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Volume 44 Number 2 2007
Pages 279 — 294


Abstract - Pain and palliative medicine

Victor T. Chang, MD;1-2* Brooke Sorger, PhD;3 Kenneth E. Rosenfeld, MD;4-5 Karl A. Lorenz, MD, MSHS;4-5 Amos F. Bailey, MD;6-7 Trinh Bui, PharmD;3 Lawrence Weinberger, PhD;1 Marcos Montagnini, MD, FACP8

1Department of Veterans Affairs (VA) New Jersey Health Care System, East Orange, NJ; 2University of Medicine and Dentistry of New Jersey, Newark, NJ; 3James J. Peters VA Medical Center (VAMC), Bronx, NY; 4VA Greater Los Angeles Healthcare System, Los Angeles, CA; 5David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; 6Birmingham VAMC, Birmingham, AL; 7University of Alabama, Birmingham, AL; 8VA
Ann Arbor Health Care System, Ann Arbor, MI

Abstract — Severe pain is highly prevalent, with rates of 40% to 70% in patients with advanced cancer, liver disease, heart failure, human immunodeficiency virus, and renal failure. Wide variations in pain assessment and reporting methods and the measurement of multiple symptoms should be addressed in future studies. Regarding psychological approaches, determining whether hypnotherapy or other individual psychotherapeutic interventions reduce pain and/or psychological distress in a palliative care population is difficult. Interest is increasing in the concept of demoralization syndromes and the role of posttraumatic stress disorder in modulating responses to pain at the end of life. We review evidence from multiple studies that the use of rehabilitative therapy improves functional status and pain control among patients with advanced cancer, and we raise the possibility that rehabilitation therapy will be helpful in patients with other advanced diseases. We summarize ongoing clinical trials of electronic order sets, clinical care pathways, and care management pathways to improve pain management in palliative care. Wagner's Chronic Illness Model provides a way of analyzing how healthcare systems can be changed to provide adequate and continuing pain management in palliative care. Much work remains to ensure that pain is recognized, treated, and monitored effectively.

Key words: cancer, health services, heart failure, HIV, information technology, pain, palliative, PTSD, quality care, rehabilitation, veterans.


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