Current opinion in supportive and palliative care
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Recent reports of the benefits of helium/oxygen gas mixtures (heliox) use for the relief of dyspnoea and exercise limitation have stimulated interest in the use of heliox in the palliation of dyspnoea especially in chronic obstructive pulmonary disease patients. With better understanding of the mechanistic causes of dyspnoea in these patients theoretical benefits of heliox have been suggested. This report considers the evidence to support this role and reviews the current position on heliox administration and use as a carrier gas for nebulization therapies. ⋯ Heliox use could prove beneficial either administered alone or as an addition to current therapies for the palliation of dyspnoea and give significant improvement in outcomes of rehabilitation programmes. There is still an urgent need to identify which patients are the best candidates for heliox use and translate the significant short-term benefits into long-term improvements in functioning and quality of life.
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Neuropathic pain is a chronic pain condition arising from injury or disease of the peripheral or central nervous system with a substantial impact on quality of life. This brief review focuses on the increasing evidence for effective treatments and discusses an evidence-based algorithm for treating neuropathic pain conditions. ⋯ For each patient, considerations on the underlying pain mechanisms, immediate and potential long-term side effects, and price as well as comorbidities and concurrent medications will decide which drug should be the first choice, but until further progress is made towards a mechanism-based classification, treatment is likely to be a trial-and-error process where drug combinations may also be considered.
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This paper reviews the current evidence for the pharmacological treatment of refractory symptomatic breathlessness in people with advanced life-limiting illnesses. The paper does not explore changes in function. ⋯ Low-dose regular opioids, especially sustained-release preparations, have a key role in the pharmacological management of dyspnoea when titrated for effect, and may be used regularly across a range of underlying pathophysiologies. Key research questions for all the current symptomatic pharmacological agents used in refractory dyspnoea remain.
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To discuss three emerging areas of research triggering new hypotheses for mechanisms of dyspnea. ⋯ Dyspnea in chronic obstructive pulmonary disease is clearly related to hyperinflation, and lung volumes are valuable for characterizing disease. It remains unclear whether a limitation in tidal volume due to dynamic hyperinflation is the key factor in exertional dyspnea in this disease. Research of inhaled furosemide demonstrates the importance of afferent sensory input in modifying dyspnea, and deserves further study. The contributions of the affective and sensory components of dyspnea remain unclear, but should be studied further.
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Curr Opin Support Palliat Care · Aug 2007
ReviewNew aspects in performing interventional techniques for chronic pain.
We will evaluate the usefulness of the new intrathecal analgesic ziconotide in palliative care medicine. We will also examine the place and efficacy of neurolytic celiac plexus blockade in patients suffering from malignancy in the upper abdomen, after introducing better localization methods of the celiac plexus. ⋯ The place of ziconotide in palliative care is doubtful due to unpredictable and sometimes long-lasting side effects. Real evidence on the efficacy and duration of neurolytic celiac plexus blocks for relief of pancreatic cancer pain is still not available. Future studies will need to be performed applying validated measurement instruments and assessing the patient's impression of the procedure's demands in terms of physical and mental tolerance.