A Systematic Review of the Effectiveness of Oral Baclofen in the Management of Hiccups in Adult Palliative Care Patients

Abstract

Hiccup is a recognised symptom amongst the palliative care population. It can be debilitating, with significant impact on quality of life. The pathophysiology is poorly understood and the list of aetiological factors is extensive. The current treatment recommendations are based on a small body of evidence and there remains uncertainty regarding optimal management. The aim of this study was to systematically review the evidence for oral baclofen in the management of hiccups in adult palliative care patients. A search was conducted using MEDLINE, Embase, the Cochrane library and CINAHL, as well as a hand search and review of the grey literature. Relevant articles were identified using pre-defined eligibility criteria. Quality assessment was guided by the SIGN grading system, CASP, Hawker et al's checklist and Cochrane's risk of bias tool. A narrative approach was used for data synthesis. Four relevant articles were identified; one randomised controlled trial and three case series. This gave a combined total of 22 patients, all of whom benefited from the use of oral baclofen in the treatment of hiccups, with few reports of side effects. The dose ranged from 10mg once only to 20mg TDS, and the duration from 1–24 days. However, the overall quality of the evidence was low. While baclofen is an option in the management of hiccups, it is difficult to make recommendations based on the body of evidence presented in this systematic review. There is a lack of RCTs in this field and further research is warranted.