Leading palliative care experts illustrate how you can improve both communication with cancer patients and their quality of life.For more than twenty years, this guide has been the go-to resource for ...busy practicing oncology and palliative care clinicians. This fourth edition, now titled Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer, provides physicians, advanced practice clinicians, and patients and their families with detailed information and advice for alleviating the suffering of cancer patients and their loved ones. Drawing on the work of experts who have developed revolutionary approaches to symptom management and palliative care, as well as on lessons learned during her decades as a teacher and clinician, Dr. Janet L. Abrahm and her coauthors illustrate how to help patients and families understand their prognosis, communicate their care preferences, and minimize their distress.This edition reflects important updates in the field while addressing the informational needs of a broader market of health care providers, including social workers, psychologists, psychiatrists, bereavement counselors, and chaplains. This new edition features three new chapters—Spiritual Care in Palliative Care, Psychological Considerations, and Bereavement—as well as specific guidelines about • advance care planning at all phases of cancer• understanding complex family dynamics and communication challenges• partnering with interpreters in the care of patients and family members with limited English-language proficiency• special considerations to take into account for LGBTQ+ patients and their loved ones• caring for patients who have a serious mental illness along with a cancer diagnosis• nonpharmacologic management of pain and other symptoms associated with cancer or its treatmentThe book features self-reflective exercises that encourage readers to consider their own biases before having discussions with patients and family members, as well as numerous patient stories that illustrate the techniques and insights clinicians can use to provide holistic, multidimensional care for a diverse cancer patient population.
Older adults can be especially susceptible to the debilitating effects of chronic pain, yet there are often barriers to successfully alleviating pain on the part of elderly patients and the health ...care professionals who treat them. This comprehensive guide to geriatric pain management provides the most current information available on assessment and treatment of pain in older adults. In a concise, reader-friendly format, the book provides techniques, tips, and tools for assessing pain and examines barriers to appropriate treatment. It addresses the physiological and psychosocial factors underlying the process and occurrence of pain and helps nurses to develop a comprehensive multimodal approach to pain management that includes pharmacological and nonpharmacological interventions. The guide provides detailed coverage of medications commonly used for pain management, including all contraindications and side effects, so that nurses will be able to evaluate the best use of a medication in the context of comorbidities and sensitivities of each individual. Also addressed are chronic illnesses common to the elderly population, palliative and hospice care, treatment of concurrent depression and anxiety, treatment of cognitively impaired elderly, and techniques for assessment and intervention in cases of substance abuse.
Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.
To compare pain neuroscience education combined with cognition-targeted motor ...control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.
Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.
Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).
Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).
There were 22 men and 38 women in the experimental group (mean SD age, 39.9 12.0 years) and 25 men and 35 women in the control group (mean SD age, 40.5 12.9 years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal EM mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).
Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.
clinicaltrials.gov Identifier: NCT02098005.
All in your head Buchbinder, Mara
2015., 20150605, 2015, 2015-06-05
eBook
Although pain is a universal human experience, many view the pain of others as private, resistant to language, and, therefore, essentially unknowable. And, yet, despite the obvious limits to ...comprehending another's internal state, language is all that we have to translate pain from the solitary and unknowable to a phenomenon richly described in literature, medicine, and everyday life. Without denying the private dimensions of pain,All in Your Headoffers an entirely fresh perspective that considers how pain may be configured, managed, explained, and even experienced in deeply relational ways.Drawing on ethnographic fieldwork in a pediatric pain clinic in California, Mara Buchbinder explores how clinicians, adolescent patients, and their families make sense of puzzling symptoms and work to alleviate pain. Through careful attention to the language of pain-including narratives, conversations, models, and metaphors-and detailed analysis of how young pain sufferers make meaning through interactions with others, her book reveals that however private pain may be, making sense of it is profoundly social.
The skeletal system is the third most common site for cancer metastases, surpassed only by the lungs and liver. Many tumors, especially those of the breast, prostate, lungs, and kidneys, have a ...strong predilection to metastasize to bone, which causes pain, hypercalcemia, pathological skeletal fractures, compression of the spinal cord or other nervous structures, decreased mobility, and increased mortality. Metastatic cancer-induced bone pain (CIBP) is a type of chronic pain with unique and complex pathophysiology characterized by nociceptive and neuropathic components. Its treatment should be multimodal (pharmacological and non-pharmacological), including causal anticancer and symptomatic analgesic treatment to improve quality of life (QoL). The aim of this paper is to discuss the mechanisms involved in the occurrence and persistence of cancer-associated bone pain and to review the treatment methods recommended by experts in clinical practice. The final part of the paper reviews experimental therapeutic methods that are currently being studied and that may improve the efficacy of bone pain treatment in cancer patients in the future.
Inadequately treated acute and chronic pain remains a major cause of suffering and dissatisfaction in pain therapy. A cause for the variable success of pharmacologic pain therapy is the different ...genetic disposition of patients to develop pain or to respond to analgesics. The patient's phenotype may be regarded as the result of synergistic or antagonistic effects of several genetic variants concomitantly present in an individual. Variants modulate the risk of developing painful disease or its clinical course (e.g., migraine, fibromyalgia, low back pain). Other variants modulate the perception of pain (e.g., OPRM1 or GCH1 variants conferring modest pain protection by increasing the tone of the endogenous opioid system or decreasing nitric oxide formation). Other polymorphisms alter pharmacokinetic mechanisms controlling the local availability of active analgesic molecules at their effector sites (e.g., decreased CYP2D6 related prodrug activation of codeine to morphine). In addition, genetic variants may alter pharmacodynamic mechanisms controlling the interaction of the analgesic molecules with their target structures (e.g., opioid receptor mutations). Finally, opioid dosage requirements may be increased depending on the risk of drug addiction (e.g., DRD2 polymorphisms decreasing the functioning of the dopaminergic reward system). With the complex nature of pain involving various mechanisms of nociception, drug action, drug pharmacology, pain disease and possibly substance addiction, a multigenic or even genome wide approach to genetics could be required to base individualized pain therapy on the patient's genotype.
Background
Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR ...distraction on acute pain intensity in children is uncertain.
Objectives
To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting.
Search methods
We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors.
Selection criteria
Randomised controlled trials (RCTs), including cross‐over and cluster‐RCTs, comparing VR distraction to no distraction, non‐VR distraction or other VR distraction.
Data collection and analysis
We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post‐procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain‐related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables.
Main results
We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results.
We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision.
1: VR distraction versus no distraction
Acute pain intensity: during procedure
Self‐report: one study (42 participants) found no beneficial effect of non‐immersive VR (very low‐certainty evidence).
Observer‐report: no data.
Behavioural measurements (observer‐report): two studies, 62 participants; low‐certainty evidence. One study (n = 42) found no beneficial effect of non‐immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR.
Acute pain intensity: post‐procedure
Self‐report: 10 studies, 461 participants; very low‐certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi‐immersive or non‐immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group.
Observer‐report: two studies (216 participants; low‐certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers.
Behavioural measurements (observer‐report): one study (42 participants) found no beneficial effect of non‐immersive VR (very low‐certainty evidence).
Adverse effects: five studies, 154 participants; very low‐certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group.
2: VR distraction versus other non‐VR distraction
Acute pain intensity: during procedure
Self‐report, observer‐report and behavioural measurements (observer‐report): two studies, 106 participants:
Self‐report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low‐certainty evidence).
Observer‐report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low‐certainty evidence).
Behavioural measurements (observer‐report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low‐certainty evidence).
Acute pain intensity: post‐procedure
Self‐report: eight studies, 575 participants; very low‐certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between‐group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non‐VR distraction. One study (n = 18) found no beneficial effect of semi‐immersive VR. Two studies (n = 100) reported no between‐group difference.
Observer‐report: three studies, 187 participants; low‐certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores.
Behavioural measurements (observer‐report): two studies, 106 participants; low‐certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores.
Adverse effects: six studies, 429 participants; very low‐certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber‐sickness before and after VR immersion.
3: VR distraction versus other VR distraction
We did not identify any studies for this comparison.
Authors' conclusions
We found low‐certainty and very low‐certainty evidence of the effectiveness of VR distraction compared to no distraction or other non‐VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well‐designed, large, high‐quality trials may have an important impact on our confidence in the results.
Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial ...lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections.
Abstract Context Progress in the science of pain has led pain specialists to move away from an organ-centred understanding of pain located in the pelvis to an understanding based on the mechanism of ...pain and integrating, as far as possible, psychological, social, and sexual dimensions of the problem. This change is reflected in all areas, from taxonomy through treatment. However, deciding what is adequate investigation to rule out treatable disease before moving to this way of engaging with the patient experiencing pain is a complex process, informed by pain expertise as much as by organ-based medical knowledge. Objective To summarise the evolving changes in the management of patients with chronic pelvic pain by referring to the 2012 version of the European Association of Urology (EAU) guidelines on chronic pelvic pain. Evidence acquisition The working panel highlights some of the most important aspects of the management of patients with chronic pelvic pain emerging in recent years in the context of the EAU guidelines on chronic pelvic pain. The guidelines were completely updated in 2012 based on a systematic review of the literature from online databases from 1995 to 2011. According to this review, levels of evidence and grades of recommendation were added to the text. A full version of the guidelines is available at the EAU office or Web site ( www.uroweb.org ). Evidence synthesis The previously mentioned issues are explored in this paper, which refers throughout to dilemmas for the physician and treatment team as well as to the need to inform and engage the patient in a collaborative empirical approach to pain relief and rehabilitation. These issues are exemplified in two case histories. Conclusions Chronic pelvic pain persisting after appropriate treatment requires a different approach focussing on pain. This approach integrates the medical, psychosocial, and sexual elements of care to engage the patient in a collaborative journey towards self-management.
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