Please note that any alterations made during the publishing process may not appear in this version."NOTICE: this is the authors' version of a work that was accepted for publication in the Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Cities. Published Journal Articles (PJAs) Definition: A published journal article (PJA) is the definitive final record of published research that appears or will appear in the journal and embodies all value-adding publisher activities including copy-editing, formatting and (if relevant) pagination. Policy: Elsevier guarantees each PJA's authenticity, we work with others (e.g. national libraries) to preserve them for posterity and in perpetuity, and we invest to drive their usage. We strictly apply an absolute guideline regarding their location: every PJA will reside only on a completely controlled site because this is the only way that we as the publisher can guarantee each PJA's permanence, authenticity and that it is not altered. The continued viability of scholarly journals and their PJAs is also important to the research community. Publishers invest significant time, money and resources to create, maintain and develop both journals' reputations and the publishing process. The distribution of PJAs is therefore also subject to strict guidelines so that journals' ability to recoup the investments required to create them are not compromised. An author may use the PJA for personal use and internal institutional use (see above for definitions of these terms). In the interest of safeguarding the correct scientific record, however, Elsevier does not permit the posting of PJAs (Elsevier-provided PDF or HTML files) on any open websites. This is to ensure that the final published version of an article, which has been edited and peer-reviewed according to the publishing standards of an Elsevier journal, is always recognized as such only via the journal itself, whether in print or electronic format. PJAs may not be used for commercial use or for systematic distribution (see above for definitions of these terms). Tables: 6 References: 25Funding : This study was generously funded by National Health and Medical Research Council grant #480459. 2Archived at Flinders University: dspace.flinders.edu.au Abstract ContextRandomised controlled trials (RCTs) can answer questions of efficacy, but rarely generate a complete safety profile. Long term pharmacovigilance studies complement RCTs. ObjectivesLevel I evidence supports short term efficacy of opioids in reducing refractory dyspnoea. This study aims to determine: the minimum effective daily dose of sustained release morphine to reduce refractory breathlessness; and whether net clinical benefits are sustained safely. MethodsIn a phase II d...

Background This analysis aims to evaluate health-related quality of life (HrQoL) (primary outcome for this analysis), nausea and vomiting, and pain in patients with inoperable malignant bowel obstruction (IMBO) due to cancer or its treatments randomised to standardised therapies plus octreotide or placebo over a maximum of 72 h in a double-blind clinical trial. Methods Adults with IMBO and vomiting recruited through 12 services spanning inpatient, consultative and community settings in Australia were randomised to subcutaneous octreotide infusion or saline. HrQoL was measured at baseline and treatment cessation (EORTC QLQ-C15-PAL). Mean within-group paired differences between baseline and post-treatment scores were analysed using Wilcoxon Signed Rank test and between group differences estimated using linear mixed models, adjusted for baseline score, sex, age, time, and study arm. Results One hundred six of the 112 randomised participants were included in the analysis (n = 52 octreotide, n = 54 placebo); 6 participants were excluded due to major protocol violations. Mean baseline HrQoL scores were low (octreotide 22.1, 95% CI 14.3, 29.9; placebo 31.5, 95% CI 22.3, 40.7). There was no statistically significant within-group improvement in the mean HrQoL scores in the octreotide (p = 0.21) or placebo groups (p = 0.78), although both groups reported reductions in mean nausea and vomiting (octreotide p < 0.01; placebo p = 0.02) and pain scores (octreotide p < 0.01; placebo p = 0.03). Although no statistically significant difference in changes in HrQoL scores between octreotide and placebo were seen, an adequately powered study is required to fully assess any differences in HrQoL scores. Conclusion The HrQoL of patients with IMBO and vomiting is poor. Further research to formally evaluate the effects of standard therapies for IMBO is therefore warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000211369 (date registered 18/04/2008)

statement: research questions in COPD" by CELLI et al.[1] is a timely summary of the current evidence and the questions that arise directly from where that evidence reaches its limits. Such documents are crucial in framing research strategies for researchers and research funders.Daily breathlessness at rest or on minimal exertion is experienced by many of the 330 million people living with chronic obstructive pulmonary disease (COPD) globally. It is a debilitating and burdensome symptom, experienced for long periods of time, not just in the last weeks or months of life. It occurs despite inhaled treatments prescribed to reduce breathlessness: their failure to fully relieve breathlessness may add to patients' despair and, at the very time when more support is needed, doctors often turn away. The majority of people with COPD will have a prolonged period of life with such severe breathlessness. The ATS/ERS statement signals the need for research into: 1) methods of alleviating breathlessness by modifying the underlying disease course; 2) pulmonary rehabilitation; and 3) symptom control and advance planning during the terminal stages of the disease. While these are important goals and the document flags symptom control as important (and laudably notes that pulmonary function tests and imaging are surrogates for assessing breathlessness), the statement ignores the pressing need for research that ensures relief of breathlessness for the prolonged duration when COPD is already maximally treated; this seems a significant omission.This burden of breathlessness in COPD starts well before the "end of life" for most people [2][3][4]. Palliating chronic refractory breathlessness must be an ongoing focus for research if we are to make a difference to the lives of these tens of millions of people now and into the future [5,6]. Even if a treatment were to be found today that could cure or prevent COPD, there is a generation of people who experience breathlessness as a daily challenge that deserve the combined intellectual expertise of the global research community.The inclusion of ways to treat chronic refractory breathlessness more effectively in optimally treated COPD is a worthy research goal, building on the emerging evidence of the mechanisms and management of breathlessness. Managing breathlessness has the potential to improve markedly people's function for day-to-day activities, such as self-care, and ensure that they are more comfortable, even when the underlying cause(s) of their breathlessness cannot be reversed or stabilised. Level 1 efficacy evidence (meta-analyses), which needs to be confirmed by adequately powered trials, already identifies an important role for nonpharmacological interventions, oxygen, and regular, low-dose morphine in reducing breathlessness in this population [7][8][9][10][11][12]. A research programme also needs to include subsequent effectiveness studies. The recognition that breathlessness is truly multidimensional, and that modification of its affective component can bring significant clini...

No abstract

Background: Shoulder pain is a distressing but under-reported and poorly managed symptom in people with motor neurone disease. Objectives: This study aimed to assess the efficacy of suprascapular nerve block for the management of shoulder pain in patients with motor neurone disease. Methods: A total of 27 patients with motor neurone disease and shoulder pain were offered a suprascapular nerve block. Ten of these patients had bilateral shoulder pain and both were injected, making a total of 37 shoulders. The patients were followed up for a total of 3 months, or until death. Shoulder pain was measured using the pain scale (out of 100) of the shoulder pain and disability index and compared with baseline scores and a placebo control group from an earlier study using the same methodology (ACTRN12619000353190). Results: Following the nerve block there was a significant improvement of pain scores from baseline (58.4) at week 1 (20.8, p < 0.000), week 6 (17.6, p < 0.000) and week 12 (30.4, p = 0.001) and a significant improvement compared with the control group across each time interval. Conclusion: Suprascapular nerve block is a safe, effective therapy for patients with chronic shoulder pain.