Oral modified release morphine for breathlessness in chronic heart failure: a randomized placebo-controlled trial.

Aims: Morphine is shown to relieve chronic breathlessness in chronic obstructive pulmonary disease. There are no definitive data in people with heart failure. We aimed to determine the effectiveness and cost-effectiveness of 12 weeks morphine therapy for the relief of chronic breathlessness in people with chronic heart failure compared with placebo.

Prescribing in Chronic Severe Hepatic Impairment.

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available via www.palliativedrugs.

Ranitidine: forgotten drug of delayed gastric emptying.

Delayed gastric emptying in the presence or absence of mechanical bowel obstruction can cause distressing symptoms in palliative care patients. We present two patients, both with vomiting due to delayed gastric emptying and gastric outlet obstruction secondary to pancreatic cancer, treated with subcutaneous ranitidine resulting in a symptomatic response. We hypothesise that ranitidine is a useful adjunct to standard treatment with prokinetic agents or octreotide in such patients and potentially those with proximal mechanical bowel obstruction from other malignancies with associated delayed gastric emptying.

Spironolactone.

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.

Furosemide.

Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.

Blinded Patient Preference for Morphine Compared to Placebo in the Setting of Chronic Refractory Breathlessness--An Exploratory Study.

Context: Patients' preference for morphine therapy has received little attention in the setting of chronic refractory breathlessness. However, this is one important factor in considering longer term therapy.

Objectives: The aim of this secondary analysis was to explore blinded patient preference of morphine compared to placebo for this indication and to define any predictors of preference.

Systematic literature review: xerostomia in advanced cancer patients.

Purpose: Dry mouth (xerostomia) is one of the commonest symptoms in cancer patients and can adversely affect quality of life. The aim of this review was to determine the effectiveness of pharmacological and non-pharmacological interventions in treating xerostomia in adult advanced cancer patients.

Methods: The literature search was performed in February 2014 using databases including EMBASE, MEDLINE, CINAHL, BNI and Cochrane library.

The relationship between two performance scales: New York Heart Association Classification and Karnofsky Performance Status Scale.

Context: Performance status is used to quantify the well-being and functional status of people with illness. Clinicians and researchers from differing fields may not instinctively understand the scales, typically disease specific, used in other disciplines.

Objectives: To provide a preliminary description of the relationship between the Karnofsky Performance Status Scale (KPS) and the New York Heart Association Classification (NYHA) and to stimulate discussion in research and clinical practice.

Clinically important differences in the intensity of chronic refractory breathlessness.

Context: Clinically important differences in chronic refractory breathlessness are ill defined but important in clinical practice and trial design.

Objectives: To estimate the clinical relevance of differences in breathlessness intensity using distribution and patient anchor methods.

Methods: This was a retrospective data analysis from 213 datasets from four clinical trials for refractory breathlessness.

Repeat dose opioids may be effective for breathlessness in chronic heart failure if given for long enough.

Background: The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF).

Objective: Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF.

Methods: We conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo.

Opioids for chronic refractory breathlessness: patient predictors of beneficial response.

Chronic refractory breathlessness is common and distressing in advanced disease. Despite level I evidence to support the use of opioids for this symptom, not all patients benefit. This study aimed to discover which patient characteristics predict those most likely to gain improvement in breathlessness.

Attitudes to morphine in chronic heart failure patients.

Objectives: Low-dose opioids are used for the palliation of pain, breathlessness and cough in advanced chronic heart failure (CHF) patients. The authors wanted to determine any potential barriers or facilitators to opioid administration in patients with CHF by assessing their knowledge, concerns and attitudes to morphine therapy.

Methods: Semistructured interviews were held with a purposive sample of 10 men with symptoms of CHF.

Minimally clinically important difference in chronic breathlessness: every little helps.

Objectives: The aim of the study was to determine the minimally clinically important difference (MCID) for breathlessness due to chronic heart failure (CHF).

Background: The measurement of breathlessness is difficult because it is subjective and multifactorial. Statistically significant changes in assessment may not be clinically meaningful.

Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults.

Background: Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominantly used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role in pain management but the effectiveness of TENS is currently unknown.

Attitudes to morphine in chronic heart failure patients.

Objectives: Low-dose opioids are used for the palliation of pain, breathlessness and cough in advanced chronic heart failure (CHF) patients. The authors wanted to determine any potential barriers or facilitators to opioid administration in patients with CHF by assessing their knowledge, concerns and attitudes to morphine therapy.

Methods: Semistructured interviews were held with a purposive sample of 10 men with symptoms of CHF.

Short-term opioids for breathlessness in stable chronic heart failure: a randomized controlled trial.

Aims: To assess the effect of oral opioids vs. placebo on breathlessness in patients with chronic heart failure (CHF).

Methods And Results: Oral morphine (Oramorph), oral oxycodone (Oxynorm), and placebo were studied in an outpatient setting.

The management of dyspnoea in chronic heart failure.

Purpose Of Review: To identify current management options for dyspnoeic people with chronic heart failure (CHF).

Recent Findings: Research in people with CHF studying dyspnoea as a primary endpoint remains sparse. However, attention is turning towards symptoms as well as survival, and the need for agreed outcome measurement is recognized.

Measurement of breathlessness in clinical trials in patients with chronic heart failure: the need for a standardized approach: a systematic review.

Aims: Chronic breathlessness is a major symptom for patients with compensated chronic heart failure (CHF) and its impact is different to the breathlessness resulting from pulmonary oedema. This systematic review aims to establish which tools have been used for research into the subjective severity of breathlessness in patients with compensated CHF and to discuss recommendations for the future.

Methods And Results: Medline (1950-2008), Embase (1980-2008), Cinahl (1982-2008), and Cochrane databases were searched for clinical studies in patients with compensated CHF including a subjective measure of breathlessness severity as an outcome measure.

A cochrane systematic review of transcutaneous electrical nerve stimulation for cancer pain.

Cancer-related pain is complex and multi-dimensional; yet, the mainstay of cancer pain management has been the biomedical approach. There is a need for nonpharmacological and innovative pain management strategies. Transcutaneous electrical nerve stimulation (TENS) may have a role.

Review of the evidence for the management of dyspnoea in people with chronic heart failure.

Purpose Of Review: To identify current management options for dyspnoeic people with chronic heart failure.

Recent Findings: Optimization of chronic heart failure treatment is important for symptom control and survival. This review therefore includes recent advances in cardiac treatment as well as interventions directed solely at dyspnoea management although dyspnoea is rarely a primary endpoint in cardiac trials.

Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults.

Background: Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown.