Current opinion in supportive and palliative care
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The purpose of this review is to provide the reader with an up-to-date overview on the biopsychosocial model in cancer pain. ⋯ The biopsychosocial model is a helpful way to comprehensively approach the conceptualization and treatment of pain in cancer patients at all stages of the disease process. We currently have an established base of research on the importance of biopsychosocial model in cancer pain. Our ability to treat patients with cancer pain effectively will improve as we gain a better understanding of which treatments work for which patients.
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Curr Opin Support Palliat Care · Jun 2014
ReviewPhenotyping neuropathic pain patients: implications for individual therapy and clinical trials.
The sensory phenotype can be used as a surrogate marker of underlying mechanisms of pain generation and is assessed by tools like the Quantitative Sensory Testing, Patient Reported Outcomes or the Capsaicin Response Test. In order to establish an individualized, mechanism-based treatment of pain, it has to be demonstrated that subgroups of patients with a distinct sensory phenotype respond differently to a certain treatment. ⋯ The discussed trials show the importance of the development of an individualized pain therapy. Up to now, no clinical trial has prospectively used the sensory phenotype as an inclusion or stratification criterion. Academic researchers and pharmaceutical industry should be encouraged to implement this approach in future trial designs.
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Curr Opin Support Palliat Care · Jun 2014
ReviewDescending pain modulation and chronification of pain.
Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain 'chronification'. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. ⋯ Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain 'chronification'. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain.
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Curr Opin Support Palliat Care · Mar 2014
ReviewThe provision of home-based palliative care for those with advanced heart failure.
Although widely recognized as best practice for advanced heart failure patients, palliative care is underused by this population. The purpose of this brief review is to highlight recent findings related to home-based palliative care among patients with advanced heart failure. ⋯ New models integrating home-based palliative care and standard heart failure care have shown to be effective in reducing both physical and psychological symptoms in patients. Recent evidence suggests that home-based palliative care reduces hospitalizations and decrease the probability of 30-day re-admissions in patients with advanced heart failure; thus, potentially reducing costs of care and increasing likelihood of dying at home. However, caregiver burden for families of those with heart failure remains an issue. Research that addresses caregiver burden and the challenges of providing palliative care to patients with the uncertain disease trajectory seen in advanced heart failure require further research.
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Curr Opin Support Palliat Care · Dec 2013
ReviewStatus of palliative care in Latin America: looking through the Latin America Atlas of Palliative Care.
Several studies have been published reporting the status of palliative care in different countries of Latin America, but no studies have been published on the status of the discipline across the whole region. This article provides a summary of the current situation as reported in the Atlas of Palliative Care recently completed by the Latin American Association for Palliative Care. The aim of this project was to collect information on the degree of palliative care development, help create a network, and influence the progress of palliative care across Latin America. ⋯ The information in this review gives a broad notion of the current status of palliative care in Latin America. The Atlas is expected to help the progress of palliative care and serve as a driver of the field in Latin America and other regions.