Judith H. Watt-Watson

Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy.

Background: Painful neuropathy is one of the most common long‐term complications of diabetes mellitus and often proves difficult to relieve. Methods: Patients with diabetic neuropathy with moderate or greater pain for at least 3 months, were evaluated for efficacy, safety and health‐related quality of life (QOL) while receiving controlled‐release (CR) oxycodone (OxyContin®) or active placebo. Patients underwent washout from all opioids 2–7 days before randomization to 10 mg CR oxycodone or active placebo (0.25 mg benztropine) q12h. The dose was increased, approximately weekly, to a maximum of 40 mg q12h CR oxycodone or 1 mg q12h benztropine, with crossover to the alternate treatment after a maximum of 4 weeks. Acetaminophen, 325–650 mg q4‐6h prn was provided as rescue. Results: Thirty‐six patients were evaluable for efficacy (21 men, 15 women, mean age 63.0±9.4 years). CR oxycodone resulted in significantly lower (P=0.0001) mean daily pain (21.8±20.7 vs. 48.6±26.6 mm VAS), steady pain (23.5±23.0 vs. 47.6±30.7 mm VAS), brief pain (21.8±23.5 vs. 46.7±30.8 mm VAS), skin pain (14.3±20.4 vs. 43.2±31.3 mm VAS), and total pain and disability (16.8±15.6 vs. 25.2±16.7; P=0.004). Scores from 6 of the 8 SF‐36 domains and both summary scales, Standardized Physical Component (P=0.0002) and Standardized Mental Component (P=0.0338) were significantly better during CR oxycodone treatment. The number needed to treat to obtain one patient with at least 50% pain relief is 2.6 and clinical effectiveness scores favoured treatment with CR oxycodone over placebo (P=0.0001). Conclusion: CR oxycodone is effective and safe for the management of painful diabetic neuropathy and improves QOL.

Nurses' knowledge of pain issues: A survey

Abstract This descriptive study examined the knowledge base, related to pain assessment and narcotic administration, of nurses voluntarily attending pain presentations. Data were collected from 106 graduate nurses and 101 baccalaureate nursing students, using a questionnaire which was administered and collected prior to the presentation. The majority of registered nurses were graduates of ten years or less and were working in hospital settings. The scores ranged from 13% to 88% ( = 52%, median=54%, SD=14), and analysis of variance was-not significant for differences among baccalaureate graduates, other graduates, and third-year baccalaureate students. Lack of knowledge about pain assessment and narcotic administration was evident. Graduate and student nurses expressed frustration with difficulties in pain assessment and inadequate pain relief for patients. This study points to major problems that need to be addressed in nursing education.

Canadian Pain Society Position Statement on Pain Relief

The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.

Sickness impact profile: A measure of dysfunction with chronic pain patients

Although chronic pain may affect all facets of a patients life, there is no generally accepted method of measuring the extent of the disability experienced. This component of a larger study examined changes in usual activities and relationships for patients experiencing chronic nonmalignant pain, in order to understand the impact of pain on an individuals life. The effect of pain intensity and depression on the performance of usual daily activities was assessed by the Sickness Impact Profile (SIP). The sample of 34 subjects, 17 women and 17 men, rated their pain as moderate to severe on a linear analogue scale (mean 64). Thirty percent of subjects were moderately to severely depressed as measured by the Beck Depression Inventory (mean 21). The SIP scores indicated severe disruption in daily activities and relationships for this sample. Significant correlations between the SIP and visual analogue scales measuring coping adequacy and activity levels were interesting and warrant further study.

Treatment of Neuropathic Pain: Focus on Antidepressants, Opioids and Gabapentin

BACKGROUND: The treatment of neuropathic pain continues to be difficult. Randomized, controlled trials (RCTs) provide some evidence to guide therapy. Most data relate to antidepressant therapy, although there is information on anticonvulsants and other treatments. Mistaken beliefs about many of these treatments are prevalent and need to be dispelled. Opioids are increasingly being used for the refractory patient. There has been recent enthusiasm for the anticonvulsant gabapentin for the treatment of these conditions.