Journal of palliative medicine
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Milnacipran is one of the classes of drugs that are serotonin and norepinephrine reuptake inhibitors (SNRIs). It is a promising drug for the treatment of neuropathic pain in patients with advanced cancer. However, we found that neuromuscular and somatosensory disorders occurred when milnacipran was used as an adjuvant analgesic. ⋯ This is the first report that demonstrates an adverse reaction of milnacipran when used as an analgesic adjuvant, and not as an antidepressant drug, for neuropathic pain in patients with advanced cancer. The analgesic effect of SNRIs will likely be used in the management of neuropathic pain in the future; however, clinicians should be aware of the early adverse reactions to these agents.
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Few studies incorporate patient self-assessment scales in prognostic models of survival prediction. The Edmonton Symptom Assessment Scale (ESAS) is commonly used as a symptom screening tool in cancer patients. ⋯ All ESAS scores significantly worsened in the last 4 weeks prior to death compared with those in the previous months. Sudden deterioration of the global ESAS symptoms may predict impending death. Future studies on a prognostic model should incorporate both ESAS symptom severity and trends.
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Major depression and delirium are prevalent, underrecognized, and undertreated in hospice and palliative care settings. Furthermore, they are both associated with significant morbidity and mortality. ⋯ These results support the notion that depression and delirium are very common in hospice inpatients, and that screening for both is relatively easy and practical for hospice clinicians to conduct.
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Accurate assessment in hospice patients who cannot communicate their pain is almost impossible, increasing their risk for unrecognized and inadequately managed pain. ⋯ The MOPAT has preliminary evidence of reliability, validity, and clinical utility. Full-scale psychometric testing in hospice and acute care hospital patients is currently underway.
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Abstract Dexmedetomidine (Precedex®) is an alpha-2 adrenergic agonist that can produce sedation and analgesia without causing respiratory depression. Its use has been described in patients undergoing mechanical ventilation, sedation for surgical and nonsurgical procedures, and prevention of withdrawal. We describe its use as an adjuvant analgesic in a patient with cancer pain refractory to multiple treatment modalities.