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New Pain Management Vistas in Palliative Care

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Essentials of Palliative Care

Abstract

It is an exciting time in medicine and this is true in Palliative Care. Evolving technological advances and novel therapeutic agents have provided hope and promise in managing the often complicated Palliative Care patient. This chapter focuses on new agents in various stages of development that potentially may provide therapeutic benefits in the Palliative Care environment. Advances in drug delivery are presented in this review and it is certain this will impact health care delivery in many settings, including Palliative Care. Further, a detailed discussion of local anesthetics, including pharmacology, toxicity, common and advanced techniques, and evolving technological advances with ultrasound and continuous catheters is presented for the clinician managing Palliative Care patients.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Christopher K. Merritt M.D., Lien B. Tran M.D. & Alan David Kaye M.D., Ph.D.

  2. Department of Anesthesiology, Guthrie Clinic-Big Flats, Horseheads, NY, USA

    Rinoo V. Shah M.D., M.B.A.

Authors
  1. Christopher K. Merritt M.D.
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  2. Lien B. Tran M.D.
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  3. Rinoo V. Shah M.D., M.B.A.
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  4. Alan David Kaye M.D., Ph.D.
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Corresponding author

Correspondence to Christopher K. Merritt M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Members of which of the following classes of agents are currently available for clinical use (select all that apply):

    1. (a)

      Anti-NGF agents

    2. (b)

      VGCC blocking agents

    3. (c)

      High-dose topical capsaicin

    4. (d)

      FAAH inhibitors

  2. 2.

    Extended release enteral formulations may allow for all of the following except:

    1. (a)

      Improved compliance

    2. (b)

      Reduced adverse effects

    3. (c)

      Improved rapidity of effect onset

    4. (d)

      Simpler dosing regimen

  3. 3.

    Which of the following parenteral analgesics would be least suited to rapid control of breakthrough pain?

    1. (a)

      Sufentanil NanoTab® PCA System

    2. (b)

      Transdermal fentanyl patch

    3. (c)

      Buccal fentanyl lozenge

    4. (d)

      Ionsys® iontophoretic transdermal fentanyl

  4. 4.

    Monitoring for regional anesthesia under moderate sedation include all of the following except:

    1. (a)

      Electrocardiography

    2. (b)

      Pulse oximetry

    3. (c)

      Neurological checks every 1 h

    4. (d)

      End-tidal CO2 monitoring

  5. 5.

    Regional anesthesia:

    1. (a)

      May not be feasible in patients with severe edema or contractures

    2. (b)

      Can be used in any patient suffering from chronic pain

    3. (c)

      Is more effective than opioids and should be the first-line treatment for chronic pain

    4. (d)

      Is not recommended for patients experiencing a sickle cell crisis

  6. 6.

    Risks of continuous catheter regional nerve blocks include which of the following?

    1. (a)

      Infection at the site of catheter insertion

    2. (b)

      Cardiovascular collapse from local anesthetic toxicity

    3. (c)

      Falls from lower extremity nerve blocks

    4. (d)

      All of the above

Answers

  1. 1.

    (b, c)

  2. 2.

    (c)

  3. 3.

    (b)

  4. 4.

    (c)

  5. 5.

    (a)

  6. 6.

    (d)

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Merritt, C.K., Tran, L.B., Shah, R.V., Kaye, A.D. (2013). New Pain Management Vistas in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_26

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