The purposes of the study were to determine the knowledge and attitudes about cancer pain management (CPM) among practicing physicians in six Minnesota communities and to determine the physician-related barriers to optimal CPM. Eligible community physicians were surveyed by telephone. The study analyzed responses of 145 physicians (response rate, 87%). The majority of the physicians were primary care specialists (73%). Significant knowledge deficits were identified in nine of 14 CPM principles, but inappropriate attitudes were found in only two of nine CPM concepts. Medical specialty had the strongest influence on knowledge and attitudes, with primary care physicians having significantly better outcomes than surgeons or medical subspecialists. Effective education strategies must address knowledge deficits, attitudes, and motivations of the relevant peer group influencing physicians, as well as those of individual physicians. The Minnesota Cancer Pain Project is testing strategies to enhance CPM by physicians and improve patient outcomes.
Long-term oral administration of the long-acting opiate 1-alpha-acetylmethadol (LAAM) to female rats beginning on the day of conception interfered with the dams' ability to carry litters to term. When treatment was initiated 3 weeks prior to mating this effect was not observed. Daily administration of the opiate antagonist naloxone from day 14 of gestation through term, to precipitate withdrawal in utero, resulted in increased stillbirths, decreased pup weight and size, and weight loss 24 hours after birth. These data question the validity of animal experiments which purport to be models for methadone maintenance programs but in which treatment is started immediately prior to or soon after conception. They also suggest that withdrawal in utero may be responsible for many of the adverse effects of opiates on human and animal development.
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