The use of opioid analgesics in chronic pain therapy — a retrospective, single-center study

Introduction: The use of opioids is fundamental in moderate and severe pain management. There is anincrease in opioids use in highly developed countries, while at the same time in other countries, difficultiesin access to appropriate pain treatment are observed. The aim of the study was to determine the use ofopioids in the treatment of chronic cancer-related and non-cancer pain.Material and methods: The study covered the medical documentation of patients under the care of thePain Medicine Clinic, Palliative Medicine Clinic and Hospice in the period 01.01.2017–30.04.2017 whichreported: sex, age, duration of medical services, primary diagnosis, opioid treatment — pharmacologicalsubstances, a form of supply and side effects.Results: In the study, 634 medical consultations of 196 patients were analyzed and 32 (16%) of them werecancer patients. The predominant cause of pain were degenerative diseases, disorders of the spinal nervesand nerve plexuses. Oxycodone was most often used as a monotherapy for cancer and non-cancer pain.Transdermal buprenorphine was significantly more frequently used in non-cancer pain and transdermalfentanyl was more frequently administered in cancer-related pain. In the group of cancer patients, theprinciples of multi–modal therapy were more often applied and no adverse effects were noted.Conclusions: Opioids are the primary method in pharmacotherapy at the specialist level. Oxycodone iswidely used in monotherapy of cancer-related and non-cancer pain. Various forms of the supply of opioidsin the therapy of chronic cancer pain is not associated with the risk of side effects.Palliat Med Pract 2019; 13, 1: 11–1

Advanced COPD in a patient treated in the Intensive Care Unit

Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death worldwide and 7th inthe classification of years of life lost or lived with disability. Indeed, COPD prevalence is still increasing.Moreover, chronic respiratory failure in advanced COPD is one of the most common indications for palliativecare. The deterioration of general health, including respiratory failure, raises many doubts as to theneed for hospitalization, prognosis and medical interventions. The decision to start palliative care provisionin COPD patients is based on poor prognosis, but it is not clear when it should be started. Properand specialized palliative care in this patient population can limit hospital, Intensive Care Unit (ICU), andemergency admissions.A case of a patient with advanced COPD receiving palliative care and the treatment in the ICU is presented.Due to pneumonia with permanent respiratory hypercapnia, the patient was hospitalized and qualified totracheostomy and invasive ventilation. In bronchofiberoscopy granulation tissue narrowing the airwaysbelow the tracheotomy tube, confirmed by the CT scan. The patient was qualified for rigid bronchofiberoscopyto widen the trachea. Antibiotic therapy with multidirectional pharmacological treatment wasprovided at the ICU. The patient was discharged home in a fairly good general condition, on his breathingwith passive oxygen therapy, periodically requiring assisted mechanical ventilation, without carbon dioxideretention, and with effective cough reflexes. Mechanical causes of respiratory failure in ventilated advancedCOPD patients should be considered. Short–time-intensive therapy treatment may improve the generalcondition of ventilated advanced COPD patients

The role of pregabalin in neuropathic pain management in cancer patients

Despite the wide availability of analgesics for prescription in cancer pain, including both opioid and non-opioidmedications, population studies have for many years demonstrated unadvisable pain management.International analyses indicate inadequate use of opioid and adjuvant drugs per capita. At the same time,patients complain about the accompanying pain, not treated effectively, especially in the course of cancer.One of the many causes of cancer pain that is difficult to treat is the co-occurrence of neuropathic pain.The article presents contemporary views on the treatment of neuropathic pain associated with cancer,including the site of application of gabapentinoids in the treatment scheme

Hospitalizacja pacjentów ze schorzeniami nienowotworowymi w hospicjum stacjonarnym — doświadczenia ośrodka w Białymstoku

 Background. Current epidemiological observations indicate an increasing need for palliative care for patients with non-cancer diseases, including end-stage heart failure. One of the forms of palliative care are medical services provided in stationary hospice. The aim of the study was to present the characteristics of patients hospitalized in hospice stationary care, and in particular to determine the proportion of non-cancer patients. Patients and methods. The study consisted in analyzing the annual medical records of patients hospitalized in the stationary hospice and recording information on referrals, diagnoses determining admission to the hospice and time of hospitalization. The obtained data was analyzed with non-parametric tests, assuming p &lt; 0.05 as the level of statistical significance. Results. During the study period, 708 patients were hospitalized in the stationary hospice, significantly more often patients with a diagnosis of a cancer (74%), p &lt; 0.05. Patients diagnosed with cardiology accounted for 12% of the group of non-cancer patients and 2.5% of all hospitalized patients. In the group of cancer patients end-stage heart failure was noticed in 34% cases. In the diagnosis of chronic respiratory failure, 28% of patients had a potential end-stage heart failure cause as a co-morbid diagnosis. The age of patients and their hospitalization time in the stationary hospice did not differ significantly between patients with cancer and non-cancer diseases. Conclusions. The dominant group in palliative care in the stationary hospice are still oncological patients. End-stage heart failure is the primary indication in palliative care and associated diagnosis in patients with cancer and chronic respiratory failure.Wstęp. Aktualne obserwacje epidemiologiczne wskazują na wzrastającą potrzebę prowadzenia zasad opieki paliatywnej wobec pacjentów z schorzeniami inne niż nowotworowe, w tym schyłkową niewydolność serca. Jedną z form prowadzenia opieki paliatywnej są świadczenia medyczne realizowane w ramach Hospicjum Stacjonarnego. Cel. Celem pracy była aktualizacja charakterystyki pacjentów hospitalizowanych w hospicyjnej opiece stacjonarnej, a szczególnie określenie udziału pacjentów nienowotworowych w tym pacjentów z rozpoznaniem schyłkowej choroby kardiologicznej. Metodyka i pacjenci. Badanie polegało na analizie rocznej dokumentacji medycznej pacjentów hospitalizowanych w Hospicjum Stacjonarnym i odnotowaniu informacji dotyczących skierowań, rozpoznań warunkujących przyjęcie do hospicjum oraz czasu hospitalizacji. Uzyskane dane poddano analizie testami nieparametrycznymi, przyjmując p < 0,05 za poziom istotności statystycznej. Wyniki. W badanym okresie hospitalizowano w Hospicjum Stacjonarnym 708 pacjentów, znamiennie częściej pacjentów z rozpoznaniem choroby nowotworowej (74%), p < 0,05. Pacjenci z rozpoznaniem kardiologicznym stanowili 12% grupy pacjentów nienowotworowych i 2,5 % wszystkich hospitalizowanych. W obrębie rozpoznania niewydolności oddechowej 30% pacjentów miało potencjalną przyczynę kardiologiczną jako rozpoznanie współistniejące. Łącznie pacjenci z głównym i współistniejącym rozpoznaniem kardiologicznym stanowili 4% badanej populacji. Wiek chorych i czas ich hospitalizacji w Hospicjum Stacjonarnym nie różnił się znamiennie pomiędzy pacjentami z schorzeniami nowotworowymi i nienowotworowymi. Wnioski. Dominującą grupą korzystającą z opieki paliatywnej w Hospicjum Stacjonarnym są nadal chorzy onkologiczni. Niewydolność serca jest rozpoznaniem głównym kwalifikującym do prowadzenia opieki paliatywnej oraz rozpoznaniem towarzyszącym u pacjentów z chorobą nowotworową i przewlekłą niewydolnością oddechową

Aspects of palliative medicine in intensive care units: A narrative review

The perspective of palliative care has changed dynamically over the years, and palliative medicine, which was originally concerned with patients with advanced oncology diseases, has become an interdisciplinary area. Many societies have published guidelines for the use of palliative medicine in intensive care units. This article presents indications and methods for implementing the principles of palliative medicine in intensive care units. Particular attention is devoted to the consultations of palliative medicine for current medical trends — COVID-19 infection, oncological diseases, fragility syndrome, and end-stage circulatory failure. Elements of palliative medicine are necessary in everyday practices in the intensive care unit. The most important task in cooperation is to present classifications that can help in the objective identification of patients requiring palliative care. It seems that creating the checklist of the qualifications for a palliative medicine consultation can be the next step towards making decisions about this form of therapy

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions