Pain Palliative Care Research Articles

A nationwide neurosurgical inter-disciplinary service for cancer-related refractory pain

PurposeNeurosurgical ablative procedures, such as cordotomy and cingulotomy, are often considered irreversible and destructive but can provide an effective and individualized solution for cancer-related refractory pain, when all other approaches have been unsuccessful. This paper provides an in-depth exploration of a novel approach to managing refractory cancer pain. It involves an interdisciplinary team led by a neurosurgeon at a renowned national referral center.Methodsa retrospective analysis of the medical records of all sequential patients who underwent their initial evaluation at our interdisciplinary refractory cancer pain clinic from February 2017 to January 2023.ResultsA total of 207 patients were examined in the clinic for a first visit during the study period. All patients were referred to the clinic due to severe pain that was deemed refractory by the referring physician. The mean age was 61 ± 12.3 years, with no significant sex difference (P = 0.58). The mean ECOG Performance Status score was 2.35. Conservative measures had not yet been exhausted in 28 patients (14%) and 9 patients were well controlled (4%). Neurosurgical ablative procedures were recommended for 151 (73%) of the patients. Sixty-six patients (32%) eventually underwent the procedure. 91 patients (44%) received a negative recommendation for surgery. Thirty-five patients (17%) were referred for further invasive procedures at the pain clinic.ConclusionAn Interdisciplinary cooperation between palliative care specialists, pain specialists, and neurosurgeons ensures optimal patient selection and provides safe and effective neurosurgery for the treatment of refractory cancer-related pain.

Chart Review and Practical Recommendations for the Use of Methadone as an Alternative to Opioid Rotation in the Management of Cancer-Related Pain

Abstract Introduction Palliative care, with a focus on enhancing the quality of life for individuals facing life-limiting illnesses, relies on effective pain management as a fundamental component. Opioids, particularly methadone, play a crucial role in addressing moderate to severe pain in palliative care due to their unique pharmacological properties. Methadone, a long-acting opioid agonist and N-methyl-D-aspartate receptor antagonist, is valuable for treating both nociceptive and neuropathic pain. However, the transition to methadone from other opioids requires careful consideration. Objectives This study examines the use of methadone as an alternative to morphine or fentanyl for managing refractory cancer pain in a tertiary care hospital in India. Methods We conducted a retrospective analysis of anonymized medical records of cancer patients initiated on oral methadone for pain management at a tertiary cancer center's palliative medicine outpatient clinic from February 2020 to June 2021. Data included demographic characteristics, pain descriptions, concurrent analgesic use, reasons for transitioning to methadone, rotation methods, methadone dosages, clinical outcomes, adverse effects, and treatment discontinuations. Patients were routinely followed up, with pain scores, morphine equivalent daily doses, and methadone requirements recorded at each visit. Results Forty-four patients received methadone, either as a coanalgesic (41/44) or primary opioid (3/44). Refractory cancer pain, with a neuropathic component, was the predominant indication for methadone use. Following the methadone initiation, all patients experienced significant pain relief. Median daily methadone dose increased from 5 to 7.5 mg after 1 week. Adverse effects were minimal, with one patient experiencing QTc interval prolongation. Patient-specific factors often necessitated deviations from equianalgesic conversion tables in determining methadone dosages. Conclusion Methadone offers a viable option for refractory cancer pain when conventional treatments fall short. Physicians should prioritize personalized titration and thorough assessment during opioid rotation, rather than relying solely on conversion tables. Further research is needed to explore alternative approaches for opioid rotation and to expand our understanding of methadone's optimal use in cancer pain management.

Definition and Assessment of Paediatric Breakthrough Pain: A Qualitative Interview Study.

Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals' insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: 'the elusive nature of breakthrough pain', 'breakthrough pain assessment', 'positive attitudes towards', 'reservations towards' and 'features to include in' a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept.

Хроническая (неонкологическая и онкологическая) боль: рациональный подход к консервативной терапии

INTRODUCTION. Chronic pain represents an important interdisciplinary problem. A distinction should be made between primary and secondary chronic pain, which can be subdivided into oncologic and non-oncologic pain. The diagnosis of chronic pain is based on the use of assessment scales. Therapy of patients suffering from chronic pain should be based on clinical guidelines. The choice of therapy for chronic pain syndrome should be etermined by the intensity of pain and the pathogenetic characterization of pain. Opioid therapy is one of the main ethods of treatment of chronic pain in palliative care of oncologic and non-oncologic patients. CONCLUSION. Tapentadol (Palexia retard) is an effective analgesic in the therapy of chronic pain syndrome of moderate to high intensity in patients suffering from oncologic and non-oncologic pain. KEYWORDS: chronic pain, opioids, Tapentadol

Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients

BackgroundCentral to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AimsThe purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DesignThe Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SettingsOn a six-bed adult inpatient Palliative Care Unit (PCU). Participants/SubjectsNonverbal palliative care patients. MethodsEvidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. ResultsNurses’ attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. ConclusionsMOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.

Gabapentin for Pain in Pediatric Palliative Care

ObjectiveGabapentin is commonly used to treat pain in children receiving pediatric palliative care. This study describes the real-world use of gabapentin and the associated benefits and adverse effects/events (AEs). MethodsA prospective, multicenter cohort of standardized data collection after a clinical decision was made to use gabapentin for managing neuropathic or nociplastic pain in children attended on by a pediatric palliative care service. It was conducted across 11 sites in seven countries including hospital, inpatient, and outpatient services. Clinical outcomes were graded using pain scales validated for age and cognitive ability and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) at baseline, 14 days, 28 days, six weeks and 12 weeks after initiation of gabapentin. Ad-hoc safety reporting continued throughout the study. ResultsData were collected from 127 children with a median age of 4.7 years (IQR 0.1–17.9); 61% had a neurological disorder, 21% advanced cancer and the cohort had a high level of disability (Lansky/Karnofsky performance score 37.1). Gabapentin was prescribed at standard pediatric doses. On average, 76% of children had a reduction in pain and 42% experienced a potential AE. The mean pain score decreased from 6.0 (SD 2.6) at baseline to 3.3 (SD 2.4) at 14 days and 1.8 (SD 1.8) after 12-weeks of gabapentin therapy. Ten percent had increased pain at each time point. AEs did not increase when individual changes over time were accounted for except for somnolence (7%). Serious AEs attributable to gabapentin were possible or probable in 3% of children. ConclusionsGabapentin prescribed at standard doses for advanced cancer and severe neurological injury in children under a pediatric palliative care service was associated with generally improved pain intensity at previously described levels of adverse effects.

Assessment of Knowledge about Palliative Care among Registered Nursing Professionals: A Prospective Cross-Sectional Study in a Tertiary Care Hospital in Central India

Objective: This study aimed to assess the palliative care knowledge among the registered nurses working in tertiary care hospital in Madhya Pradesh. Methods and materials: A prospective cross-sectional study was conducted on 160 registered nurses working in different departments in tertiary care hospital in Madhya Pradesh, who were selected through a purposive sampling technique. The data was collected through an online questionnaire for the socio-demographic variables and validated a self-report questionnaire to measure the knowledge of health care professionals in palliative care and the data was analysed by IBM-SPSSv26. Results: A total of 160 participants enrolled in the study. Basic knowledge care was quite high among the samples (83.75%). Item 1,2 of pain in palliative care was quite high (83.43%) and item 3,4,5 has (22%) only, overall management of pain knowledge was (47%) which is on the lower side. The use of Morphine was 31.04%, Dyspnoea Management it was 38.33%, and in the communication of prognosis, it was 81.56%. Resuscitation knowledge was 46.85%, Psycho spiritual was 24.06% and Bereavement care was 69%. Conclusion: One of the biggest challenges in providing excellent palliative care is that nurses don’t know enough about it. Therefore, improving the quality of palliative care services provided to patients could be accomplished by increasing their knowledge through in-service education and retraining on the job.

The Benefits of Integrative Medicine for Pain Management in Oncology: A Narrative Review of the Current Evidence.

The aim of this evidence-based study is to narrate and evaluate the current evidence on recommendations for practicing physicians and other healthcare providers regarding integrative approaches to managing pain in patients with cancer. This review will assess the guideline recommendations and analyze the role of integrative medicine in addressing cancer pain in patients. The literature search highlights relevant studies that will inform evidence-based recommendations for practicing physicians, highlighting their relevance and weaknesses. Acupuncture, massage, and hypnosis have intermediate-strength evidence quality and are moderately recommended for various types of cancer pain. Most of the evidence points to acupuncture being recommended for aromatase inhibitor-related joint pain, hypnosis for procedural pain, and massage for palliative care pain. Other practices with lower-quality evidence include yoga and guided imagery with progressive muscle relaxation, mostly recommended for general cancer pain or musculoskeletal pain. Additionally, music therapy is recommended for procedural or surgical pain. Low-quality or inconclusive evidence was found for other mind-body interventions or natural products. Similarly, there is insufficient evidence to provide recommendations for pediatric patients. Further research is required to enhance our understanding of the role of integrative medicine interventions in caring for cancer patients.

Catholic Teaching: A Middle Ground and Guide for End-of-Life Care and Decision-Making and an Antidote for Dying Badly in America.

Dying in the United States is characterized as: medicalized, depersonalized, high technology, fragmented with frequent transitions among care settings, burdensome to patients and families, driven by efficiency and effectiveness, and lacking in key areas, for example, access to palliative care and adequate pain and symptom treatment. Patients and families are often left with a choice of two extremes: vitalism or utilitarian pessimism (utilitarianism). The Catholic Church, however, rejects both of these extremes, and Catholic social teaching (CST) at end of life focuses on ordinary-extraordinary treatments/means, a culture of life and human dignity, accompaniment and community, and caring for whole persons through the end of life. The Catholic tradition of ordinary-extraordinary means is helpful to guide complex end-of-life decisions, regardless of one's religious beliefs, and offers a middle ground between vitalism and utilitarianism that can inform end-of-life care and decision-making for all patients in Catholic health care. While it does not provide answers, it offers guidance and enables conversations that are crucial for the dying and their families to make autonomous, informed decisions about end-of-life care. It provides an opportunity for the dying to let the care team, loved ones, and decision-makers know what a life with meaning, purpose, and passion is for them-and how they want to live and die. This article will summarize the problem, describe end-of-life Catholic teaching, and discuss how it offers a middle-ground. Arguments for and against vitalism and utilitarianism will be explored, including a discussion of CST's response to those receiving care in Catholic health care facilities who are outside the Catholic tradition and do not believe in the teaching. The last section describes a model of collaborative partnership where local parishes and Catholic health care come together to tackle the challenges of caring for and ministering to the seriously ill and those facing death.

The Relationship Between Dyspnea Severity with Radiological and Laboratory Findings in Pneumonia in Children in Pediatric Palliative Care

In care patients; pneumonia is common due to being bedridden, atrophy of respiratory muscles and use of medical devices.Dyspnea is the second most common symptom after pain in pediatric palliative care. In this study, it was aimed to examine therelationship between the severity of dyspnea and pneumonia. The study is a study that included patients admitted to pediatricpalliative care, diagnosed with pneumonia, and applied Modified Borg Scale (MBS) between December 15, 2019 and December15, 2020. The MBS has a scoring system ranging from 0 to 10 and assesses the severity of dyspnea. A total of 72 (34.4%) patientsdiagnosed with pneumonia and underwent MBS were included in the study. 51.4% (n=37) of the study group were male, and themedian age was 6.00 years (ranges of quarters=9). It was observed that the severity of dyspnea did not affect determining thepneumonia type and possible pathogen (p=0.613, p=0.948, respectively) In line with the results of the study, it can be concludedthat there is no relationship between the severity of dyspnea and pneumonia in patients in need of care.

Knowledge, Attitude, Practice and Perceived Barriers on Palliative Care Pain Management among the Healthcare Providers: A Single Centre Study

Healthcare providers’ knowledge and attitude on cancer pain control remain a debatable topic. The study aims to determine the knowledge, attitude, practice and perceived barriers among the healthcare providers in delivering effective analgesic in palliative care. A cross-sectional study was conducted among the specialists and post-graduate students from the medical and surgical programme using the convenience sampling method. A set of questionnaires related to the pain management in palliative patients was distributed. The questionnaire covered demographic characteristics, knowledge, attitudes, practice, and perceived barrier regarding cancer pain management. A total of 300 questionnaires were analysed with 75% response rate. About two-third (66.3%) of the respondents have knowledge deficit to prescribe opioids in pain management of palliative care patients. The medical specialty and lacking pain management training were significant factors associated with knowledge deficit. About half (48.3%) of the respondents thought that cancer pain therapy could be satisfactorily achieved as an outcome and 58.7% respondents admitting to practice daily pain assessment in patients with cancer. The main perceived barriers in managing pain for palliative patients were inadequate pain assessment (71.2%) and inadequate staff knowledge (53.6%). The knowledge differences among the different medical specialties and lack of pain management training have significantly impacted the pain management in palliative patients. A targeted educational strategy for pain management in palliative care patients is needed to improve physicians’ knowledge and clinical practice.

Managing pain in palliative care

Your knowledge of effective use of opioids can help ensure patient comfort.

Survival rate of patients with combined hepatocellular cholangiocarcinoma receiving medical cannabis treatment: A retrospective, cohort comparative study

Background: Cholangiocarcinoma (CCA) incidence in Northeastern Thailand is very high and a major cause of mortality. CCA patients typically have a poor prognosis and short-term survival rate due to late-stage diagnosis. Thailand is the first Southeast Asian country to approve medicinal cannabis treatment, especially for palliative care with advanced cancer patients. Methods: A retrospective cohort comparative study of survival rates among 491 newly diagnosed advanced CCA patients was carried out between September 1, 2019, and June 30, 2021. A total of 404 patients were in the standard palliative care pain management treatment group (ST), and 87 were in the medicinal cannabis treatment group (CT). Patients with CCA were recruited from four tertiary hospitals and two secondary hospitals in five provinces of Northeast Thailand. The cumulative survival rates were calculated by the Kaplan-Meier method, and independent prognostic factors were investigated using Cox regression. Results: For ST patients, there was a total follow-up time of 790 person-months, with a mortality rate of 48.35/100 person-months. For CT patients the total follow-up time was 476 person-months, with mortality rate of 10.9/ 100 person-months. The median survival time after registration at a palliative clinic was 0.83 months (95% CI: 0.71–0.95) for ST and 5.66 months (95% CI: 1.94–9.38) for CT. Multivariate analysis showed that CT treatment protocol was associated with a significantly better survival (P value <0.001; median time of CT, 5.66 months (95% CI: 1.94–9.38); median time of ST, 0.83 months (95% CI: 0.71–0.95). Therefore, CT had a reduced probability of dying from the disease (HRadj., 0.28 (95% CI: 0.20–0.37) Conclusions: The medical cannabis increased overall survival rates among CCA patients.

Virtual reality reduces pain in palliative care–A feasibility trial

BackgroundEffective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms.AimsWe investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs.DesignThis is an observational, single-arm and national single-center feasibility trial.MethodsA one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain.ResultsWe analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone.DiscussionThe present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

Rural nurses’ self-rated knowledge and skills in pain, medication, symptom and emergency management in community-based palliative care: A cross-sectional survey

BackgroundThe assessment and management of pain and symptoms in community-based palliative care patients is a measure of quality in palliative care to indicate the quality of palliative care. Studies have identified rural community-based nurses are not always confident in this area of practice. AimTo identify rural community-based nurses’ strengths and gaps in palliative care knowledge and skills regarding pain, symptom and emergency management and to determine correlates of deficient knowledge. MethodsA cross-sectional study design was used. An electronic questionnaire was emailed to 165 community-based nurses in Gippsland, Australia. Participants rated their palliative care knowledge/skills on a five-point Likert scale ranging from ‘No knowledge’ (1) to ‘Can teach others’ (5) on the following topics: pain (2 items), medication (14 items), symptoms (26 items), palliative care emergencies (12 items) and assessment tools (2 items). For each item classified as a gap or consolidation, associations between nurse characteristics and no/basic knowledge were assessed using univariable and multivariable binary logistic regression. FindingsOverall, 122 nurses (response rate = 74%) completed the questionnaire. Seventy-one percent of items were identified as practice strengths. Strengths included pain (2/2), medication management (11/14), and symptom management (22/25). Twenty-nine percent of items were identified as gaps and consolidations. Gaps and consolidations related to management of opioid medications, symptom management of delirium, and the recognition and management of rare emergency situations within palliative care. DiscussionThis study found that lack of experience and formal training in palliative care were associated with gaps in knowledge. ConclusionThis study found that lack of experience and formal training in palliative care were associated with gaps in knowledge. Targeted interventions such as training and peer mentoring have the potential to address identified gaps in rural community-based nurses... palliative care knowledge/skills and, ultimately, improve the care of palliative patients.

Role of Non-pharmacological Intervention for Pain Management in Nursing Home Residents During COVID-19: A Systematic Review

Pain experienced by nursing home residents (NHRs) is a significant concern, especially in patients with cognitive impairment. In this group, pain can be revealed through agitation, facial expressions, and altered movements. Palliative care, warm blankets, and peer-led pain management are some of the non-pharmacological management options. Our aim is to explore non-pharmacological interventions used for pain control during the COVID-19 pandemic. Google Scholar and PubMed were utilized to retrieve comprehensive non-pharmacologic pain management studies published between 2020 and 2021. Some targeted studies included randomized controlled, clustered, and clinical trials. The study targeted the general global NHR population. Keywords used: “Pain Management Program”, “nursing home”, “Pain management post-COVID-19”. Seven independent analysts reviewed the study. Eleven studies investigated non-pharmacological interventions in pain management. Five met the inclusion criteria. Two studies assessed peer-led pain management programs (PAPs). The first study found that PAPs improved pain knowledge and skills of peer volunteers in nursing homes. The second study revealed that PAP significantly improved pain self-efficacy, pain inference, and quality of life. Another study showed that visually appealing digital elements such as family photographs and natural sceneries relaxed older adults with chronic pain. Using warm blankets reduced pain and agitation in one study. An improvement in pain and severity complaints, and analgesic use requests was noted. One study revealed the insignificance of palliative care residents’ comfort in the last week of life comparing intervention and control groups. Pain is a symptom often under-reported in nursing homes. Current evidence indicates the potential role of non-pharmacological interventions, mainly utilizing appealing digital devices, warm blankets, and PAP programs. This review found that non-pharmacological interventions increase awareness about pain and increase NHRs’ quality of life during COVID19 pandemic. Further studies are needed to assess effectiveness of non-pharmacological interventions as pain management tools.

Pharmacovigilance in hospice/palliative care: Net effect of amitriptyline or nortriptyline on neuropathic pain: UTS/IMPACCT Rapid programme international consecutive cohort

Background: Real-world effectiveness of interventions in palliative care need to be systematically quantified to inform patient/clinical decisions. Neuropathic pain is prevalent and difficult to palliate. Tricyclic antidepressants have an established role for some neuropathic pain aetiologies, but this is less clear in palliative care. Aim: To describe the real-world use and outcomes from amitriptyline or nortriptyline for neuropathic pain in palliative care. Design: An international, prospective, consecutive cohort post-marketing/phase IV/pharmacovigilance/quality improvement study of palliative care patients with neuropathic pain where the treating clinician had already made the decision to use a tricyclic antidepressant. Data were entered at set times: baseline, and days 7 and 14. Likert scales graded benefits and harms. Setting/participants: Twenty-one sites (inpatient, outpatient, community) participated in six countries between June 2016 and March 2019. Patients had clinician-diagnosed neuropathic pain. Results: One hundred and fifty patients were prescribed amitriptyline (110) or nortriptyline (40) of whom: 85% had cancer; mean age 73.2 years (SD 12.3); mean 0–4 scores for neuropathic pain at baseline were 1.8 (SD 1.0). By day 14, doses of amitriptyline were 57 mg (SD 21) and nortriptyline (48 mg (SD 21). Fifty-two (34.7%) patients had pain improvement by day 14 (amitriptyline (45/110 (43.3%); nortriptyline (7/40 (18.9%)). Thirty-nine (27.7%) had new harms; (amitriptyline 29/104 (27.9%); nortriptyline 10/37 (27.0%); dizziness (n = 23), dry mouth (n = 20), constipation (n = 14), urinary retention (n = 10)). Benefits without harms occurred (amitriptyline (26/104 (25.0%); nortriptyline (4/37 (10.8%)). Conclusions: Benefits favoured amitriptyline while harms were similar for both medications.

Hypnosis and music interventions for anxiety, pain, sleep and well-being in palliative care: systematic review and meta-analysis

BackgroundMaintaining quality of life is a primary goal of palliative care (PC). Complementary interventions can help meet the needs of patients at the end of life.ObjectivesThis meta-analysis aims to (1)...

Low-dose sublingual fentanyl improves quality of life in patients with breakthrough cancer pain in palliative care.

Aim: This subanalysis of the CAVIDIOPAL study evaluated the impact of individualized management of breakthrough cancer pain (BTcP) with fentanyl on the quality of life (QoL) of advanced cancer patients in Spanish palliative care units. Patients & methods: This was a prospective, observational, multicenter study. The European Organization for Research and Treatment of Cancer's QLQ-C30 questionnaire was used at baseline (V0) and visit 28 (V28). Results: Ninety-five patients were mainly treated with 67-133μg fentanyl, showing a notable reduction in intensity (visual analog scale: 8.0 [V0] to 4.6 [V28]), frequency and duration of BTcPepisodes shortly after the first 1-2weeks of treatment, with significantly improved QoL (global health status: 31.1 [V0] to 53.1 [V28]). Conclusion: Low-dose sublingual fentanyl effectively reduced BTcPin advanced cancer patients in palliative care units, significantly improving QoL. Clinical trial registration: NCT02840500 (ClinicalTrials.gov).