Journal of pain and symptom management最新文献

{"title":"Family Experiences of Witnessing Patients' Desire to Hasten Death in Japanese Palliative Care Units.","authors":"Sayaka Maeda, Tatsuya Morita, Hitoshi Tanimukai, Yutaka Hatano, Satoru Tsuneto, Masanori Mori, Maho Aoyama, Mitsunori Miyashita","doi":"10.1016/j.jpainsymman.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.015","url":null,"abstract":"<p><strong>Context: </strong>Desire to hasten death commonly affects terminally ill cancer patients, yet family members' experiences remain poorly understood.</p><p><strong>Objectives: </strong>To examine how families experienced patients' desire to hasten death, and explore factors potentially associated with related distress.</p><p><strong>Methods: </strong>Using data from a nationwide bereaved family survey in Japanese palliative care units, we analyzed 475 valid responses (of 904 distributed; 52.5%), focusing on the 114 respondents whose patients had expressed a desire to hasten death during the final month of life. Emotional responses were assessed using a 16-item instrument, and distress-associated factors were examined using univariable analyses.</p><p><strong>Results: </strong>A desire to hasten death was reported by 24% of respondents (114/475), 35% of whom involved an explicit request to hasten death (40/114). Physical symptoms were common reasons (80%), although existential distress was also frequently reported (65%). A total of 75.8% of respondents (72/95) reported being distressed or very distressed by hearing the desire. Approximately 70% of respondents considered the patient's desire understandable and supported alleviation of suffering, including sedation, whereas nearly 30% wished that the desire could be fulfilled. About half reported uncertainty regarding how to respond and feelings of helplessness. One-quarter reported unmet needs concerning emotional support and guidance. In univariable analyses, greater emotional distress was associated with a spousal relationship, desire rooted in existential suffering, coping difficulty, and emotional overwhelm.</p><p><strong>Conclusion: </strong>A patient's desire to hasten death imposes a marked emotional burden on family members. Proactive emotional support is needed, as distress persists even when the desire is cognitively understood.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupuncture versus reflexology for cancer-related pain in palliative care: a pragmatic study.","authors":"Noah Samuels, Efrat Seckbach, Eran Ben-Arye","doi":"10.1016/j.jpainsymman.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.014","url":null,"abstract":"<p><strong>Context and objective: </strong>Integrative oncology (IO) provides evidence-based therapies addressing symptoms and wellbeing. We compared acupuncture to reflexology for pain and wellbeing among oncology patients.</p><p><strong>Methods: </strong>This comparative effectiveness observational study examined patients undergoing 8 weekly IO treatments with either acupuncture or reflexology, based on patient preference. Symptoms and wellbeing were assessed using the Measure Yourself Concerns and Wellbeing (MYCAW); Edmonton Symptom Assessment Scale (ESAS); and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).</p><p><strong>Results: </strong>Of 136 treated patients, 45 (33.1%) chose acupuncture and 91 (66.9%) reflexology. Most were female (111;81.0%), aged 59.7±14.3 years, and Jewish (125; 91.9%). A third had metastatic cancer (45; 34.4%), most undergoing adjuvant treatment (63; 48.1%). Metastatic disease was more prevalent in reflexology-treated patients (OR=2.86; p=0.018; 95%CI=1.20-6.84). Both treatments were associated with within-group improvement on ESAS fatigue, appetite; Total ESAS; and EORTC fatigue, pain and physical, emotional and social function. Only acupuncture was associated with within-group improvement on ESAS pain; and only reflexology on ESAS wellbeing and EORTC Global Health/QoL, nausea/vomiting and insomnia. Reflexology showed a between-group advantage for appetite and cognitive function.</p><p><strong>Conclusions: </strong>Both acupuncture and reflexology were associated with reduced within-group EORTC pain and ESAS and EORTC fatigue and appetite, physical, emotional and social function; only acupuncture with reduction of ESAS pain; and only reflexology improved wellbeing, somnolence and insomnia, with a between-group advantage for EORTC appetite and cognitive function. Further research is needed to confirm the findings within larger and more diverse patient populations.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study of Timely Integration of Interventional Pain Management for Advanced Cancer.","authors":"Jenna M Wilson, Inga Van Wieren, Pritesh S Topiwala, Edgar L Ross, Madeline Gorra, Alexi A Wright, Michael Hassett, Robert Jason Yong, Richard Gao, Michael Ferrick, Daniel Gorman, Kate Lally, Robert N Jamison, Andrea C Enzinger","doi":"10.1016/j.jpainsymman.2026.09.033","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.09.033","url":null,"abstract":"<p><strong>Context: </strong>. Interventional pain procedures, such as such as nerve blocks, neurolytic procedures, and therapeutic injections, can alleviate cancer pain yet are often considered only after failure of high-dose opioids.</p><p><strong>Objectives: </strong>. To assess feasibility and acceptability of timely integration of interventional pain management among patients with cancer pain.</p><p><strong>Methods: </strong>. This single-arm pilot study enrolled patients with locally advanced or metastatic cancer, moderate-to-severe pain, a prognosis of >6 months, and a daily opioid dose of ≤90 morphine milligram equivalents (MMEs), later amended to ≤200 MMEs). Patients were referred to a pain clinic for systematic consideration of interventional treatments. Surveys at baseline, 2, and 4 months assessed pain (BPI), procedural pain relief (0-100%), and quality of life (QOL; FACT-G). Feasibility and acceptability were evaluated based on time to evaluation, receipt of ≥1 procedure, and satisfaction (0-10). Linear mixed models examined changes in pain and QOL.</p><p><strong>Results: </strong>. Thirty patients with mixed cancer types were enrolled. Nearly all patients (93%) were evaluated by a pain specialist within four weeks, 56.7% received ≥1 procedure, and 83.3% rated care satisfaction ≥7 (M=8.6; SD=1.6), meeting all feasibility and acceptability benchmarks. Among those who underwent a procedure, patients reported substantial pain relief at both 2 months (M=66.7%, SD=32.8) and 4 months (M=65.3%, SD=34.4). Pain intensity (p=0.015) and pain interference (p=0.03) improved, whereas QOL remained stable (p>0.05).</p><p><strong>Conclusion: </strong>. Timely integration of interventional pain management for cancer pain was feasible and acceptable. Future research should test efficacy and strategies to support integration of procedural pain management into care pathways.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profound Relief from Treatment-Resistant Cancer Related Pain after Suzetrigine Use.","authors":"Natalie B Simon, Kara M Barnett, Joanna Serafin, Sana Shaikh","doi":"10.1016/j.jpainsymman.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.013","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure Management in Palliative Care: An Exploratory Cross-sectional Survey of Physician Practices in Germany.","authors":"Dr Med Anna-Christin Willert, Prof Dr Med Christoph J Ploner, Dr Med Verena Gaus, Pd Dr Med Alexander B Kowski","doi":"10.1016/j.jpainsymman.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.006","url":null,"abstract":"<p><strong>Context: </strong>Seizures pose significant challenges in patients with serious illness, particularly when altered consciousness or dysphagia impair the ability to take antiseizure medication (ASM). However, evidence to inform seizure management in palliative care is limited. Although guidelines exist for epilepsy populations, recommendations for people with serious illness or the end of life are scarce.</p><p><strong>Objectives: </strong>To characterize seizure management practices and use of ASM in specialized inpatient (SIPC) and outpatient palliative care (SOPC) in Germany.</p><p><strong>Methods: </strong>We conducted an exploratory cross-sectional online survey among palliative care physicians in Germany between 08/2023 and 10/2023. The questionnaire covered key domains, including ASM selection, routes of administration, timing and regimens of acute seizure treatment, transition to benzodiazepines (BZD-ASM), ASM discontinuation, and challenges encountered in clinical practice.</p><p><strong>Results: </strong>Among the 111 participating palliative care physicians, 98% reported initiating maintenance ASM, most commonly Levetiracetam (98%) and Midazolam (75%). Most physicians (99%) reported routinely using rescue medication for acute seizures. Midazolam was the most frequently reported first-line rescue medication, preferred in SIPC by 53% and in SOPC by 65%. For second-line treatment of status epilepticus, Levetiracetam was the most frequent choice in SIPC (50%), while Midazolam was preferred in SOPC (52%).</p><p><strong>Conclusion: </strong>Seizure management in palliative care in Germany reflects the specific requirements of patients with serious illness and partly deviates from established epilepsy guidelines. Findings point to a shift towards individualized approaches, including prioritization of BZD-ASM, flexible routes of administration, and increased off-label use. This highlights the need for tailored guidelines and prospective research in palliative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definition and Analysis of Opioid Switching in Advanced Cancer: Response to Kishi et al.","authors":"Aaron K Wong, Adarsh Das, Dorothy Wang, Brian Le, Jennifer Philip","doi":"10.1016/j.jpainsymman.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.007","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transdermal Buprenorphine for Pain in Pediatric Palliative Care: A 23-Patient Retrospective Study.","authors":"Felix Reschke, Rebecca Toenne, Mario Scheer, Cathrin Weigel, Monika Glowacka","doi":"10.1016/j.jpainsymman.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.005","url":null,"abstract":"<p><strong>Background: </strong>Pain management in pediatric palliative care is challenging, particularly in children with neurological impairments, feeding difficulties, or low opioid requirements. Transdermal buprenorphine offers pharmacological advantages, including stable plasma concentrations and a reduced risk of sedation; however, its use in children remains off-label and insufficiently studied.</p><p><strong>Aim: </strong>To evaluate the use, effectiveness, and safety of transdermal buprenorphine in pediatric palliative care and assess its feasibility in everyday clinical practice.</p><p><strong>Design: </strong>Retrospective observational study. Data were extracted from structured electronic medical records, including patient characteristics, analgesic indications, buprenorphine dosing and titration, clinical outcomes, and adverse effects.</p><p><strong>Setting/participants: </strong>The study included 23 pediatric patients aged 8 months to 17 years treated between April 2023 and April 2025. Participants received care either from a specialized outpatient pediatric palliative care service (SOPPC; German: Spezialisierte Ambulante Palliativversorgung für Kinder und Jugendliche, SAPV-KJ; 74%) or an inpatient pediatric palliative care unit. All patients received transdermal buprenorphine for chronic pain. Those treated with other forms of buprenorphine or alternative opioids were excluded.</p><p><strong>Results: </strong>All patients initiated treatment with a 5 µg/h patch; 43% required dose escalation. Pain control was rated as good in 87% (95% CI: 66-96%). Improved alertness was observed in 74% (95% CI: 52-88%). Mild local skin reactions occurred in 13%, and no serious adverse events were reported. Sublingual buprenorphine was used effectively for breakthrough pain in 26% of cases. Four patients were managed with transdermal buprenorphine monotherapy.</p><p><strong>Conclusions: </strong>Transdermal buprenorphine appears to be an effective and well-tolerated analgesic option for pediatric palliative care patients with low opioid needs. Its ease of use and favorable side effect profile support its potential clinical utility. Prospective studies are warranted to confirm safety and guide dosing strategies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care After Suicide Attempts: Now What?","authors":"Gregg Robbins-Welty, Jason Webb, Ann C Schwartz, Emily Pinto Taylor, Ashima Lal, Paul DeSandre, Julie Childers, Michael McGrath, Paul Noufi, Cynthia Geppert","doi":"10.1016/j.jpainsymman.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.008","url":null,"abstract":"<p><p>Patients who present after suicide attempts (SA) may experience a wide range of clinical trajectories, from full medical recovery to irreversible neurologic injury, multiorgan failure, or death. Although suicide prevention, risk assessment, and psychiatric treatment after a SA are well represented in the literature, comparatively little guidance exists for palliative care (PC) clinicians consulted after an SA. Care after SA lies at the intersection of critical care, psychiatry, and ethics, and raises distinctive challenges in prognostication, decisional capacity, decisions about life-sustaining treatment, and support for families and clinicians. This manuscript uses the case of Mr. A, a patient with a self-inflicted gunshot wound and uncertain neurologic prognosis, to describe a PC-informed framework for PC clinicians caring for patients after SA. In collaboration with psychiatry, ethics consultants, and the primary team, PC clinicians can help integrate medical and psychiatric prognosis, avoid anchoring on the attempt as evidence of stable values, support families struggling with guilt and stigma, manage distressing symptoms, and guide ethically grounded decision-making.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Selection on Daraxonrasib: P-Glycoprotein (P-gp) Blockade and Opioid.","authors":"Mellar P Davis, Samantha N Woods","doi":"10.1016/j.jpainsymman.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.010","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Unscheduled Hospitalization in Pancreatic Cancer: A Point for Palliative Care Integration.","authors":"Juan Luis Torres-Tenor, Andrea García-Leal, María Gómez Aguilera, Iván Martínez Redondo, Rocío Morales Santos, Eduardo Bruera, Alberto Alonso Babarro","doi":"10.1016/j.jpainsymman.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.10.009","url":null,"abstract":"<p><strong>Context: </strong>Pancreatic cancer is characterized by high symptom burden, rapid deterioration, and poor survival. Despite this complexity, specialist palliative care (SPC) is often integrated late or not at all. The first unscheduled hospitalization may represent a point for SPC assessment.</p><p><strong>Objectives: </strong>To characterize frequency, clinical features, and outcomes of the first unscheduled hospitalization in pancreatic adenocarcinoma, explore factors associated with subsequent survival, and describe the timing of SPC assessment.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of consecutive adults with pancreatic adenocarcinoma managed by medical oncology at three tertiary hospitals during 2022-2023, with follow-up through 2025. Overall survival (OS) from hospitalization was estimated with Kaplan-Meier methods; univariable Cox regression assessed associations with survival.</p><p><strong>Results: </strong>Among 125 patients, 105 (84%) experienced a first unscheduled hospitalization at a median of 4.1 months after diagnosis (IQR, 1.9-8.0). Median OS was 3.8 months (95% CI, 2.1-7.1); 21/104 (20%) died in hospital, and 62/80 (78%) were readmitted after discharge. ECOG performance status 2-4 (HR, 3.30), metastatic disease (HR, 3.05), liver metastases (HR, 2.58), and strong opioid use (HR, 2.10) were associated with shorter survival. Only 11 (10%) underwent SPC assessment before hospitalization; 31 (30%) were first assessed during hospitalization, 40 (38%) afterward, and 23 (22%) remained unassessed.</p><p><strong>Conclusion: </strong>A first unscheduled hospitalization occurred in most patients, marking limited survival, high in-hospital mortality, and frequent readmission. Most lacked prior SPC assessment. This event may serve as a pragmatic safety net for palliative care integration, complementing earlier needs- and prognosis-based referral strategies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}