Shortcuts June 2013
Clin J Pain. 2013 Mar 26. [Epub ahead of print]
Do Patient-perceived Pros and Cons of Opioids Predict Sustained Higher-Dose Use?
Thielke SM, Turner JA, Shortreed SM, Saunders K, Leresche L, Campbell CI, Weisner CC, Korff MV.
Using a patient completed questionnaire, this study evaluated the effect of opioids (≥50 mg morphine- equivalent/day) over 1 year in 1229 patients with chronic non-cancer pain on their perceived benefits and harms of the opioids. The Prescribed Opioid Difficulties Scale questionnaire was used to detect opioid related benefits, concerns and side effects. At 1 year, over 80% of patients continued taking ≥50 mg morphine-equivalent/day, irrespective of benefits, problems, side effects, or helpfulness. Higher scores on the problems and concerns sections of the Prescribed Opioid Difficulties Scale were negatively associated with higher opioid dose after 1 year. However, pain reduction, side effects, and bothersomeness were not associated with continued higher-dose use, suggesting the difficulty of reducing higher-dose opioids in patients taking them in the long term.
Drugs Aging. 2013 Mar 9. [Epub ahead of print]
Studies to Reduce Unnecessary Medication Use in Frail Older Adults: A Systematic Review.
Tjia J, Velten SJ, Parsons C, Valluri S, Briesacher BA.
In a systematic review of interventions that reduced medication use in frail older adults and those who were at the end of life, 15 randomized controlled trials, 4 non-randomized trials, 6 pre-post studies and 11 case series were identified. These included mixed populations who were in variable social and health care settings. There was heterogeneity between study designs, samples, and measures with 21 studies using criteria to identify unnecessary medications (including drug indication, duplication, and efficacy). Pharmacists were involved or led in 25 interventions and physicians led in 5. Due to variability in the studies, overall effect sizes could not be determined, with the authors concluding that there has been little high quality research in this area.
J Pain Symptom Manage. 2013 Mar 24. [Epub ahead of print]
Boland E, Eiser C, Ezaydi Y, Greenfield DM, Ahmedzai SH, Snowden JA.
This study characterised health-related quality of life and symptom burden in 32 patients with advanced, intensively treated myeloma. These patients had undergone hematopoietic stem cell transplantation and subsequent treatment for at least one episode of progressive disease but were stable, with their disease controlled at the time of the study. The Short Form-12, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Multiple Myeloma Module, Brief Pain Inventory-Short Form, self-report Leeds Assessment of Neuropathic Symptoms and Signs and Profile of Concerns were used. Interleukin-6 and tumour necrosis factor-alpha were measured.
The self-reported questionnaires showed that in these patients fatigue and pain (predominantly neuropathic in 50%) were the major symptoms. These impacted negatively on physical functioning which was associated with work disability, concerns regarding loss of independence and poor quality of life. Serum interleukin-6 levels correlated with pain, insomnia, and anorexia, and inversely correlated with physical functioning. The authors concluded that in view of these needs, systematic assessment is routinely indicated in patients with advanced myeloma, even in stable disease.
J R Soc Med. 2013 Feb;106(2):57-67.
The long-term impact of early parental death: lessons from a narrative study.
Ellis J, Dowrick C, Lloyd-Williams M.
Using an qualitative design of written and oral narrative analysis, Ellis et al explored the views of 26 women and 7 men who had experienced the death of a parent before the age of 18 on how they perceived the impact of this experience on adult life. Although individual experiences of bereavement in childhood were unique, narrative analysis threw up three themes linking parental loss to a negative impact on trust, relationships, self-esteem, self-worth, loneliness and isolation and the ability to express feelings in adulthood. The three narrative themes were: i) disruptions and discontinuity such as moving home and separation from family and friends; ii) poor social networks with a lack of support for the child and surviving parent; iii) poor communication, without clear, honest and information relevant to the child’s level of understanding. The authors propose a model for identifying and supporting those more at risk of a poorer outcome as an adult, based on continuity, social support and communication.
by Jason Boland