Palliative Pain Management Research Articles

Report from the Third Conference in Zielona Góra: palliative medicine, supportive care, and pain management

Report from the Third Conference in Zielona Góra: palliative medicine, supportive care, and pain management

Epidural Analgesia for Palliative Pain Management for A Patient with An Advanced Stage Prostate Cancer: A Case Report

Introduction: Patients with advanced-stage cancer should be able to stay at home with their families without suffering from pain. This case report aims to discuss challenges in pain management of a patient with bone metastasis of prostate cancer who received epidural analgesia at home. Challenges were related to the patients, health professionals, and system. Understanding each factor will bring insights to develop a workable pain management program in the palliative setting. Case Presentation: A 66-year-old male was diagnosed with left sacroiliac joint pain due to metastatic prostate cancer. After a three-year history of prostate cancer and ineffective chemotherapy, the patient complained of pain in the left hip that did not improve with conventional medications (paracetamol, tramadol, and Morphine Sustained Release/MST). In response, the consideration of an epidural implant emerged as a potential solution, offering the prospect of home-based care and autonomous medication administration through an epidural continuous block with intermittent drug injection. Conclusions: This case highlights home-based interventional pain management for cancer, addressing challenges at the patient, health professional, and system level. Overcoming these challenges requires a multidisciplinary approach and robust institutional policies. The insights gained offer valuable lessons for hospitals aiming to enhance the competence of pain and palliative care teams and establish comprehensive support systems in hospital and home settings.

Report of the Second Conference in Zielona Góra: Palliative medicine, supportive care and pain management in cancer patients

Report of the Second Conference in Zielona Góra: Palliative medicine, supportive care and pain management in cancer patients

Digital skills among students of the master's program in Palliative Care and Pain Management

Digital skills among students of the master's program in Palliative Care and Pain Management

Non-pharmacological pain palliation methods in chronic pancreatitis.

Chronic pancreatitis (CP) is a condition characterized by persistent and often severe pain resulting from the inflammatory disease of the pancreas. While pharmacological treatments play a significant role in palliative pain management, some patients require non-pharmacological methods. This review article focuses on non-pharmacological approaches used to alleviate pain in CP. The article examines non-pharmacological palliation options, including surgery, endoscopic approaches, neurostimulation techniques, acupuncture, and other alternative medicine methods. The effectiveness of each method is evaluated, taking into consideration patient compliance and side effects. Additionally, this article emphasizes the importance of personalized pain management in CP and underscores the need for a multidisciplinary approach. It aims to summarize the existing knowledge on the use of non-pharmacological palliation methods to improve the quality of life for patients with CP.

Early versus delayed computed tomography-guided celiac plexus neurolysis for palliative pain management in patients with advanced pancreatic cancer: a retrospective cohort study.

Abdominal and back pain is the most frequent symptom in patients with pancreatic cancer, with pain management being extremely challenging. This study aimed to evaluate pain control, opioid consumption, pain-interfered quality of life, and survival after early and delayed computed tomography (CT)-guided celiac plexus neurolysis (CPN). A retrospective analysis of pancreatic cancer patients receiving CPN for pain (n = 56) between June 2018 and June 2021 was done. The patients were grouped as early group (n = 22) and delayed group (n = 34) on the basis of the presence of persistent refractory pain according to expert consensus on refractory cancer pain. Both groups were comparable in demographic characteristics and baseline pain conditions measured using the numeric rating scale (5.77 ± 1.23 vs. 6.27 ± 1.21; p = 0.141). The pain scores were significantly reduced in both groups; early CPN resulted in significantly lower scores from 3 to 5 months. The opioid consumption gradually decreased to a minimum at 2 weeks but increased at 1 month (35.56 ± 30.14 mg and 50.48 ± 47.90 mg, respectively); significantly larger consumption from 2 to 4 months was seen in the delayed group. The total pain interference was lower than baseline in all patients, with significant improvement after early CPN in sleep, appetite, enjoyment of life, and mood. The average survival time of the two groups was comparable. Early application of CT-guided CPN for patients with advanced pancreatic cancer may help reduce pain exacerbation and opioids consumption, without influencing the survival.

A comparative evaluation of fentanyl and hydromorphone efficacy profiles in palliative cancer pain management: a case report

A comparative evaluation of fentanyl and hydromorphone efficacy profiles in palliative cancer pain management: a case report

Palliative care and pain management in patients with stomach cancer

Introduction: Palliative care and pain management are increasingly important for the active and comprehensive treatment of patients who do not respond to curative treatment. Objective: To identify palliative care and pain management in patients with stomach cancer. Methods: Using a qualitative and descriptive approach, national and international literature, publications and scientific articles were reviewed to investigate palliative care and pain management in patients with stomach cancer. Results: The articles identified five treatments focused on palliative care, defined as palliative gastrectomy, bypass, palliative radiotherapy, and stenting. Pain management in patients with gastric cancer was also examined using selected studies. Conclusion: Studies focused on controlling symptoms and maintaining or improving quality of life in patients with gastric cancer were analyzed. The collected studies reported survival as the primary outcome variable. Consistent evidence was identified that patients with advanced gastric cancer benefit in both survival and quality of life with a combination of chemotherapy plus supportive care compared to receiving supportive care alone, which will be in combination with the use of opioid analgesics.

Trends in utilization of first-line palliative care in non-metastatic hepatocellular carcinoma.

e16234 Background: Palliative care therapies are known to improve the quality of life and even the survival of some patients. Although non-metastatic (stages I-III) hepatocellular carcinoma (HCC) patients often present with significant symptoms, first-line palliative care treatment is uncommon in this setting. Here we characterized rates of palliative care utilization among non-metastatic HCC patients and determined factors associated with palliative care receipt. Methods: We conducted a retrospective review of adult National Cancer Database patients diagnosed with metastatic HCC between 2004 and 2019. We used descriptive analysis for determining palliative care utilization, including palliative chemotherapy, surgery, radiotherapy, and pain management. We performed multivariable logistic regression analysis to assess the association of characteristics with palliative treatment utilization. Results: Among 121,151 patients diagnosed with stage I-III HCC, the utilization of first-line palliative care subsets was only a small portion of 3966 (3.3%). The most commonly used palliative care treatment was pain management (37.4%), followed by systemic chemotherapy (31.1%), radiotherapy (13%), surgery (9.9%), and combination therapies (8.6%). The higher stage, high comorbidity score, and decreased life expectancy were more likely to be associated with received PC. Stage 2 and 3 diseases were associated with increased odds of PC receipt compared to stage 1 disease (odds ratio [OR] = 1.63 [1.45-1.83] and OR = 3.57 [3.22-3.95]; respectively). Comorbidity score 3 was significantly more likely to receive PC than comorbidity score 0 (OR = 1.54 [1.41–1.69]). In addition, life expectancy >24 months was significantly less associated with PC receipt compared to life expectancy < 6 months (OR: 0.23 [0.20-0.26]). Conclusions: First-line palliative care subsets are underutilized to control symptoms among patients with non-metastatic HCC. Targeted efforts should be focused on increasing palliative care delivery in this group which has a vast potential to benefit.

Cancer pain: way to overcome

Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187

Regional blocks for pain control at the end of life in pediatric oncology.

Pain management at the end of life is a fundamental aspect of care and can improve patients' quality of life. Interventional approaches may be underutilized for pediatric cancer patients. To describe a single institution's 10 years of experience with regional pain management at the end of life in pediatric oncology. A retrospective cohort study of 27 patients with pediatric cancer who died between April 2011 and December 2021 and received continuous nerve block (CNB) catheters or single-shot nerve blocks (SSBs) during their last three months of life. The type of blocks, analgesic efficacy, and palliative care involvement were evaluated. Twenty-two patients (81.5%) had solid tumor diagnoses, including carcinomas, sarcomas, and neuroblastoma. Most (59%) patients received CNB catheters, and 12 patients (44%) received SSBs for pain control. The mean pain score decreases for CNB catheters and SSBs after interventions were -2.5 and -2.8, respectively, on an 11-point scale. Decreases in opioid patient-controlled analgesia dosing requirements were noted in 56% of patients with CNB catheters; likewise, in 25% of patients with SSBs at 24 h and in 8% at 5 days after interventions. Nearly all patients had PC involvement and received care from pain specialists (96% and 93%, respectively). Twenty-three (85%) had physician orders for scope of treatment orders completed before death. Regional pain control interventions can be effective and safe for relieving regional pain and suffering in dying children and young adults. The collaboration between palliative care and pain management specialists at the end of life can help alleviate suffering and improve quality of life.

Evaluation of a Developed MRI-Guided Focused Ultrasound System in 7 T Small Animal MRI and Proof-of-Concept in a Prostate Cancer Xenograft Model to Improve Radiation Therapy.

Focused ultrasound (FUS) can be used to physiologically change or destroy tissue in a non-invasive way. A few commercial systems have clinical approval for the thermal ablation of solid tumors for the treatment of neurological diseases and palliative pain management of bone metastases. However, the thermal effects of FUS are known to lead to various biological effects, such as inhibition of repair of DNA damage, reduction in tumor hypoxia, and induction of apoptosis. Here, we studied radiosensitization as a combination therapy of FUS and RT in a xenograft mouse model using newly developed MRI-compatible FUS equipment. Xenograft tumor-bearing mice were produced by subcutaneous injection of the human prostate cancer cell line PC-3. Animals were treated with FUS in 7 T MRI at 4.8 W/cm2 to reach ~45 °C and held for 30 min. The temperature was controlled via fiber optics and proton resonance frequency shift (PRF) MR thermometry in parallel. In the combination group, animals were treated with FUS followed by X-ray at a single dose of 10 Gy. The effects of FUS and RT were assessed via hematoxylin-eosin (H&E) staining. Tumor proliferation was detected by the immunohistochemistry of Ki67 and apoptosis was measured by a TUNEL assay. At 40 days follow-up, the impact of RT on cancer cells was significantly improved by FUS as demonstrated by a reduction in cell nucleoli from 189 to 237 compared to RT alone. Inhibition of tumor growth by 4.6 times was observed in vivo in the FUS + RT group (85.3%) in contrast to the tumor volume of 393% in the untreated control. Our results demonstrated the feasibility of combined MRI-guided FUS and RT for the treatment of prostate cancer in a xenograft mouse model and may provide a chance for less invasive cancer therapy through radiosensitization.

Impact of Telehealth on Palliative Care and Pain Management in Primary Care

Primary health care focuses on the public's needs for a sustainable healthy existence without placing any financial burden on patients in order to ensure the highest degree of health and well-being and their equitable distribution. When pain management and palliative care are incorporated into primary healthcare, patients' quality of life and satisfaction improve. Palliative care includes supportive medical care for patients at any stage of disease with the goals of symptom relief, pain control, stress management, carer respite, and enhancing the quality of life. Globally, a wide range of technologies have been created to establish novel approaches to treating various chronic pain problems. Furthermore, utilising telehealth systems, which have been increasingly included in specialized palliative care over the past ten years and most recently during the COVID-19 pandemic, is one way to address the growing need for palliative care. Through the utilisation of a wide variety of public communication channels, telehealth can be employed for various primary healthcare goals. Telehealth is expected to be effective for conducting routine evaluations. reduced patient burden and missed appointments, as well as improved convenience and treatment of some chronic illnesses such as diabetes and hypertension. However, patients must get instruction and assistance in using this platform, with specific support made accessible for groups known to be at risk. Telehealth’s role in primary care needs further elaborated study. The purpose of this research is to review the available information about the impact of telehealth on palliative care and pain management in primary care.Primary health care focuses on the public's needs for a sustainable healthy existence without placing any financial burden on patients in order to ensure the highest degree of health and well-being and their equitable distribution. When pain management and palliative care are incorporated into primary healthcare, patients' quality of life and satisfaction improve. Palliative care includes supportive medical care for patients at any stage of disease with the goals of symptom relief, pain control, stress management, carer respite, and enhancing the quality of life. Globally, a wide range of technologies have been created to establish novel approaches to treating various chronic pain problems. Furthermore, utilising telehealth systems, which have been increasingly included in specialized palliative care over the past ten years and most recently during the COVID-19 pandemic, is one way to address the growing need for palliative care. Through the utilisation of a wide variety of public communication channels, telehealth can be employed for various primary healthcare goals. Telehealth is expected to be effective for conducting routine evaluations. reduced patient burden and missed appointments, as well as improved convenience and treatment of some chronic illnesses such as diabetes and hypertension. However, patients must get instruction and assistance in using this platform, with specific support made accessible for groups known to be at risk. Telehealth’s role in primary care needs further elaborated study. The purpose of this research is to review the available information about the impact of telehealth on palliative care and pain management in primary care.

A case of Morganella morganii bacteremia secondary to wound infection in middleaged immunocompromised patient in Saudi Arabia

Background: Morganella morganii is a facultative, anaerobic, Gram-negative bacillus commonly found in the environment and in the intestinal tracts of humans, mammals, and reptiles as normal flora. Despite its wide distribution, it is a rare cause of community-acquired infection and is most frequently seen in postoperative and other nosocomial settings. Case Presentation: A 50-year-old woman presented to our emergency department with an ulcerated wound infection, which she acquired 2 weeks ago. She is a known case of schizophrenia, metastatic breast cancer with hormonal therapy, and palliative pain management. While culturing her wound, we found her M. Morganii positive. Her condition was complicated by bacteremia. She passed away during her hospital stay. Conclusion: This study warrants clinicians to be aware of the rare yet very dangerous presentation of M. Morganii in an immunocompromised patient.

Knowledge and attitude toward geriatric palliative care: a systematic review

Palliative care is described as a technique that improves the patients' and their families' quality of life, who are dealing with problems associated with life-threatening sickness. The specialist palliative care refers to the provision of palliative care by multidisciplinary teams with specialized skills, competencies, experience, and training in palliative care. As a result, palliative medicine is becoming more widely acknowledged as a medical subspecialty at a global level. Thus, this study aimed to explore the knowledge and attitude toward geriatric palliative care. The PubMed and Google Scholar databases were used to explore studies. Original research reporting medical therapies used in the knowledge and attitude toward geriatric palliative care and full-text publications served as the inclusion criterion. Though 130 articles were obtained, only 8 met the inclusion criteria. This study demonstrated poor knowledge and attitude of health professionals toward geriatric palliative care, pain management for patients, and training in end-of-life medicine. Prior training, previous contact with dying patients, and prior medical residency were essential to a better knowledge of end-of-life care. The studies elaborated on the urgency for educational training programs focused on improving geriatric palliative care, pain, dyspnea, and gastrointestinal issue management, especially those involving contact with dying patients.

Report of the First Conference in Zielona Góra: Palliative medicine, supportive care and pain management in patients with non-cancer diseases

Report of the First Conference in Zielona Góra: Palliative medicine, supportive care and pain management in patients with non-cancer diseases

Palliative Sedation Therapy Practice Comparison - A Survey of Pediatric Palliative Care and Pain Management Specialists.

Context: Palliative sedation therapy (PST) can relieve suffering at end-of-life (EOL) in children with intolerable and refractory symptoms. However, updated and consistent guidance on PST practices are imperative. Objectives: We investigate current variations in clinical practice and PST implementation among pediatric palliative care (PPC) and pain management (PM) specialists. Methods: We distributed an IRB-exempt electronic anonymous survey via email through the Society of Pediatric Pain Medicine, and the American Academy of Hospice and Palliative Medicine. Survey responses were collated and descriptively reported. Results: Of 83 survey responses, the majority (75%) represented large academic children's hospitals. The distribution between PPC and pediatric pain management specialists' responses was 60% and 40%, respectively. Most respondents reported having designated pain management and/or palliative care teams (70% and 90%, respectively). Approximately half (48%) reported following an institutional PST protocol, most not requiring formal ethics consult (69%). Only 54% of respondents noted that the Do Not Resuscitate (DNR) order was required prior to PST initiation. PST was primarily utilized for children with oncologic diagnoses (76%). The primary and secondary medications of choice for PST implementation were reported to be opioids (39%) and benzodiazepines (36%) by pain management specialists, and benzodiazepines (52%) and barbiturates (28%) by palliative care specialists. Conclusions: Our study highlights the variability in the practice and implementation of PST. Further educational efforts are key for establishing PST practices and efficient protocol development.

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.

Trends in utilization of first-line palliative treatments for anal squamous cell carcinoma.

Anal squamous cell carcinoma patients often present with significant symptoms, including pain, bleeding, and obstructive symptoms. This requires palliation-directed therapy as a first-line treatment to alleviate symptoms. The proportion of patients receiving first-line palliative treatments is unknown. We aimed to study the factors associated with the use of first-line palliative treatments in stage II-IV anal squamous cell carcinoma patients. We used the National Cancer Database to identify adult patients diagnosed with stage II-IV anal squamous cell carcinoma between 2004 and 2016. We performed univariable and multivariable logistic regression analysis to determine the clinical and sociodemographic variables associated with the utilization of palliative treatment in the first-line setting, including palliative radiotherapy, chemotherapy, surgery, and pain management. Among 16,944 patients diagnosed with stage II-IV anal squamous cell carcinoma, only a small proportion of 492 (2.9%) required first-line palliative treatments to control symptoms. The majority of these patients received palliative radiotherapy (32%), followed by palliative surgery (25%), palliative chemotherapy (19%), combination therapies (14%), and pain management (10%). On multivariable analysis, higher stage disease, lower income, Medicare and Medicaid insurance, and life expectancy <6 months were associated with higher odds of use of first-line palliative therapy. First-line use of palliative treatments to control symptoms is needed in a small proportion of anal squamous cell cancer patients. It was utilized in all stages, but it was most frequently observed in patients with stage IV disease and patients with <6 months life expectancy. First-line palliative therapy was also more frequent in lower-income patients and patients with Medicare and Medicaid insurance which highlights the disparities in anal cancer management.

Palliative care: Inclusion of pregabalin in the pain management of terminal cancer patients in a national level cancer treatment institute of Nepal

In palliative care, prevention approaches and pain management are used to help terminally ill patients and their family members cope with their sufferings. In terminally ill cancer patients, pain management is considered to be the most important. Cancer patients with neuropathic pain may be effectively treated with adjuvants such as pregabalin.A retrospective study performed in the palliative care unit of BP Koirala Memorial Cancer Hospital, Nepal emphasizes upon the various patients with different types and stages of cancer with majority having pain as the common and profound symptom, and the inclusion of various drugs including pregabalin in pain management.While opioids have remained the mainstay of pain management of oncotic patients, a number of patients with neuropathic pain found significant relief form pain after pregabalin was included in the treatment package.