Primary care providers are positioned to identify patients, well in advance of their deaths, who could benefit from palliative care services, but little is known about how to correctly identify these upstream palliative care patients. This article reports on efforts to devise a methodology for identifying such patients and to offer preliminary estimates of their prevalence in urban, primary care practices. The data presented here suggest 2 conclusions: (1) that electronic databases may be used to create a preliminary screen to assist clinicians in the early identification of patients in need of palliative care, and (2) that 1% to 3% of patients in primary care practices may benefit from palliative care services. Currently, there are no standards regarding the role of primary care providers in end-of-life care and it is hoped that this article will contribute to developing such standards.
Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differences; identifying red and yellow flags early; understanding and differentiating tolerance, dependence and addiction; minimizing side effects; and being familiar with and using CAM therapies when good evidence of efficacy exists. The pharmacologic management of pain requires thorough knowledge of nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors, and opioids. A table of equianalgesic dosages is useful because patients may need to move from one opioid to another. Accompanying this article are papers discussing 5 common pain disorders seen by family physicians, including: neck pain, low back pain, joint pain, pelvic pain, and cancer/end of life pain. The family physician who learns these principles of pain management and the algorithms for these common pain disorders can serve patients well. (J Am Board Fam Pract 2004;17:S1-12.)Pain management is an important initiative today. Patients often present to their family physicians with short-and long-term pain episodes, making this setting ideally suited for addressing pain management. Because the family physician has the opportunity to both initially assess the patient and then provide continuing care, he/she can initiate prompt, appropriate pain control and then escalate or taper medications as the therapeutic response dictates.
Family physicians take pride in addressing the totality of a patient's experience of disease and are skilled in a multidisciplinary approach to care. As such, they have an important role to play in managing adult cancer pain. Although 75% to 90% of cancer patients could receive adequate pain relief from routine pharmacologic therapies delivered by family physicians, pain continues to be undertreated in this population. Pain is a global experience affecting the whole person. Our role as patient advocates and educators makes us well suited to participate in the current national attempt to redress the lack of attention to this important component of suffering. This article reviews commonly seen cancer pain syndromes, with specific recommendations concerning assessment, reassessment, management, and indications for consultation. (J Am Board Fam Pract 2004;17:S48 -56.)
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