Latest & greatest articles for palliative care

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Top results for palliative care

81. Palliative care - cough: Morphine

Palliative care - cough: Morphine Morphine | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Morphine Palliative care - cough: Morphine Last revised in April 2020 Morphine Morphine should be titrated in the same way as for pain relief. The initial starting dose will depend on the person's previous exposure to opioids. For more information about the use of morphine in pain relief, see the Prodgiy topic on . For someone not already taking an opioid, a dose of 2.5

2019 NICE Clinical Knowledge Summaries

82. Palliative care - cough: Codeine

Palliative care - cough: Codeine Codeine | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Codeine Palliative care - cough: Codeine Last revised in April 2020 Codeine If the person is already taking a strong opioid such as morphine, do not try a weak opioid such as codeine. Instead an 'as required' dose of morphine solution should be used to relieve cough and, if this is beneficial, continue to use in this way, or increase the regular morphine dose [ ]. Codeine

2019 NICE Clinical Knowledge Summaries

83. Palliative care - cough

Palliative care - cough Palliative care - cough | Topics A to Z | CKS | NICE Search CKS… Menu Palliative care - cough Palliative care - cough Last revised in April 2020 Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found in the airways. Management Prescribing information Background information Palliative care - cough: Summary Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found (...) obstructive pulmonary disease, and gastro-oesophageal reflux disease. When assessing someone with cough in palliative care, the following should be elicited: The impact on the person's quality of life. The severity, time of onset, and duration of the cough. The pattern and character of the cough. Any associated symptoms, such as nasal discharge, sputum, blood, or breathlessness. When examining someone with cough in palliative care, features to help determine the underlying cause should be identified

2019 NICE Clinical Knowledge Summaries

84. Palliative care - constipation: What doses of laxatives may be needed in palliative care?

Palliative care - constipation: What doses of laxatives may be needed in palliative care? Doses of laxatives | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Doses of laxatives Palliative care - constipation: What doses of laxatives may be needed in palliative care? Last revised in October 2016 What doses of laxatives may be needed in palliative care? Table 4 . Laxative doses that may be needed to manage constipation in palliative care. Laxative Licensed (...) dose (adults) Dose that may be needed in palliative care (off–label) Arachis (peanut) oil (retention enema) 1 enema (130 mL) at bedtime, as required Use maximum licensed dose Bisacodyl (tablets) 5–10 mg at night, increased if necessary to a maximum dose of 20 mg at night 20 mg three times a day Bisacodyl (suppositories) 1 suppository (10 mg) in the morning 20 mg daily Co-danthramer Strong (dantron/poloxamer 37.5/500 mg capsules or 75/1000 mg suspension) 1–2 capsules (or 5 mL only) at night 3

2019 NICE Clinical Knowledge Summaries

85. Palliative care - constipation: Which laxative should I prescribe?

Palliative care - constipation: Which laxative should I prescribe? Choice of laxative | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Choice of laxative Palliative care - constipation: Which laxative should I prescribe? Last revised in October 2016 Which laxative should I prescribe? The final choice of laxative will often depend on individual preference, and what has previously been tried. Advantages and disadvantages of different laxatives are detailed (...) . Syrup is unpalatable. Sodium picosulfate 6–12 hours Licensed only for short-term use. Syrup is palatable. Bisacodyl 6–12 hours No syrup available. Licensed only for short-term use. Dantron(terminal care only) 6–12 hours Restricted to use in terminal care. Prolonged contact with the skin (e.g. faecal or urinary incontinence) can cause a dantron burn — an erythematous rash with a sharply demarcated border. Available only combined with a softener: Concerns about possible carcinogenicity (from high-dose

2019 NICE Clinical Knowledge Summaries

86. Palliative cancer care - pain: What issues should I consider before prescribing baclofen?

Palliative cancer care - pain: What issues should I consider before prescribing baclofen? Baclofen | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Baclofen Palliative cancer care - pain: What issues should I consider before prescribing baclofen? Last revised in October 2016 What issues should I consider before prescribing baclofen? Sedation, drowsiness and nausea are commonly reported adverse effects. Do not stop baclofen abruptly; sudden withdrawal can (...) Formulary [ ], expert opinion from a palliative care text book: The Palliative Care Formulary [ ], and information published by the Medicines and Healthcare products Regulatory Agency (MHRA) [ ]. © .

2019 NICE Clinical Knowledge Summaries

87. Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug?

Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug? Tricyclic antidepressants | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Tricyclic antidepressants Palliative cancer care - pain: What issues should I consider before prescribing a tricyclic antidepressant drug? Last revised in October 2016 What issues should I consider before prescribing a tricyclic antidepressant drug? For prescribing

2019 NICE Clinical Knowledge Summaries

88. Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug?

Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? NSAIDs | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu NSAIDs Palliative cancer care - pain: What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? Last revised in October 2016 What issues should I consider before prescribing a nonsteroidal anti-inflammatory drug? For detailed information on prescribing

2019 NICE Clinical Knowledge Summaries

89. Palliative cancer care - pain: Scenario: Spinal cord compression

Palliative cancer care - pain: Scenario: Spinal cord compression Scenario: Spinal cord compression | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Spinal cord compression Palliative cancer care - pain: Scenario: Spinal cord compression Last revised in October 2016 Scenario: Spinal cord compression From age 16 years onwards. When should I suspect spinal cord compression? Suspect spinal metastases if any of the following features are present: Pain (...) dysfunction). Neurological signs of spinal cord or cauda equina compression. Basis for recommendation This recommendation is based on the National Institute for Health and Care Excellence guideline Metastatic spinal cord compression [ ]. How should I manage spinal cord compression? If spinal metastases are thought to be the cause of the pain, seek urgent (within 24 hours) specialist advice from a metastatic spinal cord compression coordinator if available, or alternatively the person's palliative care

2019 NICE Clinical Knowledge Summaries

90. Palliative cancer care - pain: Scenario: Managing neuropathic pain

Palliative cancer care - pain: Scenario: Managing neuropathic pain Scenario: Managing neuropathic pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing neuropathic pain Palliative cancer care - pain: Scenario: Managing neuropathic pain Last revised in October 2016 Scenario: Managing neuropathic pain From age 16 years onwards. How should I manage neuropathic pain? Consider whether there is a treatable underlying cause (for example, nerve compression (...) persists. Basis for recommendation The recommendation to manage any treatable causes of neuropathic pain is based on a textbook on symptom relief in palliative care [ ], a chapter from the ABC of palliative care [ ], a textbook of symptom management in advanced cancer [ ], the Palliative Care Formulary [ ], and palliative care guidelines: Neuropathic pain [ ]. If pain is purely neuropathic and reversible conditions (for example, vitamin B 12 deficiency) have been excluded, CKS recommends

2019 NICE Clinical Knowledge Summaries

91. Palliative cancer care - pain: Scenario: Managing muscle spasm pain

Palliative cancer care - pain: Scenario: Managing muscle spasm pain Scenario: Managing muscle spasm pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing muscle spasm pain Palliative cancer care - pain: Scenario: Managing muscle spasm pain Last revised in October 2016 Scenario: Managing muscle spasm pain From age 16 years onwards. How should I manage muscle spasm? Consider whether there is a treatable underlying cause. Try simple measures (...) depending on clinical response. The suggested dose of baclofen to treat muscle spasm is 5–10 mg three times a day. However, baclofen should be titrated slowly, which may limit its usefulness in people requiring palliative care. Choice of drug will also depend on any other actions (for example, diazepam may be more appropriate for people with co-existing anxiety) and potential for adverse effects. For more detail, see the prescribing information sections on and . If these measures are not effective

2019 NICE Clinical Knowledge Summaries

92. Palliative cancer care - pain: Scenario: Managing intracranial pressure pain

Palliative cancer care - pain: Scenario: Managing intracranial pressure pain Scenario: Managing intracranial pressure pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing intracranial pressure pain Palliative cancer care - pain: Scenario: Managing intracranial pressure pain Last revised in October 2016 Scenario: Managing intracranial pressure pain From age 16 years onwards. How should I manage pain from raised intracranial pressure? Consider (...) threshold for considering gastroprotection with a proton pump inhibitor. Response to dexamethasone should be assessed after 5–7 days, but extensive cerebral oedema may take 2–3 weeks to resolve. If there has been no response, discontinue dexamethasone immediately. If there has been a benefit, review frequently and reduce to the lowest dose that controls symptoms (for example, reduce by 2 mg every fifth day). Basis for recommendation This recommendation is based on expert opinion in a palliative care

2019 NICE Clinical Knowledge Summaries

93. Palliative cancer care - pain: Strong opioids

Palliative cancer care - pain: Strong opioids Strong opioids | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Strong opioids Palliative cancer care - pain: Strong opioids Last revised in October 2016 Strong opioids Initiation of oral morphine Initially prescribe either immediate-release or modified-release oral morphine: Immediate-release oral morphine has a rapid onset of action (about 20 minutes) but it requires administration every 4 hours to maintain (...) started review the person after 24 hours and recalculate the total morphine requirement and titrate the dose as required. For more information see For people previously on an alternative strong opioid: CKS recommends seeking specialist advice because of the differences in opinion regarding conversion ratios. Seek specialist palliative care advice for people with renal impairment, hepatic impairment, people with increased intracranial pressure, or people at risk of respiratory depression. For people

2019 NICE Clinical Knowledge Summaries

94. Palliative cancer care - pain: Scenario: Managing colic

Palliative cancer care - pain: Scenario: Managing colic Scenario: Managing colic | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing colic Palliative cancer care - pain: Scenario: Managing colic Last revised in October 2016 Scenario: Managing colic From age 16 years onwards. How should I manage intestinal colic? Consider whether there is a treatable underlying cause: It may be possible to treat certain causes of colicky pain (for example, bowel colic (...) -hourly, or 40–300 mg as a subcutaneous infusion over 24 hours via a syringe driver. Basis for recommendation This recommendation is based on expert opinion in a palliative care guideline [ ], expert opinion published in a textbook: A guide to symptom relief in palliative care [ ], the British National Formulary [ ], and feedback from expert reviewers of this CKS topic. Oral hyoscine butylbromide is not recommended for this purpose because it has very poor oral bioavailability [ ]. © .

2019 NICE Clinical Knowledge Summaries

95. Palliative cancer care - pain: Scenario: Managing bone pain

Palliative cancer care - pain: Scenario: Managing bone pain Scenario: Managing bone pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing bone pain Palliative cancer care - pain: Scenario: Managing bone pain Last revised in October 2016 Scenario: Managing bone pain From age 16 years onwards. How should I manage bone pain? Consider whether there is a treatable underlying cause and discuss with an oncologist if this is suspected (for example (...) , regarding radiotherapy for bone metastases). Seek urgent advice from an orthopaedic surgeon if there is evidence or suspicion of an actual or imminent fracture. For symptomatic relief: Apply hot or cold packs. Use standard analgesia in a stepwise approach (see ). If incident pain occurs on movement, encourage the person to take a dose of their breakthrough analgesia 20–30 minutes before anticipated movement. See . If pain is difficult to manage, seek advice from a specialist (such as a palliative care

2019 NICE Clinical Knowledge Summaries

96. Palliative cancer care - pain: Scenario: End of life care

Palliative cancer care - pain: Scenario: End of life care Scenario: End of life care | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: End of life care Palliative cancer care - pain: Scenario: End of life care Last revised in October 2016 Scenario: End of life care End of life care It can often be difficult to be certain that a person is dying, but it is essential to recognize the signs of dying in order to appropriately care for people at the end of life (...) . For more information see the CKS topic on . An individualised care plan including the areas of symptom control and anticipatory prescribing should be created. For more information see the CKS topic on . Follow the principles of pain management used at other times when caring for people in the last days of life, for example, matching the medicine to the severity of pain and, when possible, using the dying person's preferences for how it is given. Consider non-pharmacological management of pain

2019 NICE Clinical Knowledge Summaries

97. Palliative cancer care - pain: Scenario: Acute severe pain

Palliative cancer care - pain: Scenario: Acute severe pain Scenario: Acute severe pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Acute severe pain Palliative cancer care - pain: Scenario: Acute severe pain Last revised in October 2016 Scenario: Acute severe pain From age 16 years onwards. How should I manage acute severe pain? Immediately relieve pain using a subcutaneous or slow intravenous dose of a strong opioid. The dose depends on the person's (...) dose of morphine is approximately half of the 4-hourly oral morphine dose. For more detailed information on converting oral morphine to a subcutaneous dose, see the conversion table in . Following this, seek immediate specialist palliative care advice regarding further management and try to determine the cause of the pain. Always take into account the person's circumstances and wishes: If the person wishes to stay at home and is near the end of life, then control of symptoms should be attempted

2019 NICE Clinical Knowledge Summaries

98. Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol

Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol Codeine, dihydrocodeine and tramadol | Prescribing information | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Codeine, dihydrocodeine and tramadol Palliative cancer care - pain: Codeine, dihydrocodeine and tramadol Last revised in October 2016 Codeine, dihydrocodeine and tramadol For a detailed information on prescribing codeine, dihydrocodeine and tramadol, see the CKS topic on . © .

2019 NICE Clinical Knowledge Summaries

99. Palliative cancer care - pain: Scenario: Assessment of pain

Palliative cancer care - pain: Scenario: Assessment of pain Scenario: Assessment of pain | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Assessment of pain Palliative cancer care - pain: Scenario: Assessment of pain Last revised in October 2016 Scenario: Assessment of pain From age 16 years onwards. How should I approach pain assessment? Discuss pain with the person directly if possible. The person, if competent and able to communicate, is the most reliable (...) This recommendation is based on expert opinion in guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN): Control of pain in adults with cancer: a national clinical guideline [ ] and expert opinion in a text book: A guide to symptom relief in palliative care [ ]. How should I assess pain severity? Use a validated structured pain assessment tool, for example: Numerical rating scale — mark on a scale of 0 (no pain) to 10 (worst possible pain) how strong the pain is. Visual analogue scale

2019 NICE Clinical Knowledge Summaries

100. Palliative cancer care - pain: Scenario: Managing pain - non-emergency

Palliative cancer care - pain: Scenario: Managing pain - non-emergency Scenario: Managing pain - non-emergency | Management | Palliative cancer care - pain | CKS | NICE Search CKS… Menu Scenario: Managing pain - non-emergency Palliative cancer care - pain: Scenario: Managing pain - non-emergency Last revised in October 2016 Scenario: Managing pain - non-emergency From age 16 years onwards. How should I treat persistent pain in a non-emergency situation? Prescribe analgesia for continuous pain (...) if appropriate), step treatment up or down as necessary, and stop unnecessary medication that has not worked. Basis for recommendation The recommendation to use analgesia at regular intervals for continuous pain is based on the British National Formulary [ ] and the Palliative Care Formulary [ ]. This stepwise approach is based on the principles of the WHO analgesic ladder (based on the consensus of international expert opinion and clinical practice) that aims to match treatment to the intensity of the pain

2019 NICE Clinical Knowledge Summaries