Journal of pain and symptom management
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J Pain Symptom Manage · Oct 2019
Randomized Controlled Trial Multicenter StudyAdditive Duloxetine for Cancer-related Neuropathic Pain Nonresponsive or Intolerant to Opioid-Pregabalin Therapy: A Randomized Controlled Trial (JORTC-PAL08).
Although opioids and pregabalin are widely used for cancer-related neuropathic pain (CNP), no clinical trials exist to determine which medications are effective when an opioid-pregabalin combination therapy fails. ⋯ Adding duloxetine to opioid-pregabalin therapy might have clinical benefit in alleviating refractory CNP. Further studies are needed to conclude the efficacy of adding duloxetine.
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J Pain Symptom Manage · Oct 2019
Randomized Controlled TrialEffect of opioid exposure on efficacy and tolerability of sublingual fentanyl and subcutaneous morphine for severe cancer pain episodes. Secondary analysis from a double-blind double-dummy, randomized trial.
Few studies have addressed the impact of previous opioid exposure on the effect of opioids for the treatment of severe cancer pain episodes. ⋯ In this study, we could not demonstrate an effect of previous opioid exposure, from 20 to 120 mg oral morphine equivalent daily dose, on the absolute and relative efficacy and tolerability of 100 μg FST and 5 mg SCM for severe cancer pain episodes.
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J Pain Symptom Manage · Oct 2019
ReviewPalliative care transitions from acute care to community-based care - a systematic review.
Although the literature on transitions from hospital to the community is extensive, little is known about this experience within the context of palliative care (PC). ⋯ Heterogeneity of study designs, outcomes, findings, and poor methodological quality renders it challenging to draw conclusions regarding PC's impact on the transition from hospital to home. Further research should use standardized outcomes with randomized controlled trial and/or propensity matched cohort designs.
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J Pain Symptom Manage · Oct 2019
Comfort Measures Orders and Hospital Transfers: Insights from the OPTIMISTIC Demonstration Project.
Nursing facility residents and their families may identify "comfort measures" as their overall goal of care, yet some hospital transfers still occur. ⋯ Most transfers of residents with comfort measures orders were considered unavoidable. Nonetheless, we identified several opportunities for improving care processes, including communication and addressing acute changes in status.
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J Pain Symptom Manage · Oct 2019
Reasons for underreporting of uraemic pruritus in people with chronic kidney disease: A qualitative study.
Uremic pruritus, or itch, is common in people with chronic kidney disease (CKD) and has a negative impact on their lives and well-being. However, for reasons currently unknown, itch often remains unreported and therefore untreated. ⋯ Underreporting of itch is related to patients being unaware of its causes, accepting it as something to live with, prioritizing other health issues, and the length and timing of consultations. Health care professionals' assessment and management of itch vary widely and are not necessarily evidence-based. Better patient information, development of clinical practice guidelines, and incorporation of routine symptom assessments into care may improve itch reporting and management in people with CKD.