Causes of pain were analysed in 200 patients referred to a specialized cancer pain clinic. Pain caused by tumour growth was found in 158 patients, pain secondary to cancer or its treatment in 116 patients and pain unrelated to cancer in 33 patients. Visceral involvement (74 cases), bone metastases (68 cases), soft tissue invasion (56 cases) and nerve/plexus pressure or infiltration (39 cases) were the most frequent causes of pain due to tumour growth. Myogenic pain (68 cases) was the most frequent cause of secondary pain. The patients presented with a multitude of different combinations of causes of pain, the majority having at least two separate causes. Since pain treatment in cancer patients should be determined by its aetiology, a detailed analysis of the pain condition in each patient should form the basis for a rational therapy.

No abstract

Continuous reaction times (CRTs) and subjective assessment of pain intensity (PVAS) and sedation (SVAS) were compared in 14 cancer patients during chronic oral opioid therapy (daily doses of morphine: 130-400 mg) and subsequent stable epidural opioid therapy (daily doses of morphine: 32-240 mg). CRTs were also measured in 20 healthy controls. CRT results were summarized using 10%, 50% and 90% percentiles. On the basis of these values a 'variation index' was calculated (90-10%): 50%, describing the spread of the reaction time values. No statistically significant differences were found in PVAS, SVAS and CRT before and after initiation of epidural opioid administration. Calculation of confidence limits of median differences showed absolutely no tendency towards differences in CRT between the treatments. Only 4 patients experienced both increased pain relief and less sedation on epidural opioids. Comparing CRT percentiles of the cancer patients with the controls, differences were found between the control group and the oral opioid group, the latter being statistically significantly slower in the 90% percentiles (P = 0.018) and variation indexes (P = 0.018). In conclusion, no differences were found between CRT values and VAS scores in cancer patients treated with chronic oral opioids versus epidural opioids. Therefore at this dose level of chronic opioid treatment, the advantage of epidural administration seems questionable.

No abstract

These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.