Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach
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 mul...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/13/4357 |
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| author | Sossio Serra Michele Domenico Spampinato Alessandro Riccardi Mario Guarino Andrea Fabbri Luciano Orsi Fabio De Iaco |
| author_facet | Sossio Serra Michele Domenico Spampinato Alessandro Riccardi Mario Guarino Andrea Fabbri Luciano Orsi Fabio De Iaco |
| author_sort | Sossio Serra |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T01:37:31Z |
| format | Article |
| id | doaj.art-ce6adb7d861d47dc93e8148419e7c495 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T01:37:31Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ce6adb7d861d47dc93e8148419e7c4952023-11-18T16:52:43ZengMDPI AGJournal of Clinical Medicine2077-03832023-06-011213435710.3390/jcm12134357Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical ApproachSossio Serra0Michele Domenico Spampinato1Alessandro Riccardi2Mario Guarino3Andrea Fabbri4Luciano Orsi5Fabio De Iaco6Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, ItalyDepartment of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, ItalyPronto Soccorso Ospedale di Imperia, 18100 Imperia, ItalyUOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, ItalyEmergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, ItalyPalliative Care Physician and Scientific Director of “Rivista Italiane di Cure Palliative”, 26013 Crema, ItalyStruttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, ItalyAccess 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.https://www.mdpi.com/2077-0383/12/13/4357pain managementemergency departmentend of life carepalliative careacute painchronic pain |
| spellingShingle | Sossio Serra Michele Domenico Spampinato Alessandro Riccardi Mario Guarino Andrea Fabbri Luciano Orsi Fabio De Iaco Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach Journal of Clinical Medicine pain management emergency department end of life care palliative care acute pain chronic pain |
| title | Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach |
| title_full | Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach |
| title_fullStr | Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach |
| title_full_unstemmed | Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach |
| title_short | Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach |
| title_sort | pain management at the end of life in the emergency department a narrative review of the literature and a practical clinical approach |
| topic | pain management emergency department end of life care palliative care acute pain chronic pain |
| url | https://www.mdpi.com/2077-0383/12/13/4357 |
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