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Otterwell S, Baker MJ. Assessment and management of a person experiencing pain from pancreatic cancer ascites: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S16-S20. [PMID: 35271354 DOI: 10.12968/bjon.2022.31.5.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The most common type of pancreatic cancer is pancreatic adenocarcinoma, which affects the exocrine ducts. There are many risk factors associated with pancreatic cancer, including smoking, obesity, poor diet, diabetes, inactivity and genetics. In the UK, pancreatic cancer is the 10th most common cancer with a poor prognosis, with only 24% of people surviving the first year after diagnosis and 7% surviving for 5 years. The lives of those with the condition are impacted in a number of ways. This case study of a patient with pancreatic cancer explores the nursing assessment, management and evaluation of care provided from a student nurse perspective under the supervision of a qualified nurse.
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Affiliation(s)
- Siouxsie Otterwell
- Second-year Student Nurse, Florence Nightingale School of Nursing and Midwifery, King's College London
| | - Mark J Baker
- Lecturer, Florence Nightingale School of Nursing and Midwifery, King's College London
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Kašiković Lečić S, Javorac J, Živanović D, Lovrenski A, Tegeltija D, Zvekić Svorcan J, Maksimović J. Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review. Ups J Med Sci 2022; 127:8739. [PMID: 35910492 PMCID: PMC9287761 DOI: 10.48101/ujms.v127.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic, and fatal interstitial lung disease (ILD) of unknown etiology that primarily affects the elderly. Patients with IPF suffer from a heavy symptom burden and usually have a poor quality of life. Dyspnea and dry cough are predominant symptoms of IPF. Although pain is not considered one of the main symptoms of IPF, it can occur for a variety of reasons, such as hypoxia, coughing, muscle and nerve damage, deconditioning, and steroid use. The prevalence of pain in IPF patients varies greatly, ranging from around 30 to 80%, with the prevalence being estimated mostly among patients in the end-of-life period. It manifests itself in the form of muscle pain, joint discomfort, or back and chest pain. Approaches to the treatment of chronic musculoskeletal pain in patients with IPF include pharmacological and non-pharmacological measures that are also important to optimize the treatment of other symptoms (dyspnea and cough) and the optimal treatment of comorbidities. Given the scarcity of data on this symptom in the literature, this article summarizes what is currently known about the etiology and treatment of musculoskeletal pain in IPF.
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Affiliation(s)
- Svetlana Kašiković Lečić
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
| | - Jovan Javorac
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Dejan Živanović
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Aleksandra Lovrenski
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Dragana Tegeltija
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Jelena Zvekić Svorcan
- Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Medical Rehabilitation, Novi Sad, Serbia
| | - Jadranka Maksimović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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O'Brien MDC, Wand APF. A systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling older adults. Age Ageing 2020; 49:175-183. [PMID: 31971548 DOI: 10.1093/ageing/afz175] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION the ageing global population and concomitant increase in the use of opioid analgesia have highlighted the need to evaluate the effectiveness of opioids for chronic pain in older people. METHODS a systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling people aged 65 years or more was conducted using PRISMA guidelines. The databases MEDLINE, EMBASE, Pubmed and PsychINFO were searched. The quality of studies was assessed. Secondary aims were to assess correlates of opioid use and the decision-making processes of prescribers. RESULTS seven studies were identified of low to high quality. The majority of older people experienced ongoing pain despite continuing opioid therapy. There were mixed results regarding benefits of opioids in terms of activities of daily living and social engagement. In nursing home residents, opioid use at baseline was associated with severe pain, severe impairment in activities of daily living and a diagnosis of depression. Fear of causing harm to older people was common amongst opioid prescribers, limiting prescription. Facilitators of opioid prescription included educational interventions and access to an evidence base for opioid use. CONCLUSION there is limited evidence supporting the use of long-term opioid use in older people for chronic non-cancer pain and a lack of trials in this age group. Age-specific guidelines are required addressing initial assessment, indications, monitoring and de-prescribing.
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Affiliation(s)
- Michael David Cory O'Brien
- Geriatric and Rehabilitation Services, Royal Brisbane and Women's Hospital, Butterfield Street Herston, Queensland, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia
| | - Anne Pamela Frances Wand
- Older Persons' Mental Health Service, Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
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Abstract
Objective: To characterize the literature describing the therapeutic use of opioids in the elderly. Data Sources: Two electronic databases, EMBASE and MEDLINE, were searched from years 1990 to September 5, 2018. Relevant reference lists were reviewed. Searches were restricted to English language. Study Selection and Data Extraction: Two reviewers independently screened 827 citations to identify observational studies, population-based cohort studies, retrospective analyses, and control trials looking at the management of persistent pain in patients aged ≥65 years and/or frail patients. Data Synthesis: Thirty-nine articles were included in the systematic review. More specifically, 17 observational studies, 7 population-based cohort studies, 10 retrospective analyses, and 4 controlled trials. The most common etiology of persistent pain was musculoskeletal (50%), and the most often adverse effects reported were central nervous system related (41%) and falls/fractures (39%). Relevance to Patient Care and Clinical Practice: As there is a lack of strong evidence-based recommendations for opioid use in the elderly, this review aims to evaluate opioid use in the elderly and compare their efficacy and safety among this population. Conclusions: Overall, central nervous system adverse effects were most commonly seen in the elderly. However, higher quality evidence is required to further appreciate the dose-related effects on efficacy and safety of opioids in the elderly.
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Affiliation(s)
- Melissa Jassal
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Greg Egan
- Vernon Jubilee Hospital, Vernon, British Columbia, Canada
| | - Karen Dahri
- Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Ning M, Tao Y, Hu X, Guo L, Ni J, Hu J, Shen H, Chen Y. Roles of UGT2B7 C802T gene polymorphism on the efficacy of morphine treatment on cancer pain among the Chinese han population. Niger J Clin Pract 2019; 22:1319-1323. [PMID: 31607718 DOI: 10.4103/1119-3077.269019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Morphine is a common analgesic often used to manage chronic pain, especially for patients with pain due to malignancies. Since UGT2B7 plays an important role in the metabolism of morphine, UGT2B7 gene mutation may influence the efficacy of morphine in patients with cancer being treated by this medication. Aims The aim of this study is to investigate the relationship between the polymorphisms of UGT2B7 and the efficacy of morphine treatment on cancer pain among the Chinese Han population. Materials and Methods A total of 120 patients with cancer pain were enrolled in this study. Morphine was administrated through patient-controlled analgesia infusion pump, and the visual analog score (VAS) was used for pain assessment at 0.5, 4, 6, 12, 24, 48, and 72-h post morphine treatment, respectively. The plasma concentration of morphine and genetic polymorphism of UGT2B7 C802T and G221T was analyzed, respectively. Results The frequencies of UGT2B7 C802T were CC: 13.33%, CT: 45% and TT: 41.67%, and the frequencies of UGT2B7 G221T were GG: 76.67%, GT: 22.5% and TT: 0.83%. Moreover, the VAS score of patients with either C802T CT or TT was significantly higher than that in patients with C802T CC. However, no difference of VAS scores was observed between patients carrying G221T GG and patients carrying G221T GT. The plasma concentration of morphine for patients with the C802T CC was significantly lower than that in patients carrying C802T CT or TT, while there was no significant difference in the level of morphine between patients with G221T GG and G221T GT. Conclusion The polymorphism of UGT2B7 C802T, but not UGT2B7 G221T, has been associated with the efficacy of morphine treatment on cancer pain among Chinese Han population.
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Affiliation(s)
- M Ning
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Y Tao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - X Hu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - L Guo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - J Ni
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - J Hu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - H Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Y Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Prostran M, Vujović KS, Vučković S, Medić B, Srebro D, Divac N, Stojanović R, Vujović A, Jovanović L, Jotić A, Cerovac N. Pharmacotherapy of Pain in the Older Population: The Place of Opioids. Front Aging Neurosci 2016; 8:144. [PMID: 27378916 PMCID: PMC4909762 DOI: 10.3389/fnagi.2016.00144] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/02/2016] [Indexed: 01/25/2023] Open
Abstract
Pain is a common symptom in older people. It is possible that pain is underreported in older persons due to an incorrect belief that it is an inevitable part of aging. Opioid analgesics are potent medications, with confirmed efficacy for the treatment of moderate to severe pain. These drugs are commonly used in older persons. However, there is insufficient evidence regarding safety of opioids in older patients. One of the reasons for this is the lack of randomized, controlled clinical trials. People of advanced age often have comorbidites and use other prescription drugs, as well as over-the-counter (OTC) compounds, thus making them more suceptible to the risk of interactions with opioids. Significant pharmacokinetic and pharmacodynamic changes that occur with advancing age increase the risk of adverse effects of opioids. There are also some discrepancies between guidelines, which recommend the use of lower doses of opioids in older patients, and the findings in the literature which suggest that pain is often undertreated in this age group. It seems that there are significant variations in the tolerability of different opioid analgesics in older people. Morphine, fentanyl, oxycodone, and buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for these patients. However, the safety and efficacy of other opioids in older patients, especially if comorbidities and polypharmacy are present, is still questionable. This review addresses the most important aspects of the use of opioids in older persons, focusing on pharmacokinetics, pharmacodynamics, adverse effects, and interactions.
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Affiliation(s)
- Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Katarina Savić Vujović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Sonja Vučković
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Branislava Medić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Dragana Srebro
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Nevena Divac
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Radan Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | | | - Lepa Jovanović
- Institute for Gerontology and Palliative Care Belgrade, Serbia
| | - Ana Jotić
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade Belgrade, Serbia
| | - Nataša Cerovac
- Clinic for Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade Belgrade, Serbia
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