Symptom Management

Delirium is common at the end of life and is very frightening for patients and families, interfering with communication just when it is most important. Restraints should be avoided whenever possible. Insomnia is also a problem for dyspneic patients, who often fear that if they go to sleep they will not wake up. Anxiety worsens dyspnea, and dyspnea leads to anxiety. Depression and anxiety are often overlooked in patients with end-stage lung disease. Like other patients with chronic dehditating illnesses, end-stage lung patients suffer losses of independence, privacy, and a sense of wholeness. The loss of work and 

The SUPPORT study of 1832 seriously ill, hospitalized patients found that only one-fourth had discussed preferences for cardiopulmonary resuscitation with their physicians, and more than half of those who had not, did not want to do so (12). In another study, fewer than one-third of oxygen-dependent COPD patients had discussed end-of-life options with their physicians, but three-quarters reported that their doctor knew their preference (2). Clearly, someone needs to be facilitating these discussions, and palliative care physicians have experience in goals-of-care conversations. 

Introduce all participants, identify official inoxy, leader explains role 

If patient cannot attend, bring patient as a person into the room ( Tell me about ) 

Establish ground mles and ask how they like to deal with information Explain proxy s role 

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Diuretics have been the mainstay for HF symptom management for many years. 0 Diuretics are used for relief of acute symptoms of congestion and maintenance of euvolemia. These agents interfere with sodium retention by increasing urinary sodium and free water excretion. No prospective data exist on I the effects of diuretics on patient outcomes.14 Therefore, the... 

CD Since the publication of the Women s Health Initiative study, there has been an increase in the use of non-hormonal therapies for the management of menopausal symptoms. Particularly for women with CHD and breast cancer risk factors, non-hormonal therapies may offer an alternative to assist with symptom management. A wide range of therapies, both prescription and herbal, have been studied with varying degrees of success. In choosing a particular therapy, it is important to match patient symptoms with a therapy that is not only effective but also safe. 

Finlay, I.G., Bowszyc, J., Ramlau, C. and Gwiezdzinski,Z. (1996) The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers. J. Pain Symptom Manag. 11, 158-162. 

Andersen G, Christrup L, Sjogren P. Relationships among morphine metabolism, pain and side effects during long-term treatment an update. J Pain Symptom Manage 2003 25(1 ) 74—91. 

Johnson JR, Bumell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. (2010) Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC CBD extract and THC extract in patients with intractable can correlated pain. J Pain Symptom Manage 39 167-179. 

Simpson DM, Estanislao L, Brown SJ, Sampson J. (2008) An open-label pilot study of high-concentration capsaicin patch in painful hiv neuropathy. J Pain Symptom Manage 35 299-306. 

Hagen NA, Fisher KM, Lapointe B, Souich P, Chary S, Moulin D, Sellers E, Ngoc AH. (2007) An open-label, multi-dose efficacy and safety study of intramuscular tetrodotoxin in patients with severe cancer-related pain. J Pain Symptom Manage 34 171-182. 

Hagen NA, Souich P, Lapointe B, Ong-Lam M, Dubuc B, Walde D, Love R, Ngoc AH. (2008) Tetrodotoxin for moderate to severe cancer pain A randomized, double blind, parallel design multicenter study. J Pain Symptom Manage 35 420 29. 

KrechRL, Walsh D. Symptoms of pancreatic cancer. J Pain Symptom Manage 1991 6(6) 360-367. 

Rogers, A.G. (1989) Use of amitriptyline (Elavil) for phantom limb pain in younger children. J Pain Symptom Manage 4 96. 

Rusy, L.M., Troshynski, T.J., and Weisman, J. (2001) Gabapentin in phantom limb pain management in children and young adults report of seven cases. / Pain Symptom Manage 21 78—82. 

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Macleod AD Methylphenidate in terminal depression. J Pain Symptom Manage 16 193-198, 1998... 

Midazolam has also been used as an effective medication in palliative medicine when symptom management supersedes the problem of side effects (372, 373). It is used for a variety of indications, including for terminal agitation, for muscle relaxation, and as an anticonvulsant. Recommended therapy is a loading... 

Ferrante FM Principles of opioid pharmacotherapy Practical implications of basic mechanisms. J Pain Symptom Manage 1996 11 265. [PMID 8636625]... 

Aparasu, R., McCoy, R.A., Weber, C., Mair, D., Parasuraman, T.V. Opioid-induced emesis among hospitalized nonsurgical patients effect on pain and quality of life, J. Pain Symptom Manage. 1999, 18, 280-188. 

Campora, E., Merlini, L., Pace, M., Bruzzone, M., Luzzani, M., Gottlieb, A., Rosso, R. The incidence of narcotic-induced emesis, J. Pain Symptom. Manage. 1991, 6, 428-430. 

Stein, C. Peripheral analgesic actions of opioids, J. Pain Symptom. Manage. 1991, 6, 119-124. 

Jamison, R.N., Kauffmann, J., Katz, N.P. Characteristics of methadone maintenance patients with chronic pain, J. Pain Symptom Manage. 2000, 19, 53-62. 

Bruera, E., Ripamonti, C., Brennis, C., Macmillan, K., Hanson, J. A randomized double-blind crossover trial of intravenous lidocaine in the treatment of neuropathic cancer pain, J. Pain Symptom Manage. 1992, 7, 138-141. 

Ebert, B., Andersen, S Hjeds, H., Dickenson, A. H. Dextropropoxyphene acts as a noncompetitive N-methyl-D-aspartate antagonist, J. Pain Symptom Manage. 1998, 15, 269-274. 

Mercadante, S., Casuccio, A., Genovese, G. Ineffectiveness of dextromethorphan in cancer pain, J. Pain Symptom Manage. 1998, 16, 317-322. 

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