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What Interventions Are Effective for Managing Dyspnea in Heart Failure?

Introduction and Scope of the Problem Heart failure (HF) is a chronic and progressive illness that currently affects more than 6 million American adults and is projected to increase to more than 8 million individuals by 2030. Patients with advanced HF (American College of Cardiology/American Heart Association Stage D) have a multitude of symptoms, including pain, dyspnea, fatigue, depression, cachexia, and anorexia, which persist despite optimal…

What Interventions Are Effective for Managing Dyspnea in COPD?

Introduction and Scope of the Problem Dyspnea is the uncomfortable awareness of breathing often associated with air hunger, rapid breathing, and breathlessness. It has a negative impact on functional status and quality of life in individuals living with chronic obstructive pulmonary disease (COPD). Prevalence and intensity of dyspnea tend to increase with disease severity and progression over time. This chapter reviews the pathophysiology and management of…

What Interventions Are Effective for Managing Dyspnea in People With Cancer?

Introduction and Scope of the Problem Dyspnea is defined by a consensus panel of the American Thoracic Society (ATS) as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Most often termed “shortness of breath” or “breathlessness” by patients and their families, dyspnea is one of the most common symptoms experienced by patients with advanced disease including cancer. The…

When Should Nerve Blocks Be Used for Pain Management?

Introduction and Scope of the Problem Pain is a frequent and feared symptom in patients with advanced illness. It is highly prevalent in cancer and many other advanced diseases, such as human immunodeficiency virus, multiple sclerosis, congestive heart failure, and renal failure. Most patients achieve satisfactory pain relief with the WHO Three-Step Analgesic Ladder, but 10% to 20% do not. With astounding advances in medical care,…

When Should Epidural or Intrathecal Medications and Pumps Be Considered for Pain Management?

Introduction and Scope of the Problem Most patients can achieve satisfactory pain control and tolerable side effects with the standard WHO Three-Step Analgesic Pain Ladder, which increases medication potency and dosages until pain relief is achieved. However, systemic pain medications may not be effective for some patients regardless of route, because of unacceptable side effects like sedation or delirium, or refractory pain despite dose escalation. The…

How Does One Approach the Patient With an Opioid Use Disorder?

Introduction and Scope of the Problem Distinguishing between patients with the disease of addiction and patients with pain is an increasing dilemma among clinicians caring for patients taking opioids. However this distinction in patients receiving prescribed opioids may be challenging given shared pathophysiology and may not actually impact approaches to management. The two conditions often intersect, with each increasing vulnerability to and complicating treatment of the…

How Does the Opioid Epidemic Impact Palliative Medicine Practice?

Introduction and Scope of the Problem In 2017, the opioid overdose epidemic was declared a public health emergency by the U.S. Department of Health and Human Services. Since 2000, death rates from opioid overdoses have increased by 200%. Life expectancy in the United States began to decrease for the first time since 1959, related to rising overdose deaths and suicide rates. Three distinct waves describe the…

What Principles Should Guide the Prescribing of Opioids for Noncancer Pain?

Introduction and Scope of the Problem Over the past 30 years, chronic pain and opioid use have dominated the headlines, both in popular news sources and in medical journals. Chronic pain impacted the lives of more than 125 million adults in 2012, and its $635 billion economic impact on the U.S. health care system is greater than diabetes, heart disease, and cancer combined. Meanwhile, the United…

When and How Should Radiotherapy Be Considered for Pain Management?

Introduction and Scope of the Problem Patients with metastatic cancer can experience pain throughout their illness, whether it is due to the cancer itself or due to the effects of treatment such as surgical intervention, prior radiation therapy, or chemotherapy. It is estimated that approximately 30% to 50% of patients with cancer undergoing treatment experience pain, while 70% of patients with advanced cancer experience pain. When…

What Are the Approaches to Pain in Skeletal Bone Disease?

Introduction and Scope of the Problem Bone disease is a common occurrence in patients with malignancies and a common site for metastatic spread with advanced breast, lung, prostate, thyroid, and renal cancers as well as multiple myeloma. The incidence of bone metastasis in breast and prostate cancers is as high as 65% to 75%, and up to 90% to 100% in multiple myeloma. Bone metastases portend…

How Are Adjuvant Medications Such as Corticosteroids and NSAIDs Used for Pain Management?

Introduction and Scope of the Problem Pain is perhaps the most feared and persistent symptom in palliative care, affecting a major proportion of patients in this setting. Corticosteroids and nonsteroidal anti-­inflammatory drugs (NSAIDs) are frequently used to manage mild to moderate pain or as adjuvant analgesics with opioids for severe pain and are among the most widely used medications in the world. As a class of…

What Is Neuropathic Pain and How Is It Best Managed?

Introduction and Scope of the Problem As defined by the 2011 International Association for the Study of Pain (IASP), neuropathic pain is “pain caused by a lesion or disease of the somatosensory system.” This was a new definition, distinguishing a disease of the nervous system from the neuroplastic changes that occur with persistent nociceptive input. Common disease-related neuropathic conditions are often separated into two categories: central…

How Should Methadone Be Started and Titrated in Opioid-Naïve and Opioid-Exposed Patients?

Introduction and Scope of the Problem Methadone is a powerful tool for treating pain in patients with serious illness. Initially synthesized in the late 1940s, methadone has grown in popularity as an analgesic in recent years. Due to action at multiple sites, including agonism at the mu opioid receptor and antagonism at the N-methyl-D-aspartate (NMDA), serotonin, and norepinephrine receptors, methadone can provide effective analgesia with fewer…

Which Opioids Are Safest and Most Effective in Patients With Renal or Hepatic Failure?

Introduction and Scope of the Problem Opioids are a mainstay of pain management for patients with serious or advanced illness. For the majority of patients, there is no clearly preferred opioid; however, medication selection for patients with renal or hepatic impairment requires special consideration. Specifically, practitioners must be knowledgeable about the pharmacokinetic and pharmacodynamic differences between opioids and how organ dysfunction influences these properties. Pain is…

How Is Patient-Controlled Analgesia Best Used to Control Pain?

Introduction and Scope of the Problem Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” The experience of pain is subjective, and thus a patient’s self-report of pain is the gold standard for assessment. Pain is a common symptom experienced by patients with serious illness, including 30% to 60% of patients with cancer, 55% of patients with heart…

What Principles Should Guide Opioid Dose Conversions?

Introduction and Scope of the Problem Opioids can be part of a safe and effective pain management strategy for patients when prescribed according to evidence-based guidelines. Clinicians may wish to change from one opioid or route to another for a variety of reasons, including lack of therapeutic efficacy, intolerable side effects, patient preference, or availability. There are many commercially available prescribed opioids, and clinicians must choose…

How Should Opioids Be Started and Titrated?

Introduction and Scope of the Problem Despite recognition of the importance of pain management, relative availability of effective pain medications in the United States, and multiple published guidelines for the management of pain, the undertreatment of pain in patients with serious illness continues to be an ongoing and highly prevalent problem. One-quarter of older adults report pain in the last two years of life, with approximately…

Clinical trials on combination of repurposed drugs and anticancer therapies

This book section provides information about the use of existing repurposed drugs in cancer treatment and their clinical applications. Developing the same drug which has previously been designed for a certain disorder, to serve a new therapeutic application for the treatment of a different disorder with a different pharmacological activity is called drug repositioning or drug repurposing [ ]. It is the act of taking a…

Nanotechnological approaches in cancer : the role of celecoxib and disulfiram

Acknowledgments The authors acknowledge Fundação para a Ciência e a Tecnologia (FCT), the Portuguese Agency for Scientific Research, for financial support through the Research Project no. 016648 (Ref. POCI-01-0145-FEDER-016648), the project PEst-UID/NEU/04539/2013, and COMPETE (Ref. POCI-01-0145-FEDER-007440). The Coimbra Chemistry Centre is supported by FCT, through the Project PEst-OE/QUI/UI0313/2014 and POCI-01-0145-FEDER-007630. João Basso and Maria Mendes acknowledge the Ph.D. research grants SFRH/BD/149138/2019 and SFRH/BD/133996/2017 assigned by FCT. RV also acknowledges…

Nanoparticle-based formulation for drug repurposing in cancer treatment

Introduction of nanomedicine Nanomedicine was first entered the preclinical in the mid-1980s, and the first product is PEGylated adenosine deaminase enzyme that was approved by FDA in early 1990 [ ]. Ever since then, scientists hold great passion in this area and many different types of nanoparticles (NPs) have been produced. Perhaps one of the most famous products is the Doxil (DOX liposomal), which appeared in…