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NRS dyspnea

David Hui, Kelly Kilgore, Minjeong Park, Janet Williams, Diane Liu, Eduardo Bruera
CONTEXT: Episodic breathlessness is common and debilitating in cancer patients. OBJECTIVES: In this pilot study, we examined the effect of prophylactic fentanyl pectin nasal spray (FPNS) on exercise-induced dyspnea, physiologic function, and adverse events. METHODS: In this parallel, double-blind randomized placebo-controlled trial, opioid-tolerant patients performed three six-minute walk tests (6MWTs) to induce dyspnea. They were randomized to receive either FPNS (15%-25% of total daily opioid dose each time) or placebo 20 minutes before the second and third 6MWTs...
July 9, 2016: Journal of Pain and Symptom Management
David Hui, Kelly Kilgore, Susan Frisbee-Hume, Minjeong Park, Anne Tsao, Marvin Delgado Guay, Charles Lu, William William, Katherine Pisters, George Eapen, Frank Fossella, Sapna Amin, Eduardo Bruera
CONTEXT: Dexamethasone is often used to treat dyspnea in cancer patients, but evidence is lacking. OBJECTIVES: We determined the feasibility of conducting a randomized trial of dexamethasone in cancer patients and estimated the efficacy of dexamethasone in the treatment of dyspnea. METHODS: In this double-blind, randomized, controlled trial, patients with dyspnea ≥4 were randomized to receive either dexamethasone 8 mg twice daily × four days then 4 mg twice daily × three days or placebo for seven days, followed by an open-label phase for seven days...
July 2016: Journal of Pain and Symptom Management
Joshua Bauml, Andrew Haas, Charles B Simone, Susan Q Li, Roger B Cohen, Corey J Langer, Jun J Mao
PURPOSE: Dyspnea is a common and distressing symptom for patients with lung cancer (LC) because of disease burden, therapy toxicity, and comorbid illnesses. Acupuncture is a centuries-old therapy with biological plausibility for relief of dyspnea in this setting. This pilot study aimed to evaluate the feasibility and preliminary effectiveness of acupuncture for dyspnea among patients with LC. METHODS: Eligible patients had a diagnosis of LC and clinically significant dyspnea without a clear organic cause...
September 2016: Integrative Cancer Therapies
Nicholas G Wysham, Benjamin J Miriovsky, David C Currow, James E Herndon, Gregory P Samsa, Andrew Wilcock, Amy P Abernethy
CONTEXT: Measurement of dyspnea is important for clinical care and research. OBJECTIVES: To characterize the relationship between the 0-10 Numerical Rating Scale (NRS) and four-level categorical Verbal Descriptor Scale (VDS) for dyspnea assessment. METHODS: This was a substudy of a double-blind randomized controlled trial comparing palliative oxygen to room air for relief of refractory breathlessness in patients with life-limiting illness...
October 2015: Journal of Pain and Symptom Management
Theresa Morris, David Paul Sumners, David Andrew Green
Direct chest-wall percussion can reduce breathlessness in Chronic Obstructive Pulmonary Disease and respiratory function may be improved, in health and disease, by respiratory muscle training (RMT). We tested whether high-frequency airway oscillation (HFAO), a novel form of airflow oscillation generation can modulate induced dyspnoea and respiratory strength and/or patterns following 5 weeks of HFAO training (n = 20) compared to a SHAM-RMT (conventional flow-resistive RMT) device (n = 15) in healthy volunteers (13 males; aged 20-36 yrs)...
2014: PloS One
Kathleen Puntillo, Judith Eve Nelson, David Weissman, Randall Curtis, Stefanie Weiss, Jennifer Frontera, Michelle Gabriel, Ross Hays, Dana Lustbader, Anne Mosenthal, Colleen Mulkerin, Daniel Ray, Rick Bassett, Renee Boss, Karen Brasel, Margaret Campbell
PURPOSE: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. METHODS: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst...
February 2014: Intensive Care Medicine
Patrawut Intarakamhang, Piyathida Wangjongmeechaikul
It is well recognized that exercise is good for health especially as it's known to prevent metabolic syndromes such as diabetes, hypertension and heart disease. To reap the benefits from exercise the most appropriate level of intensity must be determined, the level of intensity ranging from low, low to moderate to hard (vigorous). This study is aimed to 1. To investigate and evaluate 3 subjective rating scales. The Borg scale, the Combined Numerical Rating Scale (NRS) + FACES Dyspnea Rating Scale (FACES) and the Likert scale, during hard (vigorous) exercise...
November 2013: Global Journal of Health Science
Andrea Lynne Cheville, Jeffrey Rogers Basford, Katiuska Dos Santos, Kurt Kroenke
OBJECTIVE: To assess the influence of symptom intensity, mood, and comorbidities on patient-clinician agreement and the consistency of responses to functional patient-reported outcomes (PROs). DESIGN: Two data sources were used. The first, a cross-sectional database of patients with breast cancer who completed functional PROs and were administered the FIM, was used to examine whether average pain intensity (as measured with an 11-point numeric rating scale [NRS]) and Rand Mental Health inventory scores differed among those rating their functional independence as different than clinicians...
January 2014: Archives of Physical Medicine and Rehabilitation
David Hui, Angela Xu, Susan Frisbee-Hume, Gary Chisholm, Margarita Morgado, Suresh Reddy, Eduardo Bruera
CONTEXT: Dyspnea is one of the most distressing symptoms in patients with cancer, and often worsens with breakthrough episodes on exertion. We hypothesized that fentanyl given prophylactically may alleviate breakthrough dyspnea. OBJECTIVES: To determine the feasibility of conducting a randomized trial of subcutaneous fentanyl in patients with cancer, and examine the effects of fentanyl on dyspnea, walk distance, vital signs, and adverse events. METHODS: In this double-blind, randomized, controlled trial, we asked ambulatory patients with breakthrough dyspnea to perform a baseline six minute walk test (6MWT), and then assigned them to either subcutaneous fentanyl or placebo 15 minutes before a second 6MWT...
February 2014: Journal of Pain and Symptom Management
David Hui, Margarita Morgado, Gary Chisholm, Laura Withers, Quan Nguyen, Clarence Finch, Susan Frisbee-Hume, Eduardo Bruera
CONTEXT: Dyspnea is one of the most distressing symptoms for cancer patients. The role of high-flow oxygen (HFO) and bilevel positive airway pressure (BiPAP) in the palliation of dyspnea has not been well characterized. OBJECTIVES: To determine the feasibility of conducting a randomized trial of HFO and BiPAP in cancer patients and examine the changes in dyspnea, physiologic parameters, and adverse effects with these modalities. METHODS: In this randomized study (ClinicalTrials...
October 2013: Journal of Pain and Symptom Management
Stephen G Oxberry, J Martin Bland, Andrew L Clark, John G Cleland, Miriam J Johnson
BACKGROUND: The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF). OBJECTIVE: Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF. METHODS: We conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo. Thirty-five participants from a tertiary cardiology clinic completed the RCT...
March 2013: Journal of Palliative Medicine
Asha Hareendran, Nancy K Leidy, Brigitta U Monz, Randall Winnette, Karin Becker, Donald A Mahler
BACKGROUND: Measuring dyspnea intensity associated with exercise provides insights into dyspnea-limited exercise capacity, and has been used to evaluate treatment outcomes for chronic obstructive pulmonary disease (COPD). Three patient-reported outcome scales commonly cited for rating dyspnea during exercise are the modified Borg scale (MBS), numerical rating scale for dyspnea (NRS-D), and visual analogue scale for dyspnea (VAS-D). Various versions of each scale were found. Our objective was to evaluate the content validity of scales commonly used in COPD studies, to explore their ability to capture patients' experiences of dyspnea during exercise, and to evaluate a standardized version of the MBS...
2012: International Journal of Chronic Obstructive Pulmonary Disease
Craig T Hartrick, Yeong-Shih Tang, Don Siwek, Robert Murray, David Hunstad, Greg Smith
BACKGROUND: Interscalene block (ISB) is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB) with reduced initial bolus volumes. METHODS: Subjects undergoing arthroscopic rotator cuff repair were randomized to receive 5, 10, or 20 mL ropivacaine 0...
2012: BMC Anesthesiology
Stephen G Oxberry, David J Torgerson, J Martin Bland, Andrew L Clark, John G F Cleland, Miriam J Johnson
AIMS: To assess the effect of oral opioids vs. placebo on breathlessness in patients with chronic heart failure (CHF). METHODS AND RESULTS: Oral morphine (Oramorph), oral oxycodone (Oxynorm), and placebo were studied in an outpatient setting. Once randomized, participants received all three interventions in a controlled double-blind crossover trial for 4 days each, with a 3-day washout between interventions. Patients known to the Hull and East Yorkshire Academic Cardiology department with CHF (New York Heart Association Grade III-IV) were invited to participate...
September 2011: European Journal of Heart Failure
Fumiyuki Goto, Tomoko Tsutumi, Motohiro Arai, Kaoru Ogawa
Anxiety and depression greatly affect the prognosis of and burden on subjects seen for dizziness or vertigo, who usually report multiple somatic symptoms. We studied the prevalence of these symptoms in 145 subjects hospitalized for dizziness or vertigo and taking part in 4-day group vestibular rehabilitation. Questionnaires given to determine the prevalence of somatic symptoms assessed headache, insomnia, diarrhea, constipation, stomachache, chest pain, palpitations, dyspnea, general fatigue, and stress. Quantitation used aerical rating scale (NRS)...
September 2010: Nihon Jibiinkoka Gakkai Kaiho
Amy P Abernethy, Christine F McDonald, Peter A Frith, Katherine Clark, James E Herndon, Jennifer Marcello, Iven H Young, Janet Bull, Andrew Wilcock, Sara Booth, Jane L Wheeler, James A Tulsky, Alan J Crockett, David C Currow
BACKGROUND: Palliative oxygen therapy is widely used for treatment of dyspnoea in individuals with life-limiting illness who are ineligible for long-term oxygen therapy. We assessed the effectiveness of oxygen compared with room air delivered by nasal cannula for relief of breathlessness in this population of patients. METHODS: Adults from outpatient clinics at nine sites in Australia, the USA, and the UK were eligible for enrolment in this double-blind, randomised controlled trial if they had life-limiting illness, refractory dyspnoea, and partial pressure of oxygen in arterial blood (PaO(2)) more than 7...
September 4, 2010: Lancet
David C Currow, Joanna Smith, Patricia M Davidson, Phillip J Newton, Meera R Agar, Amy P Abernethy
CONTEXT: Breathlessness reportedly worsens as death approaches for many people, but the differences in intensity and time course between underlying causes are not well described. OBJECTIVES: To determine differences in the intensity of breathlessness by diagnosis over time as death approaches in a consecutive cohort seen by a specialist palliative care service. METHODS: Patients referred to Silver Chain Hospice Care Service over a period of four years (January 2004 to December 2007) had dyspnea evaluated at every clinical encounter until death...
April 2010: Journal of Pain and Symptom Management
K E Clemens, E Klaschik
BACKGROUND AND PURPOSE: The study aimed to verify the efficacy and safety of morphine in the management of dyspnoea in patients with terminal amyotrophic lateral sclerosis (ALS). A further aim was to assess the effect of morphine on ventilation and the potential diminishing effect of nasal O(2)-insufflation preceding morphine administration on the intensity of dyspnoea. METHODS: Six dyspnoeic ALS patients were included in a prospective, non-randomized study. The intensity of dyspnoea was measured with a Numeric Rating Scale (NRS 0-10)...
May 2008: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
K E Clemens, E Klaschik
BACKGROUND AND OBJECTIVE: Dyspnoea frequently occurs in patients with advanced tumor disease receiving palliative care (prevalence > 50). Aim of the study was to assess, in dyspneic patients in palliative care, the efficacy of opioids in treating their dyspnoea and to determine whether or not nasal administration of oxygen previous to opioid administration would decrease the severity of dyspnoea. PATIENTS AND METHODS: In a prospective, non-randomised study 25 patients with cancer who had been admitted to our palliative care unit were investigated (aged 64...
September 2007: Deutsche Medizinische Wochenschrift
Saskie Dorman, Anthony Byrne, Adrian Edwards
INTRODUCTION: There is no universally accepted measurement scale to assess breathlessness in adult palliative care patients. This significantly hampers clinical practice and research into effective interventions. The aim is to systematically identify and appraise breathlessness measurement scales, which are validated for use in palliative care or which show potential for use. METHODS: We undertook systematic searches of electronic databases (Cochrane databases 2005, MEDLINE 1966-2005, OLDMEDLINE 1950-1965, EMBASE 1980-2005, PsycINFO 1872-2005, AMED 1985-2005, CINAHL 1982-2005, SIGLE 1980-2005) with follow-up searches (reference lists of included papers, hand-searches of relevant journals)...
April 2007: Palliative Medicine
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