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Subcutaneous Use of Baclofen
Painful spasticity is an often debilitating symptom that occurs mostly in patients with neurologic diseases such as multiple sclerosis or stroke. Treatment approaches include pharmacologic and nonpharmacologic interventions. Baclofen is one of the drugs commonly used to decrease elevated muscle tone. This GABAB agonist acts primarily by limiting the release of excitatory neurotransmitters on the spinal level, thereby decreasing spastic muscle tone. Baclofen is licensed for oral and intrathecal use in spasticity. The abrupt cessation of baclofen therapy can lead to withdrawal syndromes including epileptic seizures. Here, we...
Source: Journal of Pain and Symptom Management - May 30, 2014 Category: Palliative Care Authors: Constanze Rémi, Elisabeth Albrecht Tags: Letters Source Type: research

Hospice and Palliative Medicine Clinician Views of Deactivation of Ventricular Assist Devices at End of Life
Left ventricular assist devices (LVADs) provide circulatory support to patients with advanced heart failure. These devices are used as a temporary bridge to recovery, bridge to cardiac transplantation, or as destination therapy (DT)—where the patient will have the device in situ for the remainder of his/her life. Compared to medical management alone, LVAD-DT often improves survival and quality of life for patients with severe heart failure.1 However, patients with LVADs may experience a host of challenges including a catastrophic event (e.g., stroke, hemorrhage, infection), a concurrent slow decline in health (e.g., righ...
Source: Journal of Pain and Symptom Management - May 26, 2015 Category: Palliative Care Authors: Keith M. Swetz, Sara E. Wordingham, Matthew H. Armstrong, Katlyn E. Koepp, Abigale L. Ottenberg Source Type: research

Hospice and Palliative Medicine Clinician Views of Deactivation of Ventricular Assist Devices at the End of Life
Left ventricular assist devices (LVADs) provide circulatory support to patients with advanced heart failure. These devices are used as a temporary bridge to recovery, bridge to cardiac transplantation, or as destination therapy (DT)—where the patient will have the device in situ for the remainder of his/her life. Compared to medical management alone, LVAD-DT often improves survival and quality of life for patients with severe heart failure.1 However, patients with LVADs may experience a host of challenges including a catastrophic event (e.g., stroke, hemorrhage, infection), a concurrent slow decline in health (e.g., righ...
Source: Journal of Pain and Symptom Management - May 26, 2015 Category: Palliative Care Authors: Keith M. Swetz, Sara E. Wordingham, Matthew H. Armstrong, Katlyn E. Koepp, Abigale L. Ottenberg Tags: Letter Source Type: research

The Evolution of an Inpatient Palliative Care Consultation Service in an Urban Teaching Hospital.
CONCLUSION: We describe the evolution of palliative care in a safety-net hospital. Medicine services which are largely resident run adopted early. Specialty services that are attending driven adopted later. We believe house staff and nurses were the initial change agents. The number of consultations increased when house staff and students began rotating on the service suggesting unmet demand due to the limited supply of providers. PMID: 26543069 [PubMed - as supplied by publisher]
Source: The American Journal of Hospice and Palliative Care - November 5, 2015 Category: Palliative Care Authors: Liu OY, Malmstrom T, Burhanna P, Rodin MB Tags: Am J Hosp Palliat Care Source Type: research

Reversible hemiparesis in a patient with migraine.
This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID: 25166776 [PubMed - indexed for MEDLINE]
Source: Journal of Pain and Palliative Care Pharmacotherapy - November 20, 2015 Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research

“This Was Not What I Had in Mind,” and Other Palliative Challenges Encountered in Left Ventricular Assist Device (LVAD) Care (TH321)
With the evolution and growing availability of mechanical circulatory support (MCS) technology for patients with advanced heart failure come new frontiers for palliative care (PC) teams. Although data demonstrates that MCS devices, including left ventricular assist devices (LVADs), can improve survival and quality-of-life for patients with advanced heart failure, patients remain at risk for catastrophic events, like stroke or hemorrhage, persistent functional decline, or progression of other life-threatening medical conditions.
Source: Journal of Pain and Symptom Management - January 29, 2016 Category: Palliative Care Authors: J. Hunter Groninger, George Ruiz, Joan Panke, Anne Kelemen Source Type: research

Palliative Care Clinicians Caring for Patients Before and After Continuous Flow-Left Ventricular Assist Device
Left ventricular assist devices (LVADs) are an available treatment option for carefully-selected patients with advanced heart failure. Initially developed as a bridge to transplantation, LVADs are now also offered to patients ineligible for transplantation as destination therapy (DT). Individuals with a DT-LVAD will live the remainder of their lives with the device in place. While survival and quality of life improve with LVADs compared to medical therapy, complications persist including bleeding, infection, and stroke.
Source: Journal of Pain and Symptom Management - July 12, 2017 Category: Palliative Care Authors: Sara E. Wordingham, Colleen K. McIlvennan, Timothy J. Fendler, Amy L. Behnken, Shannon M. Dunlay, James N. Kirkpatrick, Keith M. Swetz Source Type: research

Seizure Bootcamp: Everything You Ever Needed to Know to Manage Seizures in End Stage Disease (FR455)
Seizures are a common occurrence in end stage disease, occurring in a wide range of conditions, including dementia, stroke, AIDS, end stage renal disease, and both primary brain tumors and metastatic disease. Not only are uncontrolled seizures a significant source of distress to both patient and families, but they present a significant management challenge to the hospice team, who are often faced with controlling seizures in the face of advancing disease, increasing seizure risk factors, and declining ability of the patient to take oral medications.
Source: Journal of Pain and Symptom Management - February 1, 2018 Category: Palliative Care Authors: Mara Lugassy, Neha Kramer, Ebtesam Ahmed, Joel Phillips, Colleen Fleming-Damon Source Type: research

Rectal administration of baclofen at the end of life
Spasticity can be a complicating symptom of a variety of neurological conditions such as multiple sclerosis, motor neuron disease, Creutzfeldt-Jakob disease, or post-stroke. Several pharmacological treatment options are available, including baclofen, tizanidine, gabapentin, botulinum toxin A and tetrahydrocannabinol/canabidiol (1, 2). However, treatment feasibility decreases as the end of life approaches, e.g. when patients are no longer able to tolerate oral medications, the onset of action would be too long, or the initiation of parenteral drug therapy (intravenous, intrathecal) is no longer indicated or appropriate.
Source: Journal of Pain and Symptom Management - August 7, 2018 Category: Palliative Care Authors: Charlotte Selge, Claudia Bausewein, Constanze Remi Source Type: research

Mechanical thrombectomy for Trousseau syndrome in a terminally ill cancer patient
Trousseau syndrome was first described by Armand Trousseau in 1865 and is characterized by hypercoagulation resulting from malignant tumors. This complication can markedly impact quality of life (QOL). This is the first report of a terminally ill patient who developed large-vessel occlusion stroke from Trousseau syndrome and underwent mechanical thrombectomy. A 75-year-old woman presented with stage IV ovarian cancer. Goals of care were transitioned to palliative care. The patient was hospitalized with vertebral compression fracture, and suddenly developed right hemiparesis and total aphasia during admission.
Source: Journal of Pain and Symptom Management - December 18, 2018 Category: Palliative Care Authors: Naoto Kuroda, Hisaya Hiramatsu, Masanori Mori, Tokutaro Tanaka Tags: Palliative Care Rounds Source Type: research

Outpatient Cardiac Palliative Care Reduces Healthcare Utilization (RP524)
The American Heart Association and American Stroke Association have put forth policy statements recommending early and continuous access to palliative care for patients with advanced heart disease. Early integration of palliative care has been proven to improve the quality of life of patients with advanced heart failure. Other studies have suggested that palliative care in general has cost savings to hospital systems.
Source: Journal of Pain and Symptom Management - June 20, 2020 Category: Palliative Care Authors: Todd Barrett Source Type: research

Electroacupuncture for Poststroke Spasticity: Results of a Pilot Pragmatic Randomized Controlled Trial
People with spasticity that occurred between 30  days and one year after stroke onset with a baseline Modified Ashworth Scale (MAS) ≥1.
Source: Journal of Pain and Symptom Management - August 4, 2020 Category: Palliative Care Authors: Yiyi Cai, Claire Shuiqing Zhang, Anthony Lin Zhang, Cliff Da Costa, Charlie Changli Xue, Zehuai Wen Tags: Original Article Source Type: research

Retrospective Analysis of CHA2DS2-VASc and HAS-BLED Scores for Hospitalized Palliative Care Patients with Atrial Fibrillation (S516)
1. Determine the risks and benefits of oral anticoagulation for patients with atrial fibrillation (AF) and serious or advanced illness2. Evaluate the risk categories for stroke and bleed risk in terms of prescribing practices for oral anticoagulation for patients with AF and serious or advanced illness
Source: Journal of Pain and Symptom Management - April 12, 2022 Category: Palliative Care Authors: Abby Stevens, PharmD, Kathryn Walker, PharmD CPE, Kristin Watson, PharmD BCCP, Mary Lynn McPherson, PharmD MA MDE BCPS Source Type: research

Documented Goals of Care Conversations with Hospitalized Patients After Severe Stroke (S513)
1. Understand the prevalence, frequency, timing, and content of a goals-of-care conversation (GOCC)2. Learn best practices in GOCC documentation
Source: Journal of Pain and Symptom Management - April 12, 2022 Category: Palliative Care Authors: Amber Comer, Claire Creutzfeldt, Robert Holloway, Stephanie Bartlett, James Slaven, Linda Williams, Alexia Torke Source Type: research

Documented Goals of Care Conversations with Hospitalized Patients After Severe Stroke (GP715)
1. Understand the prevalence, frequency, timing, and content of a goals-of-care conversation2. Learn best practices in goals-of-care conversation documentation
Source: Journal of Pain and Symptom Management - May 17, 2022 Category: Palliative Care Authors: Amber Comer, Claire Creutzfeldt, Lynn D'Cruz, Stephanie Bartlett, Robert Holloway, Alexia Torke, Laura Petras, Linda Williams Source Type: research

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