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Palliative care opioids

Steffen T Simon, Irene J Higginson, Sara Booth, Richard Harding, Vera Weingärtner, Claudia Bausewein
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 1, 2010, on 'Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults'. Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. At the time of the previously published Cochrane review, there was no evidence for a beneficial effect of benzodiazepines for the relief of breathlessness in people with advanced cancer and chronic obstructive pulmonary disease (COPD)...
October 20, 2016: Cochrane Database of Systematic Reviews
Katherine Clark, Lawrence T Lam, Nicholas J Talley, Jane L Phillips, David C Currow
OBJECTIVE: The aim of this work was to investigate whether variables identified as likely to impact the experience of constipation in other clinical settings similarly affected the experiences of constipated palliative care patients. BACKGROUND: The majority of palliative care patients with cancer are likely to be bothered by constipation symptoms at some point in their disease trajectory. Despite this, it remains unclear as to which factors predict more severe problems...
October 18, 2016: Journal of Palliative Medicine
Maxine de la Cruz, Akhila Reddy, Vishidha Balankari, Margeaux Epner, Susan Frisbee-Hume, Jimin Wu, Diane Liu, Sriram Yennurajalingam, Hilda Cantu, Janet Williams, Eduardo Bruera
BACKGROUND: Improper use, storage, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our previous study showed a large proportion of cancer patients have unsafe opioid practices. Our objective was to determine whether an improvement occurred in the patterns of use, storage, and disposal of opioids among cancer outpatients after the implementation of a patient educational program. PATIENTS AND METHODS: Our palliative care (PC) clinic provides every patient with educational material (EM) on safe opioid use, storage, and disposal every time they receive an opioid prescription...
October 14, 2016: Oncologist
Kaisa Rajala, Juho T Lehto, M Saarinen, E Sutinen, T Saarto, M Myllärniemi
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. METHODS: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death...
October 12, 2016: BMC Palliative Care
Tammy Vu Bach, Jonathan Pan, Anne Kirstein, Cindy Joanne Grief, Daphna Grossman
Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. Treating pain in patients with advanced dementia or neurodegenerative diseases that can affect swallowing is particularly challenging because most adjuvant pain medications used to ameliorate neuropathic pain must be taken orally...
October 11, 2016: Journal of Palliative Medicine
Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, Marilène Filbet
CONTEXT: In the European Association for Palliative Care recommendations for cancer pain management, there was no consensus regarding the indications, titration or monitoring of methadone. OBJECTIVES: This national, randomized, multicentre trial aimed to compare two methadone titration methods (stop-and-go vs progressive) in patients with cancer-related pain who were inadequately relieved by or intolerant to level 3 opioids. METHODS: The primary endpoint was the rate of success/failure at Day 4, defined as pain relief (reduction of at least two points on the visual scale and a pain score <5 for 2 consecutive days) and no overdose (Rudkin scale ≥3 and respiratory rate <8/min)...
September 29, 2016: Journal of Pain and Symptom Management
C Docherty, L Lester, S O'Reilly
Palliative care (PC) positively impacts patient outcomes, decreases hospital admissions and improves quality of life. Despite evidence, PC resources are reported as under-utilised. Few studies have explored patient attitudes towards PC. This study evaluated patient attitudes towards PC. It was a prospective study conducted in oncology outpatient clinics. A 26-item questionnaire was distributed to those with metastatic cancer (N = 44). Sixty percent believed PC can make people feel better, 63.4% believed PC is offered when nothing more can be done...
2016: Irish Medical Journal
Zakari A Suleiman, Kolawole W Wahab, Israel K Kolawole
OBJECTIVE: Although opioid analgesics are effective in the treatment of moderate to severe acute, cancer and chronic non-malignant pains, they are under-prescribed in Nigeria. The objective of this study was to assess the prescription pattern of opioids among physicians in a north central State, Nigeria.. DESIGN: This was a descriptive cross sectional study. SETTING: The study was conducted at the International Association for the Study of Pain (IASP)-sponsored workshops on pain and palliative care at the University of Ilorin Teaching Hospital, Ilorin, Nigeria...
June 2016: Ghana Medical Journal
Masanori Mori, Yongli Ji, Santosh Kumar, Takamaru Ashikaga, Steven Ades
BACKGROUND: Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that has been shown to relieve severe opioid-induced constipation (OIC) in patients with advanced disease receiving palliative care. Its efficacy remains unknown in cancer patients who are not terminally ill. The primary aim of this study was to evaluate the efficacy of methylnaltrexone over 48 h in cancer patients who were not terminally ill. METHODS: In this single-dose phase II trial, cancer patients with a prognosis of ≥3 months and OIC with <3 laxations during the preceding week were eligible...
September 15, 2016: International Journal of Clinical Oncology
Michael A Ueberall, Stefan Lorenzl, Eberhard A Lux, Raymond Voltz, Michael Perelman
OBJECTIVE: Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS) in the treatment of breakthrough cancer pain (BTcP) in routine clinical practice. METHODS: A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up) of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to "time to first effect", "time to maximum effect", BTcP relief, as well as changes in BTcP-related impairment of daily life activities, quality-of-life restrictions, and health care resource utilization...
2016: Journal of Pain Research
Mel Clark Taveros, Elizabeth J Chuang
CONTEXT: Prescription opioid and heroin abuse has increased substantially in recent years. Enrolment on opioid agonist therapy programmes is consequently increasing as well. As a result of these trends, more patients who present with acute pain secondary to a malignancy are also on chronic methadone maintenance therapy (MMT) for substance abuse. This combination of diagnoses presents a pain management challenge for palliative care providers. OBJECTIVES: This paper aims to gather and review the available medical literature pertaining to the use of opioid analgesia in methadone-maintained patients...
August 26, 2016: BMJ Supportive & Palliative Care
Lene Jarlbæk, Berit Johnsen, Ole Bo Hansen, Birte Hedal
The evidence for treatment of constipation in palliative care patients is poor. The condition of these patients is often complex, and results from studies performed in other patient groups cannot be extrapolated unconditionally. However, macrogol (polyethylene glycol), lactulose and sodium picosulphate seem to be well tolerated, and methylnaltrexone could be used in opioid-induced constipation, if the patients are not at risk from gastrointestinal perforation. The patients should be offered quiet and private surroundings, and attention should be payed to securing an optimal body position for defecation...
August 15, 2016: Ugeskrift for Laeger
Sebastiano Mercadante, Daniela Degiovanni, Alessandra Casuccio
CONTEXT: Mesothelioma is a very aggressive cancer that is brought on by asbestos exposure. Because there is a long latency period between exposure to asbestos and symptoms of disease, most patients with mesothelioma present with advanced disease and survive an average of 8-12 months. Thus, best supportive care should be considered critical to optimally manage these patients. AIM: The aim of this study was to examine the epidemiological characteristics and symptom burden of mesothelioma patients when admitted to home palliative care...
August 17, 2016: Current Medical Research and Opinion
Florence T Baralatei, Richard J Ackermann
Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal examination to detect masses or evidence of bowel obstruction and rectal examination to exclude fecal impaction, constipation should be managed with a stimulant laxative (eg, senna) or an osmotic laxative (eg, sorbitol). Dyspnea also is common, and often improves with use of a fan to blow air into the face, as well with breathing and relaxation exercises...
August 2016: FP Essentials
Richard A Deyo, Sara E Hallvik, Christi Hildebran, Miguel Marino, Eve Dexter, Jessica M Irvine, Nicole O'Kane, Joshua Van Otterloo, Dagan A Wright, Gillian Leichtling, Lisa M Millet
BACKGROUND: Long-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. OBJECTIVE: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. DESIGN: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges...
August 2, 2016: Journal of General Internal Medicine
(no author information available yet)
The CPD article Palliative and end of life care for people living with dementia in care homes: part 2 (29 June 2016) wrongly referred to oxycodone as a 'mild' opioid. Oxycodone is a controlled opioid for the management of high levels of pain and care must be taken in its administration.
August 3, 2016: Nursing Standard
Kazuki Sato, Mitsunori Miyashita, Tatsuya Morita, Satoru Tsuneto, Yasuo Shima
BACKGROUND: Comprehensive information on end-of-life care in specialized palliative care settings is needed to assess the quality of care. OBJECTIVE: This study aimed to investigate medical treatments in the last two weeks of life in a national sample of palliative care units in Japan. DESIGN: Retrospective cohort study. SETTING/SUBJECTS: Medical charts of 2802 consecutive cancer patients who died in 37 palliative care units were reviewed...
July 27, 2016: Journal of Palliative Medicine
Jordi Perez, Sara Olivier, Emmanouil Rampakakis, Manuel Borod, Yoram Shir
Context. The McGill University Health Center (MUHC) Cancer Pain Clinic offers an interdisciplinary approach to cancer pain management for patients. The core team includes a nurse clinician specialist in oncology and palliative care, a palliativist, an anaesthetist, and a radiation oncologist. This tailored approach includes pharmacological and nonpharmacological therapies offered concurrently in an interdisciplinary fashion. Objectives. Description of the interdisciplinary MUHC cancer pain approach and analysis of treatments and outcomes...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
Rogier Lange, Floor Overbeek, John M H de Klerk, Pieternel C M Pasker-de Jong, Alexandra M van den Berk, Rob Ter Heine, Cees J Rodenburg, Anko Kooistra, N Harry Hendrikse, Haiko J Bloemendal
AIM: Rhenium-188-HEDP ((188)Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of (188)Re-HEDP in routine clinical care. PATIENTS AND METHODS: Prostate or breast cancer patients with painful bone metastases receiving (188)Re-HEDP as a routine clinical procedure were eligible for evaluation...
September 26, 2016: Nuklearmedizin. Nuclear Medicine
Mariana da Silva Roldi, Rachel Duarte Moritz
OBJECTIVE: Evaluation of the presence of symptoms and suitability in the treatment of patients admitted to medical wards at HU-UFSC. Identification of patients eligible for palliative care (PC). METHOD: A prospective cohort study, which evaluated patients in the first 48 hours of hospitalization (D1) and after 48 hours (D2). On D1, palliative performance and symptom assessment scales were applied (PPS/ESAS). The treatment established for the control of detected symptoms was also identified...
July 2016: Revista da Associação Médica Brasileira
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