Literature Review

Updated opioid prescribing guidelines: Implications for nurse practitioners The Nurse Practitioner / Lippincott; by Rhond Winegar, PhD, DNP, APRN, FNP-BC, CCRN, CPN; Tara Martin, MSN, RN, CPN; Zhaoli Liu, PhD, FNP-C, CPPS; November 2025 issue. The opioid epidemic remains a significant public health challenge in the United States. Nurse practitioners (NPs) play a crucial role in addressing this crisis. This article discusses the implications for NPs of the Centers for Disease Control and Prevention 2022 updated clinical practice guideline on opioid prescribing, focusing on four key areas: 1) deciding whether to initiate opioids, 2) determining appropriate opioids and dosages, 3) determining treatment duration and follow-up, and 4) implementing risk assessment and mitigation strategies. Adhering to this guideline enables NPs to optimize opioid prescribing practices and deliver patient-centered care that aligns with public health priorities to combat the opioid crisis.

Ensuring safe, effective transitions to hospice Hospice News; by Jim Parker; 10/22/25 Trust, coordination among staff and speedy processes are essential to hospice referral management. This is according to new research from Transcend Strategy Group. For the consulting firm’s most recent Insights Report it conducted in-depth interviews with hospice admissions and business development professionals to identify recurring themes, barriers and opportunities. ... “We have to remember that for the person calling this is probably one of the worst days of their life — if it’s a family member, or if they’re calling on behalf of themselves — and they need help urgently,” Tony Kudner, chief strategy officer for Transcend Strategy Group, told Hospice News.

Study: Nearly two-thirds of nursing home residents were exposed to med combos linked to potential drug-drug interactions McKnights Long-Term Care News; by Foster Stubbs; 10/17/25 About 62% of nursing home residents experienced one or more drug-drug interactions (DDI) between 2018 and 2020, according to an October study published in the Journal of the American Geriatrics Society. Researchers examined 485,251 Medicare fee-for-service beneficiaries 66 years or older living in nursing homes with observable Medicare Part D prescription drug data. Data were drawn from Medicare claims linked to Minimum Data Set 3.0 clinical assessments. 

[Finland] Management of dyspnea with high-flow nasal air or fan-A randomized controlled crossover trialJournal of Pain and Symptom Management; by Sirpa Leivo-Korpela, Heidi A Rantala, Lauri Lehtimäki, Reetta P Piili, Hannele Hasala, Tarja Korhonen, Juho T Lehto; 9/25[This study aimed to] assess the effect and feasibility of HFNT [high-flow nasal therapy] with air compared to fan therapy in relieving dyspnea among non-hypoxemic patients with incurable cancer. The effect of airflow through HFNT or fan on dyspnea did not differ in non-hypoxemic patients with advanced cancer. Both therapies seemed to give slight relief on dyspnea without significant adverse events. Thus, the choice between HFNT with air or fan should be made according to the patient´s preferences.

Common hospice medications linked to higher risk of death in people with dementia EurkAlerts! American Association for the Advancement of Science (AAAS); by Michigan Medicine - University of Medicine; 10/14/25 ... [For] the growing number of Americans with dementia who enter hospice, their course is often long and unpredictable — making it especially important to ensure treatments align with each person’s goals and stage of illness. A new University of Michigan study published in JAMA Network Open finds that medications commonly prescribed to ease symptoms such as agitation, anxiety, and delirium — benzodiazepines and antipsychotics — may carry major unintended risks for people with dementia receiving hospice care. Among more than 139,000 nursing home residents with Alzheimer’s disease and related dementias enrolled in hospice between 2014 and 2018, those who began taking a benzodiazepine or an antipsychotic after enrollment were 41% and 16% more likely to die within six months, respectively, than very similar hospice patients with dementia who did not receive these medications.

Terminally ill patients would be able to use medical marijuana in Pennsylvania hospitals under new bipartisan bill Marijuana Moment; by Kyle Jaeger; 10/6/25 Bipartisan Pennsylvania senators have introduced a bill that would allow terminally ill patients to use of medical marijuana in hospitals.Similar to a law previously enacted in California, the Pennsylvania legislation from Sen. John Kane (D) and 17 bipartisan cosponsors aims to ensure that cannabis patients with severe illnesses such as cancer retain access to regulated products as an alternative treatment option.

Medicaid coverage policy variations for chronic pain and opioid use disorder treatmentJAMA Network Open; by Meredith C. B. Adams, Seth M. Eller, Cara McDonnell, Sarjona Sritharan, Rishika Chikoti, Amaar Alwani, Elaine L. Hill, Robert W. Hurley, ; 8/25Co-occurring chronic pain and opioid use disorder (OUD) are associated with a high disease burden for the patient, requiring comprehensive treatment approaches, yet Medicaid benefit structures for evidence-based therapies vary substantially across states. Our systematic economic evaluation reveals both promising developments and persistent challenges in Medicaid coverage for treatment of co-occurring OUD and chronic pain. Universal coverage of fundamental medications and basic interventional procedures provides a foundation for care, but varying implementation approaches create a complex landscape requiring further investigation.

Initiation of pregabalin vs gabapentin and development of heart failureJAMA Network Open; by Elizabeth E. Park, Laura L. Daniel, Alyson L. Dickson, Meghan Corriere, Puran Nepal, Kathi Hall, W. Dale Plummer, William D. Dupont, Katherine T. Murray, C. Michael Stein, Wayne A. Ray, Cecilia P. Chung; 8/25Both pregabalin and gabapentin are common nonopioid medications used to treat chronic pain, which affects up to 30% of patients. Because pregabalin has greater potency than gabapentin in binding to the α2δ subunit of the L-type calcium channel, pregabalin may be associated with an increased risk for heart failure (HF). The findings suggest that pregabalin should be prescribed with caution in older patients with noncancer chronic pain.

Cancer patients are living longer than ever. Pain drugmakers haven’t kept up. Biopharma Dive; by Jacob Bell; 9/25/25 Decades of slow-moving research, along with broader failures of the healthcare system, have left millions of people in daily pain. Doctors fear that’s bound to continue. ... More than 2 million people in the U.S. alone are diagnosed with cancer each year. Conservative estimates hold that between 20% and 50% experience related pain, though that figure can climb as high as 80% for patients with advanced disease. Despite the large number of patients and the need for more therapies, drugmakers have mostly shied away from pain altogether, fearing that its complicated biology makes for too risky a research investment.  ... Opioids remain the core of many treatment regimens. This lack of drug choices is aggravated by much broader failures of the healthcare system. 

Evaluating the clinical reasoning of generative AI in palliative care: A comparison with five years of pharmacy learners Journal of Palliative Medicine; by Mikaila T Lane, Toluwalase A Ajayi, Kyle P Edmonds, Rabia S Atayee; 9/9/25Context: Artificial intelligence (AI), particularly large language models (LLMs), offers the potential to augment clinical decision-making, including in palliative care pharmacy, where personalized treatment and assessments are important. Conclusions: While LLMs [large language models] show potential for augmenting clinical decision-making, their limitations in patient-centered care highlight the necessity of human oversight and reinforce that they cannot replace human expertise in palliative care. This study was conducted in a controlled research setting, where LLMs were prompted to answer clinical reasoning questions despite default safety restrictions.

[UK] Does non-beneficial nasogastric tube feeding occur during end-of-life care? An audit of outcomes for those with a malnutrition universal screening tool score of 2Journal of Palliative Medicine; by Ross Andrew James Webster, Moitree Banerjee, Rachel King, Rosana Pacella, Antonina Pereira; 8/25The consideration of artificial nutrition and hydration (ANH) is recommended for individuals with reduced nutritional intake. However, placing long-term nonoral feeding tubes is not appropriate in those with advanced dementia or if the individual is likely to die imminently—“within hours or days”. In some instances, the provision of ANH in the weeks leading up to death may be considered a “Non-Beneficial Treatment.” In [this study a] total [of] 40 (47.6%) of 84 NGT [nasogastric tube]-flagged individuals were deceased within six months. Conclusions: NGT insertions in this cohort have a high likelihood of being considered “non-beneficial.”

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Why palliative care is more than just end-of-life support MedPageToday's KevinMD.com; by Dr. Vishal Parackal; 9/1/25 ... Palliative care as a system requires strong interpersonal and cross-specialty communication for smooth functioning, as patients may require expert opinions from different fields to optimize their treatment plan. Patient education for systemic follow-ups and establishing a baseline of knowledge regarding their diagnosis and potential danger signs helps create a better environment for holistic care. While we focus on the physical aspects of care and diagnosis, we often fail to realize the psychological and mental impact that such conditions can have on the patient and their family. ... The opportunity to make a meaningful difference in patients’ lives by easing their suffering and enhancing their quality of life is profoundly fulfilling. ... Editor's Note: Excellent descriptions of palliative care.