Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2012
ReviewAcute pain management in patients with persistent pain.
Over the past 20 years, prescriptions of opioids for chronic pain have increased dramatically. This review addresses the difficulties in managing acute pain in this growing group of patients and discusses evidence relating to opioid tolerance and hyperalgesia and new avenues of research in specific painful conditions. ⋯ Much of the evidence regarding the acute pain management of chronic pain patients is extrapolated from studies of opioid-naïve patients undergoing surgery. More focused research is needed to ascertain whether this model is an appropriate one to follow for such a complex group of patients.
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Curr Opin Support Palliat Care · Jun 2012
ReviewEvidence-based spiritual care: a literature review.
As spiritual care has increasingly been considered an integral component of a healthcare treatment plan, spiritual care practitioners have been encouraged to adopt an evidence-based orientation, just as evidence-based practice is encouraged in every other aspect of healthcare. Though the notion of 'evidence-based spiritual care' is still developing, increasingly research is conducted in order to provide an evidence base to the practice of spiritual care. This article reviews spirituality and spiritual care literature from June 2010 to December 2011 that employ empirical research methods. ⋯ Conceptual analysis combined with empirical study of care giver understandings of spiritual care will assist in developing clarity and consensus about the definition of spirituality and spiritual care. Investigation and conceptualization of interdisciplinary roles and provision of spiritual care is needed for optimizing collaborative care. More knowledge is needed about how to effectively teach spiritual care.
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Curr Opin Support Palliat Care · Jun 2012
ReviewUpdate on combined modalities for the management of breathlessness.
Breathlessness is a symptom which is felt as shortness of breath or tightness in the chest. The symptom of breathlessness is essentially an awareness of difficult respiration; in other words, respiration becomes an effort. The increase due to pathological change supplements the effect of exercise. In this article, the combined modalities of palliative management of breathlessness are discussed on the basis of current literature (published and indexed in PubMed from January 2009 to week 1 in January 2012). The findings were used to derive a treatment algorithm for the management of dyspnoea. ⋯ As yet, there is no clinical trial that can accurately reflect the far-reaching effects of combined treatment modalities of breathlessness. Therefore, at present, we would recommend combining a treatment with opioids, anxiolytics and corticosteroids accompanied by oxygen and physiotherapeutic treatment options.
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Curr Opin Support Palliat Care · Jun 2012
ReviewDyspnea prevalence, trajectories, and measurement in critical care and at life's end.
Dyspnea is a multidimensional response to an asphyxial threat that heralds respiratory failure. A clinician's ability to treat dyspnea warrants understanding the prevalence, burden, trajectories, and measurement across chronic conditions and exacerbations. This review focuses on two contexts: the intensive care unit and the near death stage of illness. ⋯ In summary, new evidence is demonstrating the high prevalence and distress associated with dyspnea among critically ill patients and patients near death.