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https://www.readbyqxmd.com/read/28632194/a-mind-body-approach-to-pediatric-pain-management
#1
REVIEW
Melanie L Brown, Enrique Rojas, Suzanne Gouda
Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind-body techniques that are often used in the adult population for pain and symptom management...
June 20, 2017: Children
https://www.readbyqxmd.com/read/28614082/pharmacology-of-cough-in-palliative-care
#2
Alyn H Morice, Gabriella Shanks
PURPOSE OF REVIEW: Cough is a common and distressing symptom. It has a marked decrement on quality-of-life particularly in the arena of palliative care where coexisting symptoms such as pain may be exacerbated. Whilst local definitive treatment may alleviate coughing it usually requires general measures. The purpose of the review is to assess the current evidence relating to the pharmacological management of cough. RECENT FINDINGS: Key to understanding cough is the realization that most cough is because of a hypersensitivity of the afferent vagus nerve...
June 12, 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/28609231/methadone-dose-selection-for-treatment-of-pain-compared-with-consensus-recommendations
#3
Parisa Karimian, Rabia S Atayee, Toluwalase A Ajayi, Kyle P Edmonds
BACKGROUND: Many factors make methadone an appealing option for treatment of pain in patients seen by palliative care; however, complex drug-related properties and variable patient response complicate appropriate conversion ratios from other opioids to methadone. Currently, there is no consensus regarding one accepted conversion method. OBJECTIVE: Current patterns of prescribing for clinicians at a three-hospital academic health system on initial rotation to methadone for the management of pain were compared with a series of consensus recommendations for methadone dose calculation...
June 13, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28595027/clinical-outcomes-of-start-low-go-slow-methadone-initiation-for-cancer-related-pain-what-s-the-hurry
#4
Pippa Hawley, Lawrance Chow, Gillian Fyles, Aria Shokoohi, Mary-Jane O'Leary, Matthew Mittelstadt
BACKGROUND: Methadone has been shown to be effective for cancer pain. Most published switching methods are complete in less than three days, requiring very close supervision, usually in an inpatient setting. This need for hospitalization is a barrier to access. We present a large retrospective study of slow outpatient methadone starts and describe our starting method. METHODS: Charts were reviewed of patients referred to the Pain and Symptom Management/Palliative Care clinics at the six BC Cancer Agency's regional centers that underwent initiation of methadone for analgesia over a 14-year period...
June 8, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28589311/needs-assessment-of-primary-care-physicians-in-the-management-of-chronic-pain-in-cancer-survivors
#5
Ronald Chow, Kevin Saunders, Howard Burke, Andre Belanger, Edward Chow
INTRODUCTION: Cancer patients live longer with effective anti-cancer therapy and supportive care. About 30% of cancer survivors (non-palliative cancer patients who completed treatment) suffer from chronic pain, which will be managed by their primary care physician (PCP). The aim of this study was to assess practice patterns and treatment barriers in the management of chronic pain in cancer survivors among PCPs. METHODS: A survey using a 16-item questionnaire was sent to PCPs across Canada...
June 7, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28585274/junior-doctors-attitudes-to-opioids-for-refractory-breathlessness-in-patients-with-advanced-chronic-obstructive-pulmonary-disease
#6
Natasha Smallwood, Nicole Gaffney, Alexandra Gorelik, Louis Irving, Brian Le, Jennifer Philip
Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off-licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD. AIMS: To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD...
June 6, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28580748/opioid-addiction-and-misuse-in-adult-and-adolescent-patients-with-cancer
#7
Ross Pinkerton, Janet R Hardy
In the context of a therapeutic opioid epidemic, particularly in the USA, where increasingly stringent screening for 'at risk' individuals and close monitoring of opioid prescription and use is strongly recommended, the issue of misuse within the cancer population must be addressed. Most patients with advanced cancer will have pain requiring opioid therapy at some stage during their disease course. In the majority, this will provide good pain relief with no short- or longer-term adverse sequelae. A subset will present with substance misuse issues that will influence management and prescribing practice...
June 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28570119/effect-of-opioids-and-benzodiazepines-on-clinical-outcomes-in-patients-receiving-palliative-care-an-exploratory-analysis
#8
Jason W Boland, Victoria Allgar, Elaine G Boland, Osaretin Oviasu, Meera Agar, David C Currow, Miriam J Johnson
BACKGROUND: Medications for symptom management in palliative care have associated, but poorly understood, harms. Drug-related harms have important clinical implications, may impact on patients' compliance and contribute to symptoms. OBJECTIVE: To explore the longitudinal relationship between oral morphine equivalent daily dose (MEDD) and oral diazepam equivalent daily dose (DEDD) with functional, cognitive, and symptom outcomes in patients receiving palliative care...
June 1, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28557661/opioids-in-cancer-pain-right-or-privilege
#9
Leanne K Jackson, Syed N Imam, Ursula K Braun
Opioid analgesia is a mainstay of the treatment of cancer pain. Treatment of pain in patients with cancer with an ongoing substance abuse disorder can be difficult. We report the ethical challenges of treating a patient with cancer with a concomitant substance abuse disorder in an outpatient palliative care setting. We present an analysis of ethical considerations for the palliative care physician and strategies to aid in the successful treatment of such patients. We argue that there are select patients with cancer for whom exclusion from treatment with opioid therapy is warranted if their health is endangered by prescription of these medications...
May 30, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28551769/clinical-course-and-end-of-life-care-in-patients-who-have-died-after-allogeneic-stem-cell-transplantation
#10
Christoph Busemann, Andreas Jülich, Britta Buchhold, Vanessa Schmidt, Laila Schneidewind, Daniel Pink, Christian Andreas Schmidt, Thomas Neumann, William H Krüger
PURPOSE: Allogeneic stem cell transplantation may cure approximately 50% of patients, however, a significant part of the other half might benefit from a high-quality palliative care medicine at the end of life. Somatic, psychic and spiritual needs of these patients may differ from those of patients suffering from incurable solid tumours and are not comprehensively evaluated so far. METHODS: To address this question, data from charts of 123 patients who have died after allogeneic stem cell transplantation were extracted...
May 27, 2017: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/28537773/a-new-generation-of-comfort-care-order-sets-aligning-protocols-with-current-principles
#11
Melissa A Bender, Caroline Hurd, Nicole Solvang, Kathy Colagrossi, Diane Matsuwaka, J Randall Curtis
BACKGROUND: There are few published comfort care order sets for end-of-life symptom management, contributing to variability in treatment of common symptoms. At our academic medical centers, we have observed that rapid titration of opioid infusions using our original comfort care order set's titration algorithm causes increased discomfort from opioid toxicity. OBJECTIVE: The aim of this study was to describe the process and outcomes of a multiyear revision of a standardized comfort care order set for clinicians to treat end-of-life symptoms in hospitalized patients...
May 24, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28530501/palliative-care-for-advanced-heart-failure-in-a-department-of-veterans-affairs-regional-hospice-program-patient-selection-a-treatment-protocol-and-clinical-course
#12
George J Taylor, Dorothy M Lee, Catalin F Baicu, Michael R Zile
BACKGROUND: Palliative care for advanced heart failure (HF) is generally recommended. However, few reports have focused on the particulars of treatment, or the clinical course of HF on a specific treatment regimen. OBJECTIVE: Palliation adequate to allow patients to avoid HF admission and die at home. METHODS: Patients from a veterans administration regional practice with multiple, recent hospital admissions were enrolled in community hospice programs...
May 22, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28505689/-pain-management-in-palliative-care
#13
Martin B Steins, Corinna Eschbach, Matthias Villalobos, Michael Thomas
A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative thoracic oncology. Together with the medicamentous therapy the psychologic and social circumstances of the affected patients have to be considered as factors influencing the experience of pain. The therapeutic fundament according to the WHO guideline for cancer pain is the opiate based medicamentous adjustment combined with non-opioids. In principle, this should be performed preferably orally, as simply as possible, according to a fix drug schedule and individually adjusted to the needed dosage...
May 2017: Pneumologie
https://www.readbyqxmd.com/read/28501134/factors-associated-with-palliative-care-use-in-patients-undergoing-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy
#14
Rachel S Morris, Faiz Gani, Abdulrahman Y Hammad, Wendy Peltier, T Clark Gamblin, Kiran K Turaga, Fabian M Johnston
BACKGROUND: Peritoneal carcinomatosis represents widespread metastatic disease throughout the abdomen and/or pelvis. Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves the overall survival compared to standard therapy alone. The role palliative care (PC) plays however, remains poorly studied among these patients. METHODS: Patients who had previously undergone HIPEC and who underwent an inpatient admission from 7/1/2013 to 6/30/2014 were identified to determine which patients were referred for inpatient or outpatient palliative consultation...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28488910/methadone-induced-neurotoxicity-in-advanced-cancer-a-case-report
#15
Ann M Hoff, Kristopher N Hartwig, Drew A Rosielle
Methadone use as a second-line agent for severe cancer-related pain is increasing in the field of hospice and palliative care. It has a number of qualities that make its use favorable, including lack of known active metabolites and presumed relative safety from adverse effects such as opioid-induced neurotoxicity (OIN). This article describes a case of a patient undergoing treatment of severe cancer-related pain who developed OIN in the setting of oral methadone use. As the use of methadone increases, more research into its pharmacologic and pharmacokinetic properties will be necessary...
May 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28476739/patient-controlled-analgesia-for-cancer-related-pain-clinical-predictors-of-patient-outcomes
#16
Emily J Martin, Eric J Roeland, Madison B Sharp, Carolyn Revta, James D Murphy, Katherine E Fero, Heidi N Yeung
Background: Patient-controlled analgesia (PCA) is an effective approach to treat pain. However, data regarding patterns of PCA use for cancer pain are limited. The purpose of this study was to define the patterns of PCA use and related outcomes in hospitalized patients with cancer. Methods: We identified 90 patients with cancer admitted to a single academic center who received PCA for nonsurgical, cancer-related pain and survived to discharge between January 2013 and January 2014. Data collected included patient demographics, cancer diagnosis, type of cancer-related pain, PCA use, opioid-specific adverse events, and 30-day readmission rates for pain...
May 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28428505/-neurolysis-and-spinal-analgesia-in-cancer-pain-management
#17
Seiji Hattori, Junko Tachibana
Cancer pain appears as a complex pain and often progressive.WhenWHO pain management strategy and/or palliative care failed to relieve their pain, patients are given high dose opioids or anonymous adjuvant drugs and have no chance to meet specialized pain treatment. This section briefly covers the outline of neurolysis and spinal analgesia for these cancer patients with severe pain. Purpose of nerve block and neurolysis are to block the incoming signal of pain in order to reduce pain, reduce analgesic dose, recover ADL, and finally to be discharged from the hospital...
April 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28423917/management-of-opioid-induced-constipation-in-hospice-patients
#18
Leah Sera, Mary Lynn McPherson
BACKGROUND: Constipation is a common symptom in patients with advanced disease taking opioids. Opioid-induced constipation (OIC) is commonly treated with laxatives and stool softeners. Recently, newer agents have come to market which broaden options for patients in whom first-line therapies are not effective. OBJECTIVE: To determine what pharmacologic regimens are currently used in hospice programs to prevent and treat OIC, whether those regimens have changed with the introduction of newer agents and evidence discouraging the use of docusate, and whether hospice programs are standardizing the management of OIC...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28386399/development-of-research-priorities-in-paediatric-pain-and-palliative-care
#19
Christina Liossi, Anna-Karenia Anderson, Richard F Howard
Priority setting for healthcare research is as important as conducting the research itself because rigorous and systematic processes of priority setting can make an important contribution to the quality of research. This project aimed to prioritise clinical therapeutic uncertainties in paediatric pain and palliative care in order to encourage and inform the future research agenda and raise the profile of paediatric pain and palliative care in the United Kingdom. Clinical therapeutic uncertainties were identified and transformed into patient, intervention, comparison and outcome (PICO) format and prioritised using a modified Nominal Group Technique...
February 2017: British Journal of Pain
https://www.readbyqxmd.com/read/28379816/improving-family-medicine-with-thoughtful-research
#20
EDITORIAL
Anne Victoria Neale, Marjorie A Bowman, Dean A Seehusen
This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity. It includes hints for integrating behavioral health and care managers into family medicine practices. Opiate prescribing practices vary considerably between Japan and the United States, with helpful insights for our opiate abuse epidemic. Suicidality is high among patients taking opiates. Diagnosing hypertension the recommended way is not easily accomplished...
March 2017: Journal of the American Board of Family Medicine: JABFM
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