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• W3001479652 abstract "•Describe patient cases where the traditional palliative care tools are not adequate for refractory symptoms.•Discuss the emerging literature and practice of uncommon opioids (e.g., buprenorphine, tapentadol, levorphanol), non-opioid therapy (e.g., ketamine, lidocaine/mexiletine, dexmedetomidine).•Interventional therapy for refractory symptoms.•Identifying feasible goals for refractory symptoms, Whole person assessment, resources: OMM, Integrative Medicine, wound nurse CBT, coping, “new normal”, compassionate limit setting, Patient and provider-Knowing when to close your tool box.•List barriers and how to overcome these barriers in incorporating these additional tools in your institution, including protocol development.•Transitioning your toolbox to a hospice or home setting; opportunities and challenges including sedation at end of life. Palliative care multidisciplinary teams are commonly consulted to help with refractory cases, and in most cases our tool box is adequate to address the various levels of suffering. However, in some instances, our traditional palliative care tool box is not enough, which leads teams to search for additional modalities that we can add to our tool box. There is emerging literature and clinical practice protocols which guide us to expanding our toolbox. These include uncommon opioids in the palliative care setting, such as tapentadol, levorphanol, and buprenorphine. It is also important that the toolbox includes non-opioid therapy that can provide opioid-sparing effects (e.g., ketamine, lidocaine/mexiletine, dexmedetomidine) and that we continuously evaluate the role and benefits of non-pharmacological therapies (e.g., acupuncture, guided imagery, hypnosis, guided imagery). Additionally, collaborating with our anesthesiology colleagues to explore interventional modalities (e.g., intrathecal, epidural, peripheral nerve block, celiac plexus block, hypogastric blocks, chordotomy) is essential in refractory symptoms. The important step for many palliative care teams is to apply literature and available guidelines into their institution's approach to expanding their toolbox. Throughout the presentation we will evaluate feasible goals for refractory symptoms with whole patient assessment and highlight when compassionate limit setting, identifying a “new normal,” and knowing when to close your tool box are necessary. In this interactive preconference session we will review difficult cases and the literature but emphasize the key steps to incorporating scientific evidence into practice for audience members at their institution. Key elements we will discuss are common institutional barriers and best practice standards for overcoming these barriers. Additional discussion points for success will include feasible goals in refractory settings. And finally we will evaluate transitioning patients to home or hospice, discussing both opportunities and challenges, including the use of sedation at end of life." @default.
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• W3001479652 date "2020-02-01" @default.
• W3001479652 modified "2023-09-30" @default.
• W3001479652 title "Multidisciplinary and Multimodal Approaches for Refractory Symptoms (P14)" @default.
• W3001479652 doi "https://doi.org/10.1016/j.jpainsymman.2019.12.025" @default.
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