Pain In Palliative Care Patients Research Articles

Non-pharmacological interventions feasible in the nursing scope of practice for pain relief in palliative care patients: a systematic review.

Palliative care patients desire more symptom management interventions that are complementary to their medical treatment. Within the multi-professional team, nurses could help support pain management with non-pharmacological interventions feasible for their practice and adaptable to palliative care patients' needs. The objective was to identify non-pharmacological interventions feasible in the nursing scope of practice affecting pain in palliative care patients. A systematic review. A defined search strategy was used in PubMed, CINAHL, PsycINFO, and Embase. Search results were screened double-blinded. Methodological quality was double-appraised with the Joanna Briggs Institute Critical Appraisal Tools. Data were extracted from selected studies and the findings were summarized. The methodological quality, quantity of studies evaluating the same intervention, and consistency in the findings were synthesized in a best-evidence synthesis to rank evidence as strong, moderate, limited, mixed, or insufficient. Out of 2385 articles, 22 studies highlighted non-pharmacological interventions in the nursing scope of practice. Interventions using massage therapy and virtual reality demonstrated most evidentiary support for pain management, while art therapy lacked sufficient evidence. Mindful breathing intervention showed no significant reduction in pain. Hypnosis, progressive muscle-relaxation-interactive-guided imagery, cognitive-behavioral audiotapes, wrapped warm footbath, reflexology, and music therapy exhibited promising results in pain reduction, whereas mindfulness-based stress reduction program, aromatherapy, and aroma-massage therapy did not. Despite not all studies reaching significant changes in pain scores, non-pharmacological interventions can be clinically relevant to palliative care patients. Its use should be discussed for its potential value and nurses to be trained for safe practice. Methodologically rigorous research for non-pharmacological interventions in nursing scope of practice for pain relief in palliative care patients is necessary. The protocol for this study is registered in the International Prospective Register of Systematic Review (PROSPERO registration number: CRD42020196781).

Comprehensive Targeted Treatment for Neuropathic and Nociceptive Pain in Palliative Care Patients.

Pain is a common symptom in patients with advanced, metastatic, or terminal cancer. Neuropathic pain and psycho-emotional suffering are factors that increase the difficulty of pain management. Pain control in patients with cancer remains a challenge for medical professionals. What is the evolution of neuropathic/mixed pain compared with nociceptive pain under standardized treatment in patients with cancer? A prospective, longitudinal, open-label, nonrandomized study was conducted on patients with cancer pain. Pain type was assessed at admission using the modified Brief Pain Inventory, and pain intensity was assessed daily using the Numerical Rating Scale for 14 days and on days 21 and 28. Screening of depression was performed on days 1, 7, 14, 21, and 28 using the Hamilton Depression Rating Scale. Patients with pain and depression received analgesics with antidepressants, while patients without depression received analgesics or analgesics with an anticonvulsant depending on the pain subtype. Of 72 patients, 23 had nociceptive pain and 49 had neuropathic/mixed pain. At admission, pain intensity was higher for patients with neuropathic/mixed pain compared with nociceptive pain (mean values: 7.06 vs. 5.82) with statistical significance ( P = 0.001) and remained as such at the end of this study (mean values: 3.77 vs. 2.73). A decrease in the mean pain intensity was observed in all types of pain, but without statistical significance regardless of pain type and treatment protocol used ( P = 0.77). If depression was present, antidepressants combined with analgesics decreased pain and depression scores significantly ( P = 0.001). Patients with neuropathic/mixed pain have higher levels of pain and lower response to treatment. Identifying psycho-emotional suffering can improve pain control by intervening in the physical and psycho-emotional components of pain.

Effect of Oral Gabapentin and Pregabalin in the Management of Neuropathic Pain in Palliative Care Patients: An Institution-based Comparative Study

Effect of Oral Gabapentin and Pregabalin in the Management of Neuropathic Pain in Palliative Care Patients: An Institution-based Comparative Study

The Efficacy of Ketamine in the Palliative Care Setting: A Comprehensive Review of the Literature.

Background: Previous literature suggests that ketamine may be an effective drug in the palliative care population as this drug has been shown to treat multiple conditions that are common in these patients. Objective: This review examines the efficacy of ketamine for the treatment of depression and physical pain in palliative care patients. Methods: Eleven studies were included on the topic of ketamine as an antidepressant in the palliative care population. Additionally, 5 RCT studies were included on the topic of physical pain in this population. Results: All 11 studies, including one RCT, found antidepressant effects of ketamine in this patient population. Ketamine's effect on treating physical pain was mixed with the largest and most recent RCTs suggesting no significant analgesic effect. Discussion: This review suggests that starting qualified patients on intravenous (IV) ketamine and switching to oral or intranasal administration may be the most effective and convenient for treating depression, especially for patients who wish to receive treatment at home. Significant analgesia was found in patients who received epidural or intrathecal ketamine as well as in one study using intravenous administration. More research is necessary to determine which palliative care patients may benefit from ketamine treatment.

Differences between Transdermal Fentanyl and Buprenorphine in the Elderly Hospice Patients.

Introduction Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. However, studies have shown a controversial relationship of opioids to survival and a rise in deaths associated with the use of transdermal opioids. Although applying precise doses is paramount, we have no clear recommendations for the exact equianalgesic ratio for buprenorphine patch and no recommendation for the type of transdermal opioid to use in hospice. Methods We analyzed the differences between the transdermal fentanyl and buprenorphine group by analyzing patient characteristics and evaluating the differences in survival in hospice patients over the age of 65, from 2013 to 2017. Results A total of 292 patients (75.8%) used fentanyl patch and 93 (24.1%) were on buprenorphine patch. Patients had virtually the same characteristics in both groups. However, when using a 1:100 buprenorphine equianalgesic ratio, there were significant differences in initial and final doses, and it seems that a 1:80 conversion rate is more accurate for elderly hospice patients. Finally, there was no difference in survival between the two groups using transdermal opioids, with or without adjuvant analgesics. Discussion There were no differences in survival between the group using transdermal fentanyl and the group using buprenorphine in the elderly hospice population. Although adjuvant NSAIDs could be useful in the treatment of pain in terminal cancer, they do not affect survival or reduce the opioid doses, while a 1:80 equianalgesic ratio of buprenorphine might be the most appropriate in this population.

Matrix stimulation in cancer pain: Methodology, safety and effectiveness.

BackgroundThis feasibility study addresses the applicability of matrix electrodes for the reduction of ongoing pain in cancer patients via low‐frequency electrical stimulation (LFS).MethodsLow‐frequency matrix stimulation (4 Hz) was applied to the skin within the ‘Head's zones’ referring to the tumour localization of cancer pain patients. Pain at baseline was compared to a 3‐day treatment interval consisting of 5 min of matrix stimulation in the morning and evening followed by a 3‐day follow‐up period without therapy. Main outcome parameters included numeric rating scale values (rating scale 0–100), painDETECT, HADS, and German pain questionnaire, as well as the opioid intake, calculated as the oral morphine equivalent (OME).ResultsTwenty patients with cancer pain (aged 64.4 ± 10.3; 9 women) were examined. In the majority of patients, the pain was classified as nociceptive. The mean pain reduction achieved by matrix therapy was 30%, under stable daily controlled‐release opioid doses between 177 and 184 mg/day (OME). Seventeen patients (85%) were responders, defined by a pain reduction of at least 30%, while four responders experienced a pain reduction of over 50%. The only side effect was short‐term erythema.ConclusionFindings are consistent with the concept of synaptic long‐term depression in cancer pain induced after conditioning LFS. Despite the short, but well‐tolerated, treatment duration of 2 × 5 min/day, effects persisted throughout the 3‐day follow‐up.SignificanceCutaneous neuromodulation using LFS via a matrix electrode has been shown to be a safe intervention for effectively reducing cancer pain in palliative care patients.

A Music Therapist Shares Stories of Patients with Cancer

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Efficacy and safety of methadone in the treatment of pain in palliative care patients with cancer: The EQUIMETH2 national, randomized, open, phase III study.

212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pain relief was obtained in 80% of the patients (median of 3 days in both groups (p = 0.12)) and lasted until D56. The rate of success/failure was about 40% at D4 with no difference between the two methods. Overdoses defined as respiratory rate < 8/min were observed in 13.2% patients throughout the study with no difference between groups. 9 required naloxone. The two methods were equally considered easy by about 60% of the clinicians. Conclusions: Methadone is an effective and sustainable second-line alternative opioid in the treatment of cancer pain in palliative care patients inadequately relieved or intolerant to level 3 opioids. The two methods of titration of methadone are comparable in terms of efficacy, safety and ease of use.

Single-patient multiple crossover studies to determine the effectiveness of paracetamol in relieving pain suffered by patients with advanced cancer taking regular opioids: A pilot study

What is already known about the topic? Paracetamol is a useful adjunct when used in combination with “weak opioids” for chronic pain in palliative care patients with advanced cancer; however, it is not certain that there is continuing benefit when used in conjunction with “strong” opioids. What this paper adds? N-of-1 trials allowed individual treatment decisions to be made for each participant: there was no added benefit for any of the participants, although no conclusion about the added benefit of paracetamol above regular opioids was possible for the group, due to insufficient numbers recruited. Implications for practice, theory, or policy Paracetamol may not provide added benefit above regular opioids; this should be assessed on a case-by-case basis to justify the extra tablet load.

Music therapy for end-of-life care: An updated systematic review

Background: Music therapy during palliative and end-of-life care is well established and positive benefits for patients have been reported. Aim: Assess the effectiveness of music therapy versus standard care alone or standard care in combination with other therapies for improving psychological, physiological and social outcomes among adult patients in any palliative care setting. Data sources: In order to update an existing Cochrane systematic review, we searched MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, ClinicalTrials.gov register and Current Controlled Trials register to identify randomised or quasi-randomised controlled trials published between 2009 and April 2015. Nine electronic music therapy journals were searched from 2009 until April 2015, along with reference lists and contact was made with key experts in music therapy. Only studies published in English were eligible for inclusion. Two reviewers independently screened titles, abstracts, assessed relevant studies for eligibility, extracted data and judged risk of bias for included studies. Disagreements were resolved through discussion with a third reviewer. Data were synthesised in Revman using the random effects model. Heterogeneity was assessed using I2. Results: Three studies were included in the review. Findings suggest that music therapy may be effective for helping to reduce pain in palliative care patients (standard mean deviation = −0.42, 95% confidence interval = −0.68 to −0.17, p = 0.001). Conclusion: Available evidence did not support the use of music therapy to improve overall quality of life in palliative care. While this review suggests that music therapy may be effective for reducing pain, this is based on studies with a high risk of bias. Further high-quality research is required.

Analgesic prescribing in palliative care.

Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.

OPIOID PRESCRIBING IN A COHORT OF DISCHARGED HOSPICE PATIENTS

BackgroundMorphine is recommended by NICE (2012) as the gold standard first line oral step 3 opioid for managing pain in palliative care patients. Alternative opioids are used e.g. if patient...

Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial

ContextTreatment of pain in palliative care patients is challenging. Adjunctive methods of pain management are desirable. Music therapy offers a nonpharmacologic and safe alternative. ObjectivesTo determine the efficacy of a single music therapy session to reduce pain in palliative care patients. MethodsTwo hundred inpatients at University Hospitals Case Medical Center were enrolled in the study from 2009 to 2011. Patients were randomly assigned to one of two groups: standard care alone (medical and nursing care that included scheduled analgesics) or standard care with music therapy. A clinical nurse specialist administered pre- and post-tests to assess the level of pain using a numeric rating scale as the primary outcome, and the Face, Legs, Activity, Cry, Consolability Scale and the Functional Pain Scale as secondary outcomes. The intervention incorporated music therapist-guided autogenic relaxation and live music. ResultsA significantly greater decrease in numeric rating scale pain scores was seen in the music therapy group (difference in means [95% CI] −1.4 [−2.0, −0.8]; P<0.0001). Mean changes in Face, Legs, Activity, Cry, Consolability scores did not differ between study groups (mean difference −0.3, [95% CI] −0.8, 0.1; P>0.05). Mean change in Functional Pain Scale scores was significantly greater in the music therapy group (difference in means −0.5 ([95% CI] −0.8, 0.3; P<0.0001). ConclusionA single music therapy intervention incorporating therapist-guided autogenic relaxation and live music was effective in lowering pain in palliative care patients.

T621 EFFICACY AND SAFETY OF IMMEDIATE-RELEASE HYDROMORPHONE FOR THE MANAGEMENT OF BREAKTHROUGH PAIN IN PALLIATIVE CARE PATIENTS WITH CANCER PAIN

European Journal of Pain SupplementsVolume 5, Issue S1 p. 86-87 T621 EFFICACY AND SAFETY OF IMMEDIATE-RELEASE HYDROMORPHONE FOR THE MANAGEMENT OF BREAKTHROUGH PAIN IN PALLIATIVE CARE PATIENTS WITH CANCER PAIN K.E. Clemens, K.E. Clemens Department of Palliative Medicine, MediClin Robert Janker Klinik Bonn, Bonn, GermanySearch for more papers by this authorE. Klaschik, E. Klaschik Department of Palliative Medicine, MediClin Robert Janker Klinik Bonn, Bonn, GermanySearch for more papers by this author K.E. Clemens, K.E. Clemens Department of Palliative Medicine, MediClin Robert Janker Klinik Bonn, Bonn, GermanySearch for more papers by this authorE. Klaschik, E. Klaschik Department of Palliative Medicine, MediClin Robert Janker Klinik Bonn, Bonn, GermanySearch for more papers by this author First published: 30 January 2012 https://doi.org/10.1016/S1754-3207(11)70295-4Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume5, IssueS1September 2011Pages 86-87 RelatedInformation

Sign on the dotted line: opioid agreements in patients with a history of substance misuse

IntroductionThe management of pain in palliative care patients with a history of substance misuse can be challenging. Patients may have a low pain threshold, feel ill at ease in unfamiliar...