Family physicians who care for terminally ill patients must manage a wide range of bothersome symptoms, including pain, fatigue, dyspnea, delirium, and constipation. According to a Cochrane for Clinicians article in the December 1st issue of American Family Physician, constipation affects up to half of all patients receiving palliative care and nearly 9 in 10 palliative care patients who use opioid medications for pain. Unfortunately, a Cochrane systematic review found limited evidence on the effectiveness of laxatives in these patients, as Dr. William Cayley Jr. comments:
“For patients with constipation, especially those with opioid-induced constipation, there is insufficient evidence to recommend one laxative over another. The choice of laxatives should be based on past patient experience, tolerability, and adverse effects. Methylnaltrexone is a newer agent that may be useful especially for patients with opioid-induced constipation that has not responded to standard laxatives, but there is limited evidence of potential adverse effects. Therefore, judicious use preceded by a discussion with patients about known risks and benefits is warranted.”
The Cochrane Library recently discussed this review in its Journal Club feature, which includes open access to the full text of the review, a podcast by the authors, discussion points, and a Powerpoint slide presentation of the review’s main findings.
Additional resources for physicians and patients on advanced directives, hospice care, and ethical issues are available in the AFP By Topic collection on End-of-Life Care.
The above post was first published on the AFP Community Blog.
*This blog post was originally published at Common Sense Family Doctor*
The overdose death rate from prescription opioids, referred to as “narcotics”, has reached “epidemic levels” in the US according to a report just released by the Centers for Disease Control and Prevention (CDC). The report further states that the intentional misuse and abuse of popular opioids such as OxyContin, Vicodin, methadone and others now cause more deaths than those caused by heroin and cocaine combined.
Dr. Thomas Frieden, CDC Director told reporters that “Narcotics prescribed by physicians kill 40 people a day.” He continued by stating “Prescription painkillers are meant to help people who have severe pain. They are, however, highly addictive.”
The report states that increased prescribing of pain medications by doctors is a significant cause of this growing number of deaths. However, the situation is far more complicated than this report presents. Poor pain management and prescription drug abuse has become Read more »
A nurse recently asked a very important question that bears repeating: What effect does long-term use of pain pills have on pregnant women? She was concerned because of the increase in number of pregnant women who are taking pain pills on a long term basis based on previous surgeries, accidents or a history of chronic pain.
The most common “pain pills” prescribed are opiates which effectively eliminate or reduce pain but have a great tendency to be abused. Opioids are natural and synthetic type drugs that have the characteristics of morphine. It can only be obtained with a prescription and unfortunately physicians contribute to the problem of dependency and abuse through their lack of scrutiny regarding patient requests. My present home state of Florida has the unsavory distinction of being known as the country’s largest pill mill and it was reported that 80 percent of opiates were not dispensed by pharmacists but by physicians who dispense them from their offices. Consequently, the Florida legislators now prohibit physicians from dispensing opiates in their offices with rare exceptions.
Why are opiates or pain killers dangerous for pregnant women? Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
Living Beyond Pain
For people with severe chronic pain like Kelly Young and Teresa Shaffer—both of whom have become patient advocates—coping with agony is a fact of life. Young suffers from rheumatoid arthritis while Shaffer’s pain is linked primarily to another degenerative bone disease.
Chronic pain is one of the most difficult—and common—medical conditions. Estimated to affect 76 million Americans—more than diabetes, cancer and heart disease combined—it accompanies illnesses and injuries ranging from cancer to various forms of arthritis, multiple sclerosis and physical trauma.
Pain is defined as chronic when it persists after an injury or illness has otherwise healed, or when it lasts three months or longer. The experience of pain can vary dramatically, depending in part on whether it is affecting bones, muscles, nerves, joints or skin. Untreated pain can itself become a disease when the brain wrongly signals agony when there is no new injury or discernable other cause. Fibromyalgia—a disease in which pain in joints, muscles and other soft tissues is the primary symptom—is believed to be linked to incorrect signaling in the brain’s pain regions.
Finding a Doctor
The first step to deal with chronic pain is Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
Prescription opiates rose to one-third of all treatment admissions in 2009, from 8% in 1999, reflecting the rising trends in prescription opiate abuse. There were nearly 2 million substance abuse treatment admissions in 2009 among people ages 12 and older were reported to the Treatment Episode Data Set, a reporting system involving treatment facilities from across the country.
Five substance groups accounted for 96% of admissions: alcohol (42%), opiates (21%), marijuana (18%), cocaine (9%), and methamphetamine/amphetamines (6%), reported the Substance Abuse and Mental Health Services Administration. The data came from 49 states and Puerto Rico. Georgia and the District of Columbia did not report admissions for 2009. One person can be reported as multiple admissions in a year.
Read more »
*This blog post was originally published at ACP Internist*