Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Mar 2010
ReviewRole of cervical cordotomy and other neurolytic procedures in thoracic cancer pain.
Evaluation of the efficacy and safety of the percutaneous cervical cordotomy (PCC) in palliative care medicine in patients suffering from thoracic cancer pain; fluoroscopy-guided versus computed tomographic-guided PCC. Evaluation of recent developments in other neurolytic procedures in thoracic pain. ⋯ The results of fluoroscopy-guided PCC are satisfactory with case series reporting complete pain reduction in as much as 82-95% of the patients. For CT-guided PCC initial success rates were reported between 80.5-92.5% patients. However, the complication rates and long-term effects if measured and/or mentioned, varied. Hypothetically this technique may be more accurate and therefore probably safer than fluoroscopic-guided PCC.
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Opioids are invaluable in the treatment of moderate-to-severe pain. Unfortunately, their prolonged use may be associated with the onset of opioid-induced hyperalgesia (OIH). This review focuses on recent clinical studies that support or refute the existence of OIH in patients. ⋯ Improvements in paradoxical pain intensity upon discontinuation of opioid therapy suggests that a multidisciplinary method of pain relief is favoured for chronic-pain patients. Quantitative-sensory testing of pain is offered as the most appropriate way of diagnosing hyperalgesia. We can, thus far only reliably validate the existence of OIH development in normal human volunteers receiving acute-morphine infusions.
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Curr Opin Support Palliat Care · Dec 2009
ReviewHospitalization as an opportunity to integrate palliative care in heart failure management.
Hospitalization for heart failure is a critical event associated with high rates of readmissions, morbidity, and mortality. This review examines the role of hospitalization for heart failure as an opportunity to assess comprehensive patient needs including palliative care needs. ⋯ Hospitalization for heart failure should serve as an opportunity to assess, introduce, and provide comprehensive care that includes palliative care alongside optimal medical management. Palliative care services have the potential to positively impact the health and quality of life of patients with heart failure and should be integrated as an ongoing key component of their care.
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Curr Opin Support Palliat Care · Sep 2009
ReviewVertebral augmentation in osteoporotic and osteolytic fractures.
To discuss recent advances in percutaneous minimally invasive vertebral augmentation techniques used in the treatment of osteolytic and osteoporotic compression fractures. ⋯ The incidence of symptomatic vertebral compression fractures is on the rise. For those patients with severe pain or progressive collapse due to osteoporotic or osteolytic vertebral compression fractures, early vertebral augmentation affords excellent early pain relief, early return to function, and restores and maintains sagittal alignment.
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To summarize and discuss recent research aimed at evaluating palliative care services, and other complex interventions in end-of-life care. ⋯ Health services research is crucial in end-of-life care because of the complex services and patients and families cared for. Health services research can provide information about the most effective (and cost-effective) strategies to improve the quality of end-of-life care. During recent years some interesting research and study protocols dealing with the evaluation of complex end-of-life programs have been designed and implemented.