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Pain management, a primary focus of the oncology nurse, is undergoing a technologic boom. Assessment of high-tech treatments in medicine is an underdeveloped and controversial area. This paper is intended to promote critical thinking about methods of high-tech pain relief such as subcutaneous, IV, and intraspinal analgesia and anesthesia delivered by ambulatory, implanted, or patient-controlled devices. These issues are described within an ethical framework that focuses on the principles of autonomy, beneficence, nonmaleficence, and justice. Application of these principles to the clinical practice setting and recommendations for practice conclude this paper.

The management of chronic pain should be a priority in geriatric care. Pain is a common problem that has tremendous potential to influence the physical function and quality of life of elderly people during their remaining years. Much research and education is still needed to further our understanding of pain and its management among elderly people. Existing pain management strategies should be tailored for the special needs of the geriatric population. Applications of "high tech" pain management strategies, such as morphine pumps and chronic spinal infusions, need to be clarified for older people. Finally, family and caregiver considerations should be included in chronic pain management strategies.

The purpose of this study was to describe family factors which influence cancer pain. Previous research has focused on the patients' and professional caregivers' perspective of pain. Cancer pain is an intense burden on the entire family as well as on the patient. Findings of the study demonstrate family perceptions of pain, caregiver burden associated with pain, caregiver moods and differences in caregiver experiences of pain between three sites of care including a hospice, a community hospital and a cancer centre. Understanding the perspective of the family caregivers and their role in pain management can assist health care providers in management of the patient's pain.

A number of single measures of quality of life have been developed over the last few years. Some of these instruments have been used more frequently than others. Psychometric properties are reported in many of these instruments, and continued psychometric development is needed. Instruments differ in the content tested, and users are encouraged to have specific objectives in mind when selecting an instrument. The continued research interest and activity in the field of single measures has provided beginning tools for both research and clinical evaluations. Quality of life measures add to the depth of evaluation of the impact on cancer and cancer treatment, and provide a measurement dimension that augments that of the historic evaluation via morbidity and mortality statistics. Continued work on single measures for quality of life will provide both researchers and clinicians with valuable tools.

Pain is an understudied problem in geriatric medicine and especially among nursing home residents. The focus of this study was to describe the scope of the problem of pain in a long-term care facility. Ninety-seven subjects from a 311-bed multilevel teaching nursing home were interviewed, and charts were reviewed for pain problems and management strategies. Functional status, depression, and cognitive impairment were also evaluated. Results indicate that 71% of residents had at least one pain complaint (range, 1-4). Of subjects with pain, 34% described constant (continuous) pain and 66% described intermittent pain. Of 43 subjects with intermittent pain, 51% described pain on a daily basis. Major sources of pain included low back pain (40%), arthritis of appendicular joints (24%), previous fracture sites (14%), and neuropathies (11%). Moderately strong correlations were found between pain and infrequent attendance at recreational and social activities (r = .50). However, little correlation was observed between pain and the Yesavage Depression Scale, the Folstein Mini-Mental State Scale, or basic ADLs measured by the Katz Scale. Pain-management strategies consisted of analgesic drugs, physical therapy, and heating pads. Only 15% of patients with pain had received medication within the previous 24 hours. The findings suggest that pain is a major problem in long-term care. Strategies for pain management appear to be limited in scope and application in this setting. Important barriers were identified that influence the reporting and management of pain in this setting.

Valid measurement tools are needed by oncology researchers to help in the evaluation of the effectiveness of pain relief methods used in the treatment of cancer patients. A study was conducted to assess the validity and reliability of a tool designed to evaluate quality of life as a measure of pain management outcome in the individual patient. Items in the tested quality of life survey represented the areas of psychologic well-being, physical well-being, general and specific symptom control, and degree of social support. Using the test instrument, two oncology nurses interviewed subjects in three groups, each consisting of 50 subjects: cancer patients with pain, cancer patients without pain, and subjects with no cancer. Statistical analysis of the interview results revealed that the instrument has test-retest reliability, internal consistency, and interrater reliability, as well as content and construct validity for the major factors, psychologic well-being, worry, and nutrition. Further revision of the instrument is needed to restructure its subscales. The quality of life tool will enable researchers to evaluate a treatment regarding not only its effect on pain intensity but also its impact on the total individual.

Intravascular injections of adrenocorticotropic hormone in hypophysectomized rats were approximately 3 times more effective in stimulating increases in plasma corticosteroid concentration when given at the offset rather than the onset of the daily photoperiod (12 h:12 h light-dark cycle). Reversal of the photoperiodic schedule produced a reversal in the corticosteroid response after 5 days. Similar temporal variations in androgen and T4 responses to LH and TSH were not obtained. Although plasma corticosteroid concentrations were maintained at normal intermediate levels in rats with adrenal autotransplants, daily variations were not demonstrable. These results indicate that the circadian rhythm of plasma corticosteroid concentration is regulated by way of neural pathways to the adrenal.