Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2018
ReviewChronic postsurgical pain and cancer: the catch of surviving the unsurvivable.
Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. ⋯ Well-managed pain, irrespective of technique, reduces the risk of CPSP. The literature is inconclusive regarding an 'optimal approach.' Regional anaesthesia, intravenous lidocaine and the aggressive management of perioperative pain using multimodal analgesia including antineuropathic pain agents such as gabapentinoids and certain antidepressants are recommended. Clinicians should not rely on general anaesthesia, opioids, NSAIDs and ketamine to prevent CPSP. A blanket approach using gabapentinoids for all patients undergoing major surgery is not indicated. Instead, the presence of perioperative neuropathic pain should be checked for regularly.
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Curr Opin Support Palliat Care · Jun 2018
ReviewChinese herbal medicines in the prevention and treatment of chemotherapy-induced nausea and vomiting.
Chemotherapy-induced nausea and vomiting (CINV) critically impact on cancer patients' quality of life, causing various complications, and increasing the risk of chemotherapeutic failure. Current treatments addressing CINV are reasonably costly and have many side effects. Chinese herbal medicines (CHMs) have been widely used in treating CINV in China. Clinical trials and modern experimental studies on CINV using CHMs are reviewed for clues that may help us to better prevent and treat CINV with CHMs, and develop safe and effective treatments. ⋯ CHMs seem effective in the prevention and treatment of CINV based on the clinical trials and some animal experiments, although the scientific validity of many clinical studies remain to be confirmed as many of them were inadequately designed. Further well designed clinical trials and more preclinical studies with reliable markers are required to confirm the usefulness of CHMs as complementary medicines for treating CINV and to use CHMs as rational prescriptions rather than based only on empirical knowledge.
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Migraine is an extremely incapacitating collection of neurological symptoms that usually includes a severe, throbbing, recurring pain on one side of the head. The World Health Organization ranks migraine as the third most prevalent disease and the seventh commonest primary pain condition in the world. Trigeminovascular-mediated central sensitization has been implicated in the development of migraine symptoms including pain following light touch. This review explores the activation and sensitization of the brain systems that have emerged from recent studies and that contribute to migraine. ⋯ Several key studies have helped address the long-standing debate over whether migraine originates from vascular or neuronal dysfunction and now support that migraine is a neurological disorder. However, a complete understanding of the central nervous system dysfunction underlying this condition has yet to be elucidated.
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Curr Opin Support Palliat Care · Jun 2018
ReviewNonsteroidal anti-inflammatory drugs and cancer pain.
This review aims to appraise the most recent evidence for the use of NSAIDS in cancer pain. ⋯ Given the lack of quality evidence, NSAIDS should be prescribed on a case by case basis in discussion with the patient, with regular review of efficacy, whilst balancing the ongoing benefits and risks of continued use, taking into account the patient's likely prognosis.
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Thirst is a common and burdensome symptom of heart failure, which impacts adversely on quality of life. To date, there is limited research on the prevalence of thirst, the factors associated with thirst and interventions to help manage thirst in heart failure. This review summarizes key empirical research developments of thirst. ⋯ Despite the burden of thirst in heart failure patients, strategies to relieve thirst remains insufficiently addressed in literature. Further research to improve the understanding of the severity of thirst and its relationship to possible factors associated with thirst is required in order to develop future interventions to either prevent or alleviate troublesome thirst in patients with heart failure.