Prolonged-release oxycodone/naloxone in the treatment of cancer pain — a case report

In moderate and strong cancer pain oxycodone has become one of the most effective and popular opioids. A combination of prolonged-release oxycodone with prolonged-release naloxone is a valued option among patients suffering from pain and opioid–induced bowel dysfunction (OIBD).We present a case of a male cancer patient with chronic constipation effectively treated with oxycodone/naloxonecombination

Pacjent z rozpoznaniem cukrzycy w opiece paliatywnej

Diabetes management of the patients with advanced diseases is a significant task for palliative care team. First of all, the main aim is preservation of quality of life. Therapeutic and diet decisions should be provided on an appropriate level of intervention according to patient’s condition and prognosis. The pharmacologic therapy may include oral agents or/and insulin treatment. We should avoid metabolic de-compensation, like frequent and/or deep hypoglycaemia, symptomatic clinical dehydration, diabetic ketoacidosis, or per­sistent hyperglycaemia, especially in the case of chronic wounds, bed sores or cancer ulceration. Based on available publications, expert opinions and own experience, some glucose control target ranges and ways of making therapeutic decision in the context of limited life expectancy are suggestedProwadzenie pacjentów z cukrzycą, u kresu ich życia stanowi szczególne zadaniem zespołów opieki paliatywnej. Po pierwsze, głównym celem pozostaje troska o jakość zycia chorego. Decyzje terapeutyczne i dietetyczne powinny być podejmowane w zależności od stanu pacjenta i rokowania. Terapia farmakologiczna może obejmować leki doustne i / lub włączenie insuliny. Należy unikać stanów dekompensacji, takich jak częsta i /lub głęboka hipoglikemia, jawne klinicznie odwodnienie, cukrzycowa kwasica ketonowa lub uporczywa hiperglikemia /szczególnie w przypadku przewlekłych ran, odleżyn lub owrzodzenia nowotworowego/. Opierając się na dostępnych publikacjach, opiniach ekspertów i naszych doświadczeniach, sugerujemy pewne docelowe zakresy glikemii i sposoby podejmowania decyzji terapeutycznych w obliczu krótszej oczekiwanej długości życia Słowa kluczowe: cukrzyca, opieka paliatywna, decyzje terapeutyczn

Prolonged-release oxycodone/naloxone in the treatment of cancer pain — a case report

Oksykodon znalazł uznane miejsce w leczeniu bólu nowotworowego o średnim i znacznym natężeniu. Wykorzystanie preparatów łączących ten opioid z obwodowym antagonistą receptorów opioidowych w jelitach zapewnia chorym łagodzenie dolegliwości z jednoczesnym zapobieganiem lub zmniejszaniem objawów poopioidowych zaburzeń funkcji jelit (OIBD). W pracy przedstawiono skuteczne zastosowanie preparatu złożonego oksykodonu z naloksonem w leczeniu bólu u pacjenta w zaawansowanej fazie choroby nowotworowej z przewlekłymi zaparciami w wywiadzie.In moderate and strong cancer pain oxycodone has become one of the most effective and popular opioids. A combination of prolonged-release oxycodone with prolonged-release naloxone is a valued option among patients suffering from pain and opioid–induced bowel dysfunction (OIBD). We present a case of a male cancer patient with chronic constipation effectively treated with oxycodone/naloxone combination

Fibromyalgia in the light of different methods of treatment

Introduction and purpose: Fibromyalgia is a disease with many symptoms that are difficult to treat. The most troublesome element is muscle, bone or joint pain. Importantly, the diagnosis of this disease is based on the physical examination and the subjective examination, which shows that there are no laboratory tests to confirm its presence. Public awareness of fibromyalgia is negligible, while more research is needed on the treatment of this disease and the possible alternatives associated with it. The aim of this study was to analyze the available literature on the basis of the PubMed scientific database, considering only scientific articles that were published within the last 5 years. The following keywords were used: fibromyalgia and physiotherapy, fibromyalgia and cannabis, fibromyalgia and cytokines. Description of the state of knowledge: Treatments related to cannabinoids and physiotherapy are still developing fields of knowledge. More than 40 papers related to the topic of the study were used for the review. The need for further research is apparent, especially randomized studies in which allocation to an experimental or control group is completely random. The question of investigating the long-term effectiveness of a given treatment is also not negligible, as many studies do not have a so-called follow-up. Conclusion: Cannabinoids are effective in the treatment of complaints associated with fibromyalgia. Exercise, laser therapy and acupuncture reduce pain and improve quality of life in patients with fibromyalgia. More research on this disease is needed, especially with larger patient groups

Reading numbers aloud as a tool for the evaluation of breathlessness in Polish cancer patients

Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale (NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 ± SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 ± 1.89, NRS 5.75 ± 2.37 and VAS 5.11 ± 2.34. The average value for PEF was 183.26 ± 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 ± 29.93 and for NN/Bmax was 2.92 ± 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = –0.52 and R = –0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73–80Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale(NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 ± SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 ± 1.89, NRS 5.75 ± 2.37 and VAS 5.11 ± 2.34. The average value for PEF was 183.26 ± 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 ± 29.93 and for NN/Bmax was 2.92 ± 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = –0.52 and R = –0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73–8

The morphine and cognitive functions

Prawidłowy przebieg procesów poznawczych, a nie tylko brak bólu, warunkuje dobre funkcjonowanie pacjentów z chorobą nowotworową w społeczeństwie oraz sprawne wykonywanie codziennych czynności. Jest zatem istotnym czynnikiem wpływającym na ogólną jakość życia. Wobec coraz powszechniejszego zastosowania opioidów w celu zwalczania bólu również w chorobach innych niż nowotworowe, istnieje potrzeba podjęcia badań nad rzeczywistym wpływem opioidów na te funkcje. Dotychczas, mimo braku dowodów negatywnego wpływu morfiny na sprawność umysłową i psychomotoryczną, w wielu krajach jej przyjmowanie skutkuje niemożnością podejmowania czynności prawnych, obsługiwania maszyn i prowadzenia pojazdów. Innym ważnym powodem jest fakt, że powyższe ograniczenia zaczynają dotyczyć coraz większej liczby chorych w ogólnie dobrej kondycji fizycznej, którzy przyjmują morfinę z powodu bólu przewlekłego.Both analgia and proper cognitive functioning are mandatory for social wellbeing of cancer patients and for continuing their normal everyday activities. Good cognitive functioning is a potent factor influencing the general quality of life. As the use of opioids in the treatment of pain is becoming more and more comon in cancer as well as in non-cancer conditions, there is a need for extensive research on the influence of opioids on cognitive functions. To date, despite the lack of evidence for negative effects of morphine on the intellectual and psychomotor performance, its use precludes that the patients take legal acts, operate machines and drive a car. Another important reason is that these limitations affect the continuously growing number of patients taking morphine for chronic pain

Selected aspects of advance care planning according to Polish legal regulations — physician’s requirements

In 2017, the group of 109 experts from various countries developed the international consensus definitionof advance care planning (ACP), which is defined as enabling individuals to define objectives and preferencesfor future medical treatment and care, to discuss these goals and preferences with family and healthcareproviders, and to record and review these preferences if appropriate. ACP plays a significant role in thecare of patients with chronic diseases, and especially may have an impact on the situation of palliativecare patients, their families and healthcare professionals who look after them.This article analyses the legal constraints of ACP in Poland, and presents legal regulations related to someselected issues of ACP. One of the essential features of ACP is disclosing information to the patient andtaking into account the patient’s decisions concerning the treatment and medical care. This is providedfor in Polish law and healthcare professionals are obliged to observe it. Moreover, the Polish law includesbroad principles applying to providing the patient’s family with information about diagnosis and prognosisof the disease. However, advance directives and health care proxy have not been regulated by nationallaw yet. Therefore, it seems that the incorporation of ACP into Polish healthcare system requires the developmentof new legal regulations

Palliative care in chronic obstructive pulmonary disease

W ostatnich latach dąży się do objęcia opieką paliatywną pacjentów z innymi niż nowotwory złośliwe chorobami przewlekłymi o niekorzystnym rokowaniu, między innymi pacjentów z przewlekłą obturacyjną chorobą płuc. W tej grupie chorych zarówno jakość życia, jak i rokowanie są złe. Niestety, chorzy nie otrzymują właściwej opieki, mimo że postępująca POChP jest przyczyną prawie tylu zgonów co rak płuca. Cierpienie umierających na POChP jest nie mniejsze niż umierających na raka. Główne problemy to: duszność, kaszel, zmęczenie, depresja, a także problemy emocjonalne i psychosocjalne. Potrzeby chorych z ciężką POChP są istotnie „paliatywne”, toteż główny nacisk kładzie się na jakość kończącego się życia. Należy podkreślić, że opieka paliatywna oznacza tu nie tylko prawidłowe leczenie objawów somatycznych. Chorzy wymagają holistycznego, wielodyscyplinarnego podejścia we wdrażaniu modelu opieki, skoncentrowanego na potrzebach pacjenta i jego najbliższych.Traditionally focusing on terminally ill cancer patients, palliative care services have recently attempted to involve patients with other chronic, life - threatening diseases, e.g. chronic obstructive pulmonary disease (COPD). In this group of patients both quality of life and life expectancy is poor. Unfortunately, patients with COPD don’t receive adequate special medical service, although this progressive disease causes almost as many deaths as lung cancer. The suffering of patients dying from COPD is not smaller than cancer patients. The major symptoms are usually dyspnoe, cough, fatigue, depression, emotional and psychosocial problems. In fact, their needs are really palliative, so we try to pay attention to the quality of life of people suffering from COPD. It is important to underline that medical palliation of these patients falls not only to the management of the main clinical symptoms, but also to adopt a holistic, multiprofessional approach and working with their families and caregivers

Opieka paliatywna w przewlekłej chorobie obturacyjnej płuc (POChP)

W ostatnich latach dąży się do objęcia opieką paliatywną pacjentów z innymi niż nowotwory złośliwe chorobami przewlekłymi o niekorzystnym rokowaniu, między innymi pacjentów z przewlekłą obturacyjną chorobą płuc. W tej grupie chorych zarówno jakość życia, jak i rokowanie są złe. Niestety, chorzy nie otrzymują właściwej opieki, mimo że postępująca POChP jest przyczyną prawie tylu zgonów co rak płuca. Cierpienie umierających na POChP jest nie mniejsze niż umierających na raka. Główne problemy to: duszność, kaszel, zmęczenie, depresja, a także problemy emocjonalne i psychosocjalne. Potrzeby chorych z ciężką POChP są istotnie „paliatywne”, toteż główny nacisk kładzie się na jakość kończącego się życia. Należy podkreślić, że opieka paliatywna oznacza tu nie tylko prawidłowe leczenie objawów somatycznych. Chorzy wymagają holistycznego, wielodyscyplinarnego podejścia we wdrażaniu modelu opieki, skoncentrowanego na potrzebach pacjenta i jego najbliższych