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Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach

Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often mul...

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Autores principales: Serra, Sossio, Spampinato, Michele Domenico, Riccardi, Alessandro, Guarino, Mario, Fabbri, Andrea, Orsi, Luciano, De Iaco, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342972/
https://www.ncbi.nlm.nih.gov/pubmed/37445392
http://dx.doi.org/10.3390/jcm12134357
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author Serra, Sossio
Spampinato, Michele Domenico
Riccardi, Alessandro
Guarino, Mario
Fabbri, Andrea
Orsi, Luciano
De Iaco, Fabio
author_facet Serra, Sossio
Spampinato, Michele Domenico
Riccardi, Alessandro
Guarino, Mario
Fabbri, Andrea
Orsi, Luciano
De Iaco, Fabio
author_sort Serra, Sossio
collection PubMed
description Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.
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spelling pubmed-103429722023-07-14 Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach Serra, Sossio Spampinato, Michele Domenico Riccardi, Alessandro Guarino, Mario Fabbri, Andrea Orsi, Luciano De Iaco, Fabio J Clin Med Review Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation. MDPI 2023-06-28 /pmc/articles/PMC10342972/ /pubmed/37445392 http://dx.doi.org/10.3390/jcm12134357 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Serra, Sossio
Spampinato, Michele Domenico
Riccardi, Alessandro
Guarino, Mario
Fabbri, Andrea
Orsi, Luciano
De Iaco, Fabio
Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title_full Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title_fullStr Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title_full_unstemmed Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title_short Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
title_sort pain management at the end of life in the emergency department: a narrative review of the literature and a practical clinical approach
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342972/
https://www.ncbi.nlm.nih.gov/pubmed/37445392
http://dx.doi.org/10.3390/jcm12134357
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