Literature Review
All posts tagged with “Clinical News | Pain Management.”
MLN Fact Sheet: Creating an effective hospice Plan of Care
05/30/25 at 03:00 AMMLN Fact Sheet: Creating an efffective Hospice Plan of CareCenters for Medicare & Medicaid Services, Medicare Learning Network (MLN); 5/10/25 The hospice plan of care (POC) maps out needs and services given to a Medicare patient facing a terminal illness, as well as the patient’s family or caregiver. CMS data shows that some hospice POCs are incomplete or not followed correctly. This fact sheet educates on creating and coordinating successful hospice POCs. The primary goal of hospice care is to meet the holistic needs of an individual and their caregiver and family when curative care is no longer an option. To support this goal:
A practice model for palliative radiotherapy
05/24/25 at 03:45 AMA practice model for palliative radiotherapyCureus; Alina Zheng, Alec Zheng, Alan Zheng, Xiaodong Wu, Beatriz Amendola; 5/25Despite well-recognized challenges in implementing palliative radiation therapy (PRT), progress remains slow, and conventional approaches have yielded limited success. A specialized certification track within radiation oncology residency programs is proposed, enabling palliative care physicians to obtain limited PRT licenses under the supervision of fully licensed radiation oncologists. Dedicated PRT facilities-affiliated with comprehensive radiation therapy centers (CRTCs) and integrated into hospice settings-will enhance accessibility by reducing logistical and financial burdens. These facilities will utilize cost-effective infrastructure, including refurbished linear accelerators, modular construction, and remote physics and dosimetry support, ensuring operational costs remain significantly lower than those of conventional radiotherapy centers. Systematic studies with a PRT-oriented mindset should establish PRT-specific treatment recommendations and recommendations, moving away from conventional radiation therapy protocols. While requiring initial investment and regulatory adjustments, it has the potential to improve end-of-life care for terminally ill cancer patients, ensuring greater dignity and comfort while establishing a robust foundation for future reimbursement models.
The 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancer
05/24/25 at 03:05 AMThe 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancerJAMA Network Open; Rebecca Rodin, MD, MSc; Lihua Li, PhD; Karen McKendrick, MPH; Krista Harrison, PhD; Lauren J. Hunt, PhD, RN; Ulrike Muench, PhD, RN; Cardinale B. Smith, MD, PhD; Melissa D. Aldridge, PhD, MPH, MBA; R. Sean Morrison, MD; 5/25In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in first-line opioids while less-safe tramadol and less-effective gabapentinoid prescribing continued to rise. Further revision of the recent 2022 CDC guideline and oncology pain management guidelines may be needed to help address these potentially inappropriate analgesic shifts.
‘Marathon’ effort to refine end-of-life wound coding runs on
05/23/25 at 03:00 AM‘Marathon’ effort to refine end-of-life wound coding runs on McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Two key wound care groups are finalizing a proposal for new codes that would help skilled nursing providers avoid newly created diagnoses gaps for end-of-life skin breakdown that could lead to missed reimbursement and potential liability risks. The push comes a year and a half after nursing homes won the right to stop coding wounds that occur as part of dying as pressure injuries, which can hurt their quality ratings. But they also lost any way to code or acknowledge treatment of such skin failure in the Minimum Data Set. ...
[Brazil] Music therapy in modulating pain in palliative care patients: A systematic review and meta-analysis
04/26/25 at 03:00 AM[Brazil] Music therapy in modulating pain in palliative care patients: A systematic review and meta-analysisBritish Journal of Music Therapy; Suellen Fernanda Pinheiro Hammuod, Fernada Gonzalez Santos, Lidiane da Costa Fonseca, Elaine Kakuta, Renata Verão Brito, Karolayne Silva Souza, Eduardo Henrique Loreti; 3/25 Music therapy is an intervention that uses music for therapeutic purposes, helping to preserve mental, physical, and emotional health. Its use in the care of terminally ill patients can assist in managing pain, fatigue, quality of life (QoL), anxiety, and depression. This study aimed to analyze the effects of music therapy on pain in individuals receiving palliative care. Music therapy showed effectiveness in improving pain in patients receiving palliative care ... The effectiveness of music therapy on QoL remains debatable.
CMS releases HOPE Guidance Manual (V. 1.01) and Tables
04/25/25 at 03:00 AMCMS releases HOPE Guidance Manual (V. 1.01) and TablesCenters for Medicare and Medicaid Services (CMS); by CMS; 4/22/25On April 22, 2025, CMS released the HOPE Guidance Manual (V. 1.01) and connected tables. Providers can use v1.01 for HOPE planning, as this is considered final before HOPE implementation. Also note that earlier this month, the final HOPE data specs have also been released, helping software developers to finalize their HOPE software for testing in the coming months.
Prevention of opioid misuse and abuse through effective pain management in patients with chronic pain: An umbrella systematic review
04/19/25 at 03:20 AMPrevention of opioid misuse and abuse through effective pain management in patients with chronic pain: An umbrella systematic reviewCureus: Sana Sultana, Safeera Khan; 3/25Chronic pain is a condition that affects physical well-being as well as emotional well-being, has mental impacts on patients, and diminishes their quality of life. There is also growing evidence that opioids have only limited effectiveness in the management of CNCP [chronic non-cancer pain], and the increased availability of prescription opioids has contributed to an increase in opioid addiction cases and overdose deaths. This review was conducted to determine if adequate pain management would decrease opioid use and prevent misuse. We discussed the different pain management methods in the paper, including the different pharmacotherapy options, nerve blocks, and spinal cord stimulation. We also talk about multidisciplinary treatment with the involvement of various departments (physician, pharmacy for pill counting, physical therapy, psychological care, etc.) in managing pain; good outcomes were observed with improvement in function.
Palliative care and advanced cardiovascular disease in adults: Not just end-of-life care: A scientific statement from the American Heart Association
04/18/25 at 03:00 AMPalliative care and advanced cardiovascular disease in adults: Not just end-of-life care: A scientific statement from the American Heart Association AHAIASA Journals - American Heart Association; by Lucinda J. Graven, PhD, APRN, FAHA, Lisa Kitko, PhD, RN, FAHA, Martha Abshire Saylor, PhD, MSN, BA, RN, Larry Allen, MD, MHS, FAHA, Angela Durante, PhD, RN, Lorraine S. Evangelista, PhD, RN, CNS, WAN, FAHA, Amy Fiedler, MD, James Kirkpatrick, MD, Lakeisha Mixon, MSW, and Rachel Wells, PhD, MSN, BA on behalf of the American Heart Association Complex Cardiovascular Nursing Care Science Committee of the Council on Cardiovascular and Stroke Nursing; and Council on Cardiovascular Surgery and Anesthesia; 4/17/25 ... This scientific statement (1) discusses the application of effective communication, shared decision-making, age-friendly care, and advance care planning in advanced cardiovascular disease palliative care; (2) provides a summary of recent evidence related to palliative care and symptom management, quality of life, spiritual and psychological support, and bereavement support in individuals with advanced cardiovascular disease and their care partners; (3) discusses issues involving diversity, equity, and inclusion in cardiovascular disease palliative care; (4) highlights the ethical and legal concerns surrounding palliative care and implanted cardiac devices; and (5) provides strategies for palliative care engagement in adults with advanced cardiovascular disease for the care team.
Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysis
03/22/25 at 03:15 AMPrevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysisJAMA Network Open; Rachel V. Aaron, PhD; Scott G. Ravyts, PhD; Nicolette D. Carnahan, PhD; Kavya Bhattiprolu, BS; Nicole Harte, MClinPsychol; Claire C. McCaulley, BA; Lauren Vitalicia; Alexandria B. Rogers, PhD; Stephen T. Wegener, PhD; Joanne Dudeney, PhD; 3/25Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development.
Hastening death by stopping eating and drinking: Hope Wechkin, Thaddeus Pope, and Josh Briscoe
03/21/25 at 03:00 AMHastening death by stopping eating and drinking: Hope Wechkin, Thaddeus Pope, and Josh Briscoe GeriPal Podcasts; by Hope Wechkin, Thaddeus Pope, and Josh Briscoe Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking (VSED), and multiple episodes about the ethical issues surrounding medical aid in dying (MAID). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify for medical aid in dying medications? And is there a middle path to provide some degree of comfort while also hastening the end of life?
Revamped tool can reliably assess pain symptoms in dementia patients: researchers
03/19/25 at 02:00 AMRevamped tool can reliably assess pain symptoms in dementia patients: researchers McKnights Long-Term Care News; by Zee Johnson; 3/17/25 ... A team of researchers reconstructed the End-of-Life Dementia-Comfort Assessment in Dying, or EOLD-CAD, after a multifacility study showed that caregivers could adequately and reliably address a host of pain symptoms seen in end-of-life dementia patients. ... When clinicians working in the SNFs that were part of the trials used the EOLD-CAD, they were able to detect patterns in more than 600 residents that fell into four categories: physical distress, symptoms of dying, emotional distress, and well-being. Common symptoms observed across these categories were restlessness, shortness of breath, choking, gurgling, difficulty in swallowing, fear and anxiety. ...
Less wealth at death linked to more end-of-life symptoms
03/18/25 at 02:30 AMLess wealth at death linked to more end-of-life symptoms McKnights Long-Term Care News; by Kristen Fischer; 3/10/25 Older people with less wealth showed a higher burden of symptoms when they approached the end of their lives compared with those who had more wealth, a study found. The report was published in JAMA Network Open on March 6. Investigators looked at data from 8,976 older adults. The team evaluated 12 end-of-life symptoms including difficulty breathing, frequent vomiting, low appetite, difficulty controlling arms and legs, depression, and severe fatigue or exhaustion.Then they correlated symptoms to individuals’ wealth. Wealth was broken into three categories: low wealth was having less than $6,000; medium wealth was having between $6,000 and $120,000; and high wealth was considered having more than $120,000 at the time of death. Of respondents, 22.5% had low wealth, 50.5% had medium wealth and 27.1% had higher wealth. People who had less wealth were more likely to have a higher burden of symptoms compared to those who had more money. Functional impairment, multimorbidity and dementia were factors that affected the association, data revealed.Editor's note: Click here for this important JAMA article, posted in our Saturday Research issue 3/15/25, "Wealth disparities in end-of-life symptom burden among older adults."
Brain biomarkers for pain sensitivity
02/15/25 at 03:25 AMBrain biomarkers for pain sensitivityJAMA Neurology; Prasad Shirvalkar, MD, PhD; Christopher J. Rozell, PhD; 1/25Identifying objective biomarkers that track individual pain severity has been dubbed “the holy grail” of pain neuroscience. Chronic pain affects up to one-fifth of US adults, and its complexity is attributed to a confluence of physical, emotional, and cognitive factors that contribute to suffering and disability. The epidemic of chronic pain initially contributed to the rise of the opioid epidemic and continues to plague nearly all fields of clinical medicine. Identifying and validating biomarkers to predict individual risk for chronic pain facilitate a precision medicine approach to pain medicine. Despite the unknown provenance of the proposed biomarkers, the results of the present study have the potential to aid in the practical development of personalized pain management strategies.
HealthcareBusinessToday.com series on hospice care
02/12/25 at 03:00 AMHealthcareBusinessToday.com series on hospice careEditor's note: The following articles were posted on 2/10/25 by HealthcareBusinessToday.com.
Suzetrigine: First-in-class nonopioid pain therapy is approved by FDA
02/08/25 at 03:15 AMSuzetrigine: First-in-class nonopioid pain therapy is approved by FDAAmerican Journal of Managed Care; Giuliana Grossi; 1/25Suzetrigine (Journavx; Vertex Pharmaceuticals) received approval from the FDA for the treatment of adults with moderate-to-severe acute pain, according to an announcement from Vertex. The therapy is a novel oral, non-opioid, highly selective NaV1.8 pain signal inhibitor ... offering a non-opioid alternative amid the opioid crisis. Clinical trials demonstrated significant efficacy in postsurgical pain relief, though results varied across different conditions. Despite this, suzetrigine offers the potential to energize the nonopioid pain market, which includes other companies like Tris Pharma, Latigo Biotherapeutics, and SiteOne Therapeutics—all actively developing alternatives to opioids. Key findings from the Institute for Clinical and Economic Review analysis of the phase 3 trials include potential lifetime cost savings of $200 per patient when comparing suzetrigine with opioids, assuming a 1-week course priced at $420.
Defining spine cancer pain syndromes: A systematic review and proposed terminology
02/01/25 at 03:15 AMDefining spine cancer pain syndromes: A systematic review and proposed terminologyGlobal Spine Journal; Markian Pahuta, MD, PhD, FRCSC; Ilya Laufer, MD; Sheng-fu Larry Lo, MD; Stefano Boriani, MD; Charles Fisher, MD, MHSC, FRCSC; Nicolas Dea, MD, MSc, FRCSC; Michael H. Weber, MD, MSc, PhD, FRCSC; Dean Chou, MD; Arjun Sahgal, MD, FRCPC; Laurence Rhines, MD; Jeremy Reynolds, MB.ChB, BSc (Hons), FRCS; Aron Lazary, MD, PhD; Alessandro Gasbarrinni, MD; Jorrit-Jan Verlaan, MD, PhD; Ziya Gokaslan, MD, FACS; Chetan Bettegowda, MD, PhD; Mohamed Sarraj, MD; Ori Barzilai, MD; AO Spine Knowledge Forum Tumor; 1/25The spine is the most common site of osseous metastasis, and over one-third of patients with carcinoma or hematological malignancy will develop spinal metastases. Vertebral metastases have a negative impact on patient function and heath related quality of life (HRQoL). We consolidate the terminology used in the literature and consolidated into clinically relevant nomenclature of biologic tumor pain, mechanical pain, radicular pain, neuropathic pain, and treatment related pain. This review helps standardize terminology for cancer-related pain which may help clinicians identify pain generators.
DEA unveils long-overdue special registration for telemedicine in proposed rule
01/23/25 at 02:00 AMDEA unveils long-overdue special registration for telemedicine in proposed ruleThe National Law Review; by Marika Miller, Nathan A. Beaver of Foley & Lardner LLP; 1/21/25 In the final days of the Biden administration, the Drug Enforcement Administration (DEA) released a proposed rule that would allow practitioners with a Special Registration to prescribe Schedule III-V, and in limited circumstances Schedule II, controlled substances via telemedicine. Practitioners with a Special Registration would still need to obtain a DEA registration in each state where they prescribe or dispense controlled substances. However, the proposed rule establishes a limited, less expensive State Telemedicine Registration as an alternative to the traditional DEA registration. The proposed rule imposes several obligations on practitioners with Special Registrations when they prescribe controlled substances via telemedicine. [Click on the title's link to continue reading.]
Justice Department sues Walgreens over alleged part in opioid crisis
01/22/25 at 03:00 AMJustice Department sues Walgreens over alleged part in opioid crisis Becker's Hospital Review; by Madeline Ashley; 1/17/25 The Justice Department on Jan. 16 filed a civil complaint against Walgreens Boots Alliance and its subsidiaries alleging unlawful dispensation of millions of prescriptions in violation of the Controlled Substances Act. The complaint, filed in the U.S. District Court for the Northern District of Illinois, also alleges that Walgreens sought reimbursements from federal health programs in violation of the False Claims Act, according to a Jan. 17 news release. The Justice Department alleges that Walgreens knowingly filled millions of invalid controlled substance prescriptions since August 2012, including excessive opioid quantities, early refills and a "dangerous and abused combination of drugs" ... The complaint suggests pharmacists at Walgreens filled the prescriptions "despite clear red flags" indicating the prescriptions were likely unlawful, ignoring other internal data and evidence from pharmacists about dispensing unlawful prescriptions.
Home … where we all want to be
01/14/25 at 03:00 AMHome … where we all want to be The Journal; Dr. Sarah Phillips, Medical Director Hospice of the Panhandle; 1/12/25 Two days before Christmas, I arrived at the home of a patient who had been recently admitted to Hospice services. ... [Story of the patient being on a ventilator in a hospital.] This courageous and self-determined woman expressed the desire to be free from pain, suffering, and the complications and progression of her disease. Knowing that the ventilator was life-sustaining and essentially breathing for her, she made the decision to stop it. To ensure her comfort during discontinuation of the ventilator, the hospice team was present before, during, and after the procedure. Medications were used to ease shortness of breath, pain, and anxiety. ... “It’s a Wonderful Life” was playing on the TV, the Christmas tree was lit. I looked over and see the daughter wiping away her mother’s tears. Each reassured the other that everything will be OK and that they are at peace with this decision. As the medications took effect, the patient drifted off to sleep. The ventilator was stopped. Next, something happens that I will never forget. The daughter leans in and whispers to the patient, “Mom, the ventilator is off now, you are back in total control. This was profound to me on many levels. It certainly spoke to the power and importance of autonomy, the ability to make independent decisions that are aligned with one’s values and goals. ... Despite working in end-of-life care for over a decade, I still have these moments of being overwhelmed by the human spirit.
[Korea] A prospective, single-cohort, open, multi-center, observational study of sublingual fentanyl for breakthrough cancer pain: Effectiveness, safety, and tolerability in Korean cancer patients
01/11/25 at 03:05 AM[Korea] A prospective, single-cohort, open, multi-center, observational study of sublingual fentanyl for breakthrough cancer pain: Effectiveness, safety, and tolerability in Korean cancer patientsCancer Research and treatment; Youn Seon Choi, Su-Jin Koh, Woo Kyun Bae, Se Hyung Kim, Seong Hoon Shin, So Yeon Oh, Sang Byung Bae, Yaewon Yang, Eun-Kee Song, Yoon Young Cho, Pyung Bok Lee, Ho-Suk Oh, MinYoung Lee, Jin Seok Ahn; 12/24Fentanyl, a highly lipophilic opioid, was developed as a sublingual fentanyl tablet (SFT) for the management of breakthrough cancer pain (BTcP), and its efficacy and safety were confirmed in a randomized, controlled study. In a real-world setting, SFT provides rapid and effective analgesia in BTcP, even at the lowest dose (100 μg), and the safety profile was acceptable.
As drugstores close, more people are left in ‘pharmacy deserts’
01/02/25 at 03:00 AMAs drugstores close, more people are left in ‘pharmacy deserts’ The San Diego Union-Tribune; by The New York Times Service Syndicate; 12/31/24 In July, a notice appeared on the front door of The Drug Store, the only pharmacy in rural Kernville, in Kern County. After 45 years, the proprietor wrote regretfully, it would be closing in four days and transferring customers’ prescriptions to a Rite Aid about 12 miles away. ... Its closing created practical concerns. “We are an aging population,” Gordon, 69, said of the townspeople. ... Now, those services require a 20- to 30-minute drive to the Rite Aid, which is in Lake Isabella and which Gordon described as understaffed for its growing number of customers. “On any given day, there’s a line of 10 to 15 people waiting at the pickup window,” she said. Unlike The Drug Store, the Rite Aid doesn’t deliver. That leaves Kernville residents in what researchers call a pharmacy desert, defined as living more than 10 miles from the nearest pharmacy in rural areas, 2 miles away in suburban communities or 1 mile away in urban neighborhoods. Nearly 30% of pharmacies in the United States closed between 2010 and 2021, according to a new study in the journal Health Affairs.
Trends in private equity acquisition of pain management practices
12/28/24 at 03:45 AMTrends in private equity acquisition of pain management practicesJAMA Network Open; Geronimo Bejarano, MPH; James E. Eubanks, MD, MS; Robert T. Braun, PhD; 12/24Pain has the highest health care spending in the US and is expected to increase with the aging population, which may entice private equity acquisitions of pain management practices. Private equity has increasingly acquired physician practices and acquisitions are associated with higher spending, utilization of more expensive treatments, and increasing patient volume. In this cross-sectional study of private equity acquisitions of pain management practices, we found a rise in acquisitions over the last decade with almost 1 in 10 pain management physicians affiliated with a private equity–owned pain management practice. [The] ... high amount of consolidation within certain states poses concerns for private equity to have enough market power to control care delivery of several procedure-based specialties, including pain management. Policymakers and the Federal Trade Commission have taken notice of the harms of increases in both health care consolidation and private equity acquisitions, and there are ongoing efforts to curb their detrimental effects.
High-risk opioid prescribing and nurse practitioner independence
12/28/24 at 03:05 AMHigh-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing.
[India] Mechanisms and clinical applications of palmitoylethanolamide (PEA) in the treatment of neuropathic pain
12/28/24 at 03:00 AM[India] Mechanisms and clinical applications of palmitoylethanolamide (PEA) in the treatment of neuropathic painInflammopharmacology; Ardra Das, Preetha Balakrishnan; 12/24Palmitoylethanolamide (PEA) is emerging as a promising therapeutic agent for neuropathic and other pain-related conditions. PEA's interaction with endocannabinoid receptors decreases the inflammatory cytokine and chemokine production and thereby a descending pain sensation. Experimental evidence shows that PEA not only reduces pain and inflammation but also lowers the need for higher dosages of other drugs hence minimizing the risk of drug toxicity. The bioavailability of PEA has been enhanced by recent technological developments, which emphasize continuous research efforts to maximize PEA's therapeutic potential in pain treatment and associated medical sectors.
Early hospice care has transformative impact
11/26/24 at 03:30 AMEarly hospice care has transformative impact McKnights Senior Living; guest column by Aaron Housh, CEO of Good Samaritan Hospice in Roanoke and Christiansburg, VA; 11/25/24 Hospice care is more than a medical service — it’s a lifeline of compassion, connection and support during one of life’s most vulnerable moments. For more than 20 years, I’ve witnessed the profound impact hospice can have, not just on residents and patients but on the families who love and care for them. But this impact is magnified when hospice care is introduced early. ... One of the greatest gifts hospice provides is time — time to prepare, time to connect and time to say goodbye. A friend once shared how hospice changed her family’s experience with her mother’s death. The nurse spent time explaining what to expect, answering questions and normalizing the changes they were seeing. That preparation eliminated panic, allowing the family to focus on being present. Her mother passed with dignity, surrounded by love and understanding. This story illustrates what I’ve seen time and again: families who enter hospice early have the opportunity to build trust with their care team, process emotions and fully use the services available to them. Those families are better equipped to navigate the physical and emotional challenges of end-of-life care, creating space for meaningful moments and lasting memories.