics; the adequate use of these substances in advanced cancer patients does not exceed 6 months of treatment. Treatment is then either discontinued or changed to a following step because of side-effects (40%) or inefficacy (44%). The reduction in the use of non-narcotics corresponds to a successive increase in the use of opioids, particularly direct agonists. Through an adequate use of the analgesic ladder, pain can be relieved in the great majority of cancer patients.

Analgesics↗
PubMed1984

[The role of neurolytic therapy in blocking cancer pain].

Here is a presentation of the role played by neurolesive procedures in the management of cancer pain. The authors suggest that these procedures should be considered secondary to the analgesic drugs and should be used only in a very limited number of situations (20/25%) due to the changes in neurophysiology of nerve transmission, caused by these interventions. Open neurolesive surgical treatments have a restricted indication because they are very traumatizing and the risk-benefit ratio is scarcely positive. Generally the chemical and thermal neurolesive procedures which are more widely used are represented by: sacral subarachnoidal block, alcholization of celiac ganglion, thermorhyzotomy of Gasser's and percutaneous chordotomy. The limits and benefits of these procedures are discussed. The authors maintain that a single technique can never completely solve the problem of pain; it can give pauses from pain, which have to be integrated sooner or later by analgesic drugs, within a continuing care program.

Analgesics↗
PubMed1983

Chronic analgesic study on buprenorphine action in cancer pain. Comparison with pentazocine.

Buprenorphine appears to have an analgesic effect (evaluated after a week of treatment) statistically superior to that of the comparative drug. On the whole, during buprenorphine treatment the normal activities of life of the individual patient improved. The percentage incidence of the side-effects is similar for the two drugs. Buprenorphine, however, caused less intense side-effects than pentazocine.

Adult↗
PubMed1981

Organizing pain control and rehabilitation service in a cancer centre.

A unique programme of rehabilitation and pain control has been created within the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan. Rehabilitation of mastectomy, amputee and ostomy patients has been very active and, particularly in this last group, a good rehabilitative outcome may be observed. Pain evaluation was one of the main problems. The treatment modalities have been refined in order to obtain the maximum pain relief with the minimum trauma possible. These treatments are based on a closely monitored analgesic drug administration and on percutaneous thermocontrolled lesions. The growing needs of the Cancer Institution have brought to about 30 000 the number of treatments performed by the Service during the last year. Nevertheless, enormous efforts are necessary to break the barrier of indifference to this problem that still persists in the oncologic field.

Amputees↗
PubMedDate not supplied

Non-steroidal anti-inflammatory drugs as the first step in cancer pain therapy: double-blind, within-patient study comparing nine drugs.

The efficacy and tolerability of acetylsalicylic acid, paracetamol, diclofenac, ibuprofen, indomethacin, pirprofen, sulindac, naproxen and suprofen were compared in the treatment of cancer pain. In a double-blind, within-patient randomized study, each drug was given for 1 week to eight patients and for another week to a further eight patients. A total of 65 patients were effectively treated; only 48 completed week 1 and 41 completed week 2. Naproxen, diclofenac and indomethacin were highly effective in pain relief (tested by means of a 100 mm visual analogue scale) and were relatively well tolerated. It is concluded that these non-steroidal anti-inflammatory drugs can be considered as first choice in the treatment of cancer pain.

Acetaminophen↗
PubMedDate not supplied

Pain experienced by patients hospitalized at the National Cancer Institute of Milan: research project "towards a pain-free hospital".

According to the data of the literature, the prevalence of pain in cancer patients at various stages of the disease and the settings of care range from 38 to 51%, with an increase of up to 74% in the advanced and terminal stages. Despite published World Health Organization (WHO) guidelines for pain management, 42 to 51% of cancer patients receive inadequate analgesia and 30% receive no analgesics at all. A 3-year Research Project "Towards a Pain-free Hospital", which began one year ago, is ongoing at the National Cancer Institute of Milan. The research is organized in three subsequent steps. In the 1st one, a series of patient- and staff-oriented evaluation tools are used to assess the level of appropriateness of pain communication, assessment, management and control of the in-patients. The 2nd step will implement a number of continuing educational interventions aimed at improving patient awareness and staff knowledge of the appropriate pain assessment and management in order to respond to the patient's pain problem. In the 3rd step, all the assessment tools used in step one will be applied again to establish the prevalence of pain, the causes and intensity and patient satisfaction with pain management and to evaluate the impact of the interventions performed during the 2nd step regarding the overall ability of our hospital to tackle pain emergency in the hospitalized cancer population. The results relative to the 1st step are herein reported, in particular as regards the study on prevalence, causes, severity of pain, the interference of pain with sleep, mood and concentration, the use of pain medications and the relief obtained, the structural validity and internal consistency of the assessment tool used. A total of 258 patients hospitalized for at least 24 h were interviewed by 9 physicians using a brief structured questionnaire prepared ad hoc: 51.5% of the patients presented pain during the previous 24 h caused by surgery (49.6%) or by the tumor mass itself (29.3%). Out of the 133 patients with pain, a high degree (much or very much) of pain at rest was present in 27.1% and pain on movement in 30.8%; 31.6% did not take any analgesic treatment, and 14.3% of the latter reported a high degree of pain at rest and 21.4% on movement. Pain interfered with sleep from much to very much in 28.8% and with irritability and nervousness in 15.9% of the patients. In the 91 patients taking analgesics, 57.2% reported a high degree of pain relief. A high degree of pain and interference, however, was associated with low relief levels. The assessment tool used was shown to have a good structural validity and internal consistency (Chrombach alpha index of interference scale = 0.73). Although the Milan Cancer Institute has the longest tradition in Italy of pain assessment by means of validated tools and pain management according to the WHO guidelines and educational efforts in this field, the results of the study clearly show that it is necessary to persevere with continuing educational and informative programs in order to reduce the frequency and severity of pain and thus improve the quality of life of in-patients.

Adult↗
PubMedDate not supplied

Role of enteral nutrition in advanced cancer patients: indications and contraindications of the different techniques employed.

Over the last 20 years there has been great progress regarding total parenteral nutrition and enteral nutrition for patients who cannot take food by mouth or cannot swallow, or so that controlled feeding can be established in anorexic and malnourished patients. The use and the role of artificial nutrition is still controversial in advanced cancer patients. Such controversies often are due to the fact that these patients have a survival expectancy that varies from one to several months. The present review describes the most frequent techniques used for enteral nutrition (nasoenteral tubes, gastrostomy and jejunostomy), their indications, contraindications and complications, and gives an indication regarding which patients may really benefit from enteral nutrition taking into consideration not only the potential advantages but also the discomfort and distress related to enteral nutrition and the different techniques that are employed.

Deglutition Disorders↗
PubMedDate not supplied

Continuous subcutaneous infusion of ketorolac in cancer neuropathic pain unresponsive to opioid and adjuvant drugs. A case report.

Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.

Analgesics, Non-Narcotic↗
PubMedDate not supplied

Pharmacological treatment of cancer pain: alternative routes of opioid administration.

Cancer-related pain is present in 51% of patients at various stages of the disease, and the incidence increases up to 74% in advanced and terminal stages. The World Health Organization proposed and issued very simple guidelines for the pharmacologic treatment of cancer-related pain. According to the guidelines, opioid analgesics are the mainstay of analgesic therapy, and the first choice for drug administration is considered to be the oral route. However, in some clinical situations, the oral route is not feasible, and analgesic drugs consequently have to be administered via an alternative route. For example, this is the case when the patient presents vomiting, bowel obstruction, severe dysphagia, mental confusion and when the opioid dose has to be increased drastically in order to achieve adequate pain control. This review of the literature is aimed at describing the indications, the limits and the main aspects of the pharmacokinetics and pharmacodynamics relative to the alternative routes of administration of opioids most commonly used in clinical practice. Sublingual, rectal, subcutaneous, intravenous, transdermal and spinal administration routes are examined.

Administration, Cutaneous↗