An Overview of the Treatment of Pain in Cancer Rehabilitation
J. Michael Wieting (Michigan State University, East Lansing, Michigan, USA)
The definition of cancer pain, its etiology, and side effects will be introduced. The treatment of pain in an individualized, progressive, step-wise fashion featuring the World Health Organization algorithm will be considered, including monopioid and opioid analgesics and adjuvant therapies, anti-depressants, anti-convulsants, neuroleptic, and benzodiazenine medications as well as nerve blocks, nerve stimulation, surgery, and other methods. Functional restoration and maintaining quality of life will be emphasized throughout the presentation which will include current clinical practice and research.
PREDICTING RECOVERY AFTER SEVERE TRAUMATIC BRAIN INJURY
D. L. McLellan (University of Southampton, Southampton, UK)
In general, the outcome after traumatic brain injury is worse if the initial impact was severe leading to a low Glasgow Coma Score after resuscitation. However, subsequent episodes of hypoxemia or hypovolaemia may impart further brain damage and will affect prognosis.
One problem with such predictions is that they have been tested against outcome measures such as the Glasgow Outcome Scale. In Rehabilitation terms, this is a very crude scale since it does not clearly distinguish between people who are able to work and those that cannot, and gives little indication of the marked disturbances of social behaviour that constitute a major source of handicap after traumatic brain injury.
Recent follow-up studies in Southampton have suggested that early recovery of attention after traumatic brain injury predicts the outcome of overall cognitive function, but that social outcome is more related to the pattern of cognitive impairment that has occurred.
There is increasing evidence from Stroke research that "biological" or "natural" recovery (as assessed by measures of impairment) does not have the same predictors as rehabilitation outcome as assessed by measures of handicap. It is likely that this distinction is important in traumatic brain injury also. The pre-morbid cognitive strengths and experience of the individual may themselves affect outcome. Failure to recognize this may have led to over-optimistic prediction and assessment of brain injured children, and to an under-estimate of the ability of elderly patients to cope with the effects of their injuries.