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Opioid-Induced Constipation in Cancer Patients

Opioid-Induced Constipation in Cancer Patients

Cancer patients who receive opioid therapy for the management of persistent pain commonly experience opioid-induced bowel dysfunction. Constipation is one of the most frequent manifestations. Other symptoms include nausea, bloating, and reflux. According to studies, the prevalence of opioid-induced constipation (OIC) among people with advanced cancer varies from 25% to 90%. “OIC is a complex and potentially serious problem,” says Lara K. Dhingra, PhD. “In addition to the physical effects from both OIC and the treatments used to manage it, OIC is associated with an emotional burden for patients.” Constipation may impair quality of life (QOL) and can potentially have serious complications, including bowel obstruction and severe anorexia. OIC can also lead to time missed from work, more healthcare utilization, and changes in opioid regimens. Despite the growing recognition of adverse consequences that have been linked to OIC, little is known about the nature of psychological distress and the burden associated with this problem. There is a lack of systematic research on the affective and cognitive burden of OIC, particularly among cancer populations, a group that may be at higher risk for physical and psychological distress due to OIC. “Studies show that cancer patients are more likely to rate constipation as a cause of severe symptom distress than pain,” adds Dr. Dhingra. “This highlights the importance of developing effective treatment strategies and finding ways to reduce distress.” A Qualitative Analysis A study published in Palliative Medicine by Dr. Dhingra and colleagues used qualitative research methods to better understand the psychological distress and burden associated with OIC and its treatment in advanced cancer patients. “This type of design is ideal...
Post-Op Pain in Pediatric Urology

Post-Op Pain in Pediatric Urology

Management of pain is a critical aspect of postoperative care in pediatric urology. Currently, clinicians who aim to control postoperative pain in children use a combination of both opioids and anti-inflammatory drugs. Regional anesthesia with a caudal block is another effective pain management technique that is used in pediatric urology, but these blocks only last 6 to 8 hours unless an indwelling caudal catheter is used. Having an indwelling caudal catheter in place often limits patients’ mobility and requires a hospital admission after surgery. An Evolution in Care Continuous infusion of site-specific analgesia is a more evolved way to provide prolonged pain management. Continuous infusion has been found to result in fewer side effects and better postoperative recovery. This treatment approach has been shown to lead to earlier mobilization and earlier discharge than standard therapy. One FDA-approved device that currently is used to provide continuous infusion of analgesia is the ON-Q® pump (I-Flow/Kimberly-Clark). The device is an elastomeric pump that delivers 0.25% bupivacaine at the incision site via a flexible silver-coated catheter. The catheter, which is tunneled subcutaneously at the completion of a patient’s surgery, is attached to the elastomeric pump, which has a flow-limiting valve. The local anesthetic is delivered at a constant flow rate (0.4mg/kg) for the entire duration of use. The pump functions automatically and doesn’t require any manipulation by patients or their families. The pump is carried in a small pouch, which allows patients to maintain mobility and be discharged home. Supporting Data In a recent prospective randomized controlled trial conducted at Children’s Hospital of Orange County, my colleagues and I confirmed the efficacy of...

Appeals Court Strips Graduate of MD Degree

A three-judge panel of the US Court of Appeals for the Sixth Circuit reversed a federal district court decision and said that Case Western Reserve University could withhold an MD degree from a student who they said exhibited unprofessional behavior. I have written about this situation on two previous occasions—here and here. Briefly, a medical student who had performed well academically had committed a few transgressions outside the classroom. These included: sexually harassing some female students at a dance; attempting to avoid payment of a taxi fare; having problems interacting with staff, patients, and families, resulting in a failing grade and requirement to repeat a [sub?]internship; and asking faculty members not to mark him late for teaching sessions, which occurred 30% of the time. The issue that prompted the school to expel the student just prior to graduation was a conviction in another state for driving while intoxicated. He denied or had excuses for most of the incidents. The original court decision pointed out that his earlier problems had apparently not been considered serious because the school had given him positive letters of recommendation. The lower court also opined that professionalism was distinct from academic matters. The appeals court disagreed and said, “professionalism is part of what [medical] students must learn and practice.” It added that the school’s definition of professionalism in moral judgment terms was appropriate and should not be separated from academic performance. Here are some of the ways the school defined professionalism in its curriculum: ethical, honest, responsible and reliable behavior; respectful dialogue with peers, faculty, and patients, to enhance learning and resolve differences; recognize personal...
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