Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Mar 2012
ReviewOpioid genetics in the context of opioid switching.
On a population level, there is no difference in terms of efficacy or side-effects between any of the strong opioids. On an individual level, however, there is marked variation in response to opioids. This review presents some of the recent advances in opioid pharmacogenetic studies. ⋯ Adequately powered studies to allow identification of genetic variants with small effect size and exploration of gene-gene interaction are needed. Integration of genetic analysis in clinical studies with carefully defined outcome measures will increase the likelihood of identifying clinical and genetic factors which can be used to predict opioid response.
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Curr Opin Support Palliat Care · Mar 2012
ReviewVisceral pain: the ins and outs, the ups and downs.
Visceral pain represents a major clinical problem, yet far less is known about its mechanisms compared with somatic pains, for example, from cutaneous and muscular structures. ⋯ This review should inform on the recognition of what occurs in patients with visceral pain, why comorbidities are common and how analgesic treatments work.
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Curr Opin Support Palliat Care · Mar 2012
ReviewFuture directions in palliative thoracic radiotherapy.
Recent systematic review, practice guidelines, and consensus statements have summarized the known clinical trial information with regards to the appropriate use of external-beam radiation, brachytherapy, and concurrent chemotherapy (with external-beam radiotherapy) in the palliation of chest symptoms with thoracic radiotherapy. The purpose of this review is to describe our present knowledge with regards to palliative thoracic radiotherapeutic maneuvers and to identify potential areas for future research inquiry consistent with current knowledge gaps. ⋯ Robust clinical trial information and high-level knowledge-translation documents currently exist to guide radiotherapy practitioners to provide standard-of-care treatment for thoracic palliative scenarios.
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Interventional techniques were the mainstay for cancer pain management before the WHO ladder and opioids were freely available. The three-step WHO ladder has its limitations, and cancer pain is often under treated. Advances in treatment options mean that cancer patients are living longer and pain interventions may have a role to play even early in the cancer diagnosis for better quality of analgesia. The role of high doses of opioids in pain management is also currently under scrutiny. ⋯ Interventions form an integral part in providing pain relief in complex cancer pains. Oncologists and palliative care physicians are to be educated on the usefulness and timing of interventions in the management of complex cancer pain.
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Curr Opin Support Palliat Care · Mar 2012
Editorial ReviewRecent advances in palliative radiotherapy.