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Payne, Richard

Positions:

Esther T. Colliflower Professor of Medicine and Divinity

Medicine, Geriatrics
School of Medicine

Professor of Medicine

Medicine, Geriatrics
School of Medicine

Affiliate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1977

M.D. — Harvard University

Medical Resident, Medicine

Children's Hospital Boston

Resident In Neurology, Medicine

Cornell University

News:

Dr. Richard Payne comments: Draft of CDC's new prescribing guidelines stirs debate

December 30, 2015 — NPR’s “All Things Considered”

Project gives voice to African-American history

August 15, 2014 — Durham Herald-Sun

Grants:

Organizational Variability and Racial Disparities in Hospice Use

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 01, 2007
End Date
May 31, 2013

Palliative and End-of-Life Care in Advanced Nursing Practice

Administered By
School of Nursing
AwardedBy
Health Resources and Service Administration
Role
Faculty Member
Start Date
July 01, 2008
End Date
December 31, 2011

Caring and Connecting at End of Life: A Speaker Series of the Duke Institute of Care at the End of Life

Administered By
Divinity School
AwardedBy
Mary Duke Biddle Foundation
Role
Principal Investigator
Start Date
August 01, 2008
End Date
July 31, 2009

Prostate Cancer Recovery Enhancement (PROCARE) for African American Men

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 27, 2007
End Date
January 31, 2008
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Publications:

Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?

Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care.Examine the association between hospices' admission practices and enrollment of African Americans and whites.This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, that is, greater frequency with which hospices admitted those receiving chemotherapy, inotropes, and so forth. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age ≥ 65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership, and budget.Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P < 0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome.Hospices with larger budgets served a greater proportion of African Americans and whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults.

Authors
Johnson, KS; Payne, R; Kuchibhatla, MN; Tulsky, JA
MLA Citation
Johnson, KS, Payne, R, Kuchibhatla, MN, and Tulsky, JA. "Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?." Journal of pain and symptom management 51.4 (April 2016): 697-705.
PMID
26654945
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
697
End Page
705
DOI
10.1016/j.jpainsymman.2015.11.010

Racially Associated Disparities in Hospice and Palliative Care Access: Acknowledging the Facts While Addressing the Opportunities to Improve.

Authors
Payne, R
MLA Citation
Payne, R. "Racially Associated Disparities in Hospice and Palliative Care Access: Acknowledging the Facts While Addressing the Opportunities to Improve." Journal of palliative medicine 19.2 (February 2016): 131-133.
PMID
26840847
Source
epmc
Published In
Journal of Palliative Medicine
Volume
19
Issue
2
Publish Date
2016
Start Page
131
End Page
133
DOI
10.1089/jpm.2015.0475

A phase I study of D-methadone in patients with chronic pain.

D-Methadone is the d optical isomer of racemic mixture (DL-methadone) used clinically to treat pain and addiction in the United States. D-Methadone is practically devoid of opioid activity but maintains N-methyl-D-aspartate (NMDA) receptor antagonism. Evidence from extensive preclinical studies suggests that NMDA receptor antagonists attenuate neuronal plasticity, reverse opioid analgesic tolerance, and alleviate chronic pain states. The authors conducted a phase I open label study of D-methadone administered for the first time to patients with chronic pain to determine the safety and tolerability of D-methadone. In addition to their long-term regimen of opioids, the patients received 40 mg of D-methadone twice daily for 12 days. Analgesia and toxicity were recorded by the patients in a daily diary and assessed in clinic on days 1, 8, and 12. Eight patients of the 10 enrolled completed the study. Pain scores on Edmonton Symptom Assessment System (ESAS) did not change between days 1 and 12, but five of eight patients (62.5 percent) characterized D-methadone as moderately or very effective in relieving pain on the Global Assessment for pain. Five of the eight patients (62.5 percent) who completed the study requested to start treatment with commercially available methadone (DL-racemic methadone) after completing the study. D-Methadone at the dose of 40 mg PO Q 12 hours was well tolerated. Perspective: This is the first clinical study of D-methadone in patients suffering from chronic pain. Additional phase I and phase II studies are needed to confirm its safety and analgesic effects. If D-methadone is well tolerated, it is likely to become a useful adjuvant to the treatment of a wide spectrum of pain syndromes.

Authors
Moryl, N; Tamasdan, C; Tarcatu, D; Thaler, HT; Correa, D; Steingart, R; Payne, R; Obbens, E
MLA Citation
Moryl, N, Tamasdan, C, Tarcatu, D, Thaler, HT, Correa, D, Steingart, R, Payne, R, and Obbens, E. "A phase I study of D-methadone in patients with chronic pain." Journal of opioid management 12.1 (January 2016): 47-55.
PMID
26908303
Source
epmc
Published In
Journal of opioid management
Volume
12
Issue
1
Publish Date
2016
Start Page
47
End Page
55
DOI
10.5055/jom.2016.0311

Relieving Pain in St. Joseph, Missouri: A Health Services Partnership for Changing the Way Pain is Perceived, Judged and Treated.

Authors
Christopher, MJ; Payne, R; Felix, MRJ
MLA Citation
Christopher, MJ, Payne, R, and Felix, MRJ. "Relieving Pain in St. Joseph, Missouri: A Health Services Partnership for Changing the Way Pain is Perceived, Judged and Treated." Pain medicine (Malden, Mass.) 16.11 (November 2015): 2049-2052.
PMID
26178015
Source
epmc
Published In
Pain Medicine
Volume
16
Issue
11
Publish Date
2015
Start Page
2049
End Page
2052
DOI
10.1111/pme.12806

Automated pain intervention for underserved minority women with breast cancer.

Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. The authors evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer.Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based, interactive voice response (IVR) intervention. Women in the intervention group were called twice weekly by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients' oncologists received e-mail alerts if the reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles.The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention also was associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists who were treating the patients rated the intervention as only somewhat useful for improving symptom management.The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.

Authors
Anderson, KO; Palos, GR; Mendoza, TR; Cleeland, CS; Liao, K-P; Fisch, MJ; Garcia-Gonzalez, A; Rieber, AG; Nazario, LA; Valero, V; Hahn, KM; Person, CL; Payne, R
MLA Citation
Anderson, KO, Palos, GR, Mendoza, TR, Cleeland, CS, Liao, K-P, Fisch, MJ, Garcia-Gonzalez, A, Rieber, AG, Nazario, LA, Valero, V, Hahn, KM, Person, CL, and Payne, R. "Automated pain intervention for underserved minority women with breast cancer." Cancer 121.11 (June 2015): 1882-1890.
PMID
25711974
Source
epmc
Published In
Cancer
Volume
121
Issue
11
Publish Date
2015
Start Page
1882
End Page
1890
DOI
10.1002/cncr.29204

Culturally relevant palliative care.

The journey to excellence in palliative care practice is to recognize the three identities of patients, refine skills in assessment to understand these interrelated dimensions of personhood, and hone the practices of caring to deliver truly comprehensive and personalized care. These practices require clinicians to first connect to persons with illness on a human-human level. Being fully present and engaged with patients is critical to practicing high-quality palliative care. Clinicians must encourage and elicit the story of the illness and the life of the person experiencing the illness.

Authors
Payne, R
MLA Citation
Payne, R. "Culturally relevant palliative care." Clinics in geriatric medicine 31.2 (May 2015): 271-279.
PMID
25920062
Source
epmc
Published In
Clinics in Geriatric Medicine
Volume
31
Issue
2
Publish Date
2015
Start Page
271
End Page
279
DOI
10.1016/j.cger.2015.01.010

Medication monitoring and drug testing ethics project.

In 2012, Duke University initiated a research project, funded by an unrestricted research grant from Millennium Laboratories, a drug testing company. The project focused on assessing the frequency and nature of questionable, unethical, and illegal business practices in the clinical drug testing industry and assessing the potential for establishing a business code of ethics. Laboratory leaders, clinicians, industry attorneys, ethicists, and consultants participated in the survey, were interviewed, and attended two face-to-face meetings to discuss a way forward. The study demonstrated broad acknowledgment of variations in the legal and regulatory environment, resulting in inconsistent enforcement of industry practices. Study participants expressed agreement that overtly illegal practices sometimes exist, particularly when laboratory representatives and clinicians discuss reimbursement, extent of testing, and potential business incentives with medical practitioners. Most respondents reported directly observing probable violations involving marketing materials, contracts, or, in the case of some individuals, directly soliciting people with offers of clinical supplies and other "freebies." While many study respondents were skeptical that voluntary standards alone would eliminate questionable business practices, most viewed ethics codes and credentialing as an important first step that could potentially mitigate uneven enforcement, while improving quality of care and facilitating preferred payment options for credentialed parties. Many were willing to participate in future discussions and industry-wide initiatives to improve the environment.

Authors
Payne, R; Moe, JL; Sevier, CH; Sevier, D; Waitzkin, M
MLA Citation
Payne, R, Moe, JL, Sevier, CH, Sevier, D, and Waitzkin, M. "Medication monitoring and drug testing ethics project." Journal of opioid management 11.1 (January 2015): 82-88.
PMID
25750169
Source
epmc
Published In
Journal of opioid management
Volume
11
Issue
1
Publish Date
2015
Start Page
82
End Page
88
DOI
10.5055/jom.2015.0256

Relying on Trust for Research on Medical Practice in Learning Health Systems.

Authors
McNolty, LA; Payne, R
MLA Citation
McNolty, LA, and Payne, R. "Relying on Trust for Research on Medical Practice in Learning Health Systems." The American journal of bioethics : AJOB 15.9 (January 2015): 30-32.
PMID
26305748
Source
epmc
Published In
American Journal of Bioethics
Volume
15
Issue
9
Publish Date
2015
Start Page
30
End Page
32
DOI
10.1080/15265161.2015.1062172

Race and residence: Intercounty variation in black-white differences in hospice use

Context: Although blacks use hospice at lower rates than whites in the U.S., racial differences in hospice use vary by geographic area. Objectives: To describe intercounty variability in black-white differences in hospice use and the association with the supply of health care resources. Methods: Subjects were a retrospective cohort of Medicare beneficiaries in North and South Carolina who died in 2008. Using Wilcoxon tests and logistic regression, we examined the differences in the supply of health care resources (hospital beds and physicians per population age 65 years and older, percentage of generalists, etc.) between counties with and without racial disparity in hospice use. Counties with a racial disparity had significantly (P < 0.05) higher rates of hospice use among whites than blacks. Results: Of 76,283 decedents in 128 counties, 19.78% were black. In the 39 counties (30.47%) with racial disparity in hospice use, the mean proportion of whites who enrolled in hospice was 41.3% vs. 28.66% of blacks (P < 0.0001). Counties with more hospital beds per population age 65 years and older had a higher odds (OR, 1.39; 95% confidence interval [CI] 1.04-1.86) and those with a larger proportion of generalists had a lower odds (OR, 0.01; 95% CI 0.001-0.476) of having a racial disparity in hospice use. Conclusion: In most counties, the rates of hospice use were similar for blacks and whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds and specialists). Because of a greater preference for life-sustaining therapies, blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
Johnson, KS; Kuchibhatla, M; Payne, R; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Payne, R, and Tulsky, JA. "Race and residence: Intercounty variation in black-white differences in hospice use." Journal of Pain and Symptom Management 46.5 (November 1, 2013): 681-690.
Source
scopus
Published In
Journal of Pain and Symptom Management
Volume
46
Issue
5
Publish Date
2013
Start Page
681
End Page
690
DOI
10.1016/j.jpainsymman.2012.12.006

Race and residence: intercounty variation in black-white differences in hospice use.

CONTEXT: Although blacks use hospice at lower rates than whites in the U.S., racial differences in hospice use vary by geographic area. OBJECTIVES: To describe intercounty variability in black-white differences in hospice use and the association with the supply of health care resources. METHODS: Subjects were a retrospective cohort of Medicare beneficiaries in North and South Carolina who died in 2008. Using Wilcoxon tests and logistic regression, we examined the differences in the supply of health care resources (hospital beds and physicians per population age 65 years and older, percentage of generalists, etc.) between counties with and without racial disparity in hospice use. Counties with a racial disparity had significantly (P < 0.05) higher rates of hospice use among whites than blacks. RESULTS: Of 76,283 decedents in 128 counties, 19.78% were black. In the 39 counties (30.47%) with racial disparity in hospice use, the mean proportion of whites who enrolled in hospice was 41.3% vs. 28.66% of blacks (P < 0.0001). Counties with more hospital beds per population age 65 years and older had a higher odds (OR, 1.39; 95% confidence interval [CI] 1.04-1.86) and those with a larger proportion of generalists had a lower odds (OR, 0.01; 95% CI 0.001-0.476) of having a racial disparity in hospice use. CONCLUSION: In most counties, the rates of hospice use were similar for blacks and whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds and specialists). Because of a greater preference for life-sustaining therapies, blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available.

Authors
Johnson, KS; Kuchibhatla, M; Payne, R; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Payne, R, and Tulsky, JA. "Race and residence: intercounty variation in black-white differences in hospice use." J Pain Symptom Manage 46.5 (November 2013): 681-690.
PMID
23522516
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
46
Issue
5
Publish Date
2013
Start Page
681
End Page
690
DOI
10.1016/j.jpainsymman.2012.12.006

The oncologist as primary palliative care provider

Authors
Payne, R
MLA Citation
Payne, R. "The oncologist as primary palliative care provider." Oncology 25.13 (2011).
Source
scival
Published In
Oncology
Volume
25
Issue
13
Publish Date
2011

A rose by any other name: pain contracts/agreements.

Authors
Payne, R; Anderson, E; Arnold, R; Duensing, L; Gilson, A; Green, C; Haywood, C; Passik, S; Rich, B; Robin, L; Shuler, N; Christopher, M
MLA Citation
Payne, R, Anderson, E, Arnold, R, Duensing, L, Gilson, A, Green, C, Haywood, C, Passik, S, Rich, B, Robin, L, Shuler, N, and Christopher, M. "A rose by any other name: pain contracts/agreements." Am J Bioeth 10.11 (November 2010): 5-12.
PMID
21104545
Source
pubmed
Published In
American Journal of Bioethics
Volume
10
Issue
11
Publish Date
2010
Start Page
5
End Page
12
DOI
10.1080/15265161.2010.519425

Psychosocial distress in patients treated for cancer pain: A prospective observational study

Introduction: Untreated emotional distress negatively impacts the management of cancer pain. Objectives: The authors evaluated 64 patients with cancer pain who completed baseline and follow-up measures to identify if (1) measures of psychosocial wellbeing, pain intensity, and pain management were associated with survival time; (2) higher opioid doses were associated with less psychosocial distress; and (3) intrasubject correlations across time altered the relationship between pain, depression, social support, spirituality, and increased desire for hastened death (DHD). Methods: The main outcome measures included the Brief Pain Inventory (BPI), Daily Morphine Equivalent Dose (DMED), Beck Depression Inventory-II (BDI-II), DHD scale, Bottomley Social Support Scale, FACIT Spiritual Well-Being Scale (FACTT-Sp), Karnofsky Performance Rating Scale (KPRS), and State-Trait Anxiety Inventory (STAI). Results: There were significant differences between baseline and follow-up DHD (0.84 vs 1.38, p = 0.021) and BPI scores (6.36 vs 4.86, p < 0.001). Lower existential wellbeing was associated with reduced survival (HR = 0.78, p = 0.019); improvement in pain was associated with longer survival (HR = 1.33, p = 0.034). Higher religious wellbeing was associated with higher probability of survival to 1 year (HR = 0.41, p = 0.014), as was higher KPRS (HR = 0.97, p = 0.001) but not DMED > 300 mg. Higher existential distress and lower Bottomley scores were associated with higher hazard ratios for death at 1 year (HR = 2.78, p = 0.02) and (HR = 14.94, p = 0.002). There were significant differences in average BDI-II for persons with BPI > 7 versus those with moderate or mild pain (12.12 vs 6.82, p < 0.0001) and in DHD (1.71 vs 0.64, p = 0.002). Depression decreased in persons with DMED > 300 mg between baseline and follow-up (-1.67 vs 2.72, p = 0.024). Mean DHD was lower for persons whose pain improved versus others (0.96 vs 2.0, p = 0.026). A generalized linear model was conducted with DHD as the dependent variable and the other above variables as predictors. Higher existential wellbeing and KPRS were associated with lower DHD (β = -0.135, p = 0.049) and (β = -0.79, p = 0.006), respectively. Conclusions: The major findings of this study are that in persons with cancer pain, lower social support and existential wellbeing, but not higher DMED, were associated with shorter survival time. Treatment of cancer pain was associated with lessening of emotional distress. Lower levels of existential wellbeing and physical performance status appear to be associated with greater DHD. © 2010 Journal of Opioid Management, All Rights Reserved.

Authors
O'Mahony, S; Goulet, JL; Payne, R
MLA Citation
O'Mahony, S, Goulet, JL, and Payne, R. "Psychosocial distress in patients treated for cancer pain: A prospective observational study." Journal of Opioid Management 6.3 (2010): 211-222.
PMID
20642250
Source
scival
Published In
Journal of opioid management
Volume
6
Issue
3
Publish Date
2010
Start Page
211
End Page
222
DOI
10.5055/jom.2010.0019

Field notes

Authors
Payne, R
MLA Citation
Payne, R. "Field notes." Hastings Center Report 40.3 (2010): c3-.
Source
scival
Published In
The Hastings Center report
Volume
40
Issue
3
Publish Date
2010
Start Page
c3
DOI
10.1353/hcr.0.0262

Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care

The purpose of our review is to evaluate critically the recent literature on racial and ethnic disparities in pain and to determine how far we have come toward reducing and eliminating disparities in pain. We examined peer-reviewed research articles published between 1990 and early 2009 that focused on racial and ethnic disparities in pain in the United States. The databases used were PubMed, Medline, Scopus, CINAHL, and PsycInfo. The probable causes of minority group disparities in pain are discussed, along with suggested strategies for eliminating pain-related disparities. This review reveals the persistence of racial and ethnic disparities in acute, chronic, cancer, and palliative pain care across the lifespan and treatment settings, with minorities receiving lesser quality pain care than non-Hispanic whites. Although health and health care disparities attract local, state, and federal attention, disparities in pain care continue to be missing from publicized public health agendas and health care reform plans. Ensuring optimal pain care for all is critically important from a public health and policy perspective. A robust research program on disparities in pain is needed, and the results must be successfully translated into practices and policies specifically designed to reduce and eliminate disparities in care. Perspective: This review evaluates the recent literature on racial and ethnic disparities in pain and pain treatment. Racial and ethnic disparities in acute pain, chronic cancer pain, and palliative pain care continue to persist. Rigorous research is needed to develop interventions, practices, and policies for eliminating disparities in pain. © 2009 American Pain Society.

Authors
Anderson, KO; Green, CR; Payne, R
MLA Citation
Anderson, KO, Green, CR, and Payne, R. "Racial and Ethnic Disparities in Pain: Causes and Consequences of Unequal Care." Journal of Pain 10.12 (2009): 1187-1204.
PMID
19944378
Source
scival
Published In
The Journal of Pain
Volume
10
Issue
12
Publish Date
2009
Start Page
1187
End Page
1204
DOI
10.1016/j.jpain.2009.10.002

Sickle Cell Anemia and Pain: Will Data Prevail Over Beliefs?

Authors
Payne, R
MLA Citation
Payne, R. "Sickle Cell Anemia and Pain: Will Data Prevail Over Beliefs?." Annals of Emergency Medicine 53.5 (2009): 596-597.
PMID
19380037
Source
scival
Published In
Annals of Emergency Medicine
Volume
53
Issue
5
Publish Date
2009
Start Page
596
End Page
597
DOI
10.1016/j.annemergmed.2008.10.022

Racially based disparities in pain management: Something old, something new, but what to do?

Authors
Payne, R
MLA Citation
Payne, R. "Racially based disparities in pain management: Something old, something new, but what to do?." Pain Medicine 10.3 (2009): 432-434.
PMID
19416434
Source
scival
Published In
Pain Medicine
Volume
10
Issue
3
Publish Date
2009
Start Page
432
End Page
434
DOI
10.1111/j.1526-4637.2009.00599.x

Physicians charged with opioid-analgesic prescribing offenses

Objective. To provide a "big-picture" overview of the characteristics and outcomes of recent criminal and administrative cases in which physicians have been criminally prosecuted or charged by medical boards with offenses related to inappropriate prescribing of opioid analgesics. Design: We identified as many criminal and administrative cases of these types as possible occurring between 1998 and 2006. Cases were identified using a wide variety of sources, including organizational and government-agency databases, published news accounts and websites. Factual characteristics of these cases and their outcomes, and of the physicians involved, then were further researched using additional sources and methods. Setting: Study findings are intended to apply to practicing U.S. patient care physicians as a whole. Patients or other participants: There were no patients or participants in this study. Outcome measures: We analyzed the numbers and types of cases and physicians involved, criminal and administrative charges brought, case outcomes and sanctions, specialties and other characteristics of the physicians involved. Results: The study identified 725 doctors, representing an estimated 0.1 percent of practicing patient care physicians, charged between 1998 and 2006 with criminal and/or administrative offenses related to prescribing opioid analgesics. A plurality of these (39.3 percent) were general practice/family medicine physicians, compared with 3.5 percent who were self-identified or board-certified pain specialists. Physicians in this sample were more likely to be male, older and not board certified (P<0.001). DEA criminal and complaint investigations averaged 658 per year (2003-2006) and "for cause" surrenders of DEA registrations averaged 369.7 (2000-2006). Conclusions: Criminal or administrative charges and sanctions for prescribing opioid analgesics are rare. In addition, there appears to be little objective basis for concern pain specialists have been "singled out" for prosecution or administrative sanctioning for such offenses.

Authors
Goldenbaum, DM; Christopher, M; Gallagher, RM; Fishman, SM; Payne, R; Joranson, D; Edmondson, D; McKee, J; Thexton, A
MLA Citation
Goldenbaum, DM, Christopher, M, Gallagher, RM, Fishman, SM, Payne, R, Joranson, D, Edmondson, D, McKee, J, and Thexton, A. "Physicians charged with opioid-analgesic prescribing offenses." Journal of Medical Licensure and Discipline 94.3 (2008): 21-31.
Source
scival
Published In
Journal of Medical Licensure and Discipline
Volume
94
Issue
3
Publish Date
2008
Start Page
21
End Page
31

Physicians charged with opioid analgesic-prescribing offenses

Objective: To provide a "big picture" overview of the characteristics and outcomes of recent criminal and administrative cases in which physicians have been criminally prosecuted or charged by medical boards with offenses related to inappropriate prescribing of opioid analgesics. Design: We identified as many criminal and administrative cases of these types as possible that occurred between 1998 and 2006. Cases were identified using a wide variety of sources, including organizational and government agency databases, published news accounts, and Web sites. Factual characteristics of these cases and their outcomes, and of the physicians involved, were then further researched using additional sources and methods. Setting: Study findings are intended to apply to practicing U.S. patient care physicians as a whole. Patients or Other Participants: There were no patients or participants in this study. Outcome Measures: We analyzed the numbers and types of cases and physicians involved, criminal and administrative charges brought, case outcomes and sanctions, specialties, and other characteristics of the physicians involved. Results: The study identified 725 doctors, representing an estimated 0.1% of practicing patient care physicians, who were charged between 1998 and 2006 with criminal and/or administrative offenses related to prescribing opioid analgesics. A plurality of these (39.3%) were General Practice/Family Medicine physicians, compared with 3.5% who were self-identified or board-certified pain specialists. Physicians in this sample were more likely to be male, older, and not board certified (P <0.001). Drug Enforcement Administration (DEA) criminal and complaint investigations averaged 658 per year (2003-2006) and "for cause"surrenders of DEA registrations averaged 369.7 (2000-2006). Conclusions: Criminal or administrative charges and sanctions for prescribing opioid analgesics are rare. In addition, there appears to be little objective basis for concern that pain specialists have been "singled out" for prosecution or administrative sanctioning for such offenses. © 2008 by American Academy of Pain Medicine.

Authors
Goldenbaum, DM; Christopher, M; Gallagher, RM; Fishman, S; Payne, R; Joranson, D; Edmondson, D; Mckee, J; Thexton, A
MLA Citation
Goldenbaum, DM, Christopher, M, Gallagher, RM, Fishman, S, Payne, R, Joranson, D, Edmondson, D, Mckee, J, and Thexton, A. "Physicians charged with opioid analgesic-prescribing offenses." Pain Medicine 9.6 (2008): 737-747.
PMID
18657218
Source
scival
Published In
Pain Medicine
Volume
9
Issue
6
Publish Date
2008
Start Page
737
End Page
747
DOI
10.1111/j.1526-4637.2008.00482.x

Pain in sickle cell disease: A multidimensional construct

Authors
Benjamin, LJ; Payne, R
MLA Citation
Benjamin, LJ, and Payne, R. "Pain in sickle cell disease: A multidimensional construct." Renaissance of Sickle Cell Disease Research in the Genome Era. January 1, 2007. 99-116.
Source
scopus
Publish Date
2007
Start Page
99
End Page
116
DOI
10.1142/9781860947964_0007

Recognition and diagnosis of breakthrough pain.

OBJECTIVE: To review major clinical issues related to recognition and diagnosis of breakthrough pain. ISSUES: Persistent pain and breakthrough pain (BTP) are distinct clinical entities that should be recognized, diagnosed, and treated individually. BTP is common in patients with cancer and a variety of other chronic diseases. Reported incidence of BTP varies widely from 16% to 95% of those with persistent pain syndromes. Such variability is likely due to lack of a clear consensus on the definition of BTP. It is most commonly defined as an abrupt, short-lived, and intense pain that "breaks through" the around-the-clock analgesia that controls persistent pain. The three subtypes of BTP are incident, idiopathic, and end-of-dose failure. BTP also is categorized as somatic, visceral, neuropathic, or mixed. Appropriate assessment of the patient takes into consideration source, severity, pattern, subtype, and cause of pain. Successful treatment is important because BTP has a profound impact on the patient's quality of life, as well as cost of health care. BTP is likely to be underdiagnosed and undertreated because of the lack of consensus on its definition and unwarranted concerns among health care professionals and patients about overmedicating. Additionally, and for reasons not entirely clear, many physicians and other health care providers place a low priority on pain management and underrecognize the occurrence of BTP in patients with persistent pain. CONCLUSION: Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients.

Authors
Payne, R
MLA Citation
Payne, R. "Recognition and diagnosis of breakthrough pain." Pain Med 8 Suppl 1 (January 2007): S3-S7. (Review)
PMID
17280600
Source
pubmed
Published In
Pain Medicine
Volume
8 Suppl 1
Publish Date
2007
Start Page
S3
End Page
S7
DOI
10.1111/j.1526-4637.2006.00269.x

Recognition and treatment of menstrual migraine

BACKGROUND: Menstrual migraine is a chronic disorder affecting approximately 12.6 million women in the United States. In spite of its widespread prevalence, menstrual migraine often goes undiagnosed. REVIEW SUMMARY: Characteristics of menstrual migraine, which include functional disability, increased headache severity, and lack of aura, are often overlooked, and therefore menstrual migraine is often underdiagnosed. Use of a 3-month diary to record migraine patterns can reveal the predictable patterns associated with menstrual migraine, and a diary is demonstrated to be a useful tool in diagnosis. Optimal treatment of menstrual migraine takes advantage of the predictability of the disorder. Treatment alternatives for menstrual migraine include acute therapy and short- or long-term preventive therapies. Acute therapy is given shortly after the migraine begins. Short-term preventive therapies are effective when administered during the time that menstrual migraine is most likely to occur; the treatment window is typically 2 days prior up to 3 days after the onset of menstruation. Providing triptans, nonsteroidal anti-inflammatory drugs, or estrogen supplements (gel or patches) during this window has been demonstrated to provide effective protection during the days when patients are at greatest risk for menstrual migraine. Alternatively, long-term preventive therapy may be required for recurrent headaches in patients with concomitant medical conditions for whom migraine therapy could serve a dual purpose. CONCLUSION: By recognizing the patterns associated with menstrual migraine, prompt, acute, or preventive therapy can be used to effectively manage the disorder and reduce its related disability. © 2007 Lippincott Williams & Wilkins, Inc.

Authors
Lay, CL; Payne, R
MLA Citation
Lay, CL, and Payne, R. "Recognition and treatment of menstrual migraine." Neurologist 13.4 (2007): 197-204.
PMID
17622911
Source
scival
Published In
Neurologist
Volume
13
Issue
4
Publish Date
2007
Start Page
197
End Page
204
DOI
10.1097/NRL.0b013e31805c746f

Palliative care in the Inner City: Patient religious affiliation, underinsurance, and symptom attitude

Many barriers, including being uninsured or having less than comprehensive health insurance coverage, reduce access to palliative and end-of-life care by inner city minorities. Medicaid or Medicare coverage alone can limit options for pain and symptom management, especially when late referrals make it more difficult to achieve symptom control. Patient affiliation with a religion could offset perceived difficulties with pain medication as well as negative pain and symptom attitudes. Data were analyzed from the most recent assessments of 146 African Americans and Latinos enrolled in an outpatient palliative care unit of an inner city hospital. Fifty-seven percent were receiving palliative care for cancer. Compared with other patients, patients with a religious affiliation did not differ regarding pain medication stress. Uninsured patients with a religious affiliation reported more hopeful pain and symptom attitudes, while patients with a religious affiliation covered only by Medicaid reported less hopeful pain and symptom attitudes. More hopeful pain and symptom attitudes by religious-affiliated, uninsured patients may reveal adequate coping, yet also conceal problem domains. Conversely, less hopeful attitudes by religious-affiliated patients covered only by Medicaid serve as clues to coping difficulties and problem domains. Palliative care programs should carefully consider how to integrate religious support networks as pipelines for program referrals and potential partners for care. © 2006 American Cancer Society.

Authors
Francoeur, RB; Payne, R; Raveis, VH; Shim, H
MLA Citation
Francoeur, RB, Payne, R, Raveis, VH, and Shim, H. "Palliative care in the Inner City: Patient religious affiliation, underinsurance, and symptom attitude." Cancer 109.2 SUPPL. (2007): 425-434.
PMID
17149757
Source
scival
Published In
Cancer
Volume
109
Issue
2 SUPPL.
Publish Date
2007
Start Page
425
End Page
434
DOI
10.1002/cncr.22363

Introduction: The scope of breakthrough pain in clinical practice

Authors
Payne, R
MLA Citation
Payne, R. "Introduction: The scope of breakthrough pain in clinical practice." Pain Medicine 8.SUPPL. 1 (2007): S1-S2.
Source
scival
Published In
Pain Medicine
Volume
8
Issue
SUPPL. 1
Publish Date
2007
Start Page
S1
End Page
S2
DOI
10.1111/j.1526-4637.2006.00268.x

Hospice Partnerships with Academic Entities: Philosophical and Historical Background and Assessment of Future Needs

There is consensus that more research is needed to help improve care at the end of life. Despite the fact that hospices take care of more and more dying persons every year, hospice organizations have not been highly involved in research. The National Hospice Work Group is comprised of hospice organizations that have made promotion of research a high priority. Structured interviews were conducted with members of the National Hospice Work Group to investigate how they think about the role of academic partners in their organizational missions, what their histories of involvement with academic partners are, and what they see as their most important academic needs for continuing to advance the research agenda. Members of the National Hospice Work Group see strategic partnerships with academic entities as essential to the goal of advancing research in end-of-life care. © 2007 U.S. Cancer Pain Relief Committee.

Authors
Tolley, DC; Payne, R
MLA Citation
Tolley, DC, and Payne, R. "Hospice Partnerships with Academic Entities: Philosophical and Historical Background and Assessment of Future Needs." Journal of Pain and Symptom Management 33.1 (2007): 90-98.
PMID
17196910
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
33
Issue
1
Publish Date
2007
Start Page
90
End Page
98
DOI
10.1016/j.jpainsymman.2006.10.007

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial

Background: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. Methods: In this randomised, multi-institutional, non-blinded trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. Findings: After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%) were able to walk after treatment (odds ratio 6.2 [95% CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. Interpretation: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.

Authors
Patchell, RA; Tibbs, PA; Regine, WF; Payne, R; Saris, S; Kryscio, RJ; Mohiuddin, M; Young, B
MLA Citation
Patchell, RA, Tibbs, PA, Regine, WF, Payne, R, Saris, S, Kryscio, RJ, Mohiuddin, M, and Young, B. "Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial." Lancet 366.9486 (2005): 643-648.
PMID
16112300
Source
scival
Published In
Lancet
Volume
366
Issue
9486
Publish Date
2005
Start Page
643
End Page
648
DOI
10.1016/S0140-6736(05)66954-1

Consensus panel recommendations for the assessment and management of breakthrough pain: Part 2 management

The authors continue their discussion of pharmacological and nonpharmacological therapies with a focus on criteria for the best agent, the subtypes of breakthrough pain, and the economic and quality-of life considerations.

Authors
Bennett, D; Burton, AW; Fishman, S; Fortner, B; McCarberg, B; Miaskowski, C; Nash, D; Pappagallo, M; Payne, R; Ray, J; Viscusi, E; Wong, W
MLA Citation
Bennett, D, Burton, AW, Fishman, S, Fortner, B, McCarberg, B, Miaskowski, C, Nash, D, Pappagallo, M, Payne, R, Ray, J, Viscusi, E, and Wong, W. "Consensus panel recommendations for the assessment and management of breakthrough pain: Part 2 management." P and T 30.6 (2005): 354-361.
Source
scival
Published In
P and T
Volume
30
Issue
6
Publish Date
2005
Start Page
354
End Page
361

Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group

Background: Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. Patients and methods: A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood. Results: The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites. Conclusion: A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial. © 2005 European Society for Medical Oncology.

Authors
Cleeland, CS; Portenoy, RK; Rue, M; Mendoza, TR; Weller, E; Payne, R; Kirshner, J; Atkins, JN; Johnson, PA; Marcus, A
MLA Citation
Cleeland, CS, Portenoy, RK, Rue, M, Mendoza, TR, Weller, E, Payne, R, Kirshner, J, Atkins, JN, Johnson, PA, and Marcus, A. "Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group." Annals of Oncology 16.6 (2005): 972-980.
PMID
15821119
Source
scival
Published In
Annals of Oncology
Volume
16
Issue
6
Publish Date
2005
Start Page
972
End Page
980
DOI
10.1093/annonc/mdi191

Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study

Desire for hastened death (DHD) is reported in the literature as being common in patients with cancer pain. However, there is currently little evidence to suggest that improvement in pain results in improvement in DHD. Our objectives were to assess 1) the impact of improvements in cancer pain severity and pain's interference with daily functioning and depression on DHD, and 2) the role of factors such as social and spiritual well-being, educational level, and patient age in moderating the impact of pain and depression on DHD. This observational study included patient-rated and clinician-rated scales administered twice at 4-week intervals. We enrolled 131 newly-referred patients to the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center or newly-admitted patients to Calvary Hospital in New York. One hundred and sixteen patients completed the baseline measures and 64 patients completed both baseline and follow-up measures. The main outcome measures included the Brief Pain Inventory (BPI), Beck Depression Inventory (BDI), and the Desire for Hastened Death Scale (DHD). Sixty-six percent of patients had no DHD at baseline and 45% of patients had BDI scores of 14 or greater ('mild' depression). Only 40% of patients with moderate/severe depression were receiving antidepressants. BPI scores improved significantly from baseline to follow-up (6.36 vs. 4.86, P < 0.01). DHD scores increased significantly from baseline to follow-up (0.84 to 1.38, P = 0.03). All other measures including depression were stable. DHD scores were moderately correlated with depression (r = 0.43), low social support (r = 0.38), poor spiritual well-being (r = -0.38), religious well being (r = -0.25), pain interference (r = 0.27), higher educational level (F = 4.50, P = 0.02) and lower physical functioning (KPRS, r = -0.40), but were unrelated to sex, age, race, or marital status. In multivariate regression analyses, baseline DHD (β = 0.30, P = 0.05) and change in depression (β = 0.36, P = 0.02) were predictive of follow-up DHD. Improvement in pain interference was not predictive of follow-up DHD. The results suggest that improvement in depression moderated the severity of desire for hastened death in a population of patients with cancer pain. Depression was common in this population and was often untreated. Improvements in functional impairment due to pain did not moderate the severity of DHD in a setting of aggressive pain management. Strategies to preemptively screen for depression in the routine assessment of patients with cancer pain may be important to address DHD. © 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
O'Mahony, S; Goulet, J; Kornblith, A; Abbatiello, G; Clarke, B; Kless-Siegel, S; Breitbart, W; Payne, R
MLA Citation
O'Mahony, S, Goulet, J, Kornblith, A, Abbatiello, G, Clarke, B, Kless-Siegel, S, Breitbart, W, and Payne, R. "Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study." Journal of Pain and Symptom Management 29.5 (2005): 446-457.
PMID
15904747
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
29
Issue
5
Publish Date
2005
Start Page
446
End Page
457
DOI
10.1016/j.jpainsymman.2004.08.010

Consensus panel recommendations for the assessment and management of breakthrough pain parr I assessment

Authors
Bennett, D; Burton, AW; Fishman, S; Fortner, B; McCarberg, B; Miaskowski, C; Nash, DB; Pappagallo, M; Payne, R; Ray, J; Viscusi, ER; Wong, W
MLA Citation
Bennett, D, Burton, AW, Fishman, S, Fortner, B, McCarberg, B, Miaskowski, C, Nash, DB, Pappagallo, M, Payne, R, Ray, J, Viscusi, ER, and Wong, W. "Consensus panel recommendations for the assessment and management of breakthrough pain parr I assessment." P and T 30.5 (2005): 296-301.
Source
scival
Published In
P & T : a peer-reviewed journal for formulary management
Volume
30
Issue
5
Publish Date
2005
Start Page
296
End Page
301

Buprenorphine: Considerations for pain management

New effective analgesics are needed for the treatment of pain. Buprenorphine, a partial mu-opioid agonist which has been in clinical use for over 25 years, has been found to be amenable to new formulation technology based on its physiochemical and pharmacological profile. Buprenorphine is marketed as parenteral, sublingual, and transdermal formulations. Unlike full mu-opioid agonists, at higher doses, buprenorphine's physiological and subjective effects, including euphoria, reach a plateau. This ceiling may limit the abuse potential and may result in a wider safety margin. Buprenorphine has been used for the treatment of acute and chronic pain, as a supplement to anesthesia, and for behavioral and psychiatric disorders including treatment for opioid addiction. Prolonged use of buprenorphine can result in physical dependence. However, withdrawal symptoms appear to be mild to moderate in intensity compared with those of full mu agonists. Overdoses have primarily involved buprenorphine taken in combination with other central nervous system depressants. © 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
Johnson, RE; Fudala, PJ; Payne, R
MLA Citation
Johnson, RE, Fudala, PJ, and Payne, R. "Buprenorphine: Considerations for pain management." Journal of Pain and Symptom Management 29.3 (2005): 297-326.
PMID
15781180
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
29
Issue
3
Publish Date
2005
Start Page
297
End Page
326
DOI
10.1016/j.jpainsymman.2004.07.005

Pain education for minority patients with cancer

Authors
Anderson, KO; Mendoza, TR; Payne, R; Spigel, DR
MLA Citation
Anderson, KO, Mendoza, TR, Payne, R, and Spigel, DR. "Pain education for minority patients with cancer." Journal of Clinical Outcomes Management 12.2 (2005): 75-78.
Source
scival
Published In
Journal of clinical outcomes management : JCOM
Volume
12
Issue
2
Publish Date
2005
Start Page
75
End Page
78

Pain education for underserved minority cancer patients: A randomized controlled trial

Purpose: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. Patients and Methods: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. Results: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. Conclusion: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed. © 2004 by American Society of Clinical Oncology.

Authors
Anderson, KO; Mendoza, TR; Payne, R; Valero, V; Palos, GR; Nazario, A; Richman, SP; Hurley, J; Gning, I; Lynch, GR; Kalish, D; Cleeland, CS
MLA Citation
Anderson, KO, Mendoza, TR, Payne, R, Valero, V, Palos, GR, Nazario, A, Richman, SP, Hurley, J, Gning, I, Lynch, GR, Kalish, D, and Cleeland, CS. "Pain education for underserved minority cancer patients: A randomized controlled trial." Journal of Clinical Oncology 22.24 (2004): 4918-4925.
PMID
15611506
Source
scival
Published In
Journal of Clinical Oncology
Volume
22
Issue
24
Publish Date
2004
Start Page
4918
End Page
4925
DOI
10.1200/JCO.2004.06.115

Managing pain: The challenge in underserved populations. Appropriate use versus abuse and diversion

ISSUE: Inadequate pain management is a serious public health problem that affects a wide cross-section of Americans. Patients are often denied sufficient medication, because physicians lack training and fear scrutiny from federal and state regulatory agencies. In addition, even the state-financed system of care, Medicaid, has been increasingly denying payment for the best treatment for pain management. These factors are complicated by physician bias about various subgroups and poor physician-patient communication. Comprehensive patient assessment plays a crucial role in determining appropriate treatment and identifying potential abuse problems. Physicians must routinely document medications analgesic effects and screen for potential ill effects and drug abuse. OBJECTIVE: To examine the prevalence of the undertreatment of pain, particularly among African Americans, and to recommend relevant proactive policy and practice changes to aid in eliminating this health problem. CONSENSUS PROCESS: In July 2002, the NMA convened the "Managing Pain: The Challenge in Underserved Populations: Appropriate Use versus Abuse and Diversion" Consensus Meeting in Washington, DC. The country's most renowned experts in the area of pain management and substance abuse reviewed substantial information regarding pain management and substance abuse including the following: A draft summary paper on pain management and substance abuse that served as briefing material for consensus members; Annotated bibliographies; Articles on pain management and substance abuse; and Key presentations on pain management and substance abuse.

Authors
Primm, BJ; Perez, L; Dennis, GC; Benjamin, L; Clark, HW; Keough, K; Leak, WD; Payne, R; Smith, D; Sullivan, LW
MLA Citation
Primm, BJ, Perez, L, Dennis, GC, Benjamin, L, Clark, HW, Keough, K, Leak, WD, Payne, R, Smith, D, and Sullivan, LW. "Managing pain: The challenge in underserved populations. Appropriate use versus abuse and diversion." Journal of the National Medical Association 96.9 (2004): 1152-1161.
PMID
15481743
Source
scival
Published In
Journal of the National Medical Association
Volume
96
Issue
9
Publish Date
2004
Start Page
1152
End Page
1161

A cytokine-based neuroimmunologic mechanism of cancer-related symptoms

While many of the multiple symptoms that cancer patients have are due to the disease, it is increasingly recognized that pain, fatigue, sleep disturbance, cognitive dysfunction and affective symptoms are treatment related, and may lead to treatment delays or premature treatment termination. This symptom burden, a subjective counterpart of tumor burden, causes significant distress. Progress in understanding the mechanisms that underlie these symptoms may lead to new therapies for symptom control. Recently, some of these symptoms have been related to the actions of certain cytokines that produce a constellation of symptoms and behavioral signs when given exogenously to both humans and animals. The cytokine-induced sickness behavior that occurs in animals after the administration of infectious or inflammatory agents or certain proinflammatory cytokines has much in common with the symptoms experienced by cancer patients. Accordingly, we propose that cancer-related symptom clusters share common cytokine-based neuroimmunologic mechanisms. In this review, we provide evidence from clinical and animal studies that correlate the altered cytokine profile with cancer-related symptoms. We also propose that the expression of coexisting symptoms is linked to the deregulated activity of nuclear factor-kappa B, the transcription factor responsible for the production of cytokines and mediators of the inflammatory responses due to cancer and/or cancer treatment. These concepts open exciting new avenues for translational research in the pathophysiology and treatment of cancer-related symptoms. Copyright © 2004 S. Karger AG, Basel.

Authors
Lee, B-N; Dantzer, R; Langley, KE; Bennett, GJ; Dougherty, PM; Dunn, AJ; Meyers, CA; Miller, AH; Payne, R; Reuben, J; Wang, XS; Cleeland, CS
MLA Citation
Lee, B-N, Dantzer, R, Langley, KE, Bennett, GJ, Dougherty, PM, Dunn, AJ, Meyers, CA, Miller, AH, Payne, R, Reuben, J, Wang, XS, and Cleeland, CS. "A cytokine-based neuroimmunologic mechanism of cancer-related symptoms." NeuroImmunoModulation 11.5 (2004): 279-292.
PMID
15316238
Source
scival
Published In
Neuroimmunomodulation
Volume
11
Issue
5
Publish Date
2004
Start Page
279
End Page
292
DOI
10.1159/000079408

Parenteral methadone: An essential medication for the treatment of pain [1]

Authors
Manfredi, PL; Foley, KM; Payne, R; Houde, R; Inturrisi, CE
MLA Citation
Manfredi, PL, Foley, KM, Payne, R, Houde, R, and Inturrisi, CE. "Parenteral methadone: An essential medication for the treatment of pain [1]." Journal of Pain and Symptom Management 26.2 (2003): 687-688.
PMID
12906950
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
26
Issue
2
Publish Date
2003
Start Page
687
End Page
688
DOI
10.1016/S0885-3924(03)00259-8

QTc interval prolongation associated with intravenous methadone

Numerous medications prolong the rate-corrected QT (QTc) interval and induce arrhythmias by blocking ionic current through cardiac potassium channels composed of subunits expressed by the human ether-a-go-go-related gene (HERG). Recent reports suggest that high doses of methadone cause torsades de pointes. To date, no controlled study has described an association between methadone and QTc prolongation. The only commercial formulation of parenteral methadone available in the United States contains the preservative chlorobutanol. The objectives of this study are to determine: (1) whether the administration of intravenous (i.v.) methadone causes QTc prolongation in humans; (2) whether methadone and/or chlorobutanol block cardiac HERG potassium currents (I HERG) in vitro. Over 20 months, we identified every inpatient with at least one electrocardiogram (ECG) performed on i.v. methadone. For each patient, we measured QTc intervals for every available ECG performed on and off i.v. methadone. Concurrent methadone doses were also recorded. Similar data were collected for a separate group of inpatients treated with i.v. morphine. In a separate set of experiments IHERG was evaluated in transfected human embryonic kidney cells exposed to increasing concentrations of methadone, chlorobutanol, and the two in combination. Mean difference (±standard error) per patient in QTc intervals on and off methadone was 41.7 (±7.8)ms, p<0.0001. Mean difference in QTc intervals on and off morphine was 9.0 (±6.1)ms, p=0.15. The approximately linear relationship between QTc measurements and log-dose of methadone was significant (p<0.0001). Methadone and chlorobutanol independently block IHERG in a concentration-dependent manner with IC50 values of 20±2 μM and 4.4±0.3 mM, respectively. Chlorobutanol potentiates methadone's ability to block IHERG. Methadone in combination with chlorobutanol is associated with QTc interval prolongation. Our data strongly suggest that methadone in combination with chlorobutanol is associated with QTc interval prolongation. © 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Authors
Kornick, CA; Kilborn, MJ; Santiago-Palma, J; Schulman, G; Thaler, HT; Keefe, DL; Katchman, AN; Pezzullo, JC; Ebert, SN; Woosley, RL; Payne, R; Manfredi, PL
MLA Citation
Kornick, CA, Kilborn, MJ, Santiago-Palma, J, Schulman, G, Thaler, HT, Keefe, DL, Katchman, AN, Pezzullo, JC, Ebert, SN, Woosley, RL, Payne, R, and Manfredi, PL. "QTc interval prolongation associated with intravenous methadone." Pain 105.3 (2003): 499-506.
PMID
14527710
Source
scival
Published In
PAIN
Volume
105
Issue
3
Publish Date
2003
Start Page
499
End Page
506
DOI
10.1016/S0304-3959(03)00205-7

A safe and effective method for converting patients from transdermal to intravenous fentanyl for the treatment of acute cancer-related pain

BACKGROUND. The delayed effects (12-16 hours) of transdermal fentanyl make dose titration difficult during acute exacerbations of cancer pain. Patients at the authors' institution routinely are switched from transdermal to intravenous (IV) fentanyl using a 1:1 (transdermal:IV) conversion during severe episodes of pain. METHODS. The authors evaluated nine consecutive hospitalized patients with cancer who had severe pain for up to 6 days following the conversion from transdermal to IV fentanyl. Pain intensity was rated using an 11-point (0-10) verbal numeric rating scale (NRS). All 9 patients initially reported their pain intensity with movement as ≥ 8 during treatment with transdermal fentanyl. Eight patients initially reported their pain at rest as ≥ 8. In each patient, all transdermal patches were removed, and a continuous infusion (CI) delivering IV fentanyl at the same hourly rate was initiated simultaneously. Demand boluses of IV fentanyl equivalent in dosage to 50-100% of the CI rate remained available by patient-controlled analgesia (PCA). Pain intensity (0-10), sedation (0-3), and hourly fentanyl requirements (micrograms per hour) were assessed and recorded immediately prior to patch removal and at least once daily after the initiation of IV fentanyl. The CI and demand boluses were titrated whenever necessary on the basis of pain intensity and supplemental PCA use. RESULTS. All 9 patients reported mild levels (≤ 4) of pain at rest within 5 days. The median time to achieve mild levels of pain at rest was 1.5 days. Six patients achieved mild levels of pain with movement within 3 days. Three patients never achieved mild levels of pain with movement while receiving IV fentanyl. No serious side effects were reported. CONCLUSIONS. The conversion from transdermal to IV fentanyl can be accomplished safely and effectively using a 1:1 (transdermal:IV) conversion during acute exacerbations of cancer pain. © 2003 American Cancer Society.

Authors
Kornick, CA; Santiago-Palma, J; Schulman, G; O'Brien, PC; Weigand, S; Payne, R; Manfredi, PL
MLA Citation
Kornick, CA, Santiago-Palma, J, Schulman, G, O'Brien, PC, Weigand, S, Payne, R, and Manfredi, PL. "A safe and effective method for converting patients from transdermal to intravenous fentanyl for the treatment of acute cancer-related pain." Cancer 97.12 (2003): 3121-3124.
PMID
12784350
Source
scival
Published In
Cancer
Volume
97
Issue
12
Publish Date
2003
Start Page
3121
End Page
3124
DOI
10.1002/cncr.11457

Neuropathic pain in patients with cancer

We provide a detailed description of painful neural lesions in hospitalized patients with cancer. A total of 187 consecutive patients with cancer and pain, referred to the pain service of a cancer hospital, were evaluated within 24 hours by two neurologists and followed until discharge or death. Based on history, pain descriptors, physical examination, and radiological and electrophysiological studies, the pain was categorized as neuropathic in 103 patients. The most frequent sites of neurological injury were nerve roots, spinal cord and cauda equina, brachial and lumbosacral plexus, and peripheral nerves. There were no patients with pain caused by injury to the brain. In 93 of these patients, the pain was caused by ongoing neural injury, while, in 10 patients, the neural injury was old and stable. Within these two groups of patients with neuropathic pain, analgesic treatments differed. Prospective studies may determine if categorizing painful neurological injuries in cancer patients based on inferred pathophysiology is useful when deciding among different treatment options.

Authors
Manfredi, PL; Gonzales, GR; Sady, R; Chandler, S; Payne, R
MLA Citation
Manfredi, PL, Gonzales, GR, Sady, R, Chandler, S, and Payne, R. "Neuropathic pain in patients with cancer." Journal of Palliative Care 19.2 (2003): 115-118.
PMID
12955928
Source
scival
Published In
Journal of Palliative Care
Volume
19
Issue
2
Publish Date
2003
Start Page
115
End Page
118

Benefit-Risk Assessment of Transdermal Fentanyl for the Treatment of Chronic Pain

Transdermal fentanyl is effective and well tolerated for the treatment of chronic pain caused by malignancy and non-malignant conditions when administered according to the manufacturer's recommendations. Compared with oral opioids, the advantages of transdermal fentanyl include a lower incidence and impact of adverse effects (constipation, nausea and vomiting, and daytime drowsiness), a higher degree of patient satisfaction, improved quality of life, improved convenience and compliance resulting from administration every 72 hours, and decreased use of rescue medication. Transdermal fentanyl is a useful analgesic for cancer patients who are unable to swallow or have gastrointestinal problems. Transdermal fentanyl forms a depot within the upper skin layers before entering the microcirculation. Therapeutic blood levels are attained 12-16 hours after patch application and decrease slowly with a half-life of 16-22 hours following removal. Patients with chronic pain should be titrated to adequate relief with short-acting oral or parenteral opioids prior to the initiation of transdermal fentanyl in order to prevent exacerbations of pain or opioid-related adverse effects. Transdermal fentanyl can then be initiated based on the 24-hour opioid requirement once adequate analgesia has been achieved. The prolonged elimination of transdermal fentanyl can become problematic if patients develop opioid-related adverse effects, especially hypoventilation. Adverse effects do not improve immediately after patch removal and may take many hours to resolve. Patients who experience opioid-related toxicity associated with respiratory depression should be treated immediately with an opioid antagonist such as naloxone and closely monitored for at least 24 hours. Because of the short half-life of naloxone, sequential doses or a continuous infusion of the opioid antagonist may be necessary. Transdermal fentanyl should be administered cautiously to patients with pre-existing conditions such as emphysema that may predispose them to the development of hypoventilation. Transdermal fentanyl is indicated only for patients who require continuous opioid administration for the treatment of chronic pain that cannot be managed with other medications. It is contraindicated in the management of acute and postoperative pain, as pain may decrease more rapidly in these circumstances than fentanyl blood levels can be adjusted, leading to the development of life-threatening hypoventilation. Cognitive and physical impairments such as confusion and abnormal co-ordination can occur with transdermal fentanyl. Therefore, patients should be instructed to refrain from driving or operating machinery immediately following the initiation of transdermal fentanyl, or after any dosage increase. Patients may resume such activities once the absence of these potential adverse effects is documented.

Authors
Kornick, CA; Santiago-Palma, J; Moryl, N; Payne, R; Obbens, EAMT
MLA Citation
Kornick, CA, Santiago-Palma, J, Moryl, N, Payne, R, and Obbens, EAMT. "Benefit-Risk Assessment of Transdermal Fentanyl for the Treatment of Chronic Pain." Drug Safety 26.13 (2003): 951-973.
PMID
14583070
Source
scival
Published In
Drug Safety
Volume
26
Issue
13
Publish Date
2003
Start Page
951
End Page
973
DOI
10.2165/00002018-200326130-00004

Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula

The authors discuss the damaging influence of informal and hidden curricula on medical students and describe a two-week clerkship in pallative care and clinical ethics at their school (Weill Medical College of Cornell University). This required clerkship, begun in 1999, uses reflective practice and a special pedagogic technique, participant observation, to counteract the influences of the informal and hidden curricula. This technique seeks to immerse the participant observer in the context of care. In their role as participant observers, students are relieved of any direct clinical responsibilities for two weeks so they have time for the careful observation and reflection required and also can consider the humanistic dimensions of practice, which are often displaced by the need to master diagnostic and therapeutic skills. Course objectives include identifying psychosocial and contextual factors that influence care, principles of pain and symptom management, and ethical and legal issues at the end of life. Students are expected to learn how to apply ethical norms to patient care, describe methods of pain and symptom management, communicate in an effective and humanistic manner, and articulate models of patient-centered advocacy. The clerkship fosters professionalism in patient care, appreciation of cultural diversity, and the student's ability to assume responsibility for developing competency in these areas. Although it is too early to know whether this clerkship will ultimately affect the practice patterns of students who experience it, short-term evaluation has been very favorable.

Authors
Fins, JJ; Gentilesco, BJ; Carver, A; Lister, P; Acres, CA; Payne, R; Storey-Johnson, C
MLA Citation
Fins, JJ, Gentilesco, BJ, Carver, A, Lister, P, Acres, CA, Payne, R, and Storey-Johnson, C. "Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula." Academic Medicine 78.3 (2003): 307-312.
PMID
12634214
Source
scival
Published In
Academic Medicine
Volume
78
Issue
3
Publish Date
2003
Start Page
307
End Page
312

Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms

BACKGROUND. Cancers and cancer treatments produce multiple symptoms that collectively cause a symptom burden for patients. These symptoms include pain, wasting, fatigue, cognitive impairment, anxiety, and depression, many of which co-occur. There is growing recognition that at least some of these symptoms may share common biologic mechanisms. METHODS. In November 2001, basic and clinical scientists met to consider evidence for a cytokine-immunologic model of symptom expression along with directions for future research. RESULTS. The characteristics of cytokine-induced sickness behavior in animal models have much in common with those of symptomatic cancer patients. Sickness behavior refers to a set of physiologic and behavioral responses observed in animals after the administration of infectious or inflammatory agents or certain proinflammatory cytokines. In some cases, these responses can be prevented by cytokine antagonists. A combination of animal and human research suggests that several cancer-related symptoms may involve the actions of proinflammatory cytokines. CONCLUSIONS. Based on the similarities between cancer symptoms and sickness behavior, the authors discussed approaches to further test the implications of the relationship between inflammatory cytokines and symptoms for both symptom treatment and symptom prevention. © 2003 American Cancer Society.

Authors
Cleeland, CS; Bennett, GJ; Dantzer, R; Dougherty, PM; Dunn, AJ; Meyers, CA; Miller, AH; Payne, R; Reuben, JM; Wang, XS; Lee, B-N
MLA Citation
Cleeland, CS, Bennett, GJ, Dantzer, R, Dougherty, PM, Dunn, AJ, Meyers, CA, Miller, AH, Payne, R, Reuben, JM, Wang, XS, and Lee, B-N. "Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms." Cancer 97.11 (2003): 2919-2925.
PMID
12767108
Source
scival
Published In
Cancer
Volume
97
Issue
11
Publish Date
2003
Start Page
2919
End Page
2925
DOI
10.1002/cncr.11382

Quality of life concerns in patients with breast cancer: Evidence for disparity of outcomes and experiences in pain management and palliative care among African-American women

BACKGROUND. African-American women are at higher risk for breast cancer mortality compared with their white counterparts. Furthermore, African-American women present for diagnosis and treatment later in the disease process. It may be expected that this greater disease burden would impose more symptoms compared with women who present with earlier stage disease. However, the effect of breast cancer on the quality of life of African-American women largely has been unexplored. METHODS. A qualitative literature review was conducted to identify racial disparities in the palliative care of patients with cancer and their impact on quality of life for African-American women. A Medline search was done encompassing the years between 1985 and 2000 and included the following search terms: breast cancer, palliative care, pain management, quality of life, health care disparities, and African Americans. Relevant articles were read and summarized for inclusion in this review. RESULTS. Differences in treatment patterns, pain management, and the use of hospice care exist between African-American women and women in other ethnic groups. Explanations for these differences have not been researched well. In addition, the emotional, social, and other aspects of quality of life for African-American women with breast cancer are not well understood, in part due to the absence of a standardized quality-of-life measure. CONCLUSIONS. Physicians and other health care providers must be educated better about pain management and hospice care and, in turn, must inform their patients better about these issues. Physicians' and researchers' considerations of the influence of race and ethnicity on quality of life are critical. Furthermore, future research should be focused on the establishment of a standardized measure for quality of life that better encompasses its social, spiritual, and emotional aspects. Quality-of-life measures should be incorporated into routine health surveillance mechanisms, with an increased emphasis on minority and other under-served populations. © 2003 American Cancer Society.

Authors
Payne, R; Medina, E; Hampton, JW
MLA Citation
Payne, R, Medina, E, and Hampton, JW. "Quality of life concerns in patients with breast cancer: Evidence for disparity of outcomes and experiences in pain management and palliative care among African-American women." Cancer 97.1 SUPPL. (2003): 311-317.
PMID
12491494
Source
scival
Published In
Cancer
Volume
97
Issue
1 SUPPL.
Publish Date
2003
Start Page
311
End Page
317

Pitfalls of opioid rotation: Substituting another opioid for methadone in patients with cancer pain

The successful use of methadone in cancer pain has been supported by numerous case reports and clinical studies. Methadone is usually used as a second or third line opioid medication. As the use of methadone increases we are facing the challenge of converting methadone to other opioids as part of sequential opioid trials. Data on the equianalgesic ratios for the substitution of other opioids for methadone are lacking. We present prospective data on 13 consecutive rotations from methadone to a different opioid. The opioid rotation was followed by escalation of pain and/or severe dysphoria, not controlled by a rapid increase in the dose of the second opioid, in 12 of the 13 patients. Only one patient was successfully maintained on the second opioid after the discontinuation of methadone, while 12 patients required a switch back to methadone. We conclude that opioid rotation from methadone to another opioid is often complicated by worsening pain and dysphoria. These symptoms may not improve despite upward titration of the second opioid. A uniformly accepted conversion ratio for substituting methadone with another opioid is currently not available. More data on the rotation from methadone to other opioids are needed. © 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

Authors
Moryl, N; Santiago-Palma, J; Kornick, C; Derby, S; Fischberg, D; Payne, R; Manfred, PL
MLA Citation
Moryl, N, Santiago-Palma, J, Kornick, C, Derby, S, Fischberg, D, Payne, R, and Manfred, PL. "Pitfalls of opioid rotation: Substituting another opioid for methadone in patients with cancer pain." Revista de la Sociedad Espanola del Dolor 10.1 (2003): 14-19.
Source
scival
Published In
Revista de la Sociedad Espanola del Dolor
Volume
10
Issue
1
Publish Date
2003
Start Page
14
End Page
19

Pitfalls of opioid rotation: Substituting another opioid for methadone in patients with cancer pain

The successful use of methadone in cancer pain has been supported by numerous case reports and clinical studies. Methadone is usually used as a second or third line opioid medication. As the use of methadone increases we are facing the challenge of converting methadone to other opioids as part of sequential opioid trials. Data on the equianalgesic ratios for the substitution of other opioids for methadone are lacking. We present prospective data on 13 consecutive rotations from methadone to a different opioid. The opioid rotation was followed by escalation of pain and/or severe dysphoria, not controlled by a rapid increase in the dose of the second opioid, in 12 of the 13 patients. Only one patient was successfully maintained on the second opioid after the discontinuation of methadone, while 12 patients required a switch back to methadone. We conclude that opioid rotation from methadone to another opioid is often complicated by worsening pain and dysphoria. These symptoms may not improve despite upward titration of the second opioid. A uniformly accepted conversion ratio for substituting methadone with another opioid is currently not available. More data on the rotation from methadone to other opioids are needed. © 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

Authors
Moryl, N; Santiago-Palma, J; Kornick, C; Derby, S; Fischberg, D; Payne, R; Manfredi, PL
MLA Citation
Moryl, N, Santiago-Palma, J, Kornick, C, Derby, S, Fischberg, D, Payne, R, and Manfredi, PL. "Pitfalls of opioid rotation: Substituting another opioid for methadone in patients with cancer pain." Pain 96.3 (2002): 325-328.
PMID
11973005
Source
scival
Published In
PAIN
Volume
96
Issue
3
Publish Date
2002
Start Page
325
End Page
328
DOI
10.1016/S0304-3959(01)00465-1

Journal of pain and symptom management: Foreword

Authors
Payne, R; Tandy, AB
MLA Citation
Payne, R, and Tandy, AB. "Journal of pain and symptom management: Foreword." Journal of Pain and Symptom Management 24.1 SUPPL. 1 (2002): S2-S3.
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
24
Issue
1 SUPPL. 1
Publish Date
2002
Start Page
S2
End Page
S3
DOI
10.1016/S0885-3924(02)00416-5

A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl.

BACKGROUND: Therapeutic fentanyl blood levels are reached approximately 12-16 hours after the initial application of transdermal fentanyl patches. For this reason, fentanyl patches should not be used to treat acute exacerbations of cancer pain. Acute cancer-related pain can be treated with fentanyl administered by continuous intravenous infusion (CII) in combination with patient-controlled analgesia (PCA). Patients then can be switched from intravenous (IV) to transdermal fentanyl once stable pain relief has been achieved. The objective of the current case series was to evaluate and describe the safety and effectiveness of a method for converting hospitalized patients with cancer-related pain from IV to transdermal fentanyl. METHODS: The authors prospectively evaluated 15 consecutive cancer patients during the conversion from IV to transdermal fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous IV infusion was applied. The CII rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Demand boluses of IV fentanyl equivalent in dosage to 50-100% of the final CII rate remained available via PCA during the 24 hours after patch application. Pain intensity (on a scale of 0-10), sedation (on a scale of 0-3), and hourly PCA administration (microg/hr) were assessed and recorded immediately prior to application of the fentanyl patch and 6, 12, 18, and 24 hours thereafter. RESULTS: Pain intensity, sedation, and hourly PCA administration appeared to remain stable throughout the transition from IV to transdermal fentanyl. CONCLUSIONS: The results of the current study demonstrate that the conversion from IV to transdermal fentanyl can be accomplished safely and effectively using a 1:1 (IV:transdermal) conversion ratio and a two-step taper of the CII over 12 hours.

Authors
Kornick, CA; Santiago-Palma, J; Khojainova, N; Primavera, LH; Payne, R; Manfredi, PL
MLA Citation
Kornick, CA, Santiago-Palma, J, Khojainova, N, Primavera, LH, Payne, R, and Manfredi, PL. "A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl." Cancer 92.12 (December 2001): 3056-3061.
PMID
11753984
Source
epmc
Published In
Cancer
Volume
92
Issue
12
Publish Date
2001
Start Page
3056
End Page
3061
DOI
10.1002/1097-0142(20011215)92:12<3056::aid-cncr10166>3.0.co;2-h

Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl.

BACKGROUND: Patients often are rotated from other opioids to methadone when side effects occur before satisfactory analgesia is achieved. Various strategies have been proposed to estimate safe and effective starting doses of methadone when rotating from morphine and hydromorphone; however, there are no guidelines for estimating safe and effective starting doses of methadone when rotating from fentanyl. METHODS: The authors prospectively observed 18 consecutive patients experiencing chronic pain from cancer who underwent opioid rotation from intravenous patient-controlled analgesia (PCA) with fentanyl to intravenous PCA with methadone. Patients were switched from fentanyl to methadone because of uncontrolled pain associated with sedation or confusion. A conversion ratio of 25 microg/hour of fentanyl to 0.1 mg/hour of methadone was used to calculate the initial dose of methadone in all patients. RESULTS: Mean pain scores decreased from 8.1 to 4.8 on Day 1 after the switch and to 3.22 on Day 4 after the switch. Mean sedation scores were 1.5 before the switch and 0.44 and 0.16 on Days 1 and 4, respectively. Among the 6 patients who experienced confusion while on fentanyl before the switch, 5 improved within 2 days of the switch. None of the patients experienced toxicity from methadone. CONCLUSIONS: On the basis of this preliminary study, the authors suggest that when switching from intravenous fentanyl to methadone a conversion ratio of 25 microg/hour of fentanyl to 0.1 mg/hour of methadone may be safe and effective.

Authors
Santiago-Palma, J; Khojainova, N; Kornick, C; Fischberg, DJ; Primavera, LH; Payne, R; Manfredi, P
MLA Citation
Santiago-Palma, J, Khojainova, N, Kornick, C, Fischberg, DJ, Primavera, LH, Payne, R, and Manfredi, P. "Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl." Cancer 92.7 (October 2001): 1919-1925.
PMID
11745266
Source
epmc
Published In
Cancer
Volume
92
Issue
7
Publish Date
2001
Start Page
1919
End Page
1925
DOI
10.1002/1097-0142(20011001)92:7<1919::aid-cncr1710>3.0.co;2-g

Intravenous methadone in the management of chronic cancer pain: Safe and effective starting doses when substituting methadone for fentanyl

BACKGROUND. Patients often are rotated from other opioids to methadone when side effects occur before satisfactory analgesia is achieved. Various strategies have been proposed to estimate safe and effective starting doses of methadone when rotating from morphine and hydromorphone; however, there are no guidelines for estimating safe and effective starting doses of methadone when rotating from fentanyl. METHODS. The authors prospectively observed 18 consecutive patients experiencing chronic pain from cancer who underwent opioid rotation from intravenous patient-controlled analgesia (PCA) with fentanyl to intravenous PCA with methadone. Patients were switched from fentanyl to methadone because of uncontrolled pain associated with sedation or confusion. A conversion ratio of 25 μg/hour of fentanyl to 0.1 mg/hour of methadone was used to calculate the initial dose of methadone in all patients. RESULTS. Mean pain scores decreased from 8.1 to 4.8 on Day 1 after the switch and to 3.22 on Day 4 after the switch. Mean sedation scores were 1.5 before the switch and 0.44 and 0.16 on Days 1 and 4, respectively. Among the 6 patients who experienced confusion while on fentanyl before the switch, 5 improved within 2 days of the switch. None of the patients experienced toxicity from methadone. CONCLUSIONS. On the basis of this preliminary study, the authors suggest that when switching from intravenous fentanyl to methadone a conversion ratio of 25 μg/hour of fentanyl to 0.1 mg/hour of methadone may be safe and effective. © 2001 American Cancer Society.

Authors
Santiago-Palma, J; Khojainova, N; Kornick, C; Fischberg, DJ; Primavera, LH; Payne, R; Manfredi, P
MLA Citation
Santiago-Palma, J, Khojainova, N, Kornick, C, Fischberg, DJ, Primavera, LH, Payne, R, and Manfredi, P. "Intravenous methadone in the management of chronic cancer pain: Safe and effective starting doses when substituting methadone for fentanyl." Cancer 92.7 (2001): 1919-1925.
Source
scival
Published In
Cancer
Volume
92
Issue
7
Publish Date
2001
Start Page
1919
End Page
1925
DOI
10.1002/1097-0142(20011001)92:7<1919::AID-CNCR1710>3.0.CO;2-G

A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl

Background. Therapeutic fentanyl blood levels are reached approximately 12-16 hours after the initial application of transdermal fentanyl patches. For this reason, fentanyl patches should not be used to treat acute exacerbations of cancer pain. Acute cancer-related pain can be treated with fentanyl administered by continuous intravenous infusion (CII) in combination with patient-controlled analgesia (PCA). Patients then can be switched from intravenous (IV) to transdermal fentanyl once stable pain relief has been achieved. The objective of the current case series was to evaluate and describe the safety and effectiveness of a method for converting hospitalized patients with cancer-related pain from IV to transdermal fentanyl. Methods. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from IV to transdermal fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous IV infusion was applied. The CII rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Demand boluses of IV fentanyl equivalent in dosage to 50-100% of the final CII rate remained available via PCA during the 24 hours after patch application. Pain intensity (on a scale of 0-10), sedation (on a scale of 0-3), and hourly PCA administration (μg/hr) were assessed and recorded immediately prior to application of the fentanyl patch and 6, 12, 18, and 24 hours thereafter. Results. Pain intensity, sedation, and hourly PCA administration appeared to remain stable throughout the transition from IV to transdermal fentanyl. Conclusions. The results of the current study demonstrate that the conversion from IV to transdermal fentanyl can be accomplished safely and effectively using a 1:1 (IV:transdermal) conversion ratio and a two-step taper of the CII over 12 hours. © 2001 American Cancer Society.

Authors
Kornick, CA; Santiago-Palma, J; Khojainova, N; Primavera, LH; Payne, R; Manfredi, PL
MLA Citation
Kornick, CA, Santiago-Palma, J, Khojainova, N, Primavera, LH, Payne, R, and Manfredi, PL. "A safe and effective method for converting cancer patients from intravenous to transdermal fentanyl." Cancer 92.12 (2001): 3056-3061.
Source
scival
Published In
Cancer
Volume
92
Issue
12
Publish Date
2001
Start Page
3056
End Page
3061
DOI
10.1002/1097-0142(20011215)92:12<3056::AID-CNCR10166>3.0.CO;2-H

Sexuality rehabilitation

Sexual dysfunction is a common problem for patients with cancer as well as cancer survivors. Unfortunately, sexual difficulties are often not identified by the cancer care team, and most patients receive little or no assistance in dealing with the effects of cancer and its treatment on intimacy. In this article, recommendations concerning assessment of sexual function are presented and various treatments are reviewed. The authors recommend that questions concerning sexual difficulties and intimacy be incorporated into the initial evaluation of patients with cancer. The assessment of sexual difficulties should continue throughout treatment and recovery. The cancer care team can initiate interventions including patient education and treatments for altered desire, erectile dysfunction, and estrogen deficiency. These interventions may result in marked improvement in symptoms. Some forms of sexual dysfunction may require referral to a specialist. Based on their experience, the authors conclude that assessment and treatment of sexual dysfunction in patients with cancer should become standard practice, and that quality of life is enhanced when attention to the sexual consequences of cancer and its treatment are addressed.

Authors
Santiago-Palma, J; Payne, R
MLA Citation
Santiago-Palma, J, and Payne, R. "Sexuality rehabilitation." Cancer 92.4 SUPPL. (2001): 1008-1012.
Source
scival
Published In
Cancer
Volume
92
Issue
4 SUPPL.
Publish Date
2001
Start Page
1008
End Page
1012

Cancer: Introduction

Authors
Payne, R; Santiago-Palma, J; Cheville, A
MLA Citation
Payne, R, Santiago-Palma, J, and Cheville, A. "Cancer: Introduction." Cancer 92.4 SUPPL. (2001): 969--.
Source
scival
Published In
Cancer
Volume
92
Issue
4 SUPPL.
Publish Date
2001
Start Page
969-

Palliative care and rehabilitation

Disability in patients with advanced cancer often results from bed rest, decondiioning, and neurologic and musculoskeletal complications of cancer or cancer treatment. Terminally ill patients have a high prevalence of weakness, pain, fatigue, and dyspnea in addition to other symptoms. Rehabilitation and palliative care have emerged as two important parts of comprehensive medical care for patients with advanced disease; this article discusses the relationship between the two and the possible role of rehabilitation interventions in the care of terminally ill patients. Palliative care and rehabilitation share common goals and therapeutic approaches. Both disciplines have a multidisciplinary model of care, which aims to improve patients' levels of function and comfort. There is scarce evidence that rehabilitation interventions can impact function and symptom management in terminally ill patients. However, clinical experience suggests that the application of the fundamental principles of rehabilitation medicine is likely to improve their care. Physical function and independence should be maintained as long as possible to improve patients' quality of life and reduce the burden of care for the caregivers. Future research on the rehabilitation of terminally ill patients should focus on better understanding the role of rehabilitation and defining appropriate interventions. The development of an evidence-based body of knowledge will ensure that these patients receive appropriate rehabilitation interventions. © 2001 American Cancer Society.

Authors
Santiago-Palma, J; Payne, R
MLA Citation
Santiago-Palma, J, and Payne, R. "Palliative care and rehabilitation." Cancer 92.4 SUPPL. (2001): 1049-1052.
PMID
11519032
Source
scival
Published In
Cancer
Volume
92
Issue
4 SUPPL.
Publish Date
2001
Start Page
1049
End Page
1052

Current management of opioid-related side effects

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient's age, the presence of coexistent renal and hepatic disease, pulmonary disease, and cognitive dysfunction, a prior opioid history, use of polypharmacy, dose of opioid drug being administered, and the route of administration. The most common opioid-related side effects are constipation, sedation, nausea, vomiting, and cognitive disturbance. Less frequent side effects include urinary retention, perceptual distortion, respiratory depression, and myoclonus. In an era emphasizing quality of life in cancer care, clinicians need to be aware of (1) factors that influence the prevalence of opioid-related side effects, (2) effective management strategies, and (3) how to recognize when symptoms are opioid related as opposed to caused by other etiologies, such as the patient's disease process or treatment approaches. The use of validated instruments and repeated assessment enhances such an evaluation and subsequent treatment. This article delineates the current optimal management of opioid-related nausea and vomiting, constipation, cognitive side effects, myoclonus, and respiratory depression.

Authors
O'Mahony, S; Coyle, N; Payne, R
MLA Citation
O'Mahony, S, Coyle, N, and Payne, R. "Current management of opioid-related side effects." ONCOLOGY 15.1 (2001): 61-73.
PMID
11271983
Source
scival
Published In
ONCOLOGY
Volume
15
Issue
1
Publish Date
2001
Start Page
61
End Page
73

Long-term safety of oral transmucosal fentanyl citrate for breakthrough. Cancer pain

This open-label study evaluated the long-term safety and tolerability of oral transmucosal fentanyl citrate (OTFC) in ambulatory cancer patients with breakthrough pain undergoing cancer care at 32 university- or community-based practices. Patients had participated in a previous short-term titration trial of OTFC, were experiencing at least one episode per day of breakthrough pain, and had achieved relief of their breakthrough pain with an opioid. Patients received OTFC units at a starting dosage strength determined in the short-term trial (200-1600mg). Outcome measures included number of successfully treated breakthrough pains, global satisfaction rating (0=poor through 4=excellent), and side effects. In total, 41.766 units of OTFC were used to treat 38.595 episodes of breakthrough pain in 155 patients. Number of treatment days ranged from 1 to 423 (mean, 91 days). Patients averaged 2.9 breakthrough pain episodes per day. About 92% of episodes were successfully treated with OTFC and there was no trend toward decreased effectiveness over time. Most patients (61%) did not require dose escalation during treatment. Global satisfaction ratings were consistently above 3, indicating very good to excellent relief. Common adverse events associated with OTFC were somnolence (9%), constipation (8%), nausea (8%), dizziness (8%), and vomiting (5%). Six patients (4%) discontinued therapy due to an OTFC-related adverse event. There were no reports of abuse and no concerns about the safety of the drug raised by patients or families. OTFC was used safety and effectively during long-term treatment of breakthrough pain in cancer patients at home.

Authors
Payne, R; Coluzzi, P; Hart, L; Simmonds, M; Lyss, A; Rauck, R; Berris, R; Busch, MA; Nordbrook, E; Loseth, DB; Portenoy, RK
MLA Citation
Payne, R, Coluzzi, P, Hart, L, Simmonds, M, Lyss, A, Rauck, R, Berris, R, Busch, MA, Nordbrook, E, Loseth, DB, and Portenoy, RK. "Long-term safety of oral transmucosal fentanyl citrate for breakthrough. Cancer pain." Douleurs 2.6 (2001): 268-276.
Source
scival
Published In
Douleurs
Volume
2
Issue
6
Publish Date
2001
Start Page
268
End Page
276

Reversible spastic paraparesis induced by high-dose intravenous methadone

High doses of parenteral opioids can cause multifocal myoclonus and seizures. Spasticity has been reported in patients receiving intraspinal opioids. In this article, we describe a patient who developed reversible spastic paraparesis with prominent extensor spasms in the legs while receiving an infusion of intravenous methadone at 100 mg/hr. We discuss clinical presentation and possible pathophysiologic mechanisms of opioid side effects on the somatic motor system.

Authors
Manfredi, PL; Gonzales, GR; Payne, R
MLA Citation
Manfredi, PL, Gonzales, GR, and Payne, R. "Reversible spastic paraparesis induced by high-dose intravenous methadone." Journal of Pain 2.1 (2001): 77-79.
Source
scival
Published In
The Journal of Pain
Volume
2
Issue
1
Publish Date
2001
Start Page
77
End Page
79
DOI
10.1054/jpai.2001.9803

Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain

This open-label study evaluated the long-term safety and tolerability of oral transmucosal fentanyl citrate (OTFC) in ambulatory cancer patients with breakthrough pain undergoing cancer care at 32 university- or community-based practices. Patients had participated in a previous short-term titration trial of OTFC, were experiencing at least one episode per day of breakthrough pain, and had achieved relief of their breakthrough pain with an opioid. Patients received OTFC units at a starting dosage strength determined in the short-term trial (200-1600 μg). Outcome measures included number of successfully treated breakthrough pains, global satisfaction rating (0 = poor through 4 = excellent), and side effects. In total, 41,766 units of OTFC were used to treat 38,595 episodes of breakthrough pain in 155 patients. Number of treatment days ranged from 1 to 423 (mean, 91 days). Patients averaged 2.9 breakthrough pain episodes per day. About 92% of episodes were successfully treated with OTFC and there was no trend toward decreased effectiveness over time. Most patients (61%) did not require dose escalation during treatment. Global satisfaction ratings were consistently above 3, indicating very good to excellent relief. Common adverse events associated with OTFC were somnolence (9%), constipation (8%), nausea (8%), dizziness (8%), and vomiting (5%). Six patients (4%) discontinued therapy due to an OTFC-related adverse event. There were no reports of abuse and no concerns about the safety of the drug raised by patients or families. OTFC was used safely and effectively during long-term treatment of breakthrough pain in cancer patients at home. Copyright © 2001 U.S. Cancer Pain Relief Committee.

Authors
Payne, R; Coluzzi, P; Hart, L; Simmonds, M; Lyss, A; Rauck, R; Berris, R; Busch, MA; Nordbrook, E; Loseth, DB; Portenoy, RK
MLA Citation
Payne, R, Coluzzi, P, Hart, L, Simmonds, M, Lyss, A, Rauck, R, Berris, R, Busch, MA, Nordbrook, E, Loseth, DB, and Portenoy, RK. "Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain." Journal of Pain and Symptom Management 22.1 (2001): 575-583.
PMID
11516599
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
22
Issue
1
Publish Date
2001
Start Page
575
End Page
583
DOI
10.1016/S0885-3924(01)00306-2

Methadone analgesia in cancer pain patients on chronic methadone maintenance therapy

Methadone is currently best known for its use as the maintenance drug in opioid addiction. The main concern when using methadone for the treatment of pain is its long and unpredictable half-life, which is associated with the risk of delayed toxicity. This may result in side effects such as sedation and respiratory depression if careful titration and close observation of individual patient responses are not performed. For this reason, methadone is often viewed as a second line opioid, after other opioids with a more predictable dose-response have been tried. We report six patients with long-term exposure to methadone as a treatment for heroin dependency, who were also treated with methadone for cancer pain. The first five patients were at least partially refractory to the analgesic effects of opioids other than methadone. All six patients achieved analgesia without sedation or respiratory depression from aggressive upward methadone titration. Methadone analgesia can be considered early in the course of treatment of patients with chronic exposure to methadone who develop new or worsening pain requiring opioid therapy. Copyright © 2001 U.S. Cancer Pain Relief Committee.

Authors
Manfredi, PL; Gonzales, GR; Cheville, AL; Kornick, C; Payne, R
MLA Citation
Manfredi, PL, Gonzales, GR, Cheville, AL, Kornick, C, and Payne, R. "Methadone analgesia in cancer pain patients on chronic methadone maintenance therapy." Journal of Pain and Symptom Management 21.2 (2001): 169-174.
PMID
11226767
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
21
Issue
2
Publish Date
2001
Start Page
169
End Page
174
DOI
10.1016/S0885-3924(00)00252-9

Outcome of cancer pain consultations.

BACKGROUND: All major cancer centers in the United States are equipped with pain management consultation services. We report on the outcome of such consultations within 24 hours from the intervention. METHODS: All consecutive patients referred to the pain management service of a tertiary care cancer center were assessed before and 14-24 hours after the intervention. RESULTS: A total of 45 patients completed the study. The mean current pain intensity score was 5.2 on the Visual Analogue Scale before the consultation and 2.7 after the consultation (P < 0.05). The pain was described as excruciating on the Categorical Scale by three patients before the consultation and by no patients after the consultation. CONCLUSIONS: In hospitalized cancer patients with difficult to control pain, cancer pain consultations result in a measurable effect within 24 hours of the pharmacologic intervention. To avoid unnecessary suffering, timeliness is of the utmost importance when requesting and delivering cancer pain consultations.

Authors
Manfredi, PL; Chandler, S; Pigazzi, A; Payne, R
MLA Citation
Manfredi, PL, Chandler, S, Pigazzi, A, and Payne, R. "Outcome of cancer pain consultations." Cancer 89.4 (August 2000): 920-924.
PMID
10951358
Source
epmc
Published In
Cancer
Volume
89
Issue
4
Publish Date
2000
Start Page
920
End Page
924
DOI
10.1002/1097-0142(20000815)89:4<920::aid-cncr27>3.0.co;2-d

Minority cancer patients and their providers: pain management attitudes and practice.

BACKGROUND: The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS: In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS: Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS: Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment.

Authors
Anderson, KO; Mendoza, TR; Valero, V; Richman, SP; Russell, C; Hurley, J; DeLeon, C; Washington, P; Palos, G; Payne, R; Cleeland, CS
MLA Citation
Anderson, KO, Mendoza, TR, Valero, V, Richman, SP, Russell, C, Hurley, J, DeLeon, C, Washington, P, Palos, G, Payne, R, and Cleeland, CS. "Minority cancer patients and their providers: pain management attitudes and practice." Cancer 88.8 (April 2000): 1929-1938.
PMID
10760771
Source
epmc
Published In
Cancer
Volume
88
Issue
8
Publish Date
2000
Start Page
1929
End Page
1938
DOI
10.1002/(sici)1097-0142(20000415)88:8<1929::aid-cncr23>3.3.co;2-u

Palliative and end-of-life care in the African American Community

Authors
Crawley, L; Payne, R; Bolden, J; Payne, T; Washington, P; Williams, S
MLA Citation
Crawley, L, Payne, R, Bolden, J, Payne, T, Washington, P, and Williams, S. "Palliative and end-of-life care in the African American Community." Journal of the American Medical Association 284.19 (2000): 2518-2521.
PMID
11074786
Source
scival
Published In
JAMA : the journal of the American Medical Association
Volume
284
Issue
19
Publish Date
2000
Start Page
2518
End Page
2521

NCCN Practice Guidelines for Cancer Pain.

The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.

Authors
Benedetti, C; Brock, C; Cleeland, C; Coyle, N; Dubé, JE; Ferrell, B; 3rd, SH; Janjan, NA; Lema, MJ; Levy, MH; Loscalzo, MJ; Lynch, M; Muir, C; Oakes, L; O'Neill, A; Payne, R; Syrjala, KL; Urba, S; Weinstein, SM
MLA Citation
Benedetti, C, Brock, C, Cleeland, C, Coyle, N, Dubé, JE, Ferrell, B, 3rd, SH, Janjan, NA, Lema, MJ, Levy, MH, Loscalzo, MJ, Lynch, M, Muir, C, Oakes, L, O'Neill, A, Payne, R, Syrjala, KL, Urba, S, and Weinstein, SM. "NCCN Practice Guidelines for Cancer Pain." Oncology (Williston Park, N.Y.) 14.11 A (2000): 135-150.
PMID
11195407
Source
scival
Published In
Oncology (Williston Park, N.Y.)
Volume
14
Issue
11 A
Publish Date
2000
Start Page
135
End Page
150

Palliative treatment of last resort and assisted suicide [2] (multiple letters)

Authors
Sulmasy, DP; Ury, WA; Ahronheim, JC; Siegler, M; Kass, L; Lantos, J; Burt, RA; Foley, K; Payne, R; Gomez, C; Krizek, TJ; Pellegrino, ED; Portenoy, RK; Quill, TE; Lee, BC; Nunn, S; Jr, GLK; Snyder, L; Caplan, AL
MLA Citation
Sulmasy, DP, Ury, WA, Ahronheim, JC, Siegler, M, Kass, L, Lantos, J, Burt, RA, Foley, K, Payne, R, Gomez, C, Krizek, TJ, Pellegrino, ED, Portenoy, RK, Quill, TE, Lee, BC, Nunn, S, Jr, GLK, Snyder, L, and Caplan, AL. "Palliative treatment of last resort and assisted suicide [2] (multiple letters)." Annals of Internal Medicine 133.7 (2000): 562-564.
PMID
11015177
Source
scival
Published In
Annals of Internal Medicine
Volume
133
Issue
7
Publish Date
2000
Start Page
562
End Page
564

Publication of papers on assisted suicide and terminal sedation [3] (multiple letters)

Authors
Sulmasy, DP; Ury, WA; Ahronheim, JC; Siegler, M; Kass, L; Lantos, J; Burt, RA; Foley, K; Payne, R; Gomez, C; Krizek, TJ; Pellegrino, ED; Portenoy, RK; Snyder, L; Davidoff, F
MLA Citation
Sulmasy, DP, Ury, WA, Ahronheim, JC, Siegler, M, Kass, L, Lantos, J, Burt, RA, Foley, K, Payne, R, Gomez, C, Krizek, TJ, Pellegrino, ED, Portenoy, RK, Snyder, L, and Davidoff, F. "Publication of papers on assisted suicide and terminal sedation [3] (multiple letters)." Annals of Internal Medicine 133.7 (2000): 564-566.
PMID
11015181
Source
scival
Published In
Annals of Internal Medicine
Volume
133
Issue
7
Publish Date
2000
Start Page
564
End Page
566

Responding to intractable terminal suffering [1] (multiple letters)

Authors
Yanow, ML; Krakauer, EL; Sulmasy, DP; Ury, WA; Ahronheim, JC; Siegler, M; Kass, L; Lantos, J; Burt, RA; Foley, K; Payne, R; Gomez, C; Krizek, TJ; Pellegrino, ED; Portenoy, RK; Quill, TE; Byock, IR
MLA Citation
Yanow, ML, Krakauer, EL, Sulmasy, DP, Ury, WA, Ahronheim, JC, Siegler, M, Kass, L, Lantos, J, Burt, RA, Foley, K, Payne, R, Gomez, C, Krizek, TJ, Pellegrino, ED, Portenoy, RK, Quill, TE, and Byock, IR. "Responding to intractable terminal suffering [1] (multiple letters)." Annals of Internal Medicine 133.7 (2000): 560-562.
PMID
11015174
Source
scival
Published In
Annals of Internal Medicine
Volume
133
Issue
7
Publish Date
2000
Start Page
560
End Page
562

Responding to intractable terminal suffering.

Authors
Sulmasy, DP; Ury, WA; Ahronheim, JC; Siegler, M; Kass, L; Lantos, J; Burt, RA; Foley, K; Payne, R; Gomez, C; Krizek, TJ; Pellegrino, ED; Portenoy, RK
MLA Citation
Sulmasy, DP, Ury, WA, Ahronheim, JC, Siegler, M, Kass, L, Lantos, J, Burt, RA, Foley, K, Payne, R, Gomez, C, Krizek, TJ, Pellegrino, ED, and Portenoy, RK. "Responding to intractable terminal suffering." Annals of Internal Medicine 133.7 (2000): 560-561.
PMID
11015175
Source
scival
Published In
Annals of Internal Medicine
Volume
133
Issue
7
Publish Date
2000
Start Page
560
End Page
561

Outcome of cancer pain consultations

BACKGROUND. All major cancer centers in the United States are equipped with pain management consultation services. We report on the outcome of such consultations within 24 hours from the intervention. METHODS. All consecutive patients referred to the pain management service of a tertiary care cancer center were assessed before and 14-24 hours after the intervention. RESULTS. A total of 45 patients completed the study. The mean current pain intensity score was 5.2 on the Visual Analogue Scale before the consultation and 2.7 after the consultation (P < 0.05). The pain was described as excruciating on the Categorical Scale by three patients before the consultation and by no patients after the consultation. CONCLUSIONS. In hospitalized cancer patients with difficult to control pain, cancer pain consultations result in a measurable effect within 24 hours of the pharmacologic intervention. To avoid unnecessary suffering, timeliness is of the utmost importance when requesting and delivering cancer pain consultations. (C) 2000 American Cancer Society.

Authors
Manfredi, PL; Chandler, S; Pigazzi, A; Payne, R
MLA Citation
Manfredi, PL, Chandler, S, Pigazzi, A, and Payne, R. "Outcome of cancer pain consultations." Cancer 89.4 (2000): 920-924.
Source
scival
Published In
Cancer
Volume
89
Issue
4
Publish Date
2000
Start Page
920
End Page
924
DOI
10.1002/1097-0142(20000815)89:4<920::AID-CNCR27>3.0.CO;2-D

Minority cancer patients and their providers: Pain management attitudes and practice

BACKGROUND. The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS. In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS. Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS. Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment. (C) 2000 American Cancer Society.

Authors
Anderson, KO; Mendoza, TR; Valero, V; Richman, SP; Russell, C; Hurley, J; DeLeon, C; Washington, P; Palos, G; Payne, R; Cleeland, CS
MLA Citation
Anderson, KO, Mendoza, TR, Valero, V, Richman, SP, Russell, C, Hurley, J, DeLeon, C, Washington, P, Palos, G, Payne, R, and Cleeland, CS. "Minority cancer patients and their providers: Pain management attitudes and practice." Cancer 88.8 (2000): 1929-1938.
Source
scival
Published In
Cancer
Volume
88
Issue
8
Publish Date
2000
Start Page
1929
End Page
1938
DOI
10.1002/(SICI)1097-0142(20000415)88:8<1929::AID-CNCR23>3.0.CO;2-2

Herpes zoster [3] (multiple letters)

Authors
Carver, A; Payne, R; Foley, K; Dworkin, RH; Galer, BS; Rowbotham, MC; Gershon, AA; Perkin, RT; Breton, G; Bricaire, F; Caumes, E; Gildan, DH; Kleinschmidt-DeMasters, BK
MLA Citation
Carver, A, Payne, R, Foley, K, Dworkin, RH, Galer, BS, Rowbotham, MC, Gershon, AA, Perkin, RT, Breton, G, Bricaire, F, Caumes, E, Gildan, DH, and Kleinschmidt-DeMasters, BK. "Herpes zoster [3] (multiple letters)." New England Journal of Medicine 343.3 (2000): 221-223.
PMID
10928866
Source
scival
Published In
New England Journal of Medicine
Volume
343
Issue
3
Publish Date
2000
Start Page
221
End Page
223
DOI
10.1056/NEJM200007203430315

Racial injustice in health care

Authors
Freeman, HP; Payne, R
MLA Citation
Freeman, HP, and Payne, R. "Racial injustice in health care." New England Journal of Medicine 342.14 (2000): 1045-1047.
PMID
10749970
Source
scival
Published In
The New England journal of medicine
Volume
342
Issue
14
Publish Date
2000
Start Page
1045
End Page
1047
DOI
10.1056/NEJM200004063421411

An alternative algorithm for dosing transdermal fentanyl for cancer-related pain

Many cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines emphasize individualization of opioid treatment to provide the drug and route of administration that meet the needs of the particular patient. Intolerable side effects, ineffective pain relief, or a change in the patient's clinical status can dictate the need for a new pain management regimen. Physicians must be able to readily quantify relative analgesic potency when converting from one opioid to another or from one route of administration to another. Transdermal fentanyl (Duragesic) is an opioid agonist that has been shown to be safe and effective for the treatment of cancer pain. However, clinicians should realize that the manufacturer's recommendations for equianalgesic dosing of transdermal fentanyl may result in initial doses that are too low in some patients, and in a titration period that is too long. Under these circumstances, the patient is likely to experience unrelieved pain. An alternative dosing algorithm that considers both a review of the literature and our combined clinical experience with transdermal fentanyl should help clinicians individualize the treatment of pain.

Authors
Breitbart, W; Chandler, S; Eagel, B; Ellison, N; Enck, RE; Lefkowitz, M; Payne, R
MLA Citation
Breitbart, W, Chandler, S, Eagel, B, Ellison, N, Enck, RE, Lefkowitz, M, and Payne, R. "An alternative algorithm for dosing transdermal fentanyl for cancer-related pain." ONCOLOGY 14.5 (2000): 695-702.
PMID
10853461
Source
scival
Published In
ONCOLOGY
Volume
14
Issue
5
Publish Date
2000
Start Page
695
End Page
702

Enhancing opioid analgesia with NMDA-receptor antagonists: Clarifying the clinical importance: A roundtable discussion

Authors
Portenoy, RK; Bennett, GJ; Katz, NP; Payne, R; Price, DD
MLA Citation
Portenoy, RK, Bennett, GJ, Katz, NP, Payne, R, and Price, DD. "Enhancing opioid analgesia with NMDA-receptor antagonists: Clarifying the clinical importance: A roundtable discussion." Journal of Pain and Symptom Management 19.1 SUPPL. 1 (2000): 57-64.
PMID
10687341
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
19
Issue
1 SUPPL. 1
Publish Date
2000
Start Page
57
End Page
64
DOI
10.1016/S0885-3924(99)00133-5

Multidisciplinary care of the terminally ill patient

This article discusses sedation, the assessment and management of physical symptoms, and symptom-assessment scales for the terminally ill patient. The evaluation of the ability of the family or community to care for a terminally ill patient in pain also is discussed.

Authors
O'Mahony, S; Coyle, N; Payne, R
MLA Citation
O'Mahony, S, Coyle, N, and Payne, R. "Multidisciplinary care of the terminally ill patient." Surgical Clinics of North America 80.2 (2000): 729-745.
PMID
10836014
Source
scival
Published In
Surgical Clinics of North America
Volume
80
Issue
2
Publish Date
2000
Start Page
729
End Page
745

Chronic pain: Challenges in the assessment and management of cancer pain

Assessing and managing pain while caring for the whole patient is a challenge for physicians. Barriers to pain management include clinician- , patient- , and health system-related issues. The traditional model of care is focused on disease-specific treatments. If these treatments fail, the focus shifts to palliation. A new model of care integrates disease-specific treatments with palliative care and rehabilitation. This model includes prevention and treatment of suffering. An essential element of this model is evaluation of the patient's concerns about the future and fear. Treating patient pain with quality pain management and palliative care involves a holistic pain assessment and management strategy. Copyright (C) 2000 U.S. Cancer Pain Relief Committee.

Authors
Payne, R
MLA Citation
Payne, R. "Chronic pain: Challenges in the assessment and management of cancer pain." Journal of Pain and Symptom Management 19.1 SUPPL. 1 (2000): 12-15.
PMID
10687333
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
19
Issue
1 SUPPL. 1
Publish Date
2000
Start Page
12
End Page
15
DOI
10.1016/S0885-3924(99)00123-2

Limitations of NSAIDs for pain management: Toxicity or lack of efficacy?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of arthritis and acute and chronic pain of many etiologies, including cancer-related pain. These drugs are indicated for use as single agents in mild to moderate pain and in combination with opioid analgesics or adjuvant analgesic drugs in severe pain. NSAIDs, which nonselectively inhibit the cyclooxygenase enzymes (isoenzymes 1 and 2), pose a potentially serious risk of gastrointestinal toxicity with acute and chronic use, hematologic toxicity with acute use, and nephrotoxicity with chronic use. Patients experiencing acute and chronic pain associated with serious and even life-threatening medical illness such as cancer and human immunodeficiency virus/aquired immune deficiency syndrome (HIV/AIDS) fall into a high-risk group with respect to the use of NSAIDs. This is so because the occurrence of gastrointestinal bleeding and the masking of opportunistic infections related to the antipyretic effects of NSAIDs pose particular risk and might even cause lethal complications in patients who are neutropenic, thrombocytopenic, or otherwise immuno-compromised.

Authors
Payne, R
MLA Citation
Payne, R. "Limitations of NSAIDs for pain management: Toxicity or lack of efficacy?." Journal of Pain 1.3 SUPPL. (2000): 14-18.
Source
scival
Published In
The Journal of Pain
Volume
1
Issue
3 SUPPL.
Publish Date
2000
Start Page
14
End Page
18
DOI
10.1054/jpai.2000.16611

Sumatriptan for headache caused by head and neck cancer

The use of sumatriptan for the treatment of migraine and cluster headache is well established. Sumatriptan has also been reported to be effective for the treatment of postdural puncture headache, postictal headache, and headache related to intravenous immunoglobulin infusion. We report two patients with headache caused by locally invasive head and neck cancer relieved by oral sumatriptan.

Authors
Manfredi, PL; Shenoy, S; Payne, R
MLA Citation
Manfredi, PL, Shenoy, S, and Payne, R. "Sumatriptan for headache caused by head and neck cancer." Headache 40.9 (2000): 758-760.
PMID
11091298
Source
scival
Published In
Headache
Volume
40
Issue
9
Publish Date
2000
Start Page
758
End Page
760
DOI
10.1046/j.1526-4610.2000.00134.x

Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: A controlled dose titration study

Oral transmucosal fentanyl citrate (OTFC) is a novel opioid formulation in which the potent synthetic μ-agonist fentanyl is embedded in a sweetened matrix that is dissolved in the mouth. It is undergoing investigation as a treatment for cancer-related breakthrough pain, a prevalent phenomenon defined as a transitory flare of moderate to severe pain that interrupts otherwise controlled persistent pain. There have been no controlled trials of other treatments for this condition. To evaluate the safety and efficacy of ascending doses of OTFC, a novel controlled dose titration methodology was developed that applied blinding and randomization procedures to the evaluation of recurrent pains in the home environment. The study was a multicenter, randomized, double-blind dose titration study in ambulatory cancer patients. The sample comprised adult patients receiving a scheduled oral opioid regimen equivalent to 60-1000 mg oral morphine per day, who were experiencing at least one episode per day of breakthrough pain and had achieved at least partial relief of this pain by use of an oral opioid rescue dose. After collection of 2 days of baseline data concerning the efficacy of the usual rescue drug, patients were randomly treated with either 200 or 400 μg OTFC unit doses in double-blind fashion. Up to two breakthrough pains each day could be treated with up to four OTFC unit doses per pain. OTFC in unit doses containing 200, 400, 600, 800, 1200 or 1600 μg of fentanyl citrate were available for the study. The unit dose was titrated upward in steps until the patient had 2 consecutive days on which breakthrough pain could be treated with the single unit dose, titration was ineffective at a 1600 μg unit dose, or 20 days elapsed. To maintain the double-blind, orders to titrate up were ignored one-third of the time according to a pre-defined randomization schedule accessible only to an unblinded study pharmacist. Main outcome measures included, numeric or categorical measures of pain intensity, pain relief, and global assessment of drug performance. Dose response relationships were found suggesting that the methodology was sensitive to opioid effects. Seventy-four percent of patients were successfully titrated. There was no relationship between the total daily dose of the fixed schedule opioid regimen and the dose of OTFC required to manage the breakthrough pain. Although the study was not designed to provide a definitive comparison between OTFC and the usual rescue drug, exploratory analyses found that OTFC provided significantly greater analgesic effect at 15, 30 and 60 min, and a more rapid onset of effect, than the usual rescue drug. Adverse effects of the OTFC were typically opioid-related, specifically somnolence, nausea and dizziness. Very few adverse events were severe or serious. This study demonstrated the feasibility of controlled trial methodology in studies of breakthrough pain. OTFC appears to be a safe and effective therapy for breakthrough pain, and dose titration can usually identify a unit dose capable of providing adequate analgesia. If the lack of a relationship between the effective OTFC dose and fixed schedule opioid regimen is confirmed, dose titration may be needed in the clinical use of this formulation. Further investigation of OTFC as a specific treatment for breakthrough pain is warranted. Copyright (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.

Authors
Portenoy, RK; Payne, R; Coluzzi, P; Raschko, JW; Lyss, A; Busch, MA; Frigerio, V; Ingham, J; Loseth, DB; Nordbrock, E; Rhiner, M
MLA Citation
Portenoy, RK, Payne, R, Coluzzi, P, Raschko, JW, Lyss, A, Busch, MA, Frigerio, V, Ingham, J, Loseth, DB, Nordbrock, E, and Rhiner, M. "Oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough pain in cancer patients: A controlled dose titration study." Pain 79.2-3 (1999): 303-312.
PMID
10068176
Source
scival
Published In
PAIN
Volume
79
Issue
2-3
Publish Date
1999
Start Page
303
End Page
312
DOI
10.1016/S0304-3959(98)00179-1

NCCN practice guidelines for cancer pain

Authors
Grossman, SA; Benedetti, C; Payne, R; Syrjala, K
MLA Citation
Grossman, SA, Benedetti, C, Payne, R, and Syrjala, K. "NCCN practice guidelines for cancer pain." ONCOLOGY 13.11 A (1999): 33-44.
Source
scival
Published In
Oncology
Volume
13
Issue
11 A
Publish Date
1999
Start Page
33
End Page
44

Titrating opioids and converting to long-acting agents

Long-acting opioids are safe and generally provide more effective relief than short-acting opioids in the treatment of cancer pain, with greater patient compliance and some evidence of greater patient satisfaction. Many formulations and routes are available; this is helpful because it improves compliance. In general, patients prefer the least frequent and least in vasive methods of administration, assuming equivalent efficacy. Existing knowledge in conversion and titration of opioids is the key to achieving optimal pain management. Yet we do need a more rigorous, scientific basis for making firmer decisions.

Authors
Payne, R
MLA Citation
Payne, R. "Titrating opioids and converting to long-acting agents." ONCOLOGY 13.11 A (1999): 581-586.
Source
scival
Published In
Oncology
Volume
13
Issue
11 A
Publish Date
1999
Start Page
581
End Page
586

New perspectives in acute pain management

Authors
Payne, R
MLA Citation
Payne, R. "New perspectives in acute pain management." Cancer Control 6.2 SUPPL. (1999): 3--.
Source
scival
Published In
Cancer control : journal of the Moffitt Cancer Center
Volume
6
Issue
2 SUPPL.
Publish Date
1999
Start Page
3-

Preclinical toxicity study of intrathecal administration of the pain relievers dextrorphan, dextromethorphan, and memantine in the sheep model

Objectives: To determine the toxicity window for the continuous intrathecal administration of dextrorphan, dextromethorphan, and memantine via an implanted delivery pump. Materials and Methods: Using 48 sheep with programmable continuous intrathecal infusion systems we determined the behavioral, motor, neurological, and histopathological changes produced by a 43-day continuous infusion study of dextrorphan, dextromethorphan, and memantine dissolved in 0.9% NaCl. Daily doses of each N-methyl-D, aspartate (NMDA) antagonist were 0.013, 0.051,0.203, 0.510, 0.811, and 2.533 mg/kg/day, flow rates ranged from 13.25 ml/day to 0.051 ml/day at a concentration of 10 mg/ml. Control animals received saline in the range of 7.9985 ml/day to 1 ml/day. Conclusions: Infusion of saline in the control animals produced no behavioral or motor changes. However, infusion of dextrorphan, dextromethorphan, and memantine at the higher doses (> 0.051 mg/kg/day) produced dose-dependent negative behavioral, motor, and histopathologic changes as indicated by a series of nonparametric statistical analyses. The minimal toxic doses were dextrorphan dose 3, dextromethorphan dose 1 and memantine dose 1. This study suggests that continuous intrathecal infusion of dextrorphan, dextromethorphan, and memantine via an implantable pump system can cause significant toxicities at the higher doses studied.

Authors
Hassenbusch, SJ; Satterfield, WC; Gradert, TL; Binhazim, AW; Ahad, G; Mokhtarzadeh, M; Schapiro, SJ; Payne, R
MLA Citation
Hassenbusch, SJ, Satterfield, WC, Gradert, TL, Binhazim, AW, Ahad, G, Mokhtarzadeh, M, Schapiro, SJ, and Payne, R. "Preclinical toxicity study of intrathecal administration of the pain relievers dextrorphan, dextromethorphan, and memantine in the sheep model." Neuromodulation 2.4 (1999): 230-240.
Source
scival
Published In
Neuromodulation
Volume
2
Issue
4
Publish Date
1999
Start Page
230
End Page
240
DOI
10.1046/j.1525-1403.1999.00230.x

Quality of life and cancer pain: Satisfaction and side effects with transdermal fentanyl versus oral morphine

Purpose: To compare pain-related treatment satisfaction, patient- perceived side effects, functioning, and well-being in patients with advanced cancer who were receiving either transdermal fentanyl (Duragesic, Janssen Pharmaceuticals, Titusville, NJ) or sustained-release oral farms of morphine (MS Cantin, Perdue Frederick Co, Norwalk, CT, or Oramorph SR, Roxanne Laboratories, Columbus, OH). Patients and Methods: A total of 504 assessable cancer patients participated in this cross-sectional, quality-of-life study. Relevant elements of four validated scales were used-the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Brief Pain Inventory (BPI), the Medical Outcomes Study (MOS) questionnaire, and the Memorial Symptom Assessment Scale (MSAS)-as well as original scales that were developed and validated far this study. Results: The majority of patients in both treatment groups had late-stage (IV/D) cancer. Patients who received transdermal fentanyl were more satisfied over-all with their pain medication than those who received sustained-release oral farms of morphine (P = .035). Fentanyl patients also experienced a significantly lower frequency (P < .002) and impact (P < .001) of pain medication side effects. These results occurred despite the fact that cancer patients who received fentanyl were significantly older (P < .001) and had significantly lower functioning and well-being scores (P = .001). Measures of pain intensity, sleep adequacy, and symptoms demonstrated no significant differences between treatment groups. Conclusion: These data suggest that patients are more satisfied with transdermal fentanyl compared with sustained-release oral forms of morphine. A lower frequency and reduced impact of side effects with transdermal fentanyl may be one reason cancer patients who receive fentanyl are more satisfied with their pain management.

Authors
Payne, R; Mathias, SD; Pasta, DJ; Wanke, LA; Williams, R; Mahmoud, R
MLA Citation
Payne, R, Mathias, SD, Pasta, DJ, Wanke, LA, Williams, R, and Mahmoud, R. "Quality of life and cancer pain: Satisfaction and side effects with transdermal fentanyl versus oral morphine." Journal of Clinical Oncology 16.4 (1998): 1588-1593.
PMID
9552070
Source
scival
Published In
Journal of Clinical Oncology
Volume
16
Issue
4
Publish Date
1998
Start Page
1588
End Page
1593

Presenting symptoms in patients referred to a multidisciplinary clinic for bone metastases

Symptom control is the goal of palliative irradiation. Approximately I month is required before symptomatic relief is accomplished with radiotherapy. However, many patients with cancer-related pain do not receive adequate analgesics, and opioids are often not prescribed until patients fail to respond to palliative irradiation. The presenting symptoms of 108 patients who were referred to a multidisciplinary clinic for bone metastases were evaluated with the Wisconsin Brief Pain Inventory (BPI). This validated instrument evaluates the severity of pain using a 0-10 scale; 10 represents the worst pain imaginable. The population comprised 65 men (60 %) and 43 women whose ages ranged from 33 years to 81 years; median age was 55 years, and 69 % of patients were less than 65 years of age. Despite the presence of metastatic disease, 21 % of patients were working full-time outside the home, and 6 % were employed part-time outside the home; 13 % were homemakers. Only 17 patients (16 %) were unemployed. The time since diagnosis ranged from 2 weeks to 23 years; the median time since diagnosis was 22 months, and 30 % of patients had been diagnosed with the past 6 months. Pain was a presenting symptom in 74 % (N = 80) of patients at diagnosis. At its worst, the pain was rated as severe (levels 7-10) by 78 % and intolerable (level 10) in 22 % of the patients in the 24 hr prior to the clinic appointment. On average, the pain was rated moderate to severe (levels 4-10) in 79 % and severe in 23 % of patients. Only 45 % of patients experienced good relief from the prescribed analgesics, and 23 % of patients indicated that the prescribed analgesics were ineffective. This survey demonstrates that bone metastases incur significant pain that is often undertreated with analgesics before antineoplastic therapy is administered.

Authors
Janjan, NA; Payne, R; Gillis, T; Podoloff, D; Libshitz, HI; Lenzi, R; Theriault, R; Martin, C; Yasko, A
MLA Citation
Janjan, NA, Payne, R, Gillis, T, Podoloff, D, Libshitz, HI, Lenzi, R, Theriault, R, Martin, C, and Yasko, A. "Presenting symptoms in patients referred to a multidisciplinary clinic for bone metastases." Journal of Pain and Symptom Management 16.3 (1998): 171-178.
PMID
9769619
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
16
Issue
3
Publish Date
1998
Start Page
171
End Page
178
DOI
10.1016/S0885-3924(98)00069-4

Practice guidelines for cancer pain therapy. Issues pertinent to the revision of national guidelines.

The high prevalence of pain in cancer patients has been appreciated for a long time. However, despite release of cancer pain management guidelines by the Agency for Health Care Policy and Research (AHCPR) in 1994, pain is still undertreated. Recent reports in the literature have identified multiple factors that influence analgesic response and pain management, such as the ethnicity, gender, and age of the patient. Recognition of these factors, and the availability of new drugs, alternative delivery methods, and an enhanced understanding of pain mechanisms and receptor pharmacology compel a revision of the existing cancer pain management guidelines. Assessment and management of pain and other symptoms in cancer patients that influence the quality of survival are increasingly being incorporated into randomized-controlled clinical trials. Strategies should be developed by the National Comprehensive Cancer Network (NCCN) to develop and implement extant and revised pain management guidelines into clinical practice and test new hypotheses regarding pain management treatments in clinical trials.

Authors
Payne, R
MLA Citation
Payne, R. "Practice guidelines for cancer pain therapy. Issues pertinent to the revision of national guidelines." Oncology (Williston Park, N.Y.) 12.11 A (1998): 169-175.
PMID
10028511
Source
scival
Published In
Oncology
Volume
12
Issue
11 A
Publish Date
1998
Start Page
169
End Page
175

Economics of unrelieved cancer pain

Authors
Chandler, S; Payne, R
MLA Citation
Chandler, S, and Payne, R. "Economics of unrelieved cancer pain." American Journal of Hospice and Palliative Medicine 15.4 (1998): 223-226.
PMID
9729973
Source
scival
Published In
American Journal of Hospice & Palliative Medicine
Volume
15
Issue
4
Publish Date
1998
Start Page
223
End Page
226
DOI
10.1177/104990919801500408

Issues pertinent to the revision of national guidelines

The high prevalence of pain in cancer patients has been appreciated for a long time. However, despite release of cancer pain management guidelines by the Agency for Health Care Policy and Research (AHCPR) in 1994, pain is still undertreated. Recent reports in the literature have identified multiple factors that influence analgesic response and pain management, such as the ethnicity, gender, and age of the patient. Recognition of these factors, and the availability of new drugs, alternative delivery methods, and an enhanced understanding of pain mechanisms and receptor pharmacology compel a revision of the existing cancer pain management guidelines. Assessment and management of pain and other symptoms in cancer patients that influence the quality of survival are increasingly being incorporated into randomized-controlled clinical trials. Strategies should be developed by the National Comprehensive Cancer Network (NCCN) to develop and implement extant and revised pain management guidelines into clinical practice and test new hypotheses regarding pain management treatments in clinical trials.

Authors
Payne, R
MLA Citation
Payne, R. "Issues pertinent to the revision of national guidelines." ONCOLOGY 12.11 A (1998): 169-175.
Source
scival
Published In
Oncology
Volume
12
Issue
11 A
Publish Date
1998
Start Page
169
End Page
175

Radiotherapy residents' knowledge of and attitudes toward management of cancer pain

Purpose. To evaluate the fund of knowledge of and attitudes toward cancer pain management of radiotherapy residents across the nation. Methods. Radiotherapy (XRT) residents who had completed at least a year of training were surveyed by questionnaire. Residents (n = 10) from a training program who had been given instructional resources in cancer pain management skills were compared with residents from across the nation (n = 61). A validated survey used in national Cancer Pain Initiative Role Model Programs was administered by mail. The survey contained 30 questions that evaluated attitude alone (A), knowledge alone (K), and how attitude affects the application of knowledge (A/K). Results. The residents from the training program scored significantly higher in K (p < 0.005) and A/K (p < 0.04) than did the residents across the nation. No difference in scores evaluating A were detected (p = 0.26). Compared with the baseline knowledge of physicians in practice who had attended a workshop on cancer pain management, the national XRT residents had significantly lower scores in A (p < 0.006) and K (p < 0.001); however, no difference was found in A/K scores. After the workshop, the physicians in practice had significant gains in cancer pain management skills (p < 0.006). When the post-instruction survey was compared with the national XRT resident scores, there were marked differences in A (p < 0.00001), K (p < 0.00001) and A/K (p < 0.01). Conclusions. XRT residents in the United States are empathetic, but knowledge of cancer pain management is lacking. Instruction in the principles of cancer pain management can make a profound difference in knowledge and attitude. There is a need to recognize cancer pain management as a significant aspect of radiotherapeutic practice.

Authors
Janjan, NA; Martin, C; Weissman, D; Hill, CS; Payne, R
MLA Citation
Janjan, NA, Martin, C, Weissman, D, Hill, CS, and Payne, R. "Radiotherapy residents' knowledge of and attitudes toward management of cancer pain." Journal of Cancer Education 13.2 (1998): 65-70.
PMID
9659623
Source
scival
Published In
Journal of Cancer Education
Volume
13
Issue
2
Publish Date
1998
Start Page
65
End Page
70

World conference for cancer organisations March 3-7, 1996, Melbourne, Australia [6] (multiple letters)

Authors
Janjan, NA; Cleeland, C; Payne, R; Hill, D; Iverson, DC
MLA Citation
Janjan, NA, Cleeland, C, Payne, R, Hill, D, and Iverson, DC. "World conference for cancer organisations March 3-7, 1996, Melbourne, Australia [6] (multiple letters)." Cancer 82.1 (1998): 234-235.
PMID
9428506
Source
scival
Published In
Cancer
Volume
82
Issue
1
Publish Date
1998
Start Page
234
End Page
235

Mechanisms and management of bone pain

Authors
Payne, R
MLA Citation
Payne, R. "Mechanisms and management of bone pain." Cancer 80.8 SUPPL. (1997): 1608-1613.
PMID
9362428
Source
scival
Published In
Cancer
Volume
80
Issue
8 SUPPL.
Publish Date
1997
Start Page
1608
End Page
1613

Sickle cell-related pain: Perceptions of medical practitioners

Pain is the most common problem encountered by patients with sickle cell disease (SCD). We report the results of a survey sent to hematologists and emergency department (ED) physicians regarding their perceptions and practices concerning pain and its management. Hematologists and ED physicians differed considerably in their perceptions about the natural history of the pain, and about the percentage of patients who are addicted to analgesics. Fifty-three percent of the ED physicians and 23% of the hematologists thought that more than 20% of patients are addicted. These beliefs and perceptions about SCD-related pain and the prevalence of addiction must be addressed if clinical care is to be changed substantively.

Authors
Shapiro, BS; Benjamin, LJ; Payne, R; Heidrich, G
MLA Citation
Shapiro, BS, Benjamin, LJ, Payne, R, and Heidrich, G. "Sickle cell-related pain: Perceptions of medical practitioners." Journal of Pain and Symptom Management 14.3 (1997): 168-174.
PMID
9291703
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
14
Issue
3
Publish Date
1997
Start Page
168
End Page
174
DOI
10.1016/S0885-3924(97)00019-5

Relieving the pain of cancer.

Authors
Payne, R
MLA Citation
Payne, R. "Relieving the pain of cancer." Provider (Washington, D.C.) 23.11 (1997): 123-127.
PMID
10173667
Source
scival
Published In
Provider (Washington, D.C.)
Volume
23
Issue
11
Publish Date
1997
Start Page
123
End Page
127

High-dose epidural infusion of opioids for cancer pain: Cost issues

The safety and efficacy of intraspinal opioids as therapy for selected patients with cancer pain are well-established. The choice of the appropriate drug is influenced by many variables that are to date incompletely elucidated. The cost of therapy is an increasingly important component of decision-making. This report describes the management of a patient who achieved excellent pain control with the administration of epidural sufentanil and bupivacaine. Daily Average Wholesale Price for sufentanil was, however, $698. Until the data comparing the efficacy of different epidurally administered opioids in the treatment of cancer pain are available, we suggest that treatment with more costly opioids be reserved for patients for whom analgesia cannot be achieved after maximizing epidural morphine analgesia with aggressive side-effect management.

Authors
Manfredi, PL; Chandler, SW; Patt, R; Payne, R
MLA Citation
Manfredi, PL, Chandler, SW, Patt, R, and Payne, R. "High-dose epidural infusion of opioids for cancer pain: Cost issues." Journal of Pain and Symptom Management 13.2 (1997): 118-121.
PMID
9095570
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
13
Issue
2
Publish Date
1997
Start Page
118
End Page
121
DOI
10.1016/S0885-3924(96)00266-7

Intravenous methadone for cancer pain unrelieved by morphine and hydromorphone: Clinical observations

Methadone is a very effective second-line opioid for treatment of cancer pain. However, the starting doses of methadone indicated on opioid conversion charts may over-estimate the dose of intravenous (i.v.) methadone needed. In this report, we describe four patients with cancer-related pain treated with continuous i.v. morphine and hydromorphone. Because of persistent pain and opioid side effects limiting increases in opioid dose, each patient was switched to i.v. methadone. All four patients had excellent pain relief without significant side effects at a dose that, according to the available conversion charts, was approximately 3% of the calculated equianalgesic dose of hydromorphone. When converting from continuous i.v. hydromorphone to continuous i.v. methadone, much lower doses than those suggested by the opioid conversion charts should be used as starting doses.

Authors
Manfredi, PL; Borsook, D; Chandler, SW; Payne, R
MLA Citation
Manfredi, PL, Borsook, D, Chandler, SW, and Payne, R. "Intravenous methadone for cancer pain unrelieved by morphine and hydromorphone: Clinical observations." Pain 70.1 (1997): 99-101.
PMID
9106815
Source
scival
Published In
PAIN
Volume
70
Issue
1
Publish Date
1997
Start Page
99
End Page
101
DOI
10.1016/S0304-3959(96)03313-1

Palliation of intractable cancer pain by MRI-guided cingulotomy

Case Report: Three cases of intractable pain arising from widespread metastatic cancer with poor response to opioids were treated with MRI-guided cingulotomy. Results and Conclusions: In most cases, MRI-guided cingulotomy was associated with significant pain relief and reduced opioid use. To provide insight into the role of MRI-guided cingulotomy in oncologic pain refractory to more conservative measures, the relative risks and benefits of cingulotomy are discussed, along with the course of one patient who experienced postoperative cognitive impairment. This report also describes the relevant neurosurgical and pharmacotherapeutic issues associated with management of pain in patients with widespread metastatic disease.

Authors
Wong, ET; Gunes, S; Gaughan, E; Patt, RB; Ginsberg, LE; Hassenbusch, SJ; Payne, R
MLA Citation
Wong, ET, Gunes, S, Gaughan, E, Patt, RB, Ginsberg, LE, Hassenbusch, SJ, and Payne, R. "Palliation of intractable cancer pain by MRI-guided cingulotomy." Clinical Journal of Pain 13.3 (1997): 260-263.
PMID
9303260
Source
scival
Published In
Clinical Journal of Pain
Volume
13
Issue
3
Publish Date
1997
Start Page
260
End Page
263
DOI
10.1097/00002508-199709000-00013

Teaching cancer pain management: durability of educational effects of a role model program.

BACKGROUND: Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions. METHODS: Fifty health-care providers (13 physicians, 21 nurses, and 16 pharmacists), working as a team, participated in a Role Model Program that presented principles of cancer pain management. A questionnaire that evaluated the fund of knowledge and attitudes regarding cancer pain management was administered prior to the 1-day workshop, at the end of the workshop, and at 4 and 12 months follow-up. The workshop consisted of lectures and discussion groups; in the discussion groups, concepts were clarified, cases presented, and barriers to optimal cancer pain management identified. RESULTS: Significant improvements in attitudes (P < 0.01), knowledge (P < 0.01), and total scores (P < 0.002) were observed when the preworkshop responses were compared with those obtained immediately after instruction. Scores on the questionnaire were the same or slightly better at both 4 and 12 months in follow-up, demonstrating no loss in acquired knowledge or attitude. Comparison of the postworkshop scores with those at 12 months follow-up were significantly better in attitude (P < 0.03), and in total score (P < 0.01); improvements in knowledge also approached significance (p < 0.06). These represented continuing improvements because significant differences in the attitude scores (P < 0.05) and the total score (P < 0.05) were observed when the 4-month and 12-month follow-up responses were evaluated. The effectiveness of the program in the transference of knowledge was also measured; in the first year of the program, more than 4500 health-care professionals were subsequently informed about cancer pain management from the Role Model Participants. CONCLUSIONS: Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.

Authors
Janjan, NA; Martin, CG; Payne, R; Dahl, JL; Weissman, DE; Hill, CS
MLA Citation
Janjan, NA, Martin, CG, Payne, R, Dahl, JL, Weissman, DE, and Hill, CS. "Teaching cancer pain management: durability of educational effects of a role model program." Cancer 77.5 (March 1996): 996-1001.
PMID
8608495
Source
epmc
Published In
Cancer
Volume
77
Issue
5
Publish Date
1996
Start Page
996
End Page
1001
DOI
10.1002/(sici)1097-0142(19960301)77:5<996::aid-cncr28>3.3.co;2-r

Cerebrospinal fluid distribution of opioids after intraventricular and lumbar subarachnoid administration in sheep

The study of opioid distribution in blood and cerebrospinal fluid (CSF) is required to understand pharmacokinetic-pharmacodynamic relationships following lumbar intrathecal (it) and intracerebroventicular (icv) administration, and to investigate the contributions of spinal or supraspinal sites of action. The sheep model developed for pharmacokinetic study of analgesics allows atraumatic sampling of plasma and CSF after drug administration by the intraveneus (iv), icv, and it routes in an unanesthetized animal. Five adult female sheep were prepared with femoral vascular catheters, lumbar it and epidural cannulae, icv cannulae, and cisterna magna cannulae. Hydromorphone, methadone, naloxone, and [14C] sucrose were injected and collected by two methods: 1) injection into the icv cannula with lumbar CSF samples collected via the lumbar cannula and 2) injection into the lumbar cannula and cisternal CSF samples collected via ventriculocisternal cannula. Hydromorphone, morphine, and [14C] sucrose were detected at 90-105 min in lumbar CSF after icv injection. Hydromorphone and [14C] sucrose were detected in icv cerebrospinal fluid at 50 min after lumbar it injection. Methadone was not detected in icv cerebrospinal fluid after it injection, nor was methadone significantly detected in lumbar CSF after icv injection. These data indicate that icv and it administration of lipophilic opioids produces CSF distributions different from those of hydrophilic opioids. This suggests that lipophilic opioids such as methadone or naloxone exert their effects predominantly on tissues near the site of injection. The study of it and icv opiate administration and CSF pharmacokinetics may therefore have direct clinical implications.

Authors
Payne, R; Gradert, TL; Inturrisi, CE
MLA Citation
Payne, R, Gradert, TL, and Inturrisi, CE. "Cerebrospinal fluid distribution of opioids after intraventricular and lumbar subarachnoid administration in sheep." Life Sciences 59.16 (1996): 1307-1321.
PMID
8876660
Source
scival
Published In
Life Sciences
Volume
59
Issue
16
Publish Date
1996
Start Page
1307
End Page
1321
DOI
10.1016/0024-3205(96)00456-0

Teaching cancer pain management: Durability of educational effects of a role model program

BACKGROUND. Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions. METHODS. Fifty health-care providers (13 physicians, 21 nurses, and 16 pharmacists), working as a team, participated in a Role Model Program that presented principles of cancer pain management. A questionnaire that evaluated the fund of knowledge and attitudes regarding cancer pain management was administered prior to the 1-day workshop, at the end of the workshop, and at 4 and 12 months follow-up. The workshop consisted of lectures and discussion groups; in the discussion groups, concepts were clarified, cases presented, and barriers to optimal cancer pain management identified. RESULTS. Significant improvements in attitudes (P < 0.01), knowledge (P < 0.01), and total scores (P < 0.002) were observed when the preworkshop responses were compared with those obtained immediately after instruction. Scores on the questionnaire were the same or slightly better at both 4 and 12 months in follow-up, demonstrating no loss in acquired knowledge or attitude. Comparison of the postworkshop scores with those at 12 months follow-up were significantly better in attitude (P < 0.03), and in total score (P < 0.01); improvements in knowledge also approached significance (P < 0.06). These represented continuing improvements because significant differences in the attitude scores (P < 0.05) and the total score (P < 0.05) were observed when the 4-month and 12-month follow-up responses were evaluated. The effectiveness of the program in the transference of knowledge was also measured; in the first year of the program, more than 4500 health-care professionals were subsequently informed about cancer pain management from the Role Model Participants. CONCLUSIONS. Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.

Authors
Janjan, NA; Martin, CG; Payne, R; Dahl, JL; Weissman, DE; Hill, CS
MLA Citation
Janjan, NA, Martin, CG, Payne, R, Dahl, JL, Weissman, DE, and Hill, CS. "Teaching cancer pain management: Durability of educational effects of a role model program." Cancer 77.5 (1996): 996-1001.
Source
scival
Published In
Cancer
Volume
77
Issue
5
Publish Date
1996
Start Page
996
End Page
1001
DOI
10.1002/(SICI)1097-0142(19960301)77:5<996::AID-CNCR28>3.0.CO;2-Y

Inappropriate use of naloxone in cancer patients with pain

Opioid overdose is rarely the primary cause of altered mental status in cancer patients receiving opioid therapy. The inappropriate administration of naloxone to reverse an abnormal mental status can cause severe withdrawal symptoms and pain. To illustrate this problem, we report the case of a patient inappropriately treated with naloxone and the results of a retrospective review of the medical records of 15 consecutive patients with cancer treated with naloxone in the emergency department over a 5-month period. We offer guidelines for a more thoughtful approach to the management of patients with cancer who present with encephalopathy.

Authors
Manfredi, PL; Ribeiro, S; Chandler, SW; Payne, R
MLA Citation
Manfredi, PL, Ribeiro, S, Chandler, SW, and Payne, R. "Inappropriate use of naloxone in cancer patients with pain." Journal of Pain and Symptom Management 11.2 (1996): 131-134.
PMID
8907145
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
11
Issue
2
Publish Date
1996
Start Page
131
End Page
134
DOI
10.1016/0885-3924(95)00150-6

Commissural myelotomy for intractable cancer pain: Report of two cases

Patients: We describe two patients with cancer-related low back and bilateral lower extremity pain that failed pharmacologic treatment. Results: In both cases, commissural myelotomy provided significant pain relief. The role of myelotomy in the management of cancer pain is discussed.

Authors
Watling, CJ; Payne, R; Allen, RR; Hassenbusch, S
MLA Citation
Watling, CJ, Payne, R, Allen, RR, and Hassenbusch, S. "Commissural myelotomy for intractable cancer pain: Report of two cases." Clinical Journal of Pain 12.2 (1996): 151-156.
PMID
8776556
Source
scival
Published In
Clinical Journal of Pain
Volume
12
Issue
2
Publish Date
1996
Start Page
151
End Page
156
DOI
10.1097/00002508-199606000-00012

Intractable pain and suffering in a cancer patient

Authors
Payne, R; Cunningham, M; Weinstein, SM; Riberio, S; Patt, RB; Chiang, J
MLA Citation
Payne, R, Cunningham, M, Weinstein, SM, Riberio, S, Patt, RB, and Chiang, J. "Intractable pain and suffering in a cancer patient." Clinical Journal of Pain 11.1 (1995): 70-75.
PMID
7540440
Source
scival
Published In
Clinical Journal of Pain
Volume
11
Issue
1
Publish Date
1995
Start Page
70
End Page
75

Subarachnoid neurolytic block under general anesthesia in a 3-year-old with neuroblastoma

Case Report: A 3-year-old boy with neuroblastoma complained of severe pain in the left lower extremity. Pharmacologic management had previously been attempted, but severe pain continued, and further upward titration was complicated by sedative effects. Methods and Results: Because the focus of treatment had become the controlling of pain, a lumbosacral subarachnoid neurolytic block was performed under general anesthesia. One-time neurolysis was more acceptable to the family than a procedure like epidural analgesia, that requires greater management. Contrast medium was used to monitor the spread of the neurolytic. An epidural catheter was inserted during the neurolytic block procedure for possible future use. The short-term results were good-pain reports and opioid doses decreased greatly, although with increased incontinence. The boy had new abdominal distention and pain 5 days after neurolysis. Opioid doses and sedatives were increased. He died 3 days later.

Authors
Patt, RB; Payne, R; Farhat, GA; Reddy, SK
MLA Citation
Patt, RB, Payne, R, Farhat, GA, and Reddy, SK. "Subarachnoid neurolytic block under general anesthesia in a 3-year-old with neuroblastoma." Clinical Journal of Pain 11.2 (1995): 143-146.
PMID
7549171
Source
scival
Published In
Clinical Journal of Pain
Volume
11
Issue
2
Publish Date
1995
Start Page
143
End Page
146

Guidelines for the clinical use of transdermal fentanyl

Transdermal (TTS) fentanyl therapy has emerged as an effective alternative to the use of oral opioids for the control of pain in certain cancer patients. These patients are those with moderate to severe chronic pain, with a stable baseline pain pattern. Patients receiving this treatment should first be titrated to stable pain relief with oral opioids and should have recourse during therapy to fast-acting, short-duration analgesics for the control of incident pain. TTS fentanyl dosing schedules should be based upon the patient's requirement for rescue dosing and duration of effective pain control. The average requirement to change fentanyl patches is every 72 h, although 48-h dosing is necessary in a few patients. This novel route of fentanyl administration allows convenient outpatient treatment, the possibility of a lower Incidence of side effects, and may thus aid compliance.

Authors
Payne, R; Chandler, S; Einhaus, M
MLA Citation
Payne, R, Chandler, S, and Einhaus, M. "Guidelines for the clinical use of transdermal fentanyl." Anti-Cancer Drugs 6.SUPPL. 3 (1995): 50-53.
PMID
7606038
Source
scival
Published In
Anti-Cancer Drugs
Volume
6
Issue
SUPPL. 3
Publish Date
1995
Start Page
50
End Page
53

Preface: Policy issues related to clinical practice guidelines

Authors
Jacox, AK; Carr, DB; Payne, R
MLA Citation
Jacox, AK, Carr, DB, and Payne, R. "Preface: Policy issues related to clinical practice guidelines." Journal of Pain and Symptom Management 9.3 (1994): 143-145.
PMID
7516954
Source
scival
Published In
Journal of Pain and Symptom Management
Volume
9
Issue
3
Publish Date
1994
Start Page
143
End Page
145

Management of cancer pain: Adults

Authors
Jacox, A; Carr, DB; Payne, R; Berde, CB; Breitbart, W; Cain, JM; Chapman, R; Cleeland, CS; Ferrell, BR; Finley, RS; Hester, NO; Jr, CSH; Leak, WD; Lipman, AG; Logan, CL; McGarvey, CL; Miaskowski, CA; Mulder, DS; Paice, JA
MLA Citation
Jacox, A, Carr, DB, Payne, R, Berde, CB, Breitbart, W, Cain, JM, Chapman, R, Cleeland, CS, Ferrell, BR, Finley, RS, Hester, NO, Jr, CSH, Leak, WD, Lipman, AG, Logan, CL, McGarvey, CL, Miaskowski, CA, Mulder, DS, and Paice, JA. "Management of cancer pain: Adults." American Family Physician 49.8 (1994): 1853-1868.
PMID
8203323
Source
scival
Published In
American Family Physician
Volume
49
Issue
8
Publish Date
1994
Start Page
1853
End Page
1868

Quick reference guide for clinicians management of cancer pain: Infants, children and adolescents

Authors
Jacox, A; Payne, R; Carr, D; Berde, C; Brietbart, W; Cain, JM; Chapman, CR; Cleeland, CS; Ferrell, B; Finley, R; Hester, NK; Hill, CS; Leak, WD; Lipman, AG; Logan, CL; McGarvey, CL; Miaskowski, C; Mulder, DS
MLA Citation
Jacox, A, Payne, R, Carr, D, Berde, C, Brietbart, W, Cain, JM, Chapman, CR, Cleeland, CS, Ferrell, B, Finley, R, Hester, NK, Hill, CS, Leak, WD, Lipman, AG, Logan, CL, McGarvey, CL, Miaskowski, C, and Mulder, DS. "Quick reference guide for clinicians management of cancer pain: Infants, children and adolescents." Journal of Pharmaceutical Care in Pain and Symptom Control 2.1 (1994): 75-103.
Source
scival
Published In
Journal of Pharmaceutical Care in Pain and Symptom Control
Volume
2
Issue
1
Publish Date
1994
Start Page
75
End Page
103

Quick reference guide for clinicians management of cancer pain: Adults

Authors
Jacox, A; Payne, R; Carr, D; Berde, C; Brietbart, W; Cain, JM; Chapman, CR; Cleeland, CS; Ferrell, B; Finley, R; Hester, NK; Hill, CS; Leak, WD; Lipman, AG; Logan, CL; McGarvey, CL; Miaskowski, C; Mulder, DS
MLA Citation
Jacox, A, Payne, R, Carr, D, Berde, C, Brietbart, W, Cain, JM, Chapman, CR, Cleeland, CS, Ferrell, B, Finley, R, Hester, NK, Hill, CS, Leak, WD, Lipman, AG, Logan, CL, McGarvey, CL, Miaskowski, C, and Mulder, DS. "Quick reference guide for clinicians management of cancer pain: Adults." Journal of Pharmaceutical Care in Pain and Symptom Control 2.1 (1994): 47-73.
Source
scival
Published In
Journal of Pharmaceutical Care in Pain and Symptom Control
Volume
2
Issue
1
Publish Date
1994
Start Page
47
End Page
73

The opioid mechanism of interferon-α action

Rats were trained to discriminate the opioid receptor agonist ethylketocyclazocine (EKC) (0.3 mg/kg body weight, intraperitoneally) from saline. Interferon-alpha (IFN-α), when substituted for EKC, elicited a dose-related increase in EKC-like responses. This generalization of EKC responses was blocked by the opioid antagonist naloxone (1 mg/kg). Potentiation of responses to a low dose (0.1 mg/kg) of EKC by IFN-α (1 x 106 U/kg or 0.22 nmol/kg) was also observed. Data thus indicate the involvement of opioid neurons on the action of IFN-α. d-Amphetamine (0.8 mg/kg) was shown to potentiate both EKC (0.1 mg/kg) and IFN-α (1 x 106 U/kg). The present study confirms our previously proposed opioid-mediated dopaminergic mechanism of IFN-α.

Authors
Ho, BT; Lu, JG; Huo, YY; Fan, SH; Meyers, CA; Tansey, LW; Payne, R; Levin, VA
MLA Citation
Ho, BT, Lu, JG, Huo, YY, Fan, SH, Meyers, CA, Tansey, LW, Payne, R, and Levin, VA. "The opioid mechanism of interferon-α action." Anti-Cancer Drugs 5.1 (1994): 90-94.
PMID
8186436
Source
scival
Published In
Anti-Cancer Drugs
Volume
5
Issue
1
Publish Date
1994
Start Page
90
End Page
94

Epidural air from a bronchopleural-epidural-cutaneous fistula producing reversible myelopathy and radiculopathy symptoms

Authors
Gonzales, GR; Payne, R; Portenoy, RK; Foley, KM
MLA Citation
Gonzales, GR, Payne, R, Portenoy, RK, and Foley, KM. "Epidural air from a bronchopleural-epidural-cutaneous fistula producing reversible myelopathy and radiculopathy symptoms." Neurology 44.12 (1994): 2409-2410.
PMID
7991142
Source
scival
Published In
Neurology
Volume
44
Issue
12
Publish Date
1994
Start Page
2409
End Page
2410

New clinical-practice guidelines for the management of pain in patients with cancer

Authors
Jacox, A; Carr, DB; Payne, R
MLA Citation
Jacox, A, Carr, DB, and Payne, R. "New clinical-practice guidelines for the management of pain in patients with cancer." New England Journal of Medicine 330.9 (1994): 651-655.
PMID
7508094
Source
scival
Published In
New England Journal of Medicine
Volume
330
Issue
9
Publish Date
1994
Start Page
651
End Page
655
DOI
10.1056/NEJM199403033300926

Neurochemical basis of interleukin 2-modified discrimination behaviour

We trained one group of rats to discriminate 0.8 mg/kg intraperitoneal (i.p.) d-amphetamine from 1 ml/kg saline and the other to discriminate 0.3 mg/kg i.p. (±)-ethylketocyclazocine (EKC) from saline. Recombinant human interleukin 2 (rIL-2), 2 × 106 U/kg (or 8.2 nmol/kg) given i.p. 1 h prior to tests, potentiated responses elicited by 0.4 mg/kg d-amphetamine. This potentiation of d-amphetamine responses was suppressed by the opioid receptor antagonist naloxone (1 mg/kg) when administered i.p. together with IL-2. IL-2 (4 × 106 U/kg) alone produced EKC-like responses in the EKC-trained animals. The cytokine also potentiated 0.1 mg/kg EKC responses at 2 × 106 U/kg, an action that was suppressed by 1 mg/kg naloxone. Data from the present study show that IL-2 exerts the same neurochemical action as that previously observed with IFN-α for both d-amphetamine and EKC discrimination in rats. © 1994.

Authors
Ho, BT; Lu, J-G; Huo, Y-Y; Fan, SH; Meyers, CA; Tansey, LW; Payne, R; Levin, VA
MLA Citation
Ho, BT, Lu, J-G, Huo, Y-Y, Fan, SH, Meyers, CA, Tansey, LW, Payne, R, and Levin, VA. "Neurochemical basis of interleukin 2-modified discrimination behaviour." Cytokine 6.4 (1994): 365-367.
PMID
7948743
Source
scival
Published In
Cytokine
Volume
6
Issue
4
Publish Date
1994
Start Page
365
End Page
367

Treating cancer pain [1]

Authors
Karnad, AB; Blansfield, HN; Kilwein, JH; Goodman, AN; Marcus, CS; O'Neill, WM; Chambers, EJ; Fallon, MT; Bloomer, WD; Cleeland, CS; Jacox, A; Carr, DB; Payne, R
MLA Citation
Karnad, AB, Blansfield, HN, Kilwein, JH, Goodman, AN, Marcus, CS, O'Neill, WM, Chambers, EJ, Fallon, MT, Bloomer, WD, Cleeland, CS, Jacox, A, Carr, DB, and Payne, R. "Treating cancer pain [1]." New England Journal of Medicine 331.3 (1994): 199-201.
PMID
7516494
Source
scival
Published In
New England Journal of Medicine
Volume
331
Issue
3
Publish Date
1994
Start Page
199
End Page
201
DOI
10.1056/NEJM199407213310313

Acute pain management in infants, children, and adolescents: Operative and medical procedures, Quick Reference Guide for clinicians

Authors
Carr, DB; Jacox, AK; Chapman, CR; Ferrell, B; Fields, HL; III, GH; Hester, NO; Hill, CS; Lipman, AG; McGarvey, CL; Miaskowski, C; Mulder, DS; Payne, R; Schechter, N; Shapiro, BS; Smith, R; Tsou, CV; Vecchiarelli, L
MLA Citation
Carr, DB, Jacox, AK, Chapman, CR, Ferrell, B, Fields, HL, III, GH, Hester, NO, Hill, CS, Lipman, AG, McGarvey, CL, Miaskowski, C, Mulder, DS, Payne, R, Schechter, N, Shapiro, BS, Smith, R, Tsou, CV, and Vecchiarelli, L. "Acute pain management in infants, children, and adolescents: Operative and medical procedures, Quick Reference Guide for clinicians." Journal of Pharmaceutical Care in Pain and Symptom Control 1.1 (1993): 85-108.
Source
scival
Published In
Journal of Pharmaceutical Care in Pain and Symptom Control
Volume
1
Issue
1
Publish Date
1993
Start Page
85
End Page
108

Acute pain management in adults: Operative procedures, Quick Reference Guide for clinicians

Authors
Carr, DB; Jacox, AK; Chapman, CR; Ferrell, B; Fields, HL; III, GH; Hester, NO; Hill, CS; Lipman, AG; McGarvey, CL; Miaskowski, C; Mulder, DS; Payne, R; Schechter, N; Shapiro, BS; Smith, R; Tsou, CV; Vecchiarelli, L
MLA Citation
Carr, DB, Jacox, AK, Chapman, CR, Ferrell, B, Fields, HL, III, GH, Hester, NO, Hill, CS, Lipman, AG, McGarvey, CL, Miaskowski, C, Mulder, DS, Payne, R, Schechter, N, Shapiro, BS, Smith, R, Tsou, CV, and Vecchiarelli, L. "Acute pain management in adults: Operative procedures, Quick Reference Guide for clinicians." Journal of Pharmaceutical Care in Pain and Symptom Control 1.1 (1993): 63-84.
Source
scival
Published In
Journal of Pharmaceutical Care in Pain and Symptom Control
Volume
1
Issue
1
Publish Date
1993
Start Page
63
End Page
84

Transdermal fentanyl: suggested recommendations for clinical use.

Transdermal fentanyl offers the advantage of providing continuous administration of a potent opioid in the absence of needles and expensive drug-infusion pumps for the treatment of cancer pain. When transdermal fentanyl is initiated, it may be necessary to change the dose every 24-48 hr until an appropriate dose is titrated to the needs of the patient. This should be done by providing short-acting opioids as rescue analgesics for breakthrough pain. Well-accepted principles established for chronic opioid use in cancer pain management should apply to the administration of transdermal fentanyl as well. These include dose titration, the coadministration of adjuvant drugs to counteract opioid side effects and enhance analgesia, and the need to reassess the patient continuously for recurrent tumor and other new sources of pain. Further clinically relevant studies are needed and include 1) the determination of the relative potency of transdermal fentanyl, especially in comparison with oral and parenteral morphine; 2) a prospective study of the side-effect profile of transdermal fentanyl in relationship to oral morphine; and 3) the role of oral transmucosal administration of fentanyl in selection of starting doses of transdermal fentanyl and as a means to provide rescue doses for breakthrough pain.

Authors
Payne, R
MLA Citation
Payne, R. "Transdermal fentanyl: suggested recommendations for clinical use." Journal of pain and symptom management 7.3 Suppl (April 1992): S40-S44.
PMID
1517631
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
7
Issue
3 Suppl
Publish Date
1992
Start Page
S40
End Page
S44
DOI
10.1016/0885-3924(92)90052-j

Pain disorders

Authors
Payne, R
MLA Citation
Payne, R. "Pain disorders." Current Opinion in Neurology and Neurosurgery 4.2 (January 1, 1991): 240-244. (Review)
Source
scopus
Published In
Current Opinion in Neurology and Neurosurgery
Volume
4
Issue
2
Publish Date
1991
Start Page
240
End Page
244

Medication-induced performance deficits: analgesics and narcotics.

Pain is the most common medical complaint, and analgesic drugs are often used for its management. Seven out of 10 Americans took nonprescription pain relievers in the last year. Analgesics are classified as nonnarcotics (acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs), narcotics (which include the morphine-like drugs), and analgesic adjuvants (a heterogeneous group of drugs, including antihistamines, phenothiazines, anticonvulsants, calcium channel blockers, and tricyclic antidepressants), which may have intrinsic analgesic efficacy for specific pain syndromes or may be used as co-analgesics in combination with the traditional nonnarcotic and narcotic agents. Although these agents can be used safely most of the time by patients with acute or chronic pain, all classes of analgesics may impair cardiovascular and neuropsychiatric functioning, which may influence job performance in specific instances.

Authors
Payne, R
MLA Citation
Payne, R. "Medication-induced performance deficits: analgesics and narcotics." Journal of occupational medicine. : official publication of the Industrial Medical Association 32.4 (April 1990): 362-369.
PMID
1970835
Source
epmc
Published In
Journal of Occupational Medicine
Volume
32
Issue
4
Publish Date
1990
Start Page
362
End Page
369

Treatment of pain and migraine

Authors
Payne, R
MLA Citation
Payne, R. "Treatment of pain and migraine." Current Opinion in Neurology and Neurosurgery 3.2 (January 1, 1990): 249-254. (Review)
Source
scopus
Published In
Current Opinion in Neurology and Neurosurgery
Volume
3
Issue
2
Publish Date
1990
Start Page
249
End Page
254

Cancer pain. Anatomy, physiology, and pharmacology.

Cancer pain can be divided into three classes: somatic, visceral, and deafferentation. Somatic and visceral pain result from activation of nociceptors by tumor infiltration of tissues and from secondary inflammatory changes with release of algesic chemicals that act to sensitize nociceptors. Pain may be experienced locally (somatic and visceral) or referred to remote cutaneous sites (visceral). Deafferentation pain results from injury to the nervous system due to tumor infiltration or cancer therapy and may persist even after the cause of the injury has been removed. Somatic, visceral, and deafferentation pain may be complicated by sympathetically maintained pain, in which efferent sympathetic activity promotes persistent pain, hyperpathia, and vasomotor and sudomotor changes after tissue injury from cancer or its therapy. The neurobiology of cancer pain is complex and incompletely understood. This article summarizes current knowledge in this area and briefly discusses approaches to cancer pain management that are based on this knowledge.

Authors
Payne, R
MLA Citation
Payne, R. "Cancer pain. Anatomy, physiology, and pharmacology." Cancer 63.11 Suppl (June 1989): 2266-2274.
PMID
2655866
Source
epmc
Published In
Cancer
Volume
63
Issue
11 Suppl
Publish Date
1989
Start Page
2266
End Page
2274
DOI
10.1002/1097-0142(19890601)63:11<2266::aid-cncr2820631135>3.0.co;2-5

Pain management in sickle cell disease. Rationale and techniques.

Authors
Payne, R
MLA Citation
Payne, R. "Pain management in sickle cell disease. Rationale and techniques." Annals of the New York Academy of Sciences 565 (January 1989): 189-206.
PMID
2570546
Source
epmc
Published In
Annals of the New York Academy of Sciences
Volume
565
Publish Date
1989
Start Page
189
End Page
206
DOI
10.1111/j.1749-6632.1989.tb24166.x

Pharmacologic management of bone pain in the cancer patient.

Cancer patients may experience acute or chronic pain caused by tumor infiltration of pain-sensitive structures or related to surgery, radiation, and chemotherapy. Acute bone pain, with or without associated neurologic deficits resulting from tumor metastasis to bone and contiguous neural structures (e.g., large peripheral nerve trunks or the spinal cord), is a common cause of intractable pain in cancer patients. Most often, treatment of bone pain involves the concomitant use of focal radiation therapy and analgesic drugs, especially steroids, nonsteroidal anti-inflammatory drugs (usually in combination with opioids), and adjuvant analgesic agents such as levodopa and calcitonin. However, pharmacologic therapy is not always efficacious and may have significant side effects. Less commonly, invasive therapies, such as resection of vertebral body tumor with spinal reconstruction or pituitary ablation and intraventricular opioid administration (for diffuse bone pain), are offered. In this article I discuss current approaches to the management of pain in cancer patients, emphasizing current hypotheses on the pathogenesis of bone pain and the rationale for its pharmacologic treatment.

Authors
Payne, R
MLA Citation
Payne, R. "Pharmacologic management of bone pain in the cancer patient." The Clinical journal of pain 5 Suppl 2 (January 1989): S43-S49.
PMID
2520440
Source
epmc
Published In
Clinical Journal of Pain
Volume
5 Suppl 2
Publish Date
1989
Start Page
S43
End Page
S49

Cancer pain. Anatomy, physiology, and pharmacology

Cancer pain can be divided into three classes: somatic, visceral, and deafferentation. Somatic and visceral pain result from activation of nociceptors by tumor infiltration of tissues and from secondary inflammatory changes with release of algesic chemicals that act to sensitize nociceptors. Pain may be experienced locally (somatic and visceral) or referred to remote cutaneous sites (visceral). Deafferentation pain results from injury to the nervous system due to tumor infiltration or cancer therapy and may persist even after the cause of the injury has been removed. Somatic, visceral, and deafferentation pain may be complicated by sympathetically maintained pain, in which efferent sympathetic activity promotes persistent pain, hyperpathia, and vasomotor and sudomotor changes after tissue injury from cancer or its therapy. The neurobiology of cancer pain is complex and incompletely understood. This article summarizes current knowledge in this area and briefly discusses approaches to cancer pain management that are based on this knowledge.

Authors
Payne, R
MLA Citation
Payne, R. "Cancer pain. Anatomy, physiology, and pharmacology." Cancer 63.11 SUPPL. (1989): 2266-2274.
Source
scival
Published In
Cancer
Volume
63
Issue
11 SUPPL.
Publish Date
1989
Start Page
2266
End Page
2274

Leukemic relapse presenting as sciatic nerve involvement by chloroma (granulocytic sarcoma)

A relapse of acute nonlymphocytic leukemia in a child presented as subacute mononeuropathy involving the sciatic nerve. Surgical exploration showed a chloroma (granulocytic sarcoma) of the distal sciatic nerve, but resection and irradiation did not lead to recovery of nerve function or complete resolution of the patient's symptomatic neuropathic pain. This case represents a rare neurologic complication of what is currently an uncommon presentation for leukemic relapse, and may be the only reported case of chloromatous involvement of the peripheral nervous system (PNS) without coexisting epidural or leptomeningeal leukemia.

Authors
Stillman, MJ; Christensen, W; Payne, R; Foley, KM
MLA Citation
Stillman, MJ, Christensen, W, Payne, R, and Foley, KM. "Leukemic relapse presenting as sciatic nerve involvement by chloroma (granulocytic sarcoma)." Cancer 62.9 (1988): 2047-2050.
PMID
3167817
Source
scival
Published In
Cancer
Volume
62
Issue
9
Publish Date
1988
Start Page
2047
End Page
2050

CSF distribution of opioids in animals and man.

The CSF distribution of opioids after subarachnoid administration is important in determining therapeutic and undesirable side-effects. There are many factors which influence CSF distribution of opioids including the age, position, anatomy of the spinal column of the patient or animal, and the physico-chemical properties of the opioid solution and of the CSF. Opioids are cleared from their site of administration in CSF by three mechanisms: 1) uptake into the spinal cord, 2) diffusion through the dura and uptake into the blood, and 3) rostral-caudal CSF distribution. Physico-chemical factors such as lipid solubility, degree of ionization in the CSF and the baricity of the opioid solution are important in determining the rate of clearance by these three routes. Opioids which are highly lipid soluble, have high affinity for delta and/or kappa opiate receptor subtypes, and are largely non-ionized at physiologic CSF pH, would have optimal pharmacokinetic properties for subarachnoid administration. These properties would allow administration of a small dose of opioid which would be rapidly taken up into the spinal cord, thereby limiting CSF and vascular distribution to supraspinal brain regions.

Authors
Payne, R
MLA Citation
Payne, R. "CSF distribution of opioids in animals and man." Acta anaesthesiologica Scandinavica. Supplementum 85 (January 1987): 38-46.
PMID
2821726
Source
epmc
Published In
Acta anaesthesiologica Scandinavica. Supplementum
Volume
85
Publish Date
1987
Start Page
38
End Page
46

Lymphomatous meningitis presenting as atypical cluster headache

We report a woman who developed atypical cluster headache as the first manifestation of trigeminal dysfunction from leptomeningeal lymphoma. Progression to a complete trigeminal neuropathy led to resolution of her pain. The role of the trigeminal nerve in the expression of the signs and symptoms of cluster headache is discussed. © 1987.

Authors
DeAngelis, LM; Payne, R
MLA Citation
DeAngelis, LM, and Payne, R. "Lymphomatous meningitis presenting as atypical cluster headache." Pain 30.2 (1987): 211-216.
PMID
3670872
Source
scival
Published In
PAIN
Volume
30
Issue
2
Publish Date
1987
Start Page
211
End Page
216

Novel routes of opioid administration in the management of cancer pain.

Administration of opioids by less conventional routes may produce pain relief of more rapid onset, of longer duration, and fewer side effects in comparison with conventional oral or parenteral administration. This review will discuss the indications, efficacy, complications and potential advantages of these novel routes of administration.

Authors
Payne, R
MLA Citation
Payne, R. "Novel routes of opioid administration in the management of cancer pain." Oncology (Williston Park, N.Y.) 1.2 Suppl (1987): 10-18.
PMID
2908614
Source
scival
Published In
Oncology (Williston Park, N.Y.)
Volume
1
Issue
2 Suppl
Publish Date
1987
Start Page
10
End Page
18

Neck pain in the elderly: A management review. Part II

Rheumatoid arthritis and metastatic cancer occur commonly in the elderly, and may cause neck pain. Rheumatoid arthritis may produce cervical radiculopathy and myelopathy resulting from vertebral body subluxation, although radiological manifestations of subluxation are much more common than neurological dysfunction. Cervical spinal cord compression is a neurological emergency and may produce cervical radiculopathy as well as myelopathy. Careful neurological and radiological assessments are required to minimize pain and preserve neurological function in elderly patients suffering from neck pain complicating rheumatoid arthritis or cervical spinal metastasis.

Authors
Payne, R
MLA Citation
Payne, R. "Neck pain in the elderly: A management review. Part II." Geriatrics 42.2 (1987): 71-73.
PMID
3803932
Source
scival
Published In
Geriatrics
Volume
42
Issue
2
Publish Date
1987
Start Page
71
End Page
73

Anatomy, physiology, and neuropharmacology of cancer pain

The anatomy, physiology, and pharmacology of nociception and its modification by analgesic drugs have been studied extensively in the past decade. Although the neural mechanisms of nociceptors and the stimuli that activate them are much better understood, it must be emphasized that the perception of pain, as well as the meaning of pain to the individual, is a complex behavioral phenomenon and involves psychologic and emotional processes in addition to activation of nociceptive pathways. Pain related to malignant disease can be classified as somatic, visceral, and deafferentation in type. Somatic pain and visceral pain direct activation of nociceptors and are often a complication of tumor infiltration of tissues or injury of tissues as a consequence of cancer therapy. The management of this type of pain is typically accomplished by treating the tumor (with surgery, chemotherapy, and/or radiation therapy) and by using the appropriate non-narcotic, narcotic, and adjuvant analgesic agents. Neuroablative therapies may be helpful in specific circumstances. For example, cordotomy may be helpful for unilateral pain below the waist in patients with somatic and visceral pain. This procedure may also be helpful for early deafferentation pain (i.e., lumbosacral plexopathy) in which peripheral nerves are compressed but not infiltered or destroyed by metastatic tumor growth. Deafferentation pain may be a complication of tumor infiltration or of peripheral nerve of cancer therapy that injures neural tissues. This type of pain is often poorly tolerated and difficult to control, particularly if not treated early and aggressively. Although incompletely understood, the pathophysiology of deafferentation pain appears to be different from that of somatic or visceral pain, and the treatment approaches may be different. Management approaches to deafferentation pain usually emphasize treatment of the pain, because injury to the nervous system may be difficult to reverse, even if one can successfully treat the underlying malignancy, and many deafferentation pain syndromes occur as a complication of cancer therapy. The role of narcotic analgesics in the management of deafferentation pain is not clear, although the published experience suggests that they are less useful than in somatic or visceral pain.

Authors
Payne, R
MLA Citation
Payne, R. "Anatomy, physiology, and neuropharmacology of cancer pain." Medical Clinics of North America 71.2 (1987): 153-167.
PMID
3546978
Source
scival
Published In
Medical Clinics of North America
Volume
71
Issue
2
Publish Date
1987
Start Page
153
End Page
167

Role of epidural and intrathecal narcotics and peptides in the management of cancer pain

The spinal administration of opioids may provide analgesia of long duration to patients with bilateral or midline lower abdominal or pelvic cancer pain. However, cross-tolerance to orally and parenterally administered narcotics and the rapid development of tolerance to spinal narcotics have limited their usefulness. Opioids have extensive distribution in the CSF and plasma when administered into the epidural or intrathecal space, and delivery of drug to brain stem sites may account for many of the toxic and therapeutic effects of spinal opioids. Further clinical and pharmacokinetic studies are required to provide the information regarding: (1) the optimal opioids for use as spinal analgesics; (2) equieffective dose ratios of spinal opioids in comparison to parenteral or oral opioids; (3) strategies useful to forestall the development of tolerance of spinally administered opioids; (4) the analgesic efficacy of this therapy in opioid-tolerant patients; and (5) the role of spinally administered nonopioid analgesics in the management of cancer pain in the tolerant patient. These questions will need resolution before this therapy can be recommended for routine use in the management of cancer pain.

Authors
Payne, R
MLA Citation
Payne, R. "Role of epidural and intrathecal narcotics and peptides in the management of cancer pain." Medical Clinics of North America 71.2 (1987): 313-327.
PMID
2881034
Source
scival
Published In
Medical Clinics of North America
Volume
71
Issue
2
Publish Date
1987
Start Page
313
End Page
327

Neck pain in the elderly: A management review. Part I

Degenerative disease of the cervical spine is a common cause of neck pain in the elderly. This article reviews the pathogenesis, clinical features, and managment of cervical spondylitic radiculopathy and myelopathy in the elderly.

Authors
Payne, R
MLA Citation
Payne, R. "Neck pain in the elderly: A management review. Part I." Geriatrics 41.1 (1987): 59-65.
PMID
3803929
Source
scival
Published In
Geriatrics
Volume
41
Issue
1
Publish Date
1987
Start Page
59
End Page
65

CSF distribution of opioids in animals and man.

The CSF distribution of opioids after subarachnoid administration is important in determining therapeutic and undesirable side-effects. There are many factors which influence CSF distribution of opioids including the age, position, anatomy of the spinal column of the patient or animal, and the physico-chemical properties of the opioid solution and of the CSF. Opioids are cleared from their site of administration in CSF by three mechanisms: 1) uptake into the spinal cord, 2) diffusion through the dura and uptake into the blood, and 3) rostral-caudal CSF distribution. Physico-chemical factors such as lipid solubility, degree of ionization in the CSF and the baricity of the opioid solution are important in determining the rate of clearance by these three routes. Opioids which are highly lipid soluble, have high affinity for delta and/or kappa opiate receptor subtypes, and are largely non-ionized at physiologic CSF pH, would have optimal pharmacokinetic properties for subarachnoid administration. These properties would allow administration of a small dose of opioid which would be rapidly taken up into the spinal cord, thereby limiting CSF and vascular distribution to supraspinal brain regions.

Authors
Payne, R
MLA Citation
Payne, R. "CSF distribution of opioids in animals and man." Acta Anaesthesiologica Scandinavica, Supplement 85 (1987): 38-46.
Source
scival
Published In
Acta Anaesthesiologica Scandinavica, Supplement
Volume
85
Publish Date
1987
Start Page
38
End Page
46

A chronic sheep preparation for the study of drug pharmacokinetics in spinal and ventricular CSF

We describe a sheep preparation utilizing chronic vascular and subarachnoid catheterization and ventriculocisternal perfusion. This preparation allows simultaneous, atraumatic sampling of plasma and CSF after drug administration by the intravenous, intracerebroventricular, or lumbar intrathecal (i.t.) routes in an unanesthesized animal. This sheep preparation provides a convenient means of studying the CSF distribution of exogenous and/or endogenous substances. During intravenous infusion at a rate of 2.2 μg/kg/min, morphine appears in cisternal CSF within 15 min. The steady-state plasma concentration and CSF flux (or appearance rate) of morphine was 0.037 and 0.009 μg/min, respectively. At steady state, 0.008% of the administered dose appears in CSF/min. The coadministration of morphine, methadone, and [14C]sucrose into the fifth lumbar subarachnoid space is associated with the simultaneous appearance of morphine and [14C]sucrose, but not methadone, in cisternal CSF. The ratio of [14C]sucrose to morphine increased by nearly sevenfold in cisternal CSF, indicating clearance of morphine relative to [14C]sucrose as the compounds ascend in the CSF axis. The simultaneous appearance of morphine and [14C]sucrose in cisternal CSF after lumbar subarachnoid administration indicates that morphine, like sucrose, is distributed within the CSF by bulk flow. This sheep preparation can be used to provide the quantitative data necessary for the development of pharmacokinetic-pharmacodynamic models that relate plasma and CSF concentrations of opiates to their pharmacological effects. These studies will help to provide the pharmacological rationale for the administration of opiates by novel routes for pain management in man. © 1986.

Authors
Payne, R; Madsen, J; Harvey, RC; Inturrisi, CE
MLA Citation
Payne, R, Madsen, J, Harvey, RC, and Inturrisi, CE. "A chronic sheep preparation for the study of drug pharmacokinetics in spinal and ventricular CSF." Journal of Pharmacological Methods 16.4 (1986): 277-296.
PMID
3784573
Source
scival
Published In
Journal of Pharmacological Methods
Volume
16
Issue
4
Publish Date
1986
Start Page
277
End Page
296

Neuropathic pain syndromes, with special reference to causalgia and reflex sympathetic dystrophy

Persistent pain infrequently complicates injury to bone, soft tissue, and peripheral nerve. Reflex sympathetic dystrophy (RSD) is a generic term used to indicate a clinical syndrome consisting of pain (usually burning in quality), hyperpathia, dystrophic changes in skin, nails, and subcutaneous tissues, and sympathetic dysfunction occurring in response to bone and soft tissue injury. Causalgia is a special type of RSD complicating partial injury to peripheral nerve in which there is intense pain, sympathetic dysfunction, and dystrophic changes in the limb, and often a beneficial response to sympathetic blockade. Current available treatments of neurophatic pain, and the proposed mechanisms of pain, hyperalgesia, and sympathetic dysfunction occurring in the RSDs, will be reviewed. An approach to the management of patients with RSD will be proposed.

Authors
Payne, R
MLA Citation
Payne, R. "Neuropathic pain syndromes, with special reference to causalgia and reflex sympathetic dystrophy." Clinical Journal of Pain 2.1 (1986): 59-73.
Source
scival
Published In
Clinical Journal of Pain
Volume
2
Issue
1
Publish Date
1986
Start Page
59
End Page
73

Back pain in the elderly: Updated diagnosis and management

CT of compression fractures is a useful adjunct to the plain x-ray in excluding signs of metastasis. However, increased bone density on CT may not distinguish osteoporotic fractures from neoplastic disease, in which case radioiodine scan, bone and marrow biopsies, or myelography may be necessary. Surgery for painful osteoarthritic spinal disease is controversial. The potential advantages of surgery must be weighed against the risk of anesthesia, the length and tolerance of postoperative immobility, and the effect of laminectomy and fusion on the biomechanics of the spine. Furthermore, the elderly are at increased risk for postoperative complications.

Authors
Gandy, S; Payne, R
MLA Citation
Gandy, S, and Payne, R. "Back pain in the elderly: Updated diagnosis and management." Geriatrics 41.12 (1986): 59-74.
PMID
2946627
Source
scival
Published In
Geriatrics
Volume
41
Issue
12
Publish Date
1986
Start Page
59
End Page
74

Paraneoplastic opsoclonus-myoclonus: Association with medullary thyroid carcinoma and review of the literature

The syndrome of opsoclonus-myoclonus (OM) is an infrequent but well-known 'remote effect' of neuroblastoma in children. The OM syndrome is even less frequent in adults. A few cases of adult paraneoplastic OM have been described in association with several systemic neoplasms. We report the unique case of a 29-year-old man with metastatic medullary thyroid carcinoma in whom OM developed as part of a generalized transient encephalopathy. We outline the postulated anatomic lesions and pathophysiologic mechanisms underlying the OM syndrome, as well as examine the possible connections between the neuroendocrine derivation of medullary thyroid carcinoma and the neurotoxic and/or autoimmune theories of the causation of the OM syndrome in patients with systemic neoplasms.

Authors
Dropcho, E; Payne, R
MLA Citation
Dropcho, E, and Payne, R. "Paraneoplastic opsoclonus-myoclonus: Association with medullary thyroid carcinoma and review of the literature." Archives of Neurology 43.4 (1986): 410-415.
PMID
3954625
Source
scival
Published In
Archives of Neurology
Volume
43
Issue
4
Publish Date
1986
Start Page
410
End Page
415

CSF distribution of morphine, methadone and sucrose after intrathecal injection

The lumbar to cisternal CSF distribution of morphine and methadone were compared to C-14 sucrose, a standard marker of CSF bulk flow, after lumbar subarachnoid injections in a sheep preparation. Morphine appeared and peaked simultaneously with C-14 sucrose in cisternal CSF at 90 to 190 minutes. The mean peak cisternal CSF morphine concentrations were sustained for 30-40 minutes, and averaged 148 ng/ml, representing 0.3% of the administered dose. Methadone was not detectable in cisternal CSF up to 240-300 minutes after lumbar subarachnoid administration. The C-14 sucrose/morphine ratio was increased an average of 6.7 times in cisternal CSF as compared to the ratio wf the two compounds injected into the lumbar subarachnoid space. These studies demonstrate that morphine, a hydrophilic oploid, given intrathecally moves rostrally and appears in cisternal CSF by bulk flow. Furthermore the rostral redistribution of morphine is associated with the clearance of morphine from CSF. Methadone, a lipophilic opioid, appears to be completely cleared from CSF before it reaches the cisterna magna. These pharmacokinetic studies support a contribution of supraspinal sites to the analgesic and adverse effects produced by morphine given by spinal routes of administration. In contrast methadone appears to exert its effects predominantly at spinal sites. © 1985.

Authors
Payne, R; Inturrist, CE
MLA Citation
Payne, R, and Inturrist, CE. "CSF distribution of morphine, methadone and sucrose after intrathecal injection." Life Sciences 37.12 (1985): 1137-1144.
PMID
3839885
Source
scival
Published In
Life Sciences
Volume
37
Issue
12
Publish Date
1985
Start Page
1137
End Page
1144

Advances in the management of cancer pain

The study of pain in the cancer patient offers a unique opportunity to use clinical observations to advance biologic knowledge. The cancer patient unfortunately represents the experimental model of pain. This group of heroic patients can help teach us the physiologic and psychologic differences between acute and chronic pain, the importance and evolution of psychologic factors, the difference between pain and suffering, the clinical pharmacology of analgesic drugs, and the behavioral mechanisms humans use to suppress pain. They are a rich resource of research potential which should not go untapped. The development of better methods of pain control will benefit all patients with pain. There is a pressing need to develop innovative approaches based on sound, scientific principles, and advances in research technology offer us the opportunity to understand the complex phenomenon of pain.

Authors
Payne, R; Foley, KM
MLA Citation
Payne, R, and Foley, KM. "Advances in the management of cancer pain." Cancer Treatment Reports 68.1 (1984): 173-183.
PMID
6141006
Source
scival
Published In
Cancer Treatment Reports
Volume
68
Issue
1
Publish Date
1984
Start Page
173
End Page
183
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