Serra Sossio, Spampinato Michele Domenico, Riccardi Alessandro, Guarino Mario, Fabbri Andrea, Orsi Luciano, De Iaco Fabio
Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy.
Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy.
J Clin Med. 2023 Jun 28;12(13):4357. doi: 10.3390/jcm12134357.
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.
获得疼痛管理是所有人的一项基本人权，包括那些处于生命末期（EOL）的人。在终末期患者中，严重且无法控制的疼痛是急诊入院的常见原因，由于其成因复杂且往往是多因素的，其治疗具有挑战性。本叙述性综述的目的是确定急诊中严重生命末期疼痛管理的现有文献。检索了MEDLINE、SCOPUS、EMBASE和CENTRAL数据库，时间跨度从数据库建立至2023年4月1日，包括随机对照试验、观察性研究、系统性或叙述性综述、病例报告以及急诊生命末期疼痛管理指南。共识别出532篇文章，纳入了9篇文章（5篇叙述性综述、2篇回顾性研究和2篇前瞻性研究）。纳入的研究在用于疼痛评估和推荐的量表以及推荐的治疗方法上存在异质性。没有研究为急诊中患有疼痛的生命末期患者提供更好方法的证据。我们提供了研究结果的叙述性总结以及临床实践中生命末期疼痛管理的综述，包括（i）识别生命末期患者和未满足的姑息治疗需求，（ii）以患者为中心的对疼痛类型和严重程度的多维度评估，（iii）生命末期疼痛管理的多学科方法，包括非药物和药物技术概述；以及（iv）特殊情况的管理，包括慢性疼痛的快速急性恶化、爆发性疼痛和镇静性姑息治疗。
