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July-December 2005 Volume 11 | Issue 2
Page Nos. 62-120
Accessed 129,568 times.
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EDITORIAL |
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Doubly disadvantaged - dying of cervical cancer |
p. 62 |
Reena George DOI:10.4103/0973-1075.19181 |
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PAIN |
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Pain management in cancer cervix  |
p. 64 |
Gayatri Palat, MS Biji, MR Rajagopal DOI:10.4103/0973-1075.19182 Cancer of the cervix uteri is a common cause of pain among women. On the physical realm, the cancer may cause somatic [soft tissue and bone], visceral and neuropathic pain [lumbosacral plexopathy]. Radiotherapy and chemotherapy may cause neuropathy too. Psychological, social and cultural factors modify the pain. Evaluation of the individual type of pain and a patient-centred approach are fundamental requirements for rational management. Disease modifying treatment like radiotherapy and chemotherapy must be considered when applicable. Pain control is usually achieved by the use of WHO three-step ladder, remembering that possible association of renal dysfunction would necessitate caution in the use of NSAIDs and opioids. Side effects must be anticipated, prevented when possible, and aggressively treated; nausea and vomiting may already be present, and constipation can worsen pain when there is a pelvic mass. Pain emergencies can be treated by quick titration with intravenous morphine bolus doses. Neuropathic pain may warrant the use of usual adjuvants, with particular reference to cortico-steroids and the NMDA antagonist, ketamine. In intractable pain, many neurolytic procedures are tried, but a solid evidence base to justify their use is lacking. Continuous epidural analgesia with local anaesthetic and opioid may be needed when drug therapy fails, and desperate situations may warrant interventions such as neurolysis. Such physical measures for pain relief must be combined with psychosocial support and adequate explanations to the patient and the family. |
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Cancer and treatment related pains in patients with cervical carcinoma  |
p. 74 |
Saikat Das, Jenifer Jeba, Reena George DOI:10.4103/0973-1075.19183 Pain in carcinoma cervix is a multidimensional experience with sensory, affective and cognitive-evaluative components. Many patients do not receive adequate pain management because of a lack of proper assessment, misconceptions regarding the pharmacologic and non pharmacologic methods of pain management and failure to distinguish between different types of pain. In our audit pelvic and nodal recurrence were the commonest cause of pain presenting as as pelvic pain, [42%], lumbosacral plexopathy [40%] and abdominal pain [34%] [n = 30]. Pain on defaecation caused by rectal obstruction, and suprapubic pain due to pyometra can be relieved by colostomy and drainage. Very little literature is available on the pain syndromes associated with carcinoma cervix. The present article is a review of cancer and treatment related pains in carcinoma cervix. |
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ONCOLOGY |
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The oncologic management of carcinoma cervix after primary treatment failure |
p. 82 |
Lee Hsueh Ni, Firuza Patel, Santam Chakraborty, Suresh Sharma DOI:10.4103/0973-1075.19184 |
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PSYCHOSOCIAL ISSUES |
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Psychosocial issues faced by women with incurable cervical cancer in India - how can we help? |
p. 94 |
Mary Ann Muckaden, Mrunal Marathe, Rupali Tulshan, Maria Carvalho, Mario Pinto DOI:10.4103/0973-1075.19185 |
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SPIRITUALITY |
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Spirituality and terminal illness |
p. 98 |
Robert Twycross DOI:10.4103/0973-1075.19186 |
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NURSING |
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Nursing measures for lymphoedema in gynaecologic cancers |
p. 101 |
Ghayathri Ananthi DOI:10.4103/0973-1075.19187 |
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Wound care in resource poor settings |
p. 105 |
Sister Casilda, Manjula Krishnaswamy DOI:10.4103/0973-1075.19188 |
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BRIEF REPORT |
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Are our patients getting palliative care too late? An audit |
p. 108 |
Biju Raghavan, Gayatri Palat, MR Rajagopal DOI:10.4103/0973-1075.19189 |
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COVERAGE |
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Community participation in palliative care |
p. 111 |
Jan Stjernsward DOI:10.4103/0973-1075.19190 |
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LETTERS |
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Staff support in palliative care |
p. 118 |
Latha Vikraman, Prabha Chandra DOI:10.4103/0973-1075.19191 |
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Improving opioid availability |
p. 119 |
David E Joranson, Aaron M Gilson, Martha A Maurer DOI:10.4103/0973-1075.19192 |
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