Pain Management In Palliative Care Research Articles

Development and validation of mobile application for teaching the subject of pain management in palliative care

Resumo Introdução: Avaliação e manejo adequados da dor têm se tornado uma preocupação cada vez maior dos profissionais de saúde. Segundo a definição de cuidados paliativos da Organização Mundial da Saúde, são importantes a identificação precoce, a avaliação e o tratamento da dor. Objetivo: Este estudo teve como objetivos desenvolver e avaliar um aplicativo para dispositivos móveis voltado para o ensino de abordagem da dor em cuidados paliativos. Método: Foi desenvolvido um aplicativo móvel, seguido de sua utilização por médicos residentes e de avaliação qualiquantitativa prospectiva. Aplicou-se o teste de conhecimento. Obtiveram-se a usabilidade do aplicativo, por meio da System Usability Scale (SUS), e a satisfação, por meio do Net Promoter Score (NPS). Os dados foram tabulados no Microsoft Office Excel® e exportados para o software Statistical Package for the Social Sciences (SPSS) versão 20.0 (IBM): na realização das análises, adotou-se uma confiança de 95%. Para a análise qualitativa das avaliações, o conteúdo das respostas foi transcrito e organizado em nuvens de palavras para destacar as ideias centrais. O estudo foi aprovado pelo Comitê de Ética do Centro Universitário Christus. Resultado: Desenvolveu-se o PaliPain App, aplicativo constituído de casos clínicos de pacientes em cuidados paliativos com manifestações de dor, além de questões, vídeos e imagens, disponibilizado nas plataformas Android e iOS. Utilizaram o aplicativo 13 médicos residentes. A média de acertos de questões no pré-teste sobre dor em cuidados paliativos aumentou de 6,08 para 7,54 após manuseio do aplicativo. Na avaliação sobre a usabilidade do aplicativo, obtivemos na SUS uma média de 89,2, acima do nível considerado adequado de 70,0. Na avaliação de satisfação, 54% dos médicos responderam com pontuação 10 à pergunta: “Em uma escala de 0 a 10, quanto você recomendaria o aplicativo PaliPain a um amigo ou colega?”. Conclusão: O PaliPain App, desenvolvido e disponibilizado nas plataformas Android e iOS, foi bem avaliado pelos médicos residentes, apresentando ótimos escores de usabilidade e de satisfação. Identificamos que houve ganho de conhecimento, com pontuação média na resolução de questões aumentando de 6,08 para 7,54 após livre uso da aplicação. O PaliPain App pode ser uma ferramenta útil para ensino de abordagem de dor para médicos residentes.

Application of Cancer Pain Management in Palliative Care of Patients with Advanced Cancer

Application of Cancer Pain Management in Palliative Care of Patients with Advanced Cancer

Nursing role and strategy in pain management in palliative care

Palliative care plays a role in meeting the needs of individuals facing life limiting illnesses. One of the aspects of this specialized healthcare approach is effectively managing pain. Understanding types of pain from nociceptive to neuropathic is essential in navigating the nature of pain within a palliative care setting. Nursing strategies for pain management adopt an approach that addresses sources and aspects of pain. Alongside medication management, including opioids and complementary medications, non-pharmacological interventions such as therapy, massage and music therapy are utilized. Continuous monitoring, collaboration, patient education and addressing dimensions are crucial elements in nursing strategies. Nurses also serve as advocates, in navigating considerations related to pain management while ensuring autonomy and shared decision making. This exploration highlights the multifaceted contributions that nurses make in managing pain. It underscores the importance of research, education and fostering an organizational culture. Efforts, like these play a role in improving the efficiency of nursing practices in the changing field of palliative care. To sum up nursing shines as a guiding light, in providing evidence-based care greatly enhancing the quality of life for individuals confronting illnesses with limited time.

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.

Top Ten Tips Palliative Care Clinicians Should Know About Buprenorphine.

Pain management in palliative care (PC) is becoming more complex as patients survive longer with life-limiting illnesses and population-wide trends involving opioid misuse become more common in serious illness. Buprenorphine, a generally safe partial mu-opioid receptor agonist, has been shown to be effective for both pain management and opioid use disorder. It is critical that PC clinicians become comfortable with indications for its use, strategies for initiation while understanding risks and benefits. This article, written by a team of PC and addiction-trained specialists, including physicians, nurse practitioners, social workers, and a pharmacist, offers 10 tips to demystify buprenorphine use in serious illness.

Pancreatic Ductal Adenocarcinoma: Current and Emerging Therapeutic Uses of Focused Ultrasound.

Simple SummaryPancreatic ductal adenocarcinoma (PDAC) is an increasingly prevalent form of cancer with a low patient survival rate following diagnosis. Focused Ultrasound is an emerging modality that provides exciting opportunities in treating PDAC. This review provides an overview of the clinical application and scientific research of therapeutic focused ultrasound for the treatment of PDAC for use by clinicians and scientific researchers. In addition to providing a description of various physical mechanism underlying therapeutic applications, the current benefits, challenges, and possible future avenues for the application and development of focused ultrasound in the treatment of PDAC are summarized.Pancreatic ductal adenocarcinoma (PDAC) diagnosis accompanies a somber prognosis for the patient, with dismal survival odds: 5% at 5 years. Despite extensive research, PDAC is expected to become the second leading cause of mortality by cancer by 2030. Ultrasound (US) has been used successfully in treating other types of cancer and evidence is flourishing that it could benefit PDAC patients. High-intensity focused US (HIFU) is currently used for pain management in palliative care. In addition, clinical work is being performed to use US to downstage borderline resectable tumors and increase the proportion of patients eligible for surgical ablation. Focused US (FUS) can also induce mechanical effects, which may elicit an anti-tumor response through disruption of the stroma and can be used for targeted drug delivery. More recently, sonodynamic therapy (akin to photodynamic therapy) and immunomodulation have brought new perspectives in treating PDAC. The aim of this review is to summarize the current state of those techniques and share our opinion on their future and challenges.

Family Caregivers' Challenges in Cancer Pain Management for Patients Receiving Palliative Care.

Family caregivers (FCs) of cancer patients play a crucial role in managing their care partner's pain, but little research has examined FCs' specific challenges regarding the provision of pain management (PM) to cancer patients receiving palliative care. To determine the demographic and clinical characteristics of FCs who encounter challenges in PM and to elucidate the specific challenges that FCs face when managing pain for their care partner with cancer. We conducted a secondary analysis of 40 interview transcripts of FCs who were caring for persons with cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis. The three major identified challenges to PM for FCs of persons with cancer were: (1) communication and teamwork issues, (2) caregiver-related issues, and (3) patient-related issues. Communication and teamwork issues encompassed caregivers' receipt of inadequate information regarding PM, and inappropriate and ineffective communication from the healthcare team. Caregiver issues pertained to caregivers' fear and beliefs, concurrent responsibilities, and lack of pain-related knowledge and skills. Patient issues related to their own fear and beliefs, psychological and physiological well-being, adherence to medications, and reluctance to report pain. Findings of this study have implications for future research and practice related to cancer PM in palliative care. Results suggest the need for FC training in PM as well as clear clinical practice guidelines and resources to help providers prepare, educate, and communicate with FCs regarding PM.

Opioid Prescriber Related Barriers to Pain Management in Palliative Care

Aim: Establishing opioid prescriber- related barriers to pain management in palliative care. Introduction: Millions of people suffering from Non-communicable diseases e.g. cancer live and die with severe pain and other debilitating symptoms, which can be effectively treated and managed at affordable cost. Unfortunately, they typically lack access to medication, appropriate technology and palliative care services. Satisfactory pain management is an essential component of palliative care both in the healthcare setting and in home based care. Palliative care emphasizes on pain and symptom management in life-limiting disease management. Unfortunately, many barriers interfere with the pain and symptom management process. Barriers could be patient or healthcare related. Though nurses do not prescribe opioid analgesics they play, a pivotal role in pain management using the medication hence delay of prescription does affect nursing care. Methodology: A cross sectional study was conducted in Embu and Machakos level five hospitals and the hospices targeting 238 nurses working in these institutions. These facilities are located in the Eastern region of Kenya. Systematic Random Sampling was done to identify participants and the data collected by use of questionnaires, exported using Epidata 3.1, cleaned and coded; then analyzed using Stata version 14. Hypothesis testing was done by use of Chi – squared Test with 95% Confidence Interval. Presentation was done using tables and charts. Results: The prescriber- related barriers to pain management by use of opioids included: Delayed prescription, failure to prescribe the medication, shortage of prescribers and inadequate pain assessment. Conclusion and recommendation: Previous studies had identified some of the barriers in other countries. Many barriers interfere with the pain and symptom management process, frustrating efforts to assess and control the said symptoms. Unlike other analgesics, opioids require prescription for them to be dispensed hence prescribers are key to pain management by use of this class of drugs. Most of the barriers identified in the study could be addressed by the Government through investing in employment of prescribers, continued professional development as well as change in legislation.

Meeting at the crossroads of pain and addiction: An ethical analysis of pain management with palliative care for individuals with substance use disorders.

A growing number of individuals live with an opioid use disorder (OUD). While many go on to recover from such disorders, certainly, there will be individuals in palliative care (PC) at some point who still suffer with OUD. One of the major barriers to PC for individuals recovering and currently suffering from an OUD is the stigma related to having an OUD. Therefore, in the context of PC, it is important to understand the relationship that exists between PC, OUDs, and how stereo-types related to substance use disorders affect patient engagement in PC. For this paper, the focus will be on how stereotypes affect pain management in PC for persons with an OUD. A review of current literature regarding OUDs and pain management indicates a need for care specific to the needs of those in PC who formerly and/or currently suffer from an OUD in order to avoid relapse or worsening of their affliction while still managing their pain. The striking lack of knowledge and resources regarding OUDs and their treatment indicates a need to strengthen/increase resources for physicians to educate on treating OUDs as well as alternatives for pain management. This article presents dignity-enhancing care as a gateway to fairly treat individuals with an OUD and to get rid of the stigma associated with OUD patients.

Transdermal Buprenorphine Use for Pain Management in Palliative Care

Cancer related pain is prevalent among patients with a cancer diagnosis, occurring from the tumor itself or as a result of treatment. Many patients require opioid therapy to manage pain and providers must balance efficacy with side effects. Transdermal buprenorphine (TDB) has shown promise for pain management, however, the maximum dose available in the US is considered low, resulting in doubts of efficacy. This study set out to assess if the patch strengths available in the US (5–20 mcg/hour) are able to provide analgesia for patients with cancer in a palliative medicine clinic. This retrospective chart review analyzed patient charts for outpatient TDB use within a palliative medicine clinic in the United States. Patients had to have a follow up visit with the clinic in order to be included. Sixty-eight patients were included for analysis with 54 (79%) continuing at least 28 days and 37 (54%) continuing for at least 84 days. The median change in pain score was 0, though 25 (46%) of patients reported a decrease of 1 or more points at the first follow up. TDB is a viable option for cancer related pain for select patients, demonstrated by duration of use and stable reporting of pain.

Combination of Tramadol-Paracetamol in Palliative Care Pain Management: A Case Report

One of the basic goals of palliative care is to reduce the suffering of the patient, which includes relieving the pain. Some facts show that sometimes a doctor is afraid to give opioid analgesic mono-therapy to his patients because she is worried on one hand about the effect of addiction. In addition, in some cases, NSAID analgesics mono-therapy can also cause a series of side effects or even the patient may be contraindicated against the use of NSAID or paracetamol class drugs. Actually, this can be prevented by giving a combination of opioids and non-opioids analgesic. By providing this combination of therapy, it is hoped that this can accelerate the onset of work, extend the working period which can reduce the dose of drugs consumed, and more importantly minimize the side effects of each drug. The fixed dose combination of Tramadol-Paracetamol (Tramadol 37.5 mg–Paracetamol 325 mg) is an example of a drug combination preparation that has been shown to be effective in the treatment of pain. In this case report, a patient who is currently undergoing palliative therapy for cancer is described. On the way, the patient felt spinal pain as a result of the spread of the disease. The combination of Tramadol-paracetamol was administered twice a day with a dose that adjusted to the VAS Score observations before and after drug administration. And in this case, there was a decrease in the VAS score after being given Tramadol-Paracetamol combination.

The Effect of Pain Management in Palliative Care of Patients with Advanced Tumors

The Effect of Pain Management in Palliative Care of Patients with Advanced Tumors

Historical aspects in pain management in palliative care in an oncological reference unit.

Describe the actions implemented for pain management in palliative care oncology and analyze the contribution of Hospital do Câncer IV, as a reference unit at the National Cancer Institute. Study of the history of the present time, whose sources were written documents and interviews with five participants. The collection took place from February to June 2018. The analysis of the written sources took place through internal and external criticism of the documents, considering their chronology and theme. Professionals contributed with actions for pain management in palliative oncology care: in discussions and final drafting of ordinances, as rapporteurs at national and international events, in the elaboration of humanization conducts and systematization of assistance in addressing pain. These actions favored assistance in palliative oncology care at various levels of health care for patients and families, with greater technical and scientific recognition for all.

Komplexní přístup k léčbě bolesti v paliativní péči

Bolest představuje jeden z nejzavažnějsich projevů pokrocileho stadia nadoroveho onemocněni. V paliativni peci se s chronickou bolesti setkavame sice i u pacientů v terminalnim stadiu jiných onemocněni, největsi podil pacientů trpicich chronickou bolesti vsak zůstava mezi pacienty s nadorovou bolesti. Jelikož zasadnim způsobem ovlivňuje kvalitu života nevylecitelně nemocných, jistě může být i castým důvodem navstěvy praktickeho lekaře s požadavkem na ulevu od bolesti. Clanek přinasi přehled jak farmakologických, tak i nefarmakologických možnosti terapie.

Nurses' experiences of providing nonpharmacological pain management in palliative care: A qualitative study.

To explore the experiences and views of nurses who provide nonpharmacological therapies for chronic pain management in palliative care. Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of nonpharmacological therapies for chronic pain management in palliative care have revealed what nonpharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views and experiences regarding pain therapies in this context. A qualitative descriptive design was chosen. Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analysed using qualitative content analysis. This study aligns with the consolidated criteria for reporting qualitative research (COREQ) checklist. The analysis yielded four categories, as follows: "building and sustaining favourable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognising the diversity of patients' needs," person-centred care is expressed as being vital for individualised nonpharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognising the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal nonpharmacological pain management. The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful nonpharmacological pain management. This study emphasises the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialised training in palliative care and pain management.

Should we treat pain in the elderly palliative care cancer patients differently?

SUMMARYOpioids are considered the cornerstone of pain management in palliative care. Available data suggest that older patients use different analgesics and lower opioid doses compared to younger patients. However, it has not been elucidated yet whether such dosing is associated with worse pain levels or shorter survival in the palliative care setting. We evaluated the relationship among pain scores, quality of life, opioid dose, and survival in palliative care cancer patients in a hospice setting. A total of 137 palliative care cancer patients were analyzed prospectively. We divided patients into two groups using the age of 65 as a cut-off value. Younger patients exhibited significantly higher pain ratings (5.14 vs. 3.59, p=0.01), although older patients used almost 20 mg less oral morphine equivalent (OME) on arrival (p=0.36) and 55 mg OME/day less during the last week (p=0.03). There were no differences in survival between the two groups (17.36 vs. 17.58 days). The elderly patients also used nonsteroidal analgesics less often and paracetamol more often. Hence, using lower opioid doses in older palliative care cancer patients does not result in worse pain rating, and could be a plausible approach for pain management in this patient group.

Comparing Methadone Rotation to Consensus Opinion

ContextMethadone is a complex but useful medication for pain management in palliative care. Recent expert opinions have been published on the safe and effective use of methadone. ObjectivesTo determine the success of methadone rotations and evaluate concordance with consensus recommendations by a palliative care consult service. MethodsA retrospective study of methadone rotation practice by a palliative care consult service and outcomes for patients hospitalized between January 1, 2012 and December 31, 2018 at a single academic medical center. A successful rotation was defined as a 30% reduction in pain or as-needed medication use sustained for at least three consecutive days. Patient outcomes were compared with expert consensus recommendations. ResultsAbout 59 patients met the inclusion criteria. The study population was mostly Caucasian men and women of equal proportions who were started on methadone for inadequate pain control. Sixty-eight percent of patients were successfully rotated. Subjects who were rotated using a standardized protocol were six times more likely to have a successful rotation (odds ratio 6.28 [1.25–30.92]; P = 0.0238). ConclusionThe utilization of a standardized protocol was associated with better patient outcomes.

The inherent role of the multidisciplinary palliative care team on pain management: A critical review

Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and active-assisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions.

Challenges in Pain Management in Palliative Care

Challenges in Pain Management in Palliative Care

Opioidni i adjuvantni analgetici u savremenom lečenju bola

Morphine, as a paradigm of opioids, is 'gold standard' in treating severe pain, to which all other drugs are compared. However, abuse and respiratory depression potentials have resulted in 'opiophobia' among health professionals, and underutilization of opioids as analgesics. But, addiction and respiratory depression are almost never present in pain management in palliative care. So, fear of addiction and respiratory depression should not prevent increasing of opioid dose in those patients in paliative care who still suffer of severe pain. Opioids are ineffective in treating neuropathic pain. Antiepileptics (carbamazepine, pregabalin, gabapentin) and antidepressants (amitriptyline, duloxetine) are used for neuropathic pain.