Literature Review

MLN 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:

The 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.

[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.

Prevention 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.

Prevalence 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. 

Revamped 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. ...

Brain 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.

Suzetrigine: 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.

DEA 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.]

Home … 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.

As 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. 

High-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. 

Early 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.