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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Palliative care in heart failure


Chronic heart failure is a progressive disease with serious symptoms, which reduce patient functionality and increasingly interfere with basic daily activities. Therefore, palliative care should be incorporated relatively early in the management of the disease as supportive treatment. With its progression, the role of palliation becomes more and more important. Principles of palliative care in heart patients cannot be simply transferred from the oncology. The prognosis in patients with chronic heart failure is less reliable than in oncology. Furthermore, in cardiac patients, active treatment of the heart failure is preserved or even intensified in the advanced stage of the disease, because it can control the severity of the symptoms.

Nevertheless, when ICU treatment in the terminal stage is recognized and confirmed as futile, the duty of intensivist is to provide care so that the patient can die with preserved dignity and without any additional harm.

Key words: palliative care, heart failure

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Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments


Cancer related pain may be due to the malignant disease itself, or subsequent to treatments, such as surgery, chemotherapy or radiation therapy. The pathophysiology of pain due to cancer may be complex and include a variety of nociceptive, inflammatory, and neuropathic mechanisms. Despite modern advances in pharmacotherapy, cancer pain remains overall under-treated in a world-wide scale, and a main reason is lack of understanding of its pertinent pathophysiology and basic pharmacology.
Recently, pertinent animal models have facilitated understanding of the pathobiology and have advanced the pharmacology of cancer pain, with significant translational applicability to clinical practice. Furthermore, quantitative and qualitative systematic reviews, integrating the best available evidence, indicate the validity of treatments that fit into an expanded view of the WHO-analgesic ladder. Appropriate current treatments include a valid therapeutic role of non-opioid and opioid analgesics, adjuvants -such as gabapentin, biphosphonates, palliative radiation therapy and radiopharmaceutical compounds, and interventional pain therapy (including neuraxial drug infusion and verterbroplasty for spine metastases) in selected patients.
Overall, experimental animal models simulating cancer pain have been useful in providing pertinent information on the pathophysiology of cancer pain, and provide a testing ground for established and novel therapies, which are validated by clinical evidence. This is clinically significant, considering the epidemiological dimensions and the problematic nature of cancer pain.

Key words: cancer, pain intractable, palliative care, neoplasm metastasis, analgesics non-narcotic, analgesics opioid.

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