Peripheral neuropathic pain syndromes (PNPS) are difficult to treat because commonly used analgesics are often ineffective when, for example, touch-evoked allodynia, hyperalgesia, and pain paroxysms are present. To investigate whether lidocaine patch 5% treatment is also effective in postherpetic neuropathy (PHN) and in other PNPS, 40 patients with various forms and localizations of PNPS completed a prospective, randomized, placebo-controlled, two-way, cross-over study in three medical hospitals. Patients suffering from pain in a localized skin area with intensity above 40 mm visual analog scale (VAS) and a stable consumption of pain medication were included in this study. The study was divided into four phases: 3-day run-in phase, treatment phase 1, wash-out period, and treatment phase 2, each lasting 1 week. At the discretion of the patients, up to four patches (covering a maximum of 560 cm2) were applied onto the maximally painful area for 12 consecutive hours daily, always either by day or at night. Throughout the four phases, ongoing pain, allodynia, quality of neuropathic symptoms, quality of sleep, and adverse events were assessed. When, after the wash-out period, the pain intensity scores did not return to the pre-treatment values (+/-20%), these patients were excluded from the study. The present study revealed that, as an add-on therapy, the lidocaine patch 5% was clearly effective in reducing ongoing pain (P=0.017) and allodynia (P=0.023) during the first 8 h after application and that the patches also worked well over a period of 7 days (P=0.018) in diverse focal PNPS. Calculation of the numbers needed to treat (NNT) to obtain one patient with more than 50% relief of ongoing pain revealed that the NNT of 4.4 in the present study compared reasonably well with other studies of PHN, such as topically applied capsaicin (NNT: 5.3-infinity) or systemic treatment with gabapentin (NNT: 3.2-5.0).

There are limited data available on the conventional pharmacological treatment of constipation in palliative care patients due to insufficient randomized controlled trials. However, subcutaneously administered methylnaltrexone was found to be effective in aiding of laxation and well tolerated with limited or transient side effects in palliative care patients.

As yet, there is no clinical trial that can accurately reflect the far-reaching effects of combined treatment modalities of breathlessness. Therefore, at present, we would recommend combining a treatment with opioids, anxiolytics and corticosteroids accompanied by oxygen and physiotherapeutic treatment options.

As an adjuvant medication, the lidocaine patch is effective and safe for reducing chronic pain and physical complaints in focal non-herpetic neuropathies.

Study Objective: Cannabidiol (CBD) is increasingly used as a health supplement, though few human studies have shown benefits. The primary objective of this study was to evaluate the effects of an oral CBD-Terpene formulation on sleep physiology in insomniacs. Methods: In this pilot study, six participants with insomnia completed a placebo-controlled trial of an oral administration of CBD (300 mg) and terpenes (1 mg each of linalool, myrcene, phytol, limonene, alpha-terpinene, alpha-terpineol, alpha-pinene, and beta-caryophyllene), administered daily for 28 days using a cross-over design. Importantly, the study medication was devoid of delta-9-Tetrahydrocannabinol (delta-9-THC). The primary outcome measure was the percentage of time spent in slow wave sleep (SWS) and rapid eye movement (REM) sleep stages, as as measured by a wrist-worn sleep-tracking device. Results: This CBD-terpene regimen increased both the percentage of time (11.9 +/- 1.9%; 95% CI, 8.0 to 15.8%; P < 0.0001) and the absolute time (51.8 +/- 8.9 min/night; 95% CI, 34.3 to 69.3; P < 0.0001) participants spent in SWS and REM sleep. This treatment had no effect on total sleep time (TST) and no adverse events were reported. Conclusion: These results, if confirmed in larger clinical trials, suggest that select CBD-terpene ratios that increase SWS + REM (restorative) sleep have the potential to provide a safe and efficacious alternative to commonly prescribed sleep medications.