Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Sep 2014
ReviewOpioid management of pain: the impact of the prescription opioid abuse epidemic.
The greater emphasis on pain control over the last decade has been accompanied by increased opioid prescriptions and an epidemic of opioid abuse. This review examines the financial, regulatory, and clinical practice impact of the epidemic, the factors contributing to its growth, and strategies that may counter this public health crisis. ⋯ The opioid prescription abuse epidemic has precipitated calls for increased regulation. Clinicians can improve patient care and diminish opioid abuse by identifying patient risk factors, increasing vigilance and structure for those at risk, and providing interdisciplinary care for any patients coping in a maladaptive manner.
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Curr Opin Support Palliat Care · Sep 2014
ReviewBreathlessness in motor neurone disease: a review of the current strategies and gaps in the evidence.
This review on breathlessness and motor neurone disease (MND) is important, as palliative care teams are increasingly becoming involved in the complex care of these patients at an earlier stage in their illness. Subtle cognitive and behavioural changes with MND may make management more challenging. Breathlessness is a distressing symptom, impacting on both patients and carers. Assessment and expectant management of breathlessness improves the quality of life (QoL) and may minimize hospital admission. ⋯ Assessment of breathlessness and its successful management improves the QoL of patients with MND. Opioids in titrated doses may play a role in this. NIV improves survival in patients with respiratory failure with minimal or no bulbar symptoms and should be offered when appropriate. Preemptive education improves the uptake and understanding of the role of NIV.
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Curr Opin Support Palliat Care · Sep 2014
ReviewSupportive and palliative care of children with metabolic and neurological diseases.
To review the role of pediatric palliative care (PPC) for children with metabolic and neurological diseases. ⋯ PPC for children with metabolic and neurological diseases can lessen a child's physical discomfort and enhance parental certainty with decision-making. These areas along with other needs throughout the illness trajectory and bereavement are being increasingly met by the growing availability of PPC programmes.
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Curr Opin Support Palliat Care · Sep 2014
ReviewInhaled nebulized and intranasal opioids for the relief of breathlessness.
Inhaled nebulized and intranasal opioid administration is available with a proven short onset of action for the relief of pain. As breathlessness episodes are short, these routes of administration seem to be attractive for breathlessness management. This review describes the recent studies evaluating the effectiveness of inhaled nebulized and intranasal application of opioids for patients suffering from refractory breathlessness. ⋯ There is currently not enough evidence to support the use of inhaled application of opioids for the relief of breathlessness. There are no controlled trials assessing the efficacy and effectiveness of intranasal opioid application, but a pilot trial is underway to provide preliminary data.
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Dyspnea is a distressing consequence of many unremitting diseases. This review discusses the therapeutic use of noninvasive ventilation (NIV) in advanced illness. ⋯ NIV is an important adjunct to medications for patients with intractable dyspnea. Future research should attempt to clarify the effectiveness of NIV at controlling dyspnea within and outside the hospital. Barriers to its domiciliary application are largely unknown. Processes should be developed to optimize communication among clinicians, patients, and their caregivers around the issues of when to start NIV and how to withdraw it at the end of life.