Quality of life and healthcare resource in patients receiving opioids for chronic pain: a review of the place of oxycodone/naloxone.

In patients managed with opioids for chronic pain, opioid-induced bowel dysfunction—specifically, opioid-induced constipation (OIC)—is a common side effect, which has a significant impact on quality of life (QoL). The most recent developments for management of OIC are opioid antagonists, including naloxone, a competitive antagonist of peripheral opioid receptors that reverses opioid-induced peripheral gastrointestinal (GI) effects. A prolonged-release formulation of naloxone is available in combination with oxycodone (OXN PR).

Versatility of different pharmaceutical formulations of hydromorphone in the management of severe cancer pain and pain in palliative care.

SUMMARY The management of severe pain situations requires therapeutic expertise in dealing with changes in pain intensity, analgesic limitations and individual patient needs. Opioids are the treatment of choice in severe pain. The availability of a broad range of opioids and formulations refined the options for improved pain treatment with a specific substance.

Pharmacological treatment of constipation in palliative care.

Purpose Of Review: The prevalence of constipation in palliative care patients varies. There is uncertainty about the choice from varying recommendations for pharmacological management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines and to determine the effectiveness and safety of laxative administration for the management of constipation in palliative care patients.

Update on combined modalities for the management of breathlessness.

Purpose Of Review: Breathlessness is a symptom which is felt as shortness of breath or tightness in the chest. The symptom of breathlessness is essentially an awareness of difficult respiration; in other words, respiration becomes an effort. The increase due to pathological change supplements the effect of exercise.

Dyspnoea associated with anxiety--symptomatic therapy with opioids in combination with lorazepam and its effect on ventilation in palliative care patients.

Purpose: Opioids are used for symptomatic therapy of dyspnoea, and benzodiazepines if dyspnoea is associated with anxiety. When given at the same time, the risk of respiratory depression will increase. The aim of this study was to assess the safety of this treatment regimen in palliative care patients.

Evaluation of the clinical effectiveness of physiotherapeutic management of lymphoedema in palliative care patients.

Objective: Lymphoedema is a common sequela of cancer or its treatment that affects lymph node drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the keys to successful rehabilitation and management of patients with cancer and non-malignant motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients with lymphoedema in a far advanced stage of their disease.

Managing opioid-induced constipation in advanced illness: focus on methylnaltrexone bromide.

Constipation is a common symptom in palliative care patients which can generate considerable suffering. There is uncertainty about the choice of treatment options from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review was to evaluate the current recommendations of therapy guidelines for the management of opioid-induced constipation in palliative care patients with a focus on methylnaltrexone bromide.

Combined oral prolonged-release oxycodone and naloxone in opioid-induced bowel dysfunction: review of efficacy and safety data in the treatment of patients experiencing chronic pain.

Importance Of The Field: Despite proven analgesic efficacy, opioid use is associated with frequently dose-limiting bowel dysfunction that seriously impacts patients' quality of life (QoL). Agents used at present to manage opioid-induced constipation do not address the underlying opioid receptor-mediated cause of bowel dysfunction and are often ineffective. There is, therefore, a significant need for more effective treatment options.

[Integration of principles of palliative medicine into treatment of patients in intensive care units].

Intensive care medicine, as well as palliative medicine, is dealing with the limits of life-preserving care. Decision-making in matters of life and death is one of the greatest challenges for physicians, because it may be an area of conflict with regard to aspects of patient autonomy, medical prognosis and the ethics of medical care. At first sight palliative medicine and intensive care medicine seem to be at the opposite ends of care.

Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study.

Background: Dyspnoea is a complex experience of the body and the mind. Whereas the effects of opioids on dyspnoea in advanced disease have been the focus of studies for management of dyspnoea in palliative medicine, the role of oxygen is still unclear. The effects of symptomatic oxygen and opioid treatment on ventilation and palliation of dyspnoea in hypoxic (H) and non-hypoxic (NH) palliative care patients were assessed and compared.

Management of constipation in palliative care patients.

Purpose Of Review: Constipation is a common symptom in palliative care patients that can generate considerable suffering due to both unpleasant physical symptoms and psychological preoccupations that may arise. There is uncertainty about the choice from varying recommendations for management of constipation and a varying clinical practice in palliative care settings. The purpose of the review is to evaluate the current recommendations of therapy guidelines and to determine the effectiveness of laxative administration for the management of constipation in palliative care patients.

Attitudes toward active euthanasia among medical students at two German universities.

Aim: There has been an ongoing debate about a legalisation of active euthanasia (AE) in Germany. Palliative care education in German medical schools seeks to foster and cultivate a negative attitude toward AE, but little is known about its effectiveness in this respect. The aim of this study was to assess attitudes toward AE among students with and without palliative medicine tuition (PMT).

Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids?

Objective: Dyspnea is a highly prevalent symptom in palliative care patients. Opioids are the first-line therapy for symptomatic relief of dyspnea. However, respiratory depression is still a feared side effect of therapy with WHO III opioids.

Effect of hydromorphone on ventilation in palliative care patients with dyspnea.

Goals: This study assessed the effect of hydromorphone treatment on ventilation and the intensity of dyspnea in palliative care patients. The assessments measured changes in peripheral oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcpaCO(2)), respiratory rate (f), and pulse frequency (PF) during the titration phase with hydromorphone for symptomatic therapy of dyspnea. The aims of the study were to verify the efficacy of hydromorphone for the management of dyspnea and assess its effect on ventilation.

Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study.

Background: Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients.

[State of the art 2007].

The beginning of the modern hospice movement and palliative medicine relates to the recognition of the fact that a cure-oriented health care system often neglects the critically ill and the dying in terms of appropriate treatment and human care. Therefore, the idea was born to offer comprehensive medical, nursing, psychological, social and spiritual care for these patients and their families at a suitable location . This first location was St Christopher's Hospice in London; the starting point of a still ongoing humanly and ethically demanded development.

Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients.

This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea.