Stringent Control of Opioids: Sound Public Health Measures, but a Step Too Far in Palliative Care?
AbstractPurpose of ReviewOpioids are the only class of drug with the proven ability to control severe pain. The introduction of stringent opioid prescribing restrictions has inevitably impacted upon the ability of those prescribing opioids for advanced life-limited disease to practice as previously and could limit the supply of adequate pain relief to patients with cancer. This review considers the evidence that symptom management of patients with advanced cancer contributes to the “opioid problem” and whether there is adequate recognition of the risks involved.Recent FindingsThe literature suggests that the risk of opioid abuse is low in the palliative care population as is the risk of legal consequences for doctors prescribing opioids at the end of life. However, as many patients with cancer are living longer or surviving with chronic pain, palliative care physicians must be cognisant not only of the risks of long term opioid use but also of the risk of opioid misuse.SummaryAdherence to evidence or consensus-based guidelines is necessary to avoid inappropriate prescribing. In palliative care, it is appropriate not only to exercise a reasonable degree of opioid control and surveillance, primarily for the good of society, but also to ensure that the ability to treat pain in patients with advanced malignant disease is not compromised.
This article provides an overview of the evidence on the risks and benefits of using medical cannabis for the indications of chronic pain, cancer-related pain, cancer cachexia, dementia, and Alzheimer's disease. Currently, there is insufficient evidence to determine the effectiveness and safety of cannabinoids for most reviewed indications, with the exception of chronic pain. Future research is required before palliative care clinicians can make evidence-based decisions on the integration of medical cannabis as adjunct therapies. PMID: 32312410 [PubMed - in process]
This article provides an overview of the evidence on the risks and benefits of using medical cannabis for the indications of chronic pain, cancer-related pain, cancer cachexia, dementia, and Alzheimer ’s disease. Currently, there is insufficient evidence to determine the effectiveness and safety of cannabinoids for most reviewed indications, with the exception of chronic pain. Future research is required before palliative care clinicians can make evidence-based decisions on the integration of m edical cannabis as adjunct therapies.
The objective of our study was to estimate the healthcare expenditures associated with persistent opioid use among adults with CNCP from both payer and patient perspectives. A retrospective cohort study using data from the Medical Expenditure Panel Survey (2012-2015) was undertaken. Patients with persistent, intermittent, and no opioid use in the baseline year were identified and their healthcare expenditures in the follow-up year were examined after controlling for potential confounders. In all, 7,286 adults with CNCP matching our inclusion criteria were identified: 14%, 16%, and 70% reported persistent, intermittent, and...
Subcutaneous (SC) methylnaltrexone (MNTX, Relistor ®) is approved for opioid-induced constipation (OIC) in adults with chronic noncancer pain and OIC in adults with advanced illness or with active cancer who require opioid dosage escalation for palliative care. This post hoc analysis evaluated data pooled from 3 randomized studies of patients with advanced illness and OIC.
CONCLUSION: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly. PMID: 32041912 [PubMed - in process]
Prashant Sirohiya, Pratishtha Yadav, Sachidanand Jee Bharati, Bhatnagar SushmaIndian Journal of Palliative Care 2020 26(1):142-144 Pain adversely affects the quality of life in cancer patients. Although conventional oral analgesics and co-analgesics manage 80%–90% of pain, interventional pain management techniques may be useful in the management of cancer pain refractory to opioid analgesia or in patients unable to tolerate systemic opioids. Herein, we report three cases depicting the successful role of erector spinae plane block in our palliative care unit for the management of different chronic cancer pain.
Increasing numbers of patients living with serious illness are requesting access to medical cannabis as well as guidance about its use for pain and symptom management, as a disease-modifying drug for cancer and other diseases, and as a strategy to avoid chronic opioid and benzodiazepine use. Select palliative care clinics have incorporated cannabis into their therapeutic toolkit, and “cannabis consultations” have become an entry point for accessing palliative care for some patients. In many states, physicians and advance practice providers are responsible for counseling and registering patients for medical cann...
Palliative care practitioners are increasingly treating patients with comorbid opioid use disorder (OUD), yet guidance is lacking for managing pain in this population. Historically, palliative care clinicians have liberally prescribed opioids to patients with limited prognosis. As medicine has evolved, patients with chronic illnesses, even metastatic cancer, are living longer thanks to immunotherapies and other novel treatments. Thus, palliative care patients are at greater risk of both developing OUD and/or chemical coping while receiving intensive treatments.
Hepatocellular carcinoma (HCC), the most common type of liver cancer, develops as a complication of chronic liver disease. While palliative care has been shown to reduce rates of healthcare utilization in other populations, little is known of the impact of inpatient palliative care consultation for people with HCC.
a Cruz Diane Liu Eduardo Bruera Palliative care is seeing cancer patients earlier in the disease trajectory with a multitude of chronic issues. Chronic non-malignant pain (CNMP) in cancer patients is under-studied. In this prospective study, we examined the prevalence and management of CNMP in cancer patients seen at our supportive care clinic for consultation. We systematically characterized each pain type with the Brief Pain Inventory (BPI) and documented current treatments. The attending physician made the pain diagnoses according to the International Association for the Study of Pain (IASP) task force classific...