Current opinion in supportive and palliative care
-
Classification of neuropathic pain has been based on disease entities, anatomical localization or histological observations. There is now recognition from clinical investigations that neuropathic pain is not a monolithic entity, but instead presents as a composite of pain and other sensory symptoms. ⋯ Application of quantitative sensory testing and questionnaires can aid in more versatile descriptions of neuropathic pain symptoms. If it were possible to characterize the concert of the distinct mechanisms and symptoms that operate in one individual patient, an optimal polypharmacotherapy that addresses the specific combinations of mechanisms may be established for each patient.
-
Curr Opin Support Palliat Care · Mar 2008
ReviewTreatment of delirium in supportive and palliative care.
The past few years have witnessed increased research into delirium treatment and related issues, leading to better management (e.g. improved detection) and better understanding of phenomenology and pathophysiology. Many treatment and prevention trials have been conducted. ⋯ Use of validated detection instruments is now standard procedure in both specialized clinical practice and research. Although haloperidol remains the mainstay of treatment, recent trials have begun to discriminate between the use of different agents and pharmacological approaches.
-
Curr Opin Support Palliat Care · Mar 2008
ReviewOptimizing antiemetic therapy in multiple-day and multiple cycles of chemotherapy.
Only a few studies have investigated the effect of antiemetic therapy in patients treated with multiple-day or multiple cycles of chemotherapy. The present review will assess the available data, highlight the current recommendations and draw attention towards the remaining problems in this field of antiemetic treatment. ⋯ The development of the NK1-receptor antagonist aprepitant has significantly improved the antiemetic control in patients treated with multiple cycles of chemotherapy. Far too many patients still experience considerable emetic side effects. The effect of aprepitant in multiple-day chemotherapy has yet to be defined. The effect of new antiemetic agents such as palonosetron and olanzapine also needs to be investigated in randomized trials.
-
Curr Opin Support Palliat Care · Mar 2008
ReviewDignity-based approaches in the care of terminally ill patients.
Promoting dignified dying is an altruistic goal in palliative care. Until recently, what was meant by this construct was poorly understood. This review seeks to clarify what is meant by dignity at the end of life, what threatens dignity, and evidence of the domains that define dignity. A model of dignity is proposed from which interventions can be derived. ⋯ Despite the fact that little research exists exploring the notion of dignity at the end of life, a robust model of dignity exists and is helpful in directing interventions aimed at improving care at the end of life.
-
This review provides an overview of the immunological effects of commonly used analgesic opioid drugs with particular emphasis on human studies, with the final aim to highlight their potential clinical relevance. ⋯ The impact of opioid drug treatment on immunity may be a new safety concern for the physician. Although many advances have been made in understanding the effects of opioid drugs on immune responses, their relevance is not completely clear. The scientific community must be aware that it is about time to perform well designed clinical studies in order to assess the importance of opioid-induced immune suppression.