Merits and Liabilities of NSAID Therapy

Chronic pain in the older patient: management strategies. 2

This is the second of a two-part series, which highlights issues and strategies related to pain assessment in older adults and current problems of pain management in older adults and analgesic regimens pertinent to this population. The complexities of assessing pain in older adults and assessment techniques for accomplishing a careful evaluation of pain were presented in the first part of this series, which was published in the January issue of the Journal of Gerontological Nursing (Vol. 28, No. 1). This article addresses issues and strategies related to management of pain, particularly analgesic use, in this challenging population.

Management of pain and spinal cord compression in patients with advanced cancer. ACP-ASIM End-of-life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine

General internists often care for patients with advanced cancer. These patients have substantial morbidity caused by moderate to severe pain and by spinal cord compression. With appropriate multidisciplinary care, pain can be controlled in 90% of patients who have advanced malignant conditions, and 90% of ambulatory patients with spinal cord compression can remain ambulatory. Guidelines have been developed for assessing and managing patients with these problems, but implementing the guidelines can be problematic for physicians who infrequently need to use them. This paper traces the last year of life of Mr. Simmons, a hypothetical patient who is dying of refractory prostate cancer. Mr. Simmons and his family interact with professionals from various disciplines during this year. Advance care planning is completed and activated. Practical suggestions are offered for assessment and treatment of all aspects of his pain, including its physical, psychological, social, and spiritual dimensions. The methods of pain relief used or discussed include nonpharmacologic techniques, nonopioid analgesics, opioids, adjuvant medications, radiation therapy, and radiopharmaceutical agents. Overcoming resistance to taking opioids; initiating, titrating, and changing opioid routes and agents; and preventing or relieving the side effects they induce are also covered. Data on assessment and treatment of spinal cord compression are reviewed. Physicians can use the techniques described to more readily implement existing guidelines and provide comfort and optimize quality of life for patients with advanced cancer.

Promoting symptom control in palliative care

OBJECTIVES

To describe management of common physical problems that occur in patients with advanced cancer.

DATA SOURCES

Research and review articles, book chapters, and published guidelines.

CONCLUSIONS

Effective symptom control for patients with advanced cancer requires the coordinated efforts of a multidisciplinary team. Excellent palliation can be achieved in patients suffering from pain, as well as from gastrointestinal, respiratory, or dermatologic disorders.

IMPLICATIONS FOR NURSING PRACTICE

Nursing is the cornerstone of effective palliative care. Through accurate assessments and expertise in delivering pharmacologic and nonpharmacologic treatments, nurses ensure optimal palliation of physical symptoms.

Inhibition by cyclo-oxygenase inhibitors of interleukin-6 production by human peripheral blood mononuclear cells

The effects of cyclo-oxygenase inhibitors on interleukin-6 (IL-6) production by human peripheral blood mononuclear cells were examined. Indomethacin and Y-9223, a novel cyclo-oxygenase inhibitor, inhibited the increases in the IL-6 level in the culture medium of both mitogen-stimulated adherent cells and non-adherent cells fractionated from mononuclear cells. Northern blotting showed that the mitogen-induced increase in the expression of IL-6 mRNA was inhibited by indomethacin and Y-9223, indicating that these agents inhibit IL-6 biosynthesis. Aspirin, ibuprofen, and phenylbutazone also inhibited IL-6 production by adherent cells stimulated with lipopolysaccharide (LPS). There was, however, no direct relationship between inhibition of IL-6 and prostaglandin E2 (PGE2) production by these agents. The addition of PGE2 corresponding to the amount produced by adherent cells stimulated with LPS slightly increased IL-6 production by unstimulated adherent cells, but to a lower level than that reached with LPS. An anti-PGE2 antibody partially blocked IL-6 production by adherent cells stimulated with LPS. These results suggest that, in addition to the inhibition of PGE2 production, other mediators including cyclooxygenase products or other action mechanisms are involved in the inhibition of IL-6 production by these drugs.