Prevalence and management of symptoms during the last month of life.

BACKGROUND: The prevalence and severity of the "most troublesome" symptoms in terminally ill patients are well known and have been studied in many settings. However, these symptoms change during the course of advanced disease. OBJECTIVES: To evaluate the range and trajectory of symptoms in the final stage of life as measured a month prior to death. METHODS: Patients with an expected prognosis of less than 6 months were recruited forthe study. Excluded were non-Hebrew or Russian speakers, and patients with cognitive impairment or a diagnosis of brain tumor. A structured questionnaire was used to interview patients and their caregivers at home every 2 weeks until death. We present a comparison analysis of 45 patients who completed both interviews 2 and 4 weeks before death. RESULTS: There were five symptoms (fatigue, pain, reduced wellbeing, lack of appetite, somnolence) that were reported most frequently, occurring in more than 70% of the patients. Most of the symptoms showed a worsening trend towards death. CONCLUSIONS: Assessing the presence and severity of symptoms as a guide to start or modify treatment is recommended. Knowledge of how symptoms change in the final stage of life could better assist in the management of resources and could help patients and their families in their final preparations.

[Opioids and driving].

In many European countries the use of opioids for long-term treatment of non-malignant pain has dramatically increased during the last decade in order to improve the patient's quality of life, to allow social activities and the return to work. Therefore, the issue of driving by patients regularly taking opioids, and its medico-legal aspects, concerns physicians, patients and society. Many studies explored the effect of opioids drugs on cognitive and driving skills using healthy subjects, patients taking opioids for chronic malignant and non-malignant pain, with different administration methods and in combination with other psycho-active drugs. These studies show that the patients taking stable dosages of opioids may continue working and driving safety. The decision to allow patients to drive under stable long-term opioid therapy is always individually based and should be founded on relevant and up-to-date clinical data, including both physical and mental evaluations. The patient, on the other hand, should also be responsible for his condition before and during driving.

Post herpetic itching--a treatment dilemma.

OBJECTIVES: To present a case of severe disabling postherpetic itching (PHI) and discuss possible mechanisms and management. METHODS: We report on a 22-year-old male patient with a history of non-Hodgkin lymphoma, chronic renal failure peritoneal dialysis dependent, presented with a disabling pruritus around his left eye and forehead. Two months before, he was diagnosed with herpes zoster ophtalmicus. His itching intensity was 10/10 on a visual analog scale and he reported no pain. The neurologic examination showed a hyposensitivity to touch around his left eye. RESULTS: Our patient suffered of PHI who responded successfully to a combination of antihistamine and an antiepileptic agent. DISCUSSION: The mechanism of postherpetic neuralgia and PHI are not well understood and no single best treatment for postherpetic neuralgia and PHI is known. Clinical experience suggested that neuropathic itch may be more resistant to treatment than neuropathic pain. This immunocompromized patient with a severe disabling PHI responded to antihistaminic and anticonvulsant treatment.