scholarly journals Practice review: Evidence-based and effective management of pain in patients with advanced cancer

2020 ◽  
Vol 34 (4) ◽  
pp. 444-453
Author(s):  
Emma J Chapman ◽  
Zoe Edwards ◽  
Jason W Boland ◽  
Matthew Maddocks ◽  
Lucy Fettes ◽  
...  
Keyword(s):  
Pain Management ◽  
Advanced Cancer ◽  
Management Practice ◽  
Anaesthetic Techniques ◽  
Evidence Base ◽  
Medline Search ◽  
Strong Opioid ◽  
Drug Of Choice ◽  
Cochrane Database ◽  
Practice Review

Background: Pain of a moderate or severe intensity affects over half of patients with advanced cancer and remains undertreated in at least one-third of these patients. Aim: The aim of this study was to provide a pragmatic overview of the evidence supporting the use of interventions in pain management in advanced cancer and to identify where encouraging preliminary results are demonstrated but further research is required. Design: A scoping review approach was used to examine the evidence supporting the use of guideline-recommended interventions in pain management practice. Data sources: National or international guidelines were selected if they described pain management in adult cancer patients and were written within the last 5 years in English. The Cochrane Database of Systematic Reviews (January 2014 to January 2019) was searched for ‘cancer’ AND ‘pain’ in the title, abstract or keywords. A MEDLINE search was also made. Results: A strong opioid remains the drug of choice for treating moderate or severe pain. Bisphosphonates and radiotherapy are also effective for cancer-related bone pain. Optimal management requires a tailored approach, support for self-management and review of treatment outcomes. There is likely a role for non-pharmacological approaches. Paracetamol should not be used in patients taking a strong opioid to treat pain. Cannabis-based medicines are not recommended. Weak opioids, ketamine and lidocaine are indicated in specific situations only. Conclusion: Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation.

scholarly journals Practice review: Evidence-based and effective management of fatigue in patients with advanced cancer

2021 ◽  
pp. 026921632110467
Author(s):  
Emma J Chapman ◽  
Erica Di Martino ◽  
Zoe Edwards ◽  
Kathryn Black ◽  
Matthew Maddocks ◽  
...  
Keyword(s):  
Energy Conservation ◽  
Advanced Cancer ◽  
Healthcare Professionals ◽  
Nutritional Intervention ◽  
Evidence Base ◽  
Exercise Interventions ◽  
Fatigue Exercise ◽  
Cochrane Database ◽  
Pubmed Search ◽  
The Impact

Background: Fatigue affects most patients living with advanced cancer and is a symptom that healthcare professionals can find difficult to manage. Aim: To provide healthcare professionals with a pragmatic overview of approaches to management of fatigue in patients with advanced cancer that are commonly recommended by guidelines and to evaluate evidence underpinning them. Design: Scoping review methodology was used to determine the strength of evidence supporting use of interventions recommended in management of fatigue in patients with advanced cancer. Data sources: National or international guidelines were examined if they described the management of fatigue in adult cancer patients and were written within the last 6 years (2015–2021) in English. The Cochrane Database of Systematic Reviews (January 2011–December 2021) was searched for ‘cancer’ AND ‘fatigue’ in title, abstract or keywords. A PubMed search was also made. Results: Evidence indicates physical exercise interventions are effective and patients may benefit from energy conservation tactics. Evidence does not support use of psychostimulants such as methylphenidate. Limited data were found on efficacy of corticosteroids, psychological interventions, nutritional intervention, sleep optimization or complementary therapies for management of fatigue in advanced cancer. Conclusion: We recommend regular assessment, review and acknowledgement of the impact of fatigue. Exercise and energy conservation should be considered. Pharmacological interventions are not endorsed as a routine approach. Many interventions currently recommended by guidelines are not supported by a robust evidence base and further research on their efficacy is required.

Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer

2021 ◽  
pp. 026921632098671
Author(s):  
Janet Hardy ◽  
Alison Haywood ◽  
Kirsty Rickett ◽  
Libby Sallnow ◽  
Phillip Good
Keyword(s):  
Advanced Cancer ◽  
Symptom Control ◽  
Evidence Base ◽  
Poor Quality ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Significant Toxicity ◽  
Prescribing Practice ◽  
Practice Review ◽  
Randomised Controlled

Background: It would be unusual for a patient with advanced cancer not to be prescribed corticosteroids at some stage of their disease course for a variety of specific and non-specific indications. Aim: The aim of this practice review was to provide a pragmatic overview of the evidence supporting current practice and to identify areas in which further research is indicated. Design: A ‘state-of-the-art’ review approach was used to examine the evidence supporting the use of corticosteroids for the management of cancer-related complications and in symptom control, in the context of known risks and harms to inform quality use of this medicine. We developed ‘Do’, ‘Do not’, and ‘Don’t know’ recommendations based on current literature and identified areas for future investigation and research. Data sources: We searched MEDLINE, EMBASE and the Cochrane library from inception to 14th October 2020. Our initial search limited to reviews, reviews of reviews, randomised controlled trials (RCTs) and controlled trials was supplemented by supporting literature as appropriate. Results: Evidence to support common practice in the use of corticosteroids is lacking for most indications. This is in the context of strong evidence for the potential for significant toxicity and poor quality use of medicine. Conclusion: Guidelines recommending the widespread use of corticosteroids should acknowledge the poor evidence base supporting much current dogma. Quality research is essential not only to define the role of corticosteroids in this context but to ensure good prescribing practice.

scholarly journals Pain management practice patterns after hip arthroscopy: an international survey

2020 ◽  
Author(s):  
Flávio L Garcia ◽  
Brady T Williams ◽  
Bhargavi Maheshwer ◽  
Asheesh Bedi ◽  
Ivan H Wong ◽  
...  
Keyword(s):  
Pain Management ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Sports Medicine ◽  
Management Practice ◽  
Professional Organizations ◽  
International Survey ◽  
Nerve Blocks ◽  
Optimal Approach ◽  
Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

scholarly journals Paramedic Pain Management Practice with Introduction of a Non-opiate Treatment Protocol

2020 ◽  
Vol 21 (5) ◽  
Author(s):  
Laurel O'Connor ◽  
Julianne Dugas ◽  
Jeffrey Brady ◽  
Andrew Kamilaris ◽  
Steven Shiba ◽  
...  
Keyword(s):  
Pain Management ◽  
Management Practice ◽  
Treatment Protocol ◽  
Opiate Treatment

Seksueel onaangepast gedrag bij een patiënt met dementie: literatuurreview en casusrapport

2021 ◽  
Author(s):  
C. SEAUX ◽  
K. GOEDSEELS ◽  
J. DE LEPELEIRE
Keyword(s):  
Case Studies ◽  
Randomised Controlled Trials ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Pharmacological Interventions ◽  
Drug Of Choice ◽  
Cochrane Database ◽  
History Of ◽  
Randomised Controlled

Sexually inappropriate behaviour in a patient with dementia: literature review and case report In this paper, the medical history of a 75-year-old man with dementia and sexually inappropriate behaviour (SIB) is described. An overview of the literature regarding the approach and treatment of SIB in persons with dementia was performed. PubMed, Web of Science and the Cochrane database were consulted, and thirteen articles selected. There are no randomised controlled trials available. The literature is limited to case studies and reviews of case studies. Non-pharmacological treatments are perceived to be the first step, although they are rarely studied. There is no consensus regarding a pharmacological approach. However, all studies suggest the paradigm of “start low and go slow”. A variety of drugs have been described. When starting a pharmacological treatment, it is recommended to keep in mind comorbidities and possible side-effects. Selective serotonin reuptake inhibitors (SSRIs) seem to be the preferred first line treatment if the behaviour is not too harmful. If the behaviour is intrusive, anti-androgens seem to be the drug of choice. Further research is needed: a consensus regarding the definition and the development of a screening tool could support randomised controlled trials concerning pharmacological and non-pharmacological interventions. Research concerning ethical dilemmas should, however, not be neglected.

scholarly journals Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Abdul Rouf Pallivalappila ◽  
Derek Stewart ◽  
Ashalatha Shetty ◽  
Binita Pande ◽  
James S. McLay
Keyword(s):  
Systematic Review ◽  
Healthcare Professionals ◽  
Herbal Medicines ◽  
Evidence Base ◽  
Validity And Reliability ◽  
Alternative Medicines ◽  
Cochrane Database ◽  
Medicines Use ◽  
Data Validity ◽  
Cam Use

Aims. To undertake a systematic review of the recent (2008–2013) primary literature, describing views and experiences of CAM use during pregnancy by women and healthcare professionals.Method. Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Review Library and Allied, and Complementary Medicine Database were searched. Studies reporting systemic CAM products (homeopathic preparations, herbal medicines, Vitamins and minerals, homeopathy, and special diets) alone or in combination with other nonsystemic CAM modalities (e.g., acupuncture) were included.Results. Database searches retrieved 2,549 citations. Removal of duplicates followed by review of titles and abstracts yielded 32 relevant studies. Twenty-two reported the perspectives of women and their CAM use during pregnancy, while 10 focused on healthcare professionals. The majority of studies had significant flaws in study design and reporting, including a lack of appropriate definitions of CAM and associated modalities, absence of detailed checklists provided to participants, the use of convenience sampling, and a general lack of scientific robustness in terms of data validity and reliability.Conclusion. To permit generalisability of study findings, there is an urgent need to expand the evidence base assessing CAMs use during pregnancy using appropriately designed studies.

scholarly journals Identification and Reporting of Patient and Public Partner Authorship on Knowledge Syntheses: Rapid Review (Preprint)

2021 ◽  
Author(s):  
Ursula Ellis ◽  
Vanessa Kitchin ◽  
Mathew Vis-Dunbar
Keyword(s):  
Public Involvement ◽  
Geographic Location ◽  
Patient And Public Involvement ◽  
Advisory Council ◽  
Rapid Review ◽  
Medline Search ◽  
Ovid Medline ◽  
Cochrane Database ◽  
Wide Range ◽  
Scoping Reviews

BACKGROUND Patient and public involvement (PPI) in health research is an area of growing interest. Several studies have examined the use and impact of PPI in knowledge syntheses (systematic, scoping, and related reviews); however, few studies have focused specifically on the patient or public coauthorship of such reviews. OBJECTIVE This study seeks to identify published systematic and scoping reviews coauthored by patient or public partners and examine the characteristics of these coauthored reviews, such as which journals publish them, geographic location of research teams, and terms used to describe patient or public partner authors in affiliations, abstracts, or article text. METHODS We searched CAB Direct, CINAHL, Cochrane Database of Systematic Reviews (Ovid), Embase (Ovid), MEDLINE (Ovid), and PsycInfo from 2011 to May 2019, with a supplementary search of several PPI-focused databases. We refined the Ovid MEDLINE search by examining frequently used words and phrases in relevant search results and searched Ovid MEDLINE using the modified search strategy in June 2020. RESULTS We screened 13,998 results and found 37 studies that met our inclusion criteria. In line with other PPI research, we found that a wide range of terms were used for patient and public authors in author affiliations. In some cases, partners were easy to identify with titles such as patient, caregiver or consumer representative, patient partner, expert by experience, citizen researcher, or public contributor. In 11% (n=4) of studies, they were identified as members of a panel or advisory council. In 27% (n=10) of articles, it was either impossible or difficult to tell whether an author was a partner solely from the affiliation, and confirmation was found elsewhere in the article. We also investigated where in the reviews the partner coauthors’ roles were described, and when possible, what their specific roles were. Often, there was little or no information about which review tasks the partner coauthors contributed to. Furthermore, only 14% (5/37) of reviews mentioned patient or public involvement as authors in the abstract; involvement was often only indicated in the author affiliation field or in the review text (most often in the methods or contributions section). CONCLUSIONS Our findings add to the evidence that searching for coproduced research is difficult because of the diversity of terms used to describe patient and public partners, and the lack of consistent, detailed reporting about PPI. For better discoverability, we recommend ensuring that patient and public authorships are indicated in commonly searched database fields. When patient and public-authored research is easier to find, its impact will be easier to measure.

scholarly journals The neglected role of distress in pain management: qualitative research on a gastrointestinal ward

2018 ◽  
Vol 18 (3) ◽  
pp. 399-407
Author(s):  
Gareth Drake ◽  
Amanda C. de C. Williams
Keyword(s):  
Pain Management ◽  
Management Practice ◽  
Clinical Staff ◽  
University Hospital ◽  
Emotional Impact ◽  
Junior Doctors ◽  
Management Processes ◽  
Emergent Structure ◽  
The Impact

Abstract Background and aims Pain management for hospital inpatients remains suboptimal. Previously identified barriers to optimal pain management include staff communication difficulties, confusion around pain management roles and a lack of suitable resources for clinical staff. The emotional, relational and contextual complexities of gastrointestinal (GI) pain create particular challenges for frontline clinical staff attempting to implement a biopsychosocial approach to its management. The current study took place over 2 years, comprised an ethnographic and a feedback phase, and aimed to examine pain management processes with clinical staff in order to generate hypotheses and initiatives for improvement. This paper focuses on two overarching themes identified in the ethnographic phase of the study, centred on the neglected role of both staff and patient distress in GI pain management. Methods Grounded theory and thematic analysis methods were used as part of action research, which involves collaborative working with clinical staff. The study took place on a 60 bed GI ward in a university hospital in London. Participants were clinical staff who were either ward-based or involved in the care of particular patients. This latter group included doctors, nurses, psychologists and physiotherapists from the Acute and Complex Pain Teams. Qualitative data on pain management processes was gathered from staff interviews, consultation groups, and observations of patient-staff interactions. Recruitment was purposive and collaborative in that early participants suggested targets and staff groups for subsequent enquiry. Following the identification of initial ethnographic themes, further analysis and the use of existing literature led to the identification of two overarching pain management processes. As such the results are divided into three sections: (i) illustration of initial ethnographic themes, (ii) summary of relevant theory used, (iii) exploration of hypothesised overarching processes. Results Initially, two consultation groups, five nursing staff and five junior doctors, provided key issues that were included in subsequent interviews (n=18) and observations (n=5). Initial ethnographic themes were divided into challenges and resources, reflecting the emergent structure of interviews and observations. Drawing on attachment, psychodynamic and evolutionary theories, themes were then regrouped around two overarching processes, centred on the neglected role of distress in pain management. The first process elucidates the lack of recognition during pain assessment of the emotional impact of patient distress on staff decision-making and pain management practice. The second process demonstrates that, as a consequence of resultant staff distress, communication between staff groups was fraught and resources, such as expert team referral and pharmacotherapy, appeared to function, at times, to protect staff rather than to help patients. Interpersonal skills used by staff to relieve patient distress were largely outside systems for pain care. Conclusions Findings suggest that identified “barriers” to optimal pain management likely serve an important defensive function for staff and organisations. Implications Unless the impact of patient distress on staff is recognised and addressed within the system, these barriers will persist.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

Physician Pain Management Practice Questionnaire

2007 ◽  
Author(s):  
Brenda Breuer ◽  
Marco Pappagallo ◽  
Julia Y. Tai ◽  
Russell K. Portenoy
Keyword(s):  
Pain Management ◽  
Management Practice
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