Opioids in Palliative Care
Palliative Care; Palliative care; Analgesics, Opioid; Opioids; Cancer pain; Noncancer pain
Palliative care is an essential part of the right to health of all human beings. This medical specialty aims to improve the quality of life of patients with chronic or life-threatening conditions, their families, and caregivers. This chapter presents some conditions that benefit from palliative care and the role of opioids as pain killers and agents used to alleviate symptoms in patients with cystic fibrosis, end-of-life breathlessness, cardiovascular diseases, sickle cell disease, chronic kidney disease, and advanced chronic liver disease. It also mentions specific opioids that can be used or avoided in patients with impaired kidney or liver function, reviews opioid use for pain management in children in palliative care and at the end of life, and provides references to main opioid prescribing guidelines. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
Salazar-Trujillo NV; Torres-Méndez R; Molina-Covarrubias JC
Opioids: Pharmacology, Abuse, and Addiction
2022
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/978-3-031-09936-6_11" target="_blank" rel="noreferrer noopener">10.1007/978-3-031-09936-6_11</a>
Barriers and Adherence to Pain Management in Advanced Cancer Patients
palliative care; barriers; cancer pain; opioids; adherence to medication
AIM: To assess patients' barriers to pain management and analgesic medication adherence in advanced cancer patients METHODS: Prospective cross-sectional study in advanced cancer patients receiving chronic opioid therapy. Age, gender, cancer diagnosis, Karnofsky level, and educational status were recorded. collected. These included age, gender, cancer diagnosis, Karnofsky level, and educational status. The Brief Pain Inventory (BPI), the Edmonton Symptom Assessment Scale (ESAS), the Memorial Delirium Assessment Scale (MDAS), the Barriers Questionnaire II (BQ-II), medication Adherence Rating Scale (MARS), and Hospital Anxiety and Depression Scale (HADS) were measured. RESULTS: One-hundred-thirteen patients were analyzed. The mean age was 68 (± 13) years and 59 (52%) were males. The mean Karnofsky status was 51.4 (SD 11.5). The mean value of BQ-II items was 1.77 (SD 0.7). BQ-II was independently related with HADS-D (p=0.033), and with total HADS (p=0.049). Negative side-effects and attitudes to psychotropic medication globally prevailed among MARS items. These items were independently associated with gender (P=0.030), pain (; p=0.003), and depression (p= 0.047). CONCLUSION: Barriers to pain management were mild. Psychological factors such as depression were the main factor associated with barriers. Poor adherence to analgesic medication was mostly manifested as negative side-effects and attitudes to psychotropic medication, was more frequent observed in females and was associated with ESAS items pain and depression.
Mercadante S; Adile C; Tirelli W; Ferrera P; Penco I; Casuccio A
Pain Practice
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/papr.12965" target="_blank" rel="noreferrer noopener">10.1111/papr.12965</a>
Pediatric Palliative Care Pharmacy Pearls-A Focus on Pain and Sedation
pediatrics; palliative care; pain; pharmacology; opioids
Determining the optimal dosing regimen for pediatric patients is a challenge due to the lack of dosing guidelines and studies. In addition, many developmental pharmacology changes that occur throughout childhood that have profound impacts on the absorption, distribution, metabolism, and elimination of medications are commonly used in palliative care. Adding to that complexity, certain medications have different effects in the pediatric patient compared to the adult patient. Being aware of the pharmacokinetic changes, impact on neurodevelopment and unique medication factors that are present in pediatric patients helps clinicians treat the pediatric palliative care patient in the best and safest way possible.
Placencia J; Madden K
Children
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3390/children8100902" target="_blank" rel="noreferrer noopener">10.3390/children8100902</a>
Development and validation of pediatric opioid analgesia self-instruction system (pedoasis): An opioid knowledge tool for pediatric clinicians
education; opioids; pediatric pain; pediatric palliative care
Background: Acute pain is common in children and young adults with cancer and sickle cell disease. Current training curricula fail to adequately impart skills for pain management. We sought to develop and validate an education and assessment tool to address the safe effective use of opioids for pain management by pediatrics trainees. Method(s): The first version of the tool contained 10 case-based, multiple-choice questions. It was pilot tested within a medium-sized pediatric residency program using preintervention and postintervention surveys to assess residents' knowledge and comfort related to prescribing opioids. Content validation was performed through an expert panel of physicians. Internal reliability was tested by administering the tool to learners and practitioners with varying levels of training. Result(s): Comfort with choosing and converting between opioids increased significantly in pilot testing (P=0.005). Mean objective knowledge scores increased from 51% to 85.9% (P<0.001). The revised tool showed internal reliability within each group (Cronbach alpha 0.71 to 0.78) and significant differences in mean scores between groups (F ratio=9.45, P=0.0002). Conclusion(s): This tool demonstrates validity and internal reliability. Its use was associated with short-term educational gains and it garnered overall favorable feedback from users. Further testing is needed to assess the duration of these gains. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
MacDonell-Yilmaz RE; Anderson A; Hirway P; Welch JG
Journal of Pediatric Hematology/Oncology.
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MPH.0000000000002275" target="_blank" rel="noreferrer noopener">10.1097/MPH.0000000000002275</a>
Healthcare professionals' views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: A focus group study (DIPPER)
Breakthrough pain; diamorphine; focus groups; opioids; paediatrics; pain management; palliative care; terminal care
Background: Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed. Aim(s): To explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial. Design/ participants: Three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (n = 28), caring for children with life-limiting illnesses receiving palliative care, participated. Result(s): Oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement. Conclusion(s): There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome. Copyright © The Author(s) 2021.
Jamieson L; Harrop E; Johnson M; Liossi C; Mott C; Oulton K; Skene SS; Wong ICK; Howard RF
Palliative Medicine.
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/02692163211008737" target="_blank" rel="noreferrer noopener">10.1177/02692163211008737</a>
A Soldier’s War on Pain
Pain; Veterans; Afghanistan War (2001- ); Opioids; Pain-Relieving Drugs; Savage; Shane; Therapy and Rehabilitation; United States Defense and Military Forces; Veterans Affairs Department
After turning away from prescribed narcotics, a wounded Army sergeant has found hope. And some doctors see lessons for the business of long-term pain management.
2014-05
Meier B
The New York Times
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article