Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2018
ReviewChinese herbal medicines in the prevention and treatment of chemotherapy-induced nausea and vomiting.
Chemotherapy-induced nausea and vomiting (CINV) critically impact on cancer patients' quality of life, causing various complications, and increasing the risk of chemotherapeutic failure. Current treatments addressing CINV are reasonably costly and have many side effects. Chinese herbal medicines (CHMs) have been widely used in treating CINV in China. Clinical trials and modern experimental studies on CINV using CHMs are reviewed for clues that may help us to better prevent and treat CINV with CHMs, and develop safe and effective treatments. ⋯ CHMs seem effective in the prevention and treatment of CINV based on the clinical trials and some animal experiments, although the scientific validity of many clinical studies remain to be confirmed as many of them were inadequately designed. Further well designed clinical trials and more preclinical studies with reliable markers are required to confirm the usefulness of CHMs as complementary medicines for treating CINV and to use CHMs as rational prescriptions rather than based only on empirical knowledge.
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Migraine is an extremely incapacitating collection of neurological symptoms that usually includes a severe, throbbing, recurring pain on one side of the head. The World Health Organization ranks migraine as the third most prevalent disease and the seventh commonest primary pain condition in the world. Trigeminovascular-mediated central sensitization has been implicated in the development of migraine symptoms including pain following light touch. This review explores the activation and sensitization of the brain systems that have emerged from recent studies and that contribute to migraine. ⋯ Several key studies have helped address the long-standing debate over whether migraine originates from vascular or neuronal dysfunction and now support that migraine is a neurological disorder. However, a complete understanding of the central nervous system dysfunction underlying this condition has yet to be elucidated.
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Curr Opin Support Palliat Care · Jun 2018
ReviewNonsteroidal anti-inflammatory drugs and cancer pain.
This review aims to appraise the most recent evidence for the use of NSAIDS in cancer pain. ⋯ Given the lack of quality evidence, NSAIDS should be prescribed on a case by case basis in discussion with the patient, with regular review of efficacy, whilst balancing the ongoing benefits and risks of continued use, taking into account the patient's likely prognosis.
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Curr Opin Support Palliat Care · Jun 2018
ReviewA critical appraisal of gabapentinoids for pain in cancer patients.
Gabapentinoids are frequently used in the management of cancer pain. In recent Cochrane systematic reviews, although there was an abundance of evidence relating to non-cancer pain, only a few studies related to cancer pain. This review summarizes recent randomised controlled trials (RCTs) evaluating the use of gabapentinoids for tumour-related (as monotherapy or part of combination therapy) and treatment-related pain. ⋯ More and better quality studies are required, although it may be challenging to accomplish in this patient population. Gabapentinoids may offer benefits to cancer patients with pain, but careful titration and monitoring of adverse effects is necessary.
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Curr Opin Support Palliat Care · Jun 2018
ReviewOpioid addiction, diversion, and abuse in chronic and cancer pain.
The primary cause of overdose death in the United States is related to pharmaceutical opioids. A few particular populations that struggle with adverse outcomes related to opioid abuse are those in palliative care, those with chronic pain, and those receiving pain treatments secondary to cancer or chemotherapy. ⋯ We explore behavioral interventions, provider education, alternative pain management techniques, postmarketing surveillance, and abuse-deterrent formulas as emerging methods to counteract opioid abuse in these populations.