Abstract:
:The European Association for Palliative Care guidelines for treatment of cancer pain recommend a double dose (DD) of immediate-release morphine at bedtime instead of single doses (SD) repeated every four hours throughout the night. A previous open controlled study reported more side effects after DD than after SD. The present study was a randomized, double-blind, crossover study comparison of DD and SD of immediate-release morphine during the night, followed by an open pharmacokinetic study. The primary outcome was average pain intensity during the night, as measured on an 11-point numerical rating scale. Secondary outcomes were morning pain, number of rescue medications, adverse effects (nausea, xerostomia, tiredness, sleep quality, and number of awaking episodes) and patient preference. Morphine and metabolites were quantified by a validated liquid chromatography-tandem mass spectrometry method. Nineteen patients completed the clinical study; 13 participated in the pharmacokinetic follow up. Average pain during the night for DD vs. SD was close to statistical significance (mean 0.8 and 1.4, respectively, P=0.058; mean [95% confidence interval] for the difference was 0.50 [0.02, 1.0]). A similar trend was observed for strongest night pain (P=0.069) and sleep quality (P=0.077). Only two patients required rescue morphine. Four patients had no treatment preference; nine and six favored DD and SD, respectively. DD patients displayed higher area under the curve for morphine and morphine-6-glucuronide during the first part of the night. Although DD tended to perform slightly better than SD, a difference in average pain during the night of 0.50 has little clinical significance, and the two procedures are, therefore, clinically equivalent. It is speculated whether the initial higher exposure to morphine-6-glucuronide may have clinical significance.
journal_name
J Pain Symptom Managejournal_title
Journal of pain and symptom managementauthors
Dale O,Piribauer M,Kaasa S,Moksnes K,Knobel H,Klepstad Pdoi
10.1016/j.jpainsymman.2007.12.016subject
Has Abstractpub_date
2009-01-01 00:00:00pages
68-76issue
1eissn
0885-3924issn
1873-6513pii
S0885-3924(08)00216-9journal_volume
37pub_type
杂志文章,随机对照试验abstract::A treatment program was developed involving cognitive and behavioral strategies for the treatment of migraine headaches with adolescents at the Children's Hospital of Eastern Ontario. These techniques include: a headache diary, progressive relaxation techniques, cognitive restructuring, distraction or attention focusi...
journal_title:Journal of pain and symptom management
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abstract:CONTEXT:Mindfulness-based interventions have been receiving growing attention in cancer care. OBJECTIVES:The purpose of this randomized controlled trial is to examine the effectiveness of mindfulness-based cognitive therapy (MBCT) for psychological distress (anxiety and depression), fear of cancer recurrence (FCR), fa...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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abstract::The influence of personality characteristics on how patients cope with various challenges at the end of life has not been extensively studied. In order to examine the association between end-of-life experience and neuroticism (defined within the personality literature as a trait tendency to experience psychological di...
journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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doi:10.1016/j.jpainsymman.2003.04.003
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,评审
doi:10.1016/0885-3924(95)00137-9
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,多中心研究
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of pain and symptom management
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journal_title:Journal of pain and symptom management
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