Journal of pain and symptom management最新文献

{"title":"Practical Management of Headaches in Patients With Primary and Secondary Brain Tumors.","authors":"Megan E H Still, Joy Burke, Jennifer Robblee, Surabhi Ranjan, Nestor Galvez-Jimenez, Rachel S F Moor, Akanksha Sharma, Lalanthica Yogendran, Cara Siegel, Christine Lu-Emerson, Marianne Karam, Andrew Dhawan, Joshua A Budhu, Elizabeth Coffee, Erin M Dunbar, Denise Leung, David Schiff, Katherine B Peters, Ashley P Ghiaseddin","doi":"10.1016/j.jpainsymman.2026.03.017","DOIUrl":"10.1016/j.jpainsymman.2026.03.017","url":null,"abstract":"<p><strong>Purpose: </strong>Headaches in patients with brain tumors can be multifaceted and difficult to treat, significantly affecting quality of life.</p><p><strong>Methods: </strong>We conducted a narrative synthesis of the literature to discuss the most common causes of and treatments for headache associated with brain tumors.</p><p><strong>Results: </strong>Although increased intracranial pressure due to space-occupying lesions may be the pain driver in some instances, many patients experience secondary headaches that should be treated based on their primary characteristics, such as migraine or tension-like headache. Similarly, the location of tumors can affect pain type, inciting nerve, meningeal, or skull pain, and secondary headaches may also be induced by treatment effects from entities such as posterior reversible encephalopathy syndrome PRES or radiation necrosis.</p><p><strong>Conclusions: </strong>All these headache phenotypes should be treated based on symptoms and pain driver, with a focus on a wholistic approach incorporating both pharmacologic and nonpharmacologic options to improve the quality of life of patients with brain tumors.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645645","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":"Five-Element Music and VR for Pain and Psychological Distress in Advanced Cancer: A Randomized Trial.","authors":"Jingjing Song, Yang Zhao, Zijia Zeng, Xu Dong, Chunliu Hou, Xinyue Wang, Yonghe Liu, Junnan Zhao, Yan Li","doi":"10.1016/j.jpainsymman.2026.03.020","DOIUrl":"10.1016/j.jpainsymman.2026.03.020","url":null,"abstract":"<p><strong>Context: </strong>Pain and psychological distress are common and debilitating symptoms in patients with advanced cancer. Non-pharmacological interventions such as Five-Element Music therapy and virtual reality (VR) have shown promise in improving symptom management, but their combined effects remain unclear.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical effectiveness of the combination of Five-Element Music and VR in improving pain, anxiety, depression, and sleep quality in cancer patients, as well as its impact on serum β-endorphin (β-EP) and 5-hydroxytryptamine (5-HT) levels, providing an innovative non-pharmacological therapy for cancer patients.</p><p><strong>Methods: </strong>In this randomized controlled trial, 66 patients were allocated to an experimental group (standard care plus Five-Element Music and VR) or a control group (standard care only). The intervention comprised daily 12-minute sessions over seven consecutive days. Outcomes were analyzed using mixed-design analysis of variance (mixed ANOVA), with time (baseline vs. postintervention) as the within-subject factor and group allocation as the between-subject factor.</p><p><strong>Results: </strong>Significant time × group interaction effects were found for pain intensity (NRS), anxiety (SAS), depression (SDS), sleep quality (PSQI), and serum 5-HT. The experimental group showed significantly greater improvements over time compared to the control group in all primary and secondary outcomes (P < .05). Although serum β-EP levels increased in both groups over time (P < .001), no significant interaction effect was found. Partial eta squared values indicated moderate to large effect sizes for outcomes with significant interactions.</p><p><strong>Conclusions: </strong>The combination of Five-Element Music and VR significantly improved pain, anxiety, depression, and sleep quality in patients with advanced cancer, and modulated serum 5-HT levels. These findings support the feasibility and potential efficacy of using this non-pharmacological intervention to manage symptoms in cancer care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645643","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":"PC-FACS April 2, 2026.","authors":"","doi":"10.1016/j.jpainsymman.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.04.001","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645626","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":"Closing the Palliative Care Workforce Gap through State Lawmaking: A Survey of Legislation 2010-2023.","authors":"Eugene Rusyn, Stacie Sinclair","doi":"10.1016/j.jpainsymman.2026.03.016","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.03.016","url":null,"abstract":"<p><strong>Context: </strong>The field of palliative care faces a critical workforce shortage that jeopardizes its capacity to deliver quality care to patients with serious illness. While there have been efforts to address these shortages through policymaking at the federal level, less attention has been paid to potential state levers.</p><p><strong>Objectives: </strong>Determine what state policies have been introduced or enacted to address the palliative care workforce gap. Assess whether there are any promising policies states can implement, whether based on current state practice in palliative care or from state action to address the workforce shortage in other fields.</p><p><strong>Methods: </strong>A unique dataset was assembled containing state legislation-both enacted laws and introduced bills-from 2010 through 2023. Relevant bills and laws were classified into eight categories. To confirm the efficacy of our review, we conducted a validation of all gathered data for the period 2010-2023.</p><p><strong>Results: </strong>From 2010-2023, we identified 723 bills and laws pertaining to palliative care. Of those, fourteen related in whole or in part to workforce (representing 2% of the total) with five becoming law-representing a pass rate of 36%. Fifty-five legislative entries pertained to clinical skill-building (comprising 7.6% of bills or laws from 2010-2023), with seventeen becoming law-representing a pass rate of 31%. Taken together, these efforts represented a minority (9.5%) of state legislative action during the study period.</p><p><strong>Conclusion: </strong>Additional state policies are needed to close the palliative care workforce gap. Lessons from fields such as behavioral health and primary care can help inform future action.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638920","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":"Three Decades of Monitoring Palliative Care Development in Latin America: A Thematic Analysis of Regional and National Strategies.","authors":"Miguel Antonio Sánchez-Cárdenas, Santiago Guadarrama-Vega, María Alejandra Umbacia, Christian Acosta, Paola Ruiz, Marta Ximena León","doi":"10.1016/j.jpainsymman.2026.03.014","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2026.03.014","url":null,"abstract":"<p><strong>Context: </strong>Monitoring the development of palliative care (PC) is essential for guiding public policy, allocating resources, and reducing health inequities. Since the 1990s, Latin America has implemented various assessment strategies; however, their evolution, methodological diversity, and regional impact have not been systematically analyzed.</p><p><strong>Objectives: </strong>To analyze PC monitoring strategies implemented in Latin America between 1994 and 2025, categorizing them by monitoring domains and methodological approaches.</p><p><strong>Methods: </strong>We conducted a qualitative document study analyzing global, regional, and national reports. Inductive thematic analysis was used to classify 44 identified strategies based on the WHO Public Health Strategy pillars: policy, education, services, and medicines, including emergent dimensions such as research and community empowerment. Monitoring efforts were further categorized by Evaluation Levels (Advanced, Institutional, Intermediate, Technical, and Initial) to assess their strategic contribution to national health systems.</p><p><strong>Results: </strong>Forty-four monitoring initiatives were identified across 18 countries. The results reveal a methodological shift from participatory workshops (n=16) and expert missions (n=17) toward structured surveys and continuous national observatories. While access to essential medicines was the primary driver of early monitoring (1994-2010), recent strategies in countries such as Argentina, Colombia, Mexico, and Uruguay have adopted multidimensional frameworks. Significant heterogeneity persists, with Southern Cone countries demonstrating advanced institutionalization, while others remain dependent on external technical audits.</p><p><strong>Conclusion: </strong>Palliative care monitoring in Latin America has matured from sporadic situational diagnostics to structured comparative benchmarking. To close remaining gaps, the region must move toward harmonized, sustainable monitoring systems that integrate community empowerment and specialized pediatric care into national health agendas.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592868","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":"Impact of Virtual vs. In-Person Palliative Care on Symptom Burden: A Multisite Cohort Study.","authors":"Sarah Nouri, Steven Z Pantilat, Christine S Ritchie, Ying Shi, David O'Riordan, John Boscardin, Courtney R Lyles, Rebecca L Sudore","doi":"10.1016/j.jpainsymman.2026.03.013","DOIUrl":"10.1016/j.jpainsymman.2026.03.013","url":null,"abstract":"<p><strong>Context: </strong>Outpatient palliative care (OPC) is increasingly being delivered virtually but symptom-related outcomes associated with virtual OPC are unknown.</p><p><strong>Objectives: </strong>Examine the association over time between symptom burden and visit modality among people with serious illnesses.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included patients ≥18 years old with ≥2 visits at 58 OPC programs. We examined change in symptom burden (Edmonton Symptom Assessment Scale, ESAS; range 0-100) over time (first 4 visits) by visit modality (in-person vs. virtual vs. mixed). Using mixed effects multinomial regression, we examined the difference in the linear trend of ESAS scores over time by visit modality. We repeated analyses restricting to those with baseline moderate-to-severe symptom burden (ESAS ≥ 40/100) and stratifying by language (English vs. non-English).</p><p><strong>Results: </strong>Among 3,896 patients, 86% had all in-person visits, 4% all virtual, 10% mixed; 51% were ≥65 years old; 84% were referred for symptoms; 21% had non-English preferred languages. ESAS scores decreased significantly more for the mixed (-5.9 points; P-trend vs. virtual = .007) and in-person groups (-3.6; P-trend vs. virtual = .049) compared to the virtual group (+0.03). Among those with ESAS≥40/100 at baseline, ESAS scores decreased most in the mixed group (-24.1; P-trend vs. in-person = .02; P-trend vs. virtual <.001) followed by in-person (-17.7; P-trend vs. virtual <.001), compared with stable symptoms in the virtual group (+0.03). Trends were similar after stratifying by language.</p><p><strong>Conclusions: </strong>Our results suggest that mixed virtual and in-person care is associated with a greater reduction in symptom burden compared to in-person or virtual care alone.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574394","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":"Psychedelic Experiences and Finitude in Serious Illness: A Qualitative Synthesis.","authors":"Ana Cláudia Mesquita Garcia, Geovanna Maria Isidoro, Cremilson de Paula Silva","doi":"10.1016/j.jpainsymman.2026.03.012","DOIUrl":"10.1016/j.jpainsymman.2026.03.012","url":null,"abstract":"<p><strong>Context: </strong>People living with serious illness frequently experience intense existential suffering related to awareness of finitude. Psychedelic-assisted therapies have been associated with reductions in death anxiety and existential distress, yet the experiential processes underlying transformations in the relationship with finitude remain insufficiently understood.</p><p><strong>Objectives: </strong>To synthesize qualitative evidence on the meanings, experiential processes, and transformations related to finitude reported by people with serious illness in the context of psychedelic use.</p><p><strong>Methods: </strong>A systematic review of qualitative evidence was conducted following JBI guidance and reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases and gray literature were searched without language or date restrictions. Qualitative primary studies involving adults with serious illness who used psychedelics in clinical/therapeutic or non-clinical contexts were included. Data were synthesized using thematic synthesis.</p><p><strong>Results: </strong>Nine qualitative studies were included. The synthesis identified a process of transformation in the relationship with finitude organized across three interrelated states. Prior to the psychedelic experience, finitude was experienced as a dominant threat marked by fear of death and illness-centered identity. During the psychedelic experience, states of expanded consciousness facilitated experiences of transcendence, including symbolic encounters with death, expansion of the ego's boundaries, spiritual experiences of connection and unity, and emotionally challenging experiences. These experiences enabled the reconstruction of personal narratives and the reinterpretation of suffering as transformative. In the post-experience state, finitude became integrated into the life experience, characterized by greater acceptance of mortality, reduced death anxiety, and revaluation of life priorities.</p><p><strong>Conclusion: </strong>Psychedelic-related experiences of transcendence appear to mediate a meaningful transformation in how people with serious illness relate to finitude. Rather than eliminating suffering, this process involves its experiential traversal and integration, supporting existential adaptation at the end of life.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574512","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":"Psychostimulants for Depression in Serious Illness: Limited Evidence, Select Indications.","authors":"Karolina Sadowska, Danielle Chammas, Mia Pattillo, Cara L McDermott, Nneka N Ufere, Jason A Webb, Daniel Shalev","doi":"10.1016/j.jpainsymman.2026.03.015","DOIUrl":"10.1016/j.jpainsymman.2026.03.015","url":null,"abstract":"<p><p>Depression is common in serious illness, yet traditional antidepressants have a delayed onset. Psychostimulants offer potentially rapid symptom relief, but their evidence base for depression, especially in medically complex patients, remains unclear. In this Palliative Care Rounds, we review the evidence for the use of psychostimulants as monotherapy or augmentation for major depressive disorder, including trials enrolling patients with cancer or other serious illnesses. Evidence for monotherapy is weak: meta-analyses of small, methodologically limited trials suggest modest benefit compared with placebo. Augmentation studies demonstrate statistically significant but clinically small effects. Data on people with serious illnesses is limited to a small number of heterogeneous trials with inconsistent findings. Overall, psychostimulants have limited evidence for depression in serious illness, particularly as monotherapy. Given evidence for alternative rapid-acting interventions, such as ketamine/esketamine or second-generation antipsychotic augmentation, psychostimulants should be used sparingly and reserved for specific scenarios (e.g., comorbid attention-deficit/hyperactivity disorder or prior robust response).</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second-Generation Antipsychotics for Depression in Serious Illness: A First-Line Augmentation Strategy.","authors":"Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev","doi":"10.1016/j.jpainsymman.2026.03.010","DOIUrl":"10.1016/j.jpainsymman.2026.03.010","url":null,"abstract":"<p><p>Depression in serious illness is common, disabling, and often requires rapid improvement. Traditional antidepressants may take weeks to work, whereas second-generation antipsychotics (SGAs) have evidence for faster onset and robust augmentation effects in general psychiatric populations. In this Palliative Care Rounds, we review the general psychiatric and serious illness-specific evidence for the use of SGAs as monotherapy and augmentation therapy for depression. In the psychiatric literature, SGA augmentation improves response and remission rates (odds ratios 1.34-2.93; needed to treat 7-13), with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No randomized controlled trials have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion About Life Expectancy and Functional Prognosis in Family Members of Cancer Patients.","authors":"Yusuke Hiratsuka, Jun Hamano, Masanori Mori, Maho Aoyama, Tatsuya Morita, Satoru Tsuneto, Mitsunori Miyashita","doi":"10.1016/j.jpainsymman.2026.03.009","DOIUrl":"10.1016/j.jpainsymman.2026.03.009","url":null,"abstract":"<p><strong>Context: </strong>Prognostic information is crucial for end-of-life decision-making. While survival predictions are common, the impact on family members remains unclear. There is also a need to understand the role of discussions about functional prognosis.</p><p><strong>Objectives: </strong>This study aimed to explore (1) the frequency of discussion about life expectancy and functional prognosis in family members and (2) the impact of the discussion on family outcomes.</p><p><strong>Methods: </strong>This pre-planned analysis of a nationwide post-bereavement survey examined communication regarding life expectancy and functional prognosis. The study included bereaved family members of cancer patients who died in palliative care units between May and January of 2024. Complicated grief, depression, and unfinished business were measured using validated scales. It compared outcomes between those with and without these discussions.</p><p><strong>Results: </strong>Of the 988 questionnaires sent, 582 were analyzed. Regarding discussions with clinicians, 85.7% of family members discussed life expectancy, while 68.0% of family members discussed functional prognosis. Family members experienced better scores on measures of grief and depression. All subscales of \"unfinished business\" showed better outcomes in the groups that had these discussions.</p><p><strong>Conclusion: </strong>Discussions about life expectancy were more prevalent than discussions about functional prognosis for family members. These discussions were linked to reduced grief, depression and unfinished business for family members.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480811","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}