scholarly journals Assessment and Management of Pain in Palliative Care

2021 ◽  
Author(s):  
Sonika Charak ◽  
Robin George Thattil ◽  
Chandra Mohan Srivastava ◽  
Prabhu Prasad Das ◽  
Manish Shandilya
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Palliative Care ◽  
Cancer Pain ◽  
Pain Assessment ◽  
Staging System ◽  
Pain Site ◽  
Pain Receptors ◽  
Brain And Spinal Cord

Palliative care is an essential component in any disease management. Pain assessment acts as the connecting link between the nerves, brain and spinal cord. Classification and assessment of the pain have great significance in controlling the pain-related symptoms. Pain is broadly divided into three types nociceptive, neuropathic and mixed depending upon the damage caused. Nociceptive pain is caused due to the stimulation of the pain receptors in the tissues and is further divided into visceral and somatic depending on the pain site. Neuropathic pain arises when the nervous system gets damaged or start dysfunctioning. Cancer pain assessment includes several factors like the site, intensity, syndrome, timing and temporal variation of pain. Edmonton staging system for cancer pain prognostic is widely used for pain management includes emotional/psychological distress cognitive impairment caused by pain. A comprehensive understanding of pain assessment will help in enhancing the quality of life of the patients.

Palliative Care Emergencies

2018 ◽  
Author(s):  
Sriram Yennurajalingam
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Spinal Cord ◽  
Palliative Care ◽  
Superior Vena ◽  
Cord Compression ◽  
Risk And Benefit ◽  
Life Decision ◽  
Exacerbation Of Symptoms

Palliative care emergencies are both cancer and non-cancer-related events that demand immediate remedy or action because they cause acute exacerbation of symptoms that affect quality of life. Decision-making with regard to the type of treatment for these emergencies is critical and should be based on (a) reversibility of the problem, (b) improvement/maintenance of the patient’s quality of life with reversal, (c) the patient’s general condition and prognosis, (d) patient and family goals, and (e) the risk and benefit of treatment versus distress of symptoms. Common emergencies include spinal cord compression, hypercalcemia, impeding pathological fracture, superior vena caval syndrome, seizures, bleeding, and uncontrolled symptoms such as pain and dyspnea.

scholarly journals An Assessment of Cancer Pain Control in an LMIC Oncology Clinic

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 230s-230s
Author(s):  
A. Joseph ◽  
O. Salako ◽  
A. Alabi ◽  
A. Adenipekun
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Pain Assessment ◽  
Pain Control ◽  
Assessment Tool ◽  
Study Group ◽  
Care Providers ◽  
Prevalence Of Pain

Background: Cancer has become a leading cause of morbidity and mortality in adults globally. Pain is universally one of the most commonly encountered symptoms by health and supportive care providers involved in care of cancer patients. Inadequate pain control negatively impacts the patient´s quality of life, and may slow down the healing process. Health care providers often ignore pain control as a target of treatment as they focus on reducing the tumor burden. Pain management should be considered an important target and end point in the treatment of cancer patients. Aim: To assess the prevalence of pain, oncologists´ prescribing patterns; and efficacy of pain control in the Radiotherapy Department of the Lagos University Teaching Hospital. Methods: Adult cancer outpatients were assessed using a Universal Pain Assessment Tool and followed up for 2-6 weeks thereafter. Pain scores were assessed at first interview and at the follow-up appointment within 2 weeks minimum and 6 weeks maximum. Results: 347 adult clinic attendees were recruited, assessed, and followed up with interviewer-administered questionnaires over a close-out period of 6 weeks. There was an 85% (298 respondents) prevalence of pain in the study group; with over half of respondents characterizing their pain in the moderate to severe ranges. [Figure: see text] 9 out of 10 respondents stated the cancer was the primary source of their pain. Other sources of pain were medical tests; and treatment-related such as chemotherapy and radiation therapy. 86 patients (29% of study group) were not asked about pain by their attending physician, and all respondents stated their physician had not used any pain assessment tool to determine the nature or severity of their pain. [Figure: see text] Oral nonsteroidal analgesics were the most frequently prescribed form of pain control (237 patients), with radiotherapy coming in second (69 patients). The only available strong opioid analgesics at the oncology pharmacy were oral morphine and parenteral pentazocine. Oxycodone, fentanyl pethidine, and hydromorphone were unavailable. Interventional (e.g., cordotomy) and alternative (e.g., massage) forms of pain control were not prescribed in any patients. 43 respondents (15%) despite being in pain, did not receive any form of treatment or recommendation for pain control. At follow-up appointment 2-6 weeks after; 4 out of 10 respondents had not obtained pain relief from instituted measures. [Figure: see text] Conclusion: Undertreatment of cancer pain remains a major concern. The treatment process must begin with a proper and thorough evaluation of the patient's pain; a clear pain control goal and end point target; and regular reevaluation with application of guidelines when adequate control is not achieved. Inclusion of pain assessment and management guidelines in medical training would be of benefit to reduce the prevalence of inadequately controlled pain in patients living with cancer; ultimately improving their quality of life.

Homoeopathy in Cancer Pain Palliation and End of Life with Future Perspectives

2019 ◽  
Vol 32 (02) ◽  
pp. 095-104
Author(s):  
Jyoti Sachdeva ◽  
Joy Kumar Dey
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Pain ◽  
End Of Life ◽  
Disease Process ◽  
Symptom Burden ◽  
Holistic Approach ◽  
Future Perspective ◽  
Pain Palliation

AbstractPain is a common companion of people receiving palliative care in cancer and at the end of life. Cancer pain is multifactorial and complex. Its impact can be devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process and due to treatment-related side effects; therefore, it requires a holistic approach which can be covered by homoeopathic remedies. The purpose of this article is to enlighten the scope and future perspective of homoeopathy in pain palliative care and at the end of life. This article summarises the need of multidimensional approach towards the cancer pain palliation and at the end of life in which homoeopathy may play a key role of supportive care. Homoeopathy may become a valuable treatment in palliative care to provide relief and comfort to the dying patient, and therefore the fear of death may reduce and the family may be better prepared for the bereavement. Homoeopathy can well integrate with standard oncologic cares to improve patient outcome including symptom burden, quality of life and end-of-life outcomes, all achieved with low associated costs.

scholarly journals Leveraging Smart Health Technology to Empower Patients and Family Caregivers in Managing Cancer Pain: Protocol for a Feasibility Study

10.2196/16178 ◽  
2019 ◽  
Vol 8 (12) ◽  
pp. e16178 ◽  
Author(s):  
Virginia LeBaron ◽  
James Hayes ◽  
Kate Gordon ◽  
Ridwan Alam ◽  
Nutta Homdee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Pain ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Care Providers ◽  
Patients With Cancer ◽  
Smart Watch ◽  
Smart Health

Background An estimated 60%-90% of patients with cancer experience moderate to severe pain. Poorly managed cancer pain negatively affects the quality of life for both patients and their family caregivers and can be a particularly challenging symptom to manage at home. Mobile and wireless technology (“Smart Health”) has significant potential to support patients with cancer and their family caregivers and empower them to safely and effectively manage cancer pain. Objective This study will deploy a package of sensing technologies, known as Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), and evaluate its feasibility and acceptability among patients with cancer-family caregiver dyads. Our primary aims are to explore the ability of BESI-C to reliably measure and describe variables relevant to cancer pain in the home setting and to better understand the dyadic effect of pain between patients and family caregivers. A secondary objective is to explore how to best share collected data among key stakeholders (patients, caregivers, and health care providers). Methods This descriptive two-year pilot study will include dyads of patients with advanced cancer and their primary family caregivers recruited from an academic medical center outpatient palliative care clinic. Physiological (eg, heart rate, activity) and room-level environmental variables (ambient temperature, humidity, barometric pressure, light, and noise) will be continuously monitored and collected. Behavioral and experiential variables will be actively collected when the caregiver or patient interacts with the custom BESI-C app on their respective smart watch to mark and describe pain events and answer brief, daily ecological momentary assessment surveys. Preliminary analysis will explore the ability of the sensing modalities to infer and detect pain events. Feasibility will be assessed by logistic barriers related to in-home deployment, technical failures related to data capture and fidelity, smart watch wearability issues, and patient recruitment and attrition rates. Acceptability will be measured by dyad perceptions and receptivity to BESI-C through a brief, structured interview and surveys conducted at deployment completion. We will also review summaries of dyad data with participants and health care providers to seek their input regarding data display and content. Results Recruitment began in July 2019 and is in progress. We anticipate the preliminary results to be available by summer 2021. Conclusions BESI-C has significant potential to monitor and predict pain while concurrently enhancing communication, self-efficacy, safety, and quality of life for patients and family caregivers coping with serious illness such as cancer. This exploratory research offers a novel approach to deliver personalized symptom management strategies, improve patient and caregiver outcomes, and reduce disparities in access to pain management and palliative care services. International Registered Report Identifier (IRRID) DERR1-10.2196/16178

scholarly journals ‘Was it worth it?’ Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers

2017 ◽  
Vol 32 (1) ◽  
pp. 287-293
Author(s):  
Nishi Patel ◽  
Melanie Huddart ◽  
Helen Makins ◽  
Theresa Mitchell ◽  
Jane L Gibbins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Drug Delivery ◽  
Palliative Care ◽  
Side Effects ◽  
Cancer Pain ◽  
Family Carers ◽  
Incurable Cancer ◽  
Intrathecal Drug Delivery ◽  
The Individual

Background: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. Aim: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer. Design: Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres. Setting: A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded. Results: In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal – relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best – an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? – the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life. Conclusion: Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals ‘to be themselves’. Under these circumstances, the carers judged significant side effects to be acceptable.

scholarly journals Application of Palliative Care in Improving the Quality of Life of Patients with Cancer Pain

2017 ◽  
Vol 07 (04) ◽  
pp. 473-480
Author(s):  
Zuyan Fan ◽  
Jinxiang Lin ◽  
Xiangwei Chen ◽  
Xiuyan Huang
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Pain ◽  
Patients With Cancer

scholarly journals Leveraging Smart Health Technology to Empower Patients and Family Caregivers in Managing Cancer Pain: Protocol for a Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Virginia LeBaron ◽  
James Hayes ◽  
Kate Gordon ◽  
Ridwan Alam ◽  
Nutta Homdee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Pain ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Care Providers ◽  
Patients With Cancer ◽  
Smart Watch ◽  
Smart Health

BACKGROUND An estimated 60%-90% of patients with cancer experience moderate to severe pain. Poorly managed cancer pain negatively affects the quality of life for both patients and their family caregivers and can be a particularly challenging symptom to manage at home. Mobile and wireless technology (“Smart Health”) has significant potential to support patients with cancer and their family caregivers and empower them to safely and effectively manage cancer pain. OBJECTIVE This study will deploy a package of sensing technologies, known as Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), and evaluate its feasibility and acceptability among patients with cancer-family caregiver dyads. Our primary aims are to explore the ability of BESI-C to reliably measure and describe variables relevant to cancer pain in the home setting and to better understand the dyadic effect of pain between patients and family caregivers. A secondary objective is to explore how to best share collected data among key stakeholders (patients, caregivers, and health care providers). METHODS This descriptive two-year pilot study will include dyads of patients with advanced cancer and their primary family caregivers recruited from an academic medical center outpatient palliative care clinic. Physiological (eg, heart rate, activity) and room-level environmental variables (ambient temperature, humidity, barometric pressure, light, and noise) will be continuously monitored and collected. Behavioral and experiential variables will be actively collected when the caregiver or patient interacts with the custom BESI-C app on their respective smart watch to mark and describe pain events and answer brief, daily ecological momentary assessment surveys. Preliminary analysis will explore the ability of the sensing modalities to infer and detect pain events. Feasibility will be assessed by logistic barriers related to in-home deployment, technical failures related to data capture and fidelity, smart watch wearability issues, and patient recruitment and attrition rates. Acceptability will be measured by dyad perceptions and receptivity to BESI-C through a brief, structured interview and surveys conducted at deployment completion. We will also review summaries of dyad data with participants and health care providers to seek their input regarding data display and content. RESULTS Recruitment began in July 2019 and is in progress. We anticipate the preliminary results to be available by summer 2021. CONCLUSIONS BESI-C has significant potential to monitor and predict pain while concurrently enhancing communication, self-efficacy, safety, and quality of life for patients and family caregivers coping with serious illness such as cancer. This exploratory research offers a novel approach to deliver personalized symptom management strategies, improve patient and caregiver outcomes, and reduce disparities in access to pain management and palliative care services. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16178

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