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The article discusses the pathophysiology associated by dyspnea and explains the impacts caused by opioids on this observed pathophysiology. Oxygen, carbon dioxide and pH and central nervous system (CNS) functions play significant roles in dyspnea, which is generally associated with shortness of breath and other breathing problems. The use of opioids is shown to be beneficial in dyspnea patients, as they enhance respiration and can render survival advantages in situations.

Objective: To evaluate the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) in terminally ill patients experiencing dyspnea. Methods: Nonblinded, noncontrolled observational study of patients admitted to the hospice/palliative care unit for dyspnea from May 2006 to March 2007. Eligible patients were older than 18 years of age with satisfactory baseline cognitive function diagnosed with end-stage congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or cancer complaining of dyspnea. At the onset of dyspnea, enrolled patients were instructed to slowly dissolve the OTFC lozenge and rate their dyspnea on a 10 point visual analog scale at 15-minute intervals for 60 minutes. Respiratory rate (RR) and arterial oxygen saturation (SaO2) were recorded at similar intervals. Patients were observed for approximately 48 hours. Results: Four patients were found eligible. In all four cases, patients experienced rapid relief of dyspnea as soon as five minutes. No significant adverse events were reported. Conclusions: OTFC appears to be safe and effective for dyspnea in terminally ill patients. The study population is limited to four cases, however, the initial findings are promising and merit further research. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the shortcomings in the health care system with regards to palliative care in the cultural and societal perspectives. The author imparts that education can bridge the gap which the culturally conservative approach of dealing with death and dying has created in the society and the medical culture. He hopes that palliative care should be accepted both as medical care specialty and as an integral aspect. It also mentions lessons learned by the author.

The author discusses on the palliative treatment and evidence-based medicine. He describes the difficulties of applying the latter paradigm to the former and reflects on the challenges faced by its researchers that are working to discover new knowledge in the social movement's context. Finally, he concludes that evidence-based methodologies are just one set of tools, but not necessarily best for understanding others.

The article offers the authors' insights on the series of case discussions in the "Journal of Palliative Medicine." They say that the discussions are most closely associated with how clinicians gain their knowledge to practice. They state that the goal of the series in the journal's volume three was to reproduce the type of discussion that occurs during a particular conference in a journal format. They add that a case discussion must be practical and present news that can be used by clinicians.

Discusses the role of case discussions in palliative medicine. Effects of a case discussion on medical issues; Opportunities for case authors; Benefits of case studies for palliative medicine fellows and junior faculty.

This article presents a case study regarding the treatment of pruritus caused by cholestasis with opioid antagonists. The patient in the case study had mild cholestasis caused by hepatic metastases. Pruritus and pain was caused by liver involvement by tumor. With increasing clinical experience, it may be possible to substantially shorten the duration of naloxone infusion, in order to initiate oral naltrexone therapy in cholestatic patients. To determine how applicable the approach outlined in a hospital daycare setting may be in a patient who is receiving palliative care and is also dependent on opiate agonist therapy for the relief of pain, further clinical experience is necessary.