Journal of palliative medicine
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The sexual health needs of people with advanced incurable diseases are underexplored and under assessed by health care practitioners and under studied by researchers. The loss of sexual health can impact a person's overall quality of life and well-being. This integrative review of the literature presents the current state of the science and was conducted to identify and summarize publications in the professional literature related to the sexual health needs of people with advanced illness. ⋯ Of the 30 possibly relevant abstracts and titles identified, there was only one prospective or case control trial focusing on sexual health in this population thereby offering the practitioner little research evidence to inform clinical practice. Increasing our understanding of the sexual health needs of people facing the end of their lives is crucial if we are to conduct appropriate assessments and initiate relevant treatments. Further prospective research is required to assess and establish the sexual health concerns of people along the disease trajectory of incurable illness as well as those imminently facing the end of their lives.
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Opioid dose escalation may cause hyperalgesia, mediated by the N-methyl-D-aspartate (NMDA) pathway. Methadone is an atypical opioid that inhibits hyperalgesia through NMDA-blockade, especially at low doses. ⋯ The use of very-low-dose methadone in conjunction with adjuvant haloperidol resulted in excellent pain control without dose escalation or opioid-induced hyperalgesia, for both cancer and noncancer diseases. We conclude that low-dose methadone should be part of first-line treatment in palliative pain management.