Articles of interest in other scholarly journals
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Physicians’ self-assessment of cancer pain treatment skills-more training required.
Silvoniemi M, Vasankari T, Vahlberg T, Vuorinen E, Clemens KE, Salminen E.
In this study 720 Finnish physicians (59 oncologists) had their perception on their skills and training needs on palliative pain management assessed using a questionnaire. 46% of oncologists and 32% of other physicians knew the analgesic ladder. 46% of oncologists and 61% of other physicians considered pain treatment of cancer patients being well managed in Finland. 24% of oncologists and 5% of other physicians considered the current education in palliative care as satisfactory. Oncologists reported a training need in communication skills, ethical questions, and palliative home care, whereas the other physicians expressed need for training in pain management and palliative care.
The amygdala, a relay station for switching on and off pain.
Rouwette T, Vanelderen P, Roubos EW, Kozicz T, Vissers K.
This review outlines the role of corticotropin-releasing factor in pain processing and relates its up-regulation in the amygdala to neuropathic pain and mood disorders. The authors describe a possible mechanism by which the amygdala has a role in regulating chronic pain, by descending inhibitory pathways, and postulate that in neuropathic pain, this mechanism is dysregulated causing persistent hyperalgesia.
Risk of mortality among individual antipsychotics in patients with dementia.
Kales HC, Kim HM, Zivin K, Valenstein M, Seyfried LS, Chiang C, Cunningham F, Schneider LS, Blow FC.
The 180-day mortality was compared for antipsychotic agents in this 10 year retrospective cohort study of more than 33,000 patients with dementia aged over 65. Haloperidol was associated with the highest mortality, especially in the first 30 days of use, followed by risperidone, olanzapine and valproic acid, with quetiapine having the lowest mortality risk. For risperidone, olanzapine, valproic acid and quetiapine mortality risk was greatest in the first 120 days of use. Limitations of this study include a predominantly male cohort, use of administrative data, and the presence of Parkinson’s disease in a significantly higher proportion of patients taking quetiapine.
Kerr CW, Drake J, Milch RA, Brazeau DA, Skretny JA, Brazeau GA, Donnelly JP.
In this randomized, double-blind, placebo-controlled trial of 30 hospice patients, the effect of methylphenidate on fatigue and depression was assessed using several validated scales. Both groups had similar baseline values. Patients taking methylphenidate had lower fatigue scores (on all scales) at day 14 compared with baseline. This effect was dose-dependent, with an average effective dose of 10mg on Day 3 and 20mg on Day 14. There was no improvement in fatigue with placebo. For patients with depression on Day 0, treatment with methylphenidate was associated with an improvement in all indices for depressed mood. For the placebo group, the changes in measures of depression were inconsistent between assessment tools and were less than those detected in the methylphenidate group. There were no significant toxicities from methylphenidate.
By Jason Boland, Consultant in Palliative Medicine, Barnsley Hospice, United Kingdom