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

被引:3
|
作者
Serra, Sossio [1 ]
Spampinato, Michele Domenico [2 ]
Riccardi, Alessandro [3 ]
Guarino, Mario [4 ]
Fabbri, Andrea [5 ]
Orsi, Luciano [6 ]
De Iaco, Fabio [7 ]
机构
[1] Maurizio Bufalini Hosp, Emergency Dept, I-47521 Cesena, Italy
[2] Univ Ferrara, Dept Translat Med & Romagna, I-44124 Ferrara, Italy
[3] Pronto Soccorso Osped Imperia, I-18100 Imperia, Italy
[4] UOC MEU Osped CTO AORN Colli Napoli, I-80131 Naples, Italy
[5] Presidio Ospedaliero Morgagni Pierantoni, Emergency Dept, AUSL Romagna, I-47121 Forli, Italy
[6] Palliat Care Phys & Scientific Rivista Italiane Cu, I-26013 Crema, Italy
[7] ASL Citta Torino, Struttura Complessa Med Emergenza Urgenza Osped Ma, I-10144 Turin, Italy
关键词
pain management; emergency department; end of life care; palliative care; acute pain; chronic pain; total pain; palliative need evaluation; pain evaluation; analgesic drugs; PALLIATIVE SEDATION THERAPY; CANCER PAIN; NEUROPATHIC PAIN; EUROPEAN-ASSOCIATION; PREDICTIVE-VALIDITY; MAGNESIUM-SULFATE; BREAKTHROUGH PAIN; ANALGESIC LADDER; ELDERLY-PATIENTS; SCREENING TOOL;
D O I
10.3390/jcm12134357
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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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页数:33
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