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Pain management palliative neuropathic

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https://www.readbyqxmd.com/read/27881247/pain-management-in-ckd-a-guide-for-nephrology-providers
#1
Holly M Koncicki, Mark Unruh, Jane O Schell
Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis...
November 20, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27726521/use-of-methadone-as-an-adjuvant-medication-to-low-dose-opioids-for-neuropathic-pain-in-the-frail-elderly-a-case-series
#2
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...
December 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27491573/spontaneous-osteonecrosis-of-the-jaw-during-bisphosphonate-therapy-an-unusual-etiology-of-the-numb-chin-syndrome
#3
Tanja Fusi-Schmidhauser, Donata Bardelli
The numb chin syndrome is a rare manifestation of intractable pain in the palliative care setting and represents a major therapeutic challenge. The reported etiologies of the numb chin syndrome include trauma, infections, immune-mediated systemic conditions, and malignancy, both through local infiltration or compression of the inferior alveolar nerve sheath. The authors present the case of a patient with long-standing multiple myeloma, suffering from numb chin syndrome caused by a spontaneous osteonecrosis of the jaw after bisphosphonate therapy...
September 2016: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/27003903/functional-vitamin-b12-deficiency-in-advanced-malignancy-implications-for-the-management-of-neuropathy-and-neuropathic-pain
#4
Lawrence R Solomon
BACKGROUND AND AIM: Treatment of neuropathic pain and chemotherapy-induced peripheral neuropathy (CIPN) in patients with malignancy is often unsuccessful. Functional vitamin B12 deficiency, defined by elevated levels of the B12-dependent metabolites, methylmalonic acid (MMA), and/or homocysteine, despite normal B12 values, may cause neuropathy and is associated with disorders linked to increased oxidative stress. Since both cancer and neurotoxic antineoplastic agents increase oxidative stress, a role for functional B12 deficiency in CIPN was considered...
August 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/26511376/treatment-of-neuropathic-pain
#5
Matthew T Mendlik, Tanya J Uritsky
Neuropathic pain is notoriously variable in its severity and impact on patients, as well as in its response to treatment. Certain therapies for neuropathic pain have better evidence for their use; however, it is apparent that although some therapies provide relief for only a minority of patients, the relief may be significant. Without a trial of therapy, there is no way to know if that relief is achievable. Our treatment experiences have shown that occasionally unexpected benefit is obtained through a thorough investigation of all options, even in the setting of failure of those with the most compelling evidence or indication...
December 2015: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/25709192/management-of-ramsay-hunt-syndrome-in-an-acute-palliative-care-setting
#6
Shrenik Ostwal, Naveen Salins, Jayita Deodhar, Mary Ann Muckaden
INTRODUCTION: The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete) and might mimic other severe neurological illnesses. CASE REPORT: A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care...
January 2015: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/25544879/palliative-external-beam-radiotherapy-for-bone-metastases-from-hepatocellular-carcinoma
#7
REVIEW
Shinya Hayashi, Hidekazu Tanaka, Hiroaki Hoshi
The incidence of bone metastases (BMs) from hepatocellular carcinoma (HCC) is relatively low compared to those of other cancers, but it has increased recently, especially in Asian countries. Typically, BMs from HCC appear radiologically as osteolytic, destructive, and expansive components with large, bulky soft-tissue masses. These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth. They often compress the peripheral nerves, spinal cord, or cranial nerves, causing not only bone pain but also neuropathic pain and neurological symptoms...
December 27, 2014: World Journal of Hepatology
https://www.readbyqxmd.com/read/25493222/palliative-radiotherapy-for-bone-metastases-from-lung-cancer-evidence-based-medicine
#8
REVIEW
Alysa Fairchild
To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy (EBRT) for bone metastases (BM) from lung cancer were sought via literature search (2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory...
December 10, 2014: World Journal of Clinical Oncology
https://www.readbyqxmd.com/read/25467740/a-case-report-of-dexmedetomidine-used-to-treat-intractable-pain-and-delirium-in-a-tertiary-palliative-care-unit
#9
Neil Hilliard, Stuart Brown, Steve Mitchinson
BACKGROUND: This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. CASE PRESENTATION: A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil...
March 2015: Palliative Medicine
https://www.readbyqxmd.com/read/25417593/psychopharmacology-in-cancer
#10
REVIEW
Seema M Thekdi, Antolin Trinidad, Andrew Roth
Depression, anxiety, delirium, and other psychiatric symptoms are highly prevalent in the cancer setting, and pharmacological intervention is an important component in the overall psychosocial care of the patient. Psychopharmacology is also used as a primary or adjuvant treatment for the management of cancer-related symptoms stemming from the disease itself and/or its treatment, including sleep disturbance, loss of appetite, neuropathic pain, nausea, fatigue, and hot flashes. Psychiatrists, oncologists, and palliative care physicians working as members of a multidisciplinary team have the opportunity to target multiple symptoms that negatively affect a patient's quality of life with the strategic use of psychotropic medications when deemed appropriate...
January 2015: Current Psychiatry Reports
https://www.readbyqxmd.com/read/25387823/pain-intensity-as-prognostic-factor-in-cancer-pain-management
#11
Sebastiano Mercadante, Giampiero Porzio, Claudio Adile, Federica Aielli, Andrea Cortegiani, Amanda Caruselli, Alessandra Casuccio
AIM: The aim of this study was to prospectively assess the prognostic value of initial pain intensity and its duration in advanced cancer patients. METHODS: A prospective study was conducted in a sample of patients with cancer requiring pain control. Patients underwent standard analgesic strategies used in our palliative care units. Pain intensity was measured at admission (T0) and after successful dose titration or opioid/route switching within a week (Ts). Patients were also asked about their pain intensity reported 15 days before admission (T-15)...
January 2015: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/25112302/efficacy-of-lidocaine-in-patients-receiving-palliative-care-with-opioid-refractory-cancer-pain-with-a-neuropathic-component-study-protocol-for-a-randomized-controlled-study
#12
RANDOMIZED CONTROLLED TRIAL
Sébastien Salas, Pascal Auquier, Florence Duffaud, Stéphanie Ranque Garnier, Mélanie Deschamps, Stéphane Honoré, Patrick Sudour, Karine Baumstarck
BACKGROUND: The management of patients suffering from opioid-refractory cancer pain with a neuropathic component remains an important challenge for healthcare workers. Only one retrospective study specifically reported the use of intravenous (IV) lidocaine amongst the palliative care unit population, the study found that there was a positive response to this therapy. These preliminary uncontrolled results need to be confirmed by randomized controlled trials. The primary objective of this study is to assess the analgesic efficacy of IV lidocaine in patients in palliative care suffering from opioid-refractory cancer pain with a neuropathic component...
2014: Trials
https://www.readbyqxmd.com/read/24921674/dexmedetomidine-as-adjuvant-therapy-for-acute-postoperative-neuropathic-pain-crisis
#13
Thomas O'Neil, Phillip E Rodgers, Cameron Shultz
BACKGROUND: Dexmedetomidine is a potent α2-adrenergic agonist U.S. Food and Drug Administration (FDA) approved for sedation. While its use as an analgesic has been described in the palliative medicine literature, its use for managing an acute neuropathic pain episode is less well known. METHODS: Here we describe the use of adjuvant dexmedetomidine in a patient with metastatic sarcoma suffering from an acute postoperative neuropathic pain crisis. CONCLUSION: Among patients with acute neuropathic pain for whom additional opioids raises respiratory-related concerns, the use of dexmedetomidine should be considered as a viable treatment alternative...
October 2014: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/24841174/pain-in-the-cancer-patient-different-pain-characteristics-change-pharmacological-treatment-requirements
#14
Gerhard Müller-Schwefe, Karsten Ahlbeck, Dominic Aldington, Eli Alon, Stefano Coaccioli, Flaminia Coluzzi, Frank Huygen, Wolfgang Jaksch, Eija Kalso, Magdalena Kocot-Kępska, Hans-Georg Kress, Ana Cristina Mangas, Cesar Margarit Ferri, Bart Morlion, Andrew Nicolaou, Concepción Pérez Hernández, Joseph Pergolizzi, Michael Schäfer, Patrick Sichère
Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate...
September 2014: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/24670811/phenotyping-neuropathic-pain-patients-implications-for-individual-therapy-and-clinical-trials
#15
REVIEW
Maren Reimer, Stephanie M Helfert, Ralf Baron
PURPOSE OF REVIEW: The sensory phenotype can be used as a surrogate marker of underlying mechanisms of pain generation and is assessed by tools like the Quantitative Sensory Testing, Patient Reported Outcomes or the Capsaicin Response Test. In order to establish an individualized, mechanism-based treatment of pain, it has to be demonstrated that subgroups of patients with a distinct sensory phenotype respond differently to a certain treatment. RECENT FINDINGS: Retrospective analyses of several clinical trials revealed that the presence of certain somatosensory abnormalities in the painful area was associated with a better treatment outcome...
June 2014: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/24547601/topical-therapies-in-the-management-of-chronic-pain
#16
REVIEW
Steven P Stanos, Katherine E Galluzzi
Chronic pain, whether localized or generalized, is a widespread, often debilitating condition affecting > 25% of adults in the United States. Oral agents are the cornerstone of chronic pain treatment, but their use may be limited in certain patients, particularly the elderly. Topical therapies offer advantages over systemically administered medications, including the requirement of a lower total systemic daily dose for patients to achieve pain relief, site-specific drug delivery, and avoidance of first-pass metabolism, major drug interactions, infections, and systemic side effects...
July 2013: Postgraduate Medicine
https://www.readbyqxmd.com/read/24168350/australian-survey-of-current-practice-and-guideline-use-in-adult-cancer-pain-assessment-and-management-perspectives-of-palliative-care-physicians
#17
Melanie Lovell, Meera Agar, Tim Luckett, Patricia M Davidson, Anna Green, Josephine Clayton
BACKGROUND: Cancer pain continues to be undertreated, despite the availability of evidence-based guidelines. The Australian National Pain Strategy identified establishment of systems and guidelines to adequately manage cancer pain as a high priority. OBJECTIVES: This study aimed to identify barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; establish the perceived need for new Australian guidelines and implementation strategies; identify which guidelines are used; and identify barriers and facilitators to guideline use...
November 2013: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/24116946/methadone-rotation-for-cancer-patients-with-refractory-pain-in-a-palliative-care-unit-an-observational-study
#18
Wadih Rhondali, Flora Tremellat, Mathilde Ledoux, Jean-François Ciais, Eduardo Bruera, Marilene Filbet
BACKGROUND: Methadone has been reported to be as effective as morphine for cancer pain management. It is commonly used as an alternative opioid in case of insufficient relief. OBJECTIVE: Our aim was to assess efficacy and tolerance of opioid rotation to methadone for refractory cancer pain management in palliative care unit (PCU) inpatients. METHODS: All the patients undergoing opioid rotation to methadone from 2008 to 2011 in two PCUs (Lyon and Nice, France) were included...
November 2013: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/24107159/-polyneuropathic-pain-therapy-with-a-patient-suffering-from-generalized-castrate-%C3%A2-resistant-prostate-cancer-%C3%A2-clinical-case-report
#19
L Holubec, P Mrázková, V M Matějka, O Fiala, J Fínek
BACKGROUND: Tapentadol is a µ -opioid receptors agonist as well as an inhibitor of noradrenaline reuptake. This pharmacologic profile of tapentadol makes it a suitable drug of choice in nociceptive and neuropathic pain control. CASE REPORT: This clinical report pressents a 65year old man with poorly differentiated prostate cancer -  Gleason score 8 (4 + 4) with metastatic bone disease. Besides the initial application of bisphosphonates, the patient had been treated with androgen deprivation therapy (cyproterone acetate + leuprolide acetate) for the period of 18 months...
2013: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
https://www.readbyqxmd.com/read/23969705/topical-treatment-of-neuropathic-pain
#20
Vince Vadurri
Pikes Peak Hospice and Palliative Care, Inc., provides care for more than 200 patients with terminal disease who reside at home, in long-term care facilities, in assisted living facilities, or in its acute-care Inpatient Unit. Over the past 4 years, its pharmacy has evolved to provide individualized compounded preparations to meet the unique and complex needs of these patients. An integral part of this evolution was development and implementation of topical treatment for pain. These patients often have multiple medical conditions and complicated health issues...
May 2008: International Journal of Pharmaceutical Compounding
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