Lidocaína para el alivio del dolor en pacientes de cuidados paliativos, una serie de casos / Lidocaine for pain relief in palliative care patients, a case series

Introducción. El dolor neuropático afecta al 2 % de la población y 15 de cada 100 pacientes que acuden a consulta médica, sufren de dolor neuropático. Este tipo de dolor es muy común en pacientes con cáncer. Objetivo. Determinar si el uso de lidocaína en infusión endovenosa disminuye el dolor neuropático en los cuidados paliativos con tratamiento opioide. Metodología. Serie de casos de tres pacientes en cuidados paliativos que presentaron dolor neuropático y se les administraron múltiples infusiones de lidocaína intravenosa como coadyuvante para el manejo del dolor, se describieron las dosis utilizadas, el número de infusiones, se evaluó la mejoría del dolor a través de la escala visual análoga y se monitorizaron los posibles efectos secundarios. Resultados. Caso 1: escala visual análoga al ingreso 9/10; 24 horas posinfusión de lidocaína: 4/10. Caso 2: escala visual análoga al ingreso 6/10; 24 horas posinfusión de lidocaína 2/10. Caso 3: escala visual análoga al ingreso 8/10; 24 horas posinfusión 2/10. Conclusión. La infusión intravenosa de lidocaína al 2 % disminuyó el dolor neuropático en los tres pacientes del estudio, sin embargo, el alivio fue transitorio y el efecto positivo se perdió con el paso del tiempo

Introduction. Neuropathic pain affects 2 % of the population and 15 out of 100 patients who go to a physician suffer from neuropathic pain. This type of pain is common in cancer patients. Objective. To determine if the use of lidocaine in intravenous infusion reduces neuropathic pain in palliative care with opioid treatment. Methodology. Case series of three patients in palliative care who presented neuropathic pain and underwent multiple infusions of intravenous lidocaine as an adjuvant for pain management; the doses used and the number of infusions were described, pain improvement was evaluated through the visual analog scale and possible side effects were monitored. Results. Case 1: visual analogue scale on admission 9/10; 24 hours post lidocaine infusion: 4/10. Case 2: visual analogue scale on admission 6/10; 24 hours post lidocaine infusion 2/10. Case 3: visual analogue scale on admission 8/10; 24 hours post-infusion 2/10. Conclusion.Intravenous infusion of 2 % lidocaine reduced neuropathic pain in the three patients of the study, however, the relief is transitory, and the positive effect is lost over time.

Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Varón anciano con cáncer de mama tratado con opioides en unidad de cuidados paliativos de hospital público en El Salvador / Elderly man with breast cancer treated with opioids at the palliative care unit of a public hospital in El Salvador

El cáncer de mama en hombres es una patología poco frecuente, representa menos del 1 % de todos los cánceres masculinos y casi el 1 % de los cánceres de mama, y es responsable del 0,1 % de las muertes por cáncer en hombres. El tipo más común de cáncer de mama que se observa en los hombres es el carcinoma ductal invasivo, que constituye aproximadamente el 90 % de todos los cánceres de mama masculinos. El presente estudio reporta el caso de un hombre de 97 años al que se le diagnosticó un carcinoma ductal infiltrante invasivo que se trató con opioides en una unidad de cuidados paliativos. En este caso, que es poco frecuente en la literatura médica por el tipo de diagnóstico, sexo y edad del paciente, observamos que el buen uso de los opioides, el trabajo en equipo, el acercamiento con la familia y el seguimiento en el tiempo hace que se tomen mejores decisiones sobre el tratamiento, el bienestar, y que la calidad de vida sea mejor. (AU)

Breast cancer in men is a rare disease; it represents less than 1 % of all male cancers, and almost 1 % of breast cancers, and is responsible for 0.1 % of cancer deaths in men.The most common type of breast cancer seen in men is invasive ductal carcinoma, which accounts for approximately 90 % of all male breast cancers. The present study reports the case of a 97-year-old man who was diagnosed with invasive infiltrating ductal carcinoma, who was treated with opioids in a palliative care unit. In this case, which is rare in the medical literature due to the type of diagnosis, sex, and age of the patient, we observe that proper use of opioids, teamwork, closeness with the family, and follow-up over time result in better decisions about treatment, increased comfort, and improved quality of life. (AU)

Opioids prescription for symptoms relief and the impact on respiratory function: updated evidence.

PURPOSE OF REVIEW: Opioids are used for treating dyspnea and other symptoms in oncological and nononcological patients. The relief of respiratory fatigue and anxiety that these opioids offer is well known. One of the scarcely frequent, but very much feared, side-effects is respiratory depression. The purpose of this review is to determine whether or not the situation of an advanced-stage patient under palliative care and the use of opioids are risk factors for respiratory depression. RECENT FINDINGS: Studies conducted on respiratory function and opioids have proliferated in the past 10 years, but there is no recent review that groups the results together and evaluates their safe use in end-stage patients. SUMMARY: A bibliographic review found three randomized double-blinded placebo-controlled studies and five prospective studies, six of which showed that opioids significantly relieve dyspnea (P<0.001). The use of morphine for symptomatic relief does not significantly change the level of saturation of oxygen in the blood. In addition, the functional studies do not indicate that the use of opioids for dyspnea relief causes high CO2 levels in blood (P=0.05). The opioids used for treating dyspnea do not significantly compromise respiratory function; they are safe and effective.

A systematic review of the influence of opioids on advanced cancer patient survival.

PURPOSE OF REVIEW: Many health professionals still believe that opioids shorten the lifespan of patients. This situation implies that the ethical doctrine of double effect is often invoked to justify their use in extreme circumstances. The objective of this study is to revise the evidence existing in the recently published literature regarding the effect on patient survival of opioid used to control disease symptoms. RECENT FINDINGS: A review of the scientific literature regarding the effects of opioids on symptom control and survival does not provide any evidence that there is an association between these two variables. SUMMARY: The studies revised have not shown that the use of opioids for symptom control in advanced disease stages or in the last days of life has any effect on patient survival. Similarly, survival was not influenced by either the use of higher or lower doses of opioids, or by the practice of administering a double dose at night.

An update on the importance of monitoring serum magnesium in advanced disease patients.

PURPOSE OF REVIEW: Patients with advanced diseases are exposed to many causes of hypomagnesaemia, the most frequent being pharmacological causes through the administration of chemotherapy, antibiotics, proton pump inhibitors, and so on. The objective of this review is to demonstrate the importance of measuring magnesium levels in the blood of these patients. RECENT FINDINGS: In the last decade, studies have been published showing a direct relationship between low levels of magnesium and nonspecific symptoms including pain that is difficult to control. Nevertheless, hypomagnesaemia is still being omitted as a differential diagnosis in many such patients. SUMMARY: A review of recently published studies regarding the clinical presentation of hypomagnesaemia in patients with advanced cancer and other chronic diseases is presented. Many of the clinical conditions are reportedly alleviated with intravenous or even oral magnesium administration. The presence of nonspecific neurological signs and risk factors for hypomagnesaemia could serve as an indication that serum magnesium should be determined in these patients.

Hypomagnesemia as a possible explanation behind episodes of severe pain in cancer patients receiving palliative care.

Within an oncology setting, certain chemotherapy drugs, such as cisplatin, may lead to magnesium loss causing nephropathy. Neurological and cardiovascular symptoms caused by hypomagnesaemia are well known. The relationship between serious hypomagnesemia and severe pain is not well documented but nevertheless, when faced with unexplained episodes of pain which do not respond to powerful analgesics, it is important to review blood magnesium levels. We present two cases of opioid-refractory pain attacks. Patients received drugs which have been linked to hypomagnesemia. In both cases, endovenous magnesium replacement led to a drastic improvement in pain management.