Cancer pain assessment.

PURPOSE OF REVIEW: Adequate cancer pain assessment using valid and reliable tools is essential for proper cancer pain management. Because cancer pain can be a complex construct, assessment of its many domains should be conducted using multidimensional tools. Furthermore, there is a need to develop a standard, consensus classification system for prognosis of cancer pain. RECENT FINDINGS: Unidimensional tools for assessing cancer pain are useful for measuring cancer pain intensity. Other domains and symptoms of the cancer pain experience are assessed using a variety of multidimensional tools. There is a lack of agreement on a standard assessment tool or a standard classification system for cancer pain, although research continues to be undertaken to develop such resources for clinical and research purposes. SUMMARY: Many pain and symptom assessment tools exist for use in the cancer patient, including the Brief Pain Inventory, the McGill Pain Questionnaire, the MD Anderson Symptom Inventory, and the Edmonton Symptom Assessment System, among others. Recent literature reveals the move toward translating these and other tools to electronic applications. Further study is also underway to create a standard, prognostic classification system for cancer pain.

Recent advances in select interventional approaches to cancer-related pain.

SUMMARY Interventional approaches for cancer-related pain have demonstrated utility and safety as a component of multimodal pain management. A number of techniques have been developed and implemented to manage the variety of cancer pain conditions and syndromes that exist as a result of the underlying malignant process and its associated oncologic treatment. These procedural pain modalities continue to evolve with advances in experience, understanding and technology in the field. Neurostimulation, vertebral augmentation with stabilization and intrathecal drug delivery, are prime examples of innovative approaches in interventional pain medicine for cancer pain with continued improvement in design to better achieve adequate analgesia and reduce risk. The intent of this article is to describe the aforementioned interventions and recent developments pertaining to them.

Developing a trauma registry in a forward deployed military hospital: Preliminary report.

BACKGROUND: The 325th Field Surgical Team (FST), a US Army trauma surgical group, was deployed to Afghanistan during Operation Enduring Freedom. Unlike civilian trauma centers, complete trauma registries are lacking from the FST care model. METHODS: A trauma registry was created using a commercially available relational database. Data entry was done using a handheld personal data organizer (PDA). RESULTS: In 82 days, 125 trauma patients were evaluated and treated. The mean age was 23 +/- 11.69 and 85 (68%) were local Afghan nationals. Most patients were transported by helicopter (83; 66%); the remaining arrived by ground transportation (42; 34%). The average US military casualty arrival time from injury was 1 hour 38 minutes +/-46. The most common injury was gunshot wounds 47(38%) and the mean Injury Severity Score was 9, with 29 (23%) patients scoring > or =15. Initial mean vitals were systolic blood pressure (SBP); 119 +/- 23.7, heart rate; 103 +/- 7.35, respiratory rate; 20 +/- 7.35, and temperature (degrees C); 36.6 +/- 1.6. The median Glasgow Coma Scale was 15, and presenting mean hematocrit and base deficit were 35 +/- 9.56 and -5.02 +/- 5.03, respectively. Operative procedures were performed in 54 (43.2%) patients, and the mean time to surgery from admission was 80 +/- 11.5 minutes. The most common operative procedure was debridement or completion of amputation of lost limb debridement and completion of amputations (13). The average length of stay was 4.37 +/- 2.88 days. The mortality rate was 8%. CONCLUSION: The collection of comprehensive prospective data using a PDA can be an efficient and effective method in expanding trauma base registries in forward deployed surgical units.