Spirituality in people with advanced chronic obstructive pulmonary disease – challenge for more effective interventions, support, and healthcare education: Mini-review

More recently there has been a growing interest in spirituality in medicine, especially in the field of palliative care, oncology, intensive care, and cardiology. However, according to literature, it seems to be a limited number of researches on how healthcare professionals should provide spiritual care (SC) for people with non-malignant lung diseases and what kind of education for them enables them to do it efficiently. This mini-review aims to provide an overview of current knowledge of an area of spirituality and SC for people with advanced chronic obstructive pulmonary disease, including spiritual well-being and religious/spiritual coping, their relations with the quality of life and symptom burden, exercise capacity and daily functioning, mental health, or medication adherence. It also analyses the use of interventions to meet patients’ spiritual needs and patients’ expectations regarding SC provided by professional careers. Based on the literature authors try to show the fields that should be improved and proposed future research directions

Biographical note of Professor Jacek Łuczak

–

Preliminary experience with the use of methadone in the treatment of cancer pain

Background. In an open clinical study analgesia and side effects of methadone were assessed and the calculation of equianalgesic doses of oral morphine and methadone used in our patients was appraised. Material and methods. Methadone was administered in 12 opioid - tolerant patients with severe cancer pain. Patients received methadone because of inadequate pain control (NRS > 5) (number of patients in brackets) during treatment with morphine (4), transdermal fentanyl (3), morphine, ketamine and transdermal fentanyl (1), tramadol (1), unsatisfactory analgesia with severe drowsiness during morphine with ketamine treatment (2) and very strong pain with nausea during morphine treatment (1). We used the following dose ratios while converting oral morphine equivalent to oral methadone: 4:1 (up to 100 mg morphine daily), 6:1 (100&#8211;300 mg morphine daily) and 12:1 (daily dose of morphine over 300 mg) although in this study because of daily doses of oral morphine over 100 mg we applied only the last two dose ratios. The starting daily dose of oral methadone in patient treated with tramadol was 9 mg. The single dose of oral methadone did not exceed 30 mg regardless the daily dose of oral morphine before the switch to methadone. After starting methadone we withdrew previous opioid treatment completely in 10 patients and 2 patients were treated concomitantly with methadone and other opioids. The mean equivalent daily dose of oral morphine before switching to methadone was 750.8 &plusmn; 464 mg. Methadone was administered usually 3 times a day and 11 patients were treated with oral methadone in water solution, 1 patient received the drug rectally in suppositories. Results. The mean time of the methadone treatment was 31.7 &plusmn; 21.2 (range 7&#8211;82) days and the starting doses were increased in 11 of 12 treated patients. The mean daily doses varied from 46 &plusmn; 19.9 mg at the beginning till maximal 135.3 &plusmn; 99.9 mg and 117.7 &plusmn; 97.5 mg at the end of methadone treatment. Good analgesia expressed by decrease in pain intensity to NRS < 3 was achieved in 6 patients, partial effect (NRS 3&#8211;5) was present in 5 patients, unsatisfactory analgesia was observed in 1 patient (NRS > 5) who ceased methadone after 7 days of the treatment. The most frequent side effects were drowsiness (5 patients), constipation (5 patients), nausea and vomiting (2 patients). We did not observe serious adverse reactions especially respiratory depression, which would cause cessation of the treatment. Conclusions. The results of this preliminary study confirmed high analgesic efficacy, good adverse event profile of methadone, safety and the effectiveness of the applied method of morphine to methadone dose calculation for the oral route.Wstęp. W otwartym badaniu klinicznym dokonano oceny analgezji i objawów ubocznych metadonu oraz zastosowanego sposobu przeliczania dawek równoważnych morfiny i metadonu, podawanych drogą doustną. Materiał i metody. Metadon podawano 12 chorym z bólem nowotworowym o silnym natężeniu, wcześniej leczonych innymi opioidami. Wskazaniem do stosowania metadonu była niedostateczna kontrola bólu (NRS > 5) (w nawiasach podano liczbę chorych) podczas leczenia morfiną (4), przezskórnym fentanylem (TF) (3), morfiną, ketaminą i przezskórnym fentanylem (1), tramadolem (1), nasilone bóle i senność podczas terapii morfiną i ketaminą (2) oraz bardzo silne bóle i nudności podczas leczenia morfiną (1). Przyjęto następujący sposób przeliczania dawek równoważnych opioidów: przy ekwiwalentnej dawce dobowej doustnej morfiny do 100 mg dawkę dobową doustnego metadonu obliczano według przelicznika 4:1, przy dawce dobowej doustnej morfiny 100&#8211;300 mg według przelicznika 6:1, przy dawce dobowej doustnej morfiny powyżej 300 mg według przelicznika 12:1, przy czym z powodu ekwiwalentnych dawek dobowych doustnej morfiny powyżej 100 mg w badaniu zastosowano tylko ostatnie dwa przeliczniki. U chorej leczonej tramadolem początkowa dawka dobowa doustnego metadonu wynosiła 9 mg. Niezależnie od wielkości dawki dobowej doustnej morfiny początkowa jednorazowa dawka metadonu nie przekraczała 30 mg. Po rozpoczęciu leczenia metadonem u 10 chorych całkowicie odstawiano wcześniej przyjmowany opioid, 2 chorych otrzymywało równocześnie metadon i inne opioidy. Średnia ekwiwalentna dawka dobowa doustnej morfiny, przed zamianą na metadon, wynosiła 750,8 &plusmn; 464 mg. Metadon podawano najczęściej 3 razy dziennie - 11 chorych otrzymywało lek doustnie w roztworze wodnym, 1 chorego leczono metadonem podawanym drogą doodbytniczą w postaci czopków. Wyniki. Średni czas leczenia metadonem wynosił 31,7 &plusmn; 21,2 dni (zakres 7&#8211;82), średnie dawki dobowe leku zwiększyły się u 11 spośród 12 leczonych chorych i wynosiły na początku 46 &plusmn; 19,9 mg, maksymalnie 135,3 &plusmn; 99,9 mg, na końcu terapii 117,7 &plusmn; 97,5 mg. Korzystne efekty przeciwbólowe, wyrażające się zmniejszeniem natężenia bólu do NRS < 3, odnotowano u 6 leczonych chorych, efekt częściowy (NRS 3&#8211;5) stwierdzono u 5 chorych, u 1 pacjentki efekt analgetyczny oceniono jako niedostateczny (NRS > 5) i po 7 dniach zakończono leczenie. Spośród objawów ubocznych najczęściej występowały senność (5 chorych), zaparcie stolca (5 chorych) oraz nudności i wymioty (2 chorych). Nie obserwowano poważnych działań niepożądanych, zwłaszcza depresji oddechowej, które spowodowałyby konieczność przerwania leczenia. Wnioski. Wyniki wstępnego badania potwierdziły wysoką skuteczność analgetyczną i dobrą tolerancję metadonu oraz bezpieczeństwo i przydatność zastosowanego sposobu przeliczania dawek morfiny na dawki metadonu, podawanych drogą doustną

Use of ketamine in the treatment of cancer pain

Na podstawie danych piśmiennictwa i badań własnych autorzy przedstawili charakterystykę i zastosowanie ketaminy - antagonisty receptora NMDA - leku, który wykazuje dużą skuteczność w tzw. "bólach opornych na morfinę". Artykuł zawiera rekomendacje dotyczące stosowania ketaminy w dawkach subanestetycznych u pacjentów z nieuśmierzonym bólem nowotworowym leczonych zgodnie z zasadami Światowej Organizacji Zdrowia.The authors present the characteristics and the clinical use of ketamine - the NMDA receptor antagonist - the drug of high efficacy in pain "resistant" to morphine - on the basis of the literature and the own experience. The article contains the recommendation concerning the use of ketamine in subanaesthetic doses in patients with cancer pain that does not respond to treatment according to the WHO principles

Organizational standards for specialist palliative care for adult patients: Recommendations of the Expert Group of National Consultants in Palliative Medicine and Palliative Care Nursing

Introduction: The study aimed to develop organizational standards for specialist palliative care for adult patients (OSSPCAP) in Poland. Methods: The National Consultants in Palliative Medicine and Palliative Care Nursing appointed an Expert Group consisting of three physicians — independent researchers, two nurses and a lawyer to develop the OSSPCAP. The work was done in three stages. 1. Literature analysis (Scopus and PubMed databases) and legislation on palliative care. 2. Questionnaire development using Google Forms and survey of 120 respondents in two rounds using the Delphi method. 3. Analysis of the results by the Expert Group during remote meetings and determination of the final version of the OSSPCAP. Results: The response rate in the first round of the survey was 71 (59.17%) and in the second 58 (48.33%). The first round yielded 73 positive responses (at least 70% criterion) to 97 questions; the second round yielded 21 positive responses to 31 questions. For the remaining ten questions, the Expert Group members discussed the results obtained with at least 50% criterion of positive responses. The results of both rounds were analyzed, and the final version of the document was accepted by all members of the Expert Group. Conclusions: Palliative care was divided into two types (levels): palliative care elements (palliative care approach) and specialist palliative care. In the latter home, inpatient and outpatient care was distinguished with ensuring public funding for all their organizational units by the State, including the integration into the guaranteed benefits. Requirements and procedures for all organizational units of specialist palliative care were depicted. Three specialist inpatient palliative care referral levels were offered taking into account complexity of services for patients, under- and postgraduate education. Principles of qualifying patients for palliative care, the development of research and education in palliative medicine and palliative care nursing were presented.Introduction: The study aimed to develop organizational standards for specialist palliative care for adultpatients (OSSPCAP) in Poland.Methods: The National Consultants in Palliative Medicine and Palliative Care Nursing appointed an ExpertGroup consisting of three physicians — independent researchers, two nurses and a lawyer to developthe OSSPCAP. The work was done in three stages. 1. Literature analysis (Scopus and PubMed databases)and legislation on palliative care. 2. Questionnaire development using Google Forms and survey of120 respondents in two rounds using the Delphi method. 3. Analysis of the results by the Expert Groupduring remote meetings and determination of the final version of the OSSPCAP.Results: The response rate in the first round of the survey was 71 (59.17%) and in the second 56 (46.67%).The first round yielded 73 positive responses (at least 70% criterion) to 97 questions; the second roundyielded 21 positive responses to 31 questions. For the remaining ten questions, the Expert Group membersdiscussed the results obtained with at least 50% criterion of positive responses. The results of both roundswere analyzed, and the final version of the document was accepted by all members of the Expert Group.Conclusions: Palliative care was divided into two types (levels): palliative care elements (palliative care approach)and specialist palliative care. In the latter home, inpatient and outpatient care was distinguishedwith ensuring public funding for all their organizational units by the State, including the integration into theguaranteed benefits. Requirements and procedures for all organizational units of specialist palliative care weredepicted. Three specialist inpatient palliative care referral levels were offered taking into account complexity ofservices for patients, under- and postgraduate education. Principles of qualifying patients for palliative care,the development of research and education in palliative medicine and palliative care nursing were presented

Pharmacotherapy of pain in cancer patients – recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients

Pharmacotherapy of pain in cancer patients – recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, and Polish Society of Anaesthesiology and Intensive Therapy

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients