Effectively Starting and Titrating Intrathecal Analgesic Therapy in Patients With Refractory Cancer P

Coyne, Patrick; Smith, Thomas J.; Laird, Jill; Hansen, Lea Ann; Drake, David B.

doi:10.1188/05.cjon.581-583

Cited by 16 publications

(6 citation statements)

References 7 publications

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“…In addition to uncontrolled pain, these patients may be further burdened by many unwanted adverse effects associated with the use of their medications. 17 Thus, the most unsatisfactory circumstance whereby a patient continues to experience uncontrolled pain and is additionally burdened by the undesirable adverse effects of opioid medications is one of the most challenging issues in both palliative medicine and pain medicine.…”

Section: Refractory Painmentioning

confidence: 99%

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

O’Brien

Kane

2014

British Journal of Pain

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The vast majority of cancer patients will experience pain during the course of their illness. Thankfully, in most instances, the consistent application of analgesic guidelines, tailored to the unique needs of each individual patient, will deliver a satisfactory outcome. These guidelines recommend the skilled use of analgesic medications, often in conjunction with a range of adjuvant therapies as may be required. Despite the consistent and rational application of such strategies, it is recognised that a small but significant proportion of cancer patients continue to experience more refractory pain. In addition, these patients may experience a plethora of unwanted dose-limiting side effects associated with their analgesic medication, sometimes even at low dose. All such patients with more complex and refractory pain syndromes require a more comprehensive review and many will require interventional therapy and/or adjuvant approaches. Unfortunately, the availability and accessibility of such services are variable. Even in circumstances in which palliative medicine and pain services co-exist in the same region, there may be poor integration between the two services. Each specialty area holds a unique set of skills and competencies, yet there is considerable overlap. Patient care and outcomes will be enhanced by establishing more formal relationships between these two specialty areas.

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Section: Refractory Painmentioning

confidence: 99%

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

O’Brien

Kane

2014

British Journal of Pain

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“…This case demonstrates an example of such a clinical scenario. While there is limited experience with the use of these modalities for pediatric patients at the EOL [ 31 , 32 , 34 , 35 , 36 ], central neuraxial blocks and continuous peripheral nerve blocks are increasingly used for pain control in adult EOL care [ 30 , 37 , 38 , 39 ]. One pediatric study demonstrated that continuous catheter-delivered pain blockade during the EOL contributes to analgesia and mitigates opioid requirements [ 30 ].…”

Section: Case-based Application Of Pst Algorithmmentioning

confidence: 99%

Palliative Sedation Therapy in Pediatrics: An Algorithm and Clinical Practice Update

et al. 2022

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Palliative sedation therapy (PST) is an important clinical intervention for pediatric patients with refractory symptoms and suffering during the end-of-life (EOL) period. Variations in PST implementation including medication selection, limited literature regarding feasibility in various clinical settings, particularly non-intensive care units, and lack of education on evolving definitions and ideal practices may all contribute to the current underutilization of this valuable resource. We therefore offer a clinical algorithm for identifying appropriate patients for PST, ensuring all other modalities for symptom management have been considered and/or optimized, and present a guideline for PST implementation that can be adapted and individualized based on institutional experience and resource availability. Furthermore, through case-based clinical scenarios, we demonstrate how to incorporate this algorithm into EOL practice.

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“…23,51,52 The choice between IT drug infusion versus nerve blocks depends on the localization of pain: abdominal, thoracic, and lumbar pain would be better treated by IT infusion, while lateralized limb pain would be a better candidate to regional nerve blocks. [53][54][55] For example, percutaneous imaging-guided celiac plexus neurolysis is a valid therapeutic alternative in the management of intractable abdominal pain in patients with upper abdominal malignancy [56][57][58][59] (Figure 1). The multidetector computed tomography (MDCT) guidance has superseded other modalities allowing direct visualization of the spread of the neurolytic agent, such as ethanol, in the antecrural space.…”

Section: Peripheral Nerve Blockmentioning

confidence: 99%

Palliative care and pediatric surgical oncology

Inserra

Narciso

Paolantonio

et al. 2016

Seminars in Pediatric Surgery

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Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort.

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Effectively Starting and Titrating Intrathecal Analgesic Therapy in Patients With Refractory Cancer P

Cited by 16 publications

References 7 publications

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

Pain services and palliative medicine – an integrated approach to pain management in the cancer patient

Palliative Sedation Therapy in Pediatrics: An Algorithm and Clinical Practice Update

Palliative care and pediatric surgical oncology

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