Articles: palliative-care.
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Most US citizens die in acute care hospitals, often in physical pain, without attention to emotional and spiritual suffering. This represents an ethical failure of our current health-care system. The field of palliative medicine aims to address the physical, emotional, and spiritual needs of patients with advanced disease. ⋯ When hospitalists are not selected and trained effectively around palliative care issues, the risks are great. Discontinuity of physicians can lead to miscommunication and misunderstanding (by professionals, patient, and family); disagreement about treatment focus (especially as it relates to a shift from curative to palliative); inappropriate deferring of advance care planning to the hospital setting; and, most worrisome, a lack of expertise in symptom control, communication skills, and attention to patient and family distress and the provision of emotional and spiritual support. This article evaluates the convergence of the 2 fields of palliative medicine and hospitalist medicine and reviews the opportunities for mutual education and improved patient care.
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Pain is the most prominent symptom and clinical finding in osteoarthritis (OA). Acetaminophen and nonsteroidal anti-inflammatory drug (NSAID) therapy are the mainstays of OA analgesia, but other drug and non-drug therapy, joint injections, and surgery may be needed to provide reasonable quality of life. Regularly scheduled, low-dose opioids can produce good relief of chronic nonmalignant pain including pain caused by OA. This paper reviews the potential risks and benefits of opioids, the evidence supporting their use in OA pain, and guidelines for their use in OA pain.
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The purpose of this review was to determine how effective exercise is in the treatment of chronic pain. ⋯ Exercise is effective for the management of chronic low back pain for up to 1 year after treatment and for fibromyalgia syndrome for up to 6 months (level 2). There is conflicting evidence (level 4b) about which exercise program is effective for chronic low back pain. For chronic neck pain and for chronic soft tissue shoulder disorders and chronic lateral epicondylitis, evidence of effectiveness of exercise is limited (level 3).