Managing an Acute Pain Crisis in a Patient With Advanced Cancer

Moryl, Natalie; Coyle, Nessa; Foley, Kathleen M.

doi:10.1001/jama.299.12.1457

Cited by 39 publications

(23 citation statements)

References 93 publications

(114 reference statements)

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“…Opiates in subanalgesic dosages relieve the subjective sensation of dyspnea without improving ventilation or oxygenation [37,38]. Anxiolytic agents may be required [39], but this is matter of debate [40,41]. The use of NIV in patients with terminal dyspnea is controversial.…”

Section: Introductionmentioning

confidence: 99%

Palliative noninvasive ventilation in patients with acute respiratory failure

et al. 2011

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Over the last two decades, the increasing use of noninvasive ventilation (NIV) has diminished the need for endotracheal ventilation, thus decreasing the rate of ventilation-induced complications. Thus, NIV has decreased both intubation rates and mortality rates in specific subsets of patients with acute respiratory failure (e.g., patients with hypercapnia, cardiogenic pulmonary edema, immune deficiencies, or post-transplantation acute respiratory failure). NIV is also increasingly used as a palliative strategy when endotracheal ventilation is deemed inappropriate. In this context, palliative NIV can either be administered to offer a chance for survival, or to alleviate the symptoms of respiratory distress in dying patients. The literature provides information from 10 studies published between 1992 and 2006, in which 458 patients received palliative NIV. The technique was feasible, usually well tolerated, and half of the patients survived. The objectives of this review article are to define palliative NIV, to delineate the place for palliative NIV among overall indications of NIV, and to define the contribution of NIV to the palliative strategies available for patients with acute respiratory failure. Potential benefits and harm from NIV in patients who are not eligible for endotracheal ventilation are discussed. The appropriateness of palliative NIV should be reported in a study that relies on both quantitative criteria (rate of palliative NIV use and mortality) and qualitative criteria (patient comfort, end-of-life process, family burden, and health-care provider satisfaction).

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Section: Introductionmentioning

confidence: 99%

Palliative noninvasive ventilation in patients with acute respiratory failure

et al. 2011

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“…A pain crisis has been defined as 'an event in which the patient reports pain that is severe, uncontrolled, and causing distress for the patient, family members, or both' (Moryl et al, 2008). An acute pain crisis should be treated with a degree of urgency and a similar methodological approach as other medical crisis situations (Moryl et al, 2008).…”

Section: Principles Of Management Of Acute Cancer Painmentioning

confidence: 99%

“…An acute pain crisis should be treated with a degree of urgency and a similar methodological approach as other medical crisis situations (Moryl et al, 2008).…”

Section: Principles Of Management Of Acute Cancer Painmentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…For opioids, when moderate to severe symptoms are expected, an effective starting bolus dose should be 10% to 20% of the total daily dose of opioids. 22 Frequency of boluses should be every 15 minutes, as needed. For both opioids and benzodiazepines, if one dose was partially effective, then repeat that same dose.…”

Section: What Medications Are Used To Control Respiratory Symptoms Wimentioning

confidence: 99%