Improving outcomes of analgesic treatment: is education enough?

Article Abstract:

Even though most patients with acute pain and chronic pain from cancer could be kept pain-free by means of an aspirin-like drug and an opiate drug (such as morphine) administered properly, many patients continue to suffer pain in their last days of life. The woeful neglect of the analgesic needs of the very sick and dying is usually attributed to inadequate staff education, and attitudes (of both patients and staff) toward narcotics that restrict their use. In spite of considerable attention in textbooks, articles, and continuing education courses to pain, however, the problem persists: patients are undermedicated. Clinicians need to know more regarding the pharmacology of analgesics, and regulatory agencies must support attitude changes on the parts of physicians. In a climate of hostility toward drug abuse, patients' attitudes toward narcotics may be particularly inflexible. Starting from the premise that more information would not necessarily lead to better actions, the analgesic practices of clinicians are evaluated. Serious communication gaps exist between patients, doctors, and nurses, where pain is concerned. This is but another example of the low status historically associated in medical thinking with patients' ''subjective'' reports (symptoms), while ''objective'' signs occupy a much higher position. No medical specialty is responsible for treating symptoms, but each has its favorite lesions to heal. Better pain control can be anticipated if pain becomes more visible and its relief becomes easily possible. The availability of concise guides to analgesics, computerized drug-ordering methods, and promotion of patients as pain advocates, should help. Review procedures to evaluate clinician's abilities to manage pain should be established, with emphasis on encouragement rather than criticism. If administrative policies need changing, they should be changed; all will gain from effective, appropriate regulation of narcotics prescribing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Drug therapy, Pain, Terminal care, Beliefs, opinions and attitudes, Ethical aspects, Analgesics, editorial

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Immunoglobulin in patients with stem-cell transplants

Article Abstract:

Immunoglobulin therapy does not benefit patients who receive a blood stem cell transplant, according to a study of 200 patients. People who receive a stem cell transplant must take immunosuppressive drugs to keep their body from rejecting the transplant. But this increases their risk of infection. In this study, patients who took immunoglobulin has just as many infections as those who took a placebo, or inactive substance.

Infection, Prevention, Complications and side effects, Immunosuppressive agents, Hematopoietic stem cell transplantation

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Improving protection against infection in people without enough immunoglobulin

Article Abstract:

Giving patients with immunodeficiency a higher dose of immunoglobulin may reduce the number and duration of infections, according to a study of 46 patients with low levels of natural immunoglobulins. Immunoglobulins are natural proteins in the immune system that help kill bacteria and viruses.

Care and treatment, Immunodeficiency

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