Literature Review

Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectivesInterventional Pain Medicine; Sanjeet Narang , Jason Yong , David Hao, 9/25Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination.

Social relationships and end-of-life quality among older adults in the United States: The impacts of marital, kinship, and network ties The Journals of Gerontology; by Kafayat Mahmoud, Deborah Carr; 7/25We examine marital status differences in recent decedents’ end-of-life care and gender differences therein, and the role of other social ties (children, siblings, network members) in influencing the quality of end-of-life care. Divorced decedents fared poorly on multiple outcomes, being less likely than married or widowed persons to receive excellent care and to have personal care needs met. Divorced and widowed decedents were less likely to receive respectful treatment relative to married decedents. We found no significant gender differences in these patterns. Persons with more siblings and network members had superior pain management. Hospital patient advocates could also aid those who lack close kin at the end of life.

Caring for every breath: Carolina Caring Advanced Lung Care Program launched August 1st Carolina Caring, Newton, NC; Press Release; 8/8/25 A specialized lung care program providing care for complex respiratory conditions will bring needed comfort and support to many individuals. Launched on August 1st, 2025, Carolina Caring’s Advanced Lung Care Program helps patients receive the personalized care they need for their advanced respiratory illness at end of life, while remaining comfortably at home—leading to a reduction of hospitalizations and improved quality of life for patients and their families. 

The treatment of chemotherapy-induced peripheral neuropathy: A review of current management options and a potential role for scrambler therapyFrontiers in Pain Research; by Hassan Aboumerhi, Henry Vucetic, Andrew Gruenzel, Bahar Moftakhar, Mona Gupta, Santosh K Rao, Michael D Staudt; 7/25Chemotherapy-induced peripheral neuropathy (CIPN) presents a growing medical and financial burden on patients and the healthcare system alike. This has been treated with conservative and interventional care limited by efficacy, side effects, and lack of coverage. As such, there is an unmet treatment need for effective non-invasive or minimally invasive therapies for the treatment of CIPN. Scrambler therapy (ST) is a peripheral, non-invasive neuromodulation technique, which uses transcutaneous electrical stimulation to modulate pain signals. ST has shown mixed results in clinical trials; while some patients report symptom relief, more robust evidence is required before it can be widely recommended.

Regional anesthesia for hip fracture surgery in older adults: A retrospective comparison of outcomes using ACS NSQIP dataGeriatric Orthopaedic Surgery & Rehabilitation; Arissa M. Torrie, MD, MHS; Gerard P. Slobogean, MD, MPH; Rachel Johnson, MD; Ron E. Samet, MD; Samuel M. Galvagno, DO, PhD; Robert V. O’Toole, MD; Nathan N. O’Hara, PhD, MHA; 6/25Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. This study found that regional anesthesia, presumably using peripheral nerve block techniques, may offer advantages beyond pain control, with potential protective benefits in high-risk hip fracture patients. Future clinical trials should examine peripheral nerve block benefits beyond pain management, identify mechanisms of action, determine optimal techniques for different risk profiles, and assess long-term outcomes. By combining the insights from this study with carefully designed future research, researchers can work towards developing more effective, patient-centered approaches to anesthesia for older adults undergoing surgical fixation of hip fractures.

HOPE Tool Anxiety, Part II: From planning to practice Teleios Collaborative Network (TCN); podcast by Melissa Calkins; 6/30/25The countdown has begun. With October 1 on the horizon, hospice teams across the country are deep into training and testing—but preparation alone won’t guarantee success. The shift to HOPE isn’t just operational; it’s cultural. And real readiness goes far beyond timelines and task completion. It demands that every clinician, across every shift and care setting, understands what’s changing and feels confident in how to respond. This is the critical moment when planning must translate into practice—because once HOPE is live, the margin for error disappears.

MLN Fact Sheet: Creating an efffective Hospice Plan of CareCenters for Medicare & Medicaid Services, Medicare Learning Network (MLN); 5/10/25 The hospice plan of care (POC) maps out needs and services given to a Medicare patient facing a terminal illness, as well as the patient’s family or caregiver. CMS data shows that some hospice POCs are incomplete or not followed correctly. This fact sheet educates on creating and coordinating successful hospice POCs. The primary goal of hospice care is to meet the holistic needs of an individual and their caregiver and family when curative care is no longer an option. To support this goal:

The 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancerJAMA Network Open; Rebecca Rodin, MD, MSc; Lihua Li, PhD; Karen McKendrick, MPH; Krista Harrison, PhD; Lauren J. Hunt, PhD, RN; Ulrike Muench, PhD, RN; Cardinale B. Smith, MD, PhD; Melissa D. Aldridge, PhD, MPH, MBA; R. Sean Morrison, MD; 5/25In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in first-line opioids while less-safe tramadol and less-effective gabapentinoid prescribing continued to rise. Further revision of the recent 2022 CDC guideline and oncology pain management guidelines may be needed to help address these potentially inappropriate analgesic shifts.

[Brazil] Music therapy in modulating pain in palliative care patients: A systematic review and meta-analysisBritish Journal of Music Therapy; Suellen Fernanda Pinheiro Hammuod, Fernada Gonzalez Santos, Lidiane da Costa Fonseca, Elaine Kakuta, Renata Verão Brito, Karolayne Silva Souza, Eduardo Henrique Loreti; 3/25 Music therapy is an intervention that uses music for therapeutic purposes, helping to preserve mental, physical, and emotional health. Its use in the care of terminally ill patients can assist in managing pain, fatigue, quality of life (QoL), anxiety, and depression. This study aimed to analyze the effects of music therapy on pain in individuals receiving palliative care. Music therapy showed effectiveness in improving pain in patients receiving palliative care ... The effectiveness of music therapy on QoL remains debatable.

Prevention of opioid misuse and abuse through effective pain management in patients with chronic pain: An umbrella systematic reviewCureus: Sana Sultana, Safeera Khan; 3/25Chronic pain is a condition that affects physical well-being as well as emotional well-being, has mental impacts on patients, and diminishes their quality of life. There is also growing evidence that opioids have only limited effectiveness in the management of CNCP [chronic non-cancer pain], and the increased availability of prescription opioids has contributed to an increase in opioid addiction cases and overdose deaths. This review was conducted to determine if adequate pain management would decrease opioid use and prevent misuse. We discussed the different pain management methods in the paper, including the different pharmacotherapy options, nerve blocks, and spinal cord stimulation. We also talk about multidisciplinary treatment with the involvement of various departments (physician, pharmacy for pill counting, physical therapy, psychological care, etc.) in managing pain; good outcomes were observed with improvement in function.

Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysisJAMA Network Open; Rachel V. Aaron, PhD; Scott G. Ravyts, PhD; Nicolette D. Carnahan, PhD; Kavya Bhattiprolu, BS; Nicole Harte, MClinPsychol; Claire C. McCaulley, BA; Lauren Vitalicia; Alexandria B. Rogers, PhD; Stephen T. Wegener, PhD; Joanne Dudeney, PhD; 3/25Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development. 

Revamped tool can reliably assess pain symptoms in dementia patients: researchers McKnights Long-Term Care News; by Zee Johnson; 3/17/25 ... A team of researchers reconstructed the End-of-Life Dementia-Comfort Assessment in Dying, or EOLD-CAD, after a multifacility study showed that caregivers could adequately and reliably address a host of pain symptoms seen in end-of-life dementia patients. ... When clinicians working in the SNFs that were part of the trials used the EOLD-CAD, they were able to detect patterns in more than 600 residents that fell into four categories: physical distress, symptoms of dying, emotional distress, and well-being. Common symptoms observed across these categories were restlessness, shortness of breath, choking, gurgling, difficulty in swallowing, fear and anxiety. ...

Brain biomarkers for pain sensitivityJAMA Neurology; Prasad Shirvalkar, MD, PhD; Christopher J. Rozell, PhD; 1/25Identifying objective biomarkers that track individual pain severity has been dubbed “the holy grail” of pain neuroscience. Chronic pain affects up to one-fifth of US adults, and its complexity is attributed to a confluence of physical, emotional, and cognitive factors that contribute to suffering and disability. The epidemic of chronic pain initially contributed to the rise of the opioid epidemic and continues to plague nearly all fields of clinical medicine. Identifying and validating biomarkers to predict individual risk for chronic pain facilitate a precision medicine approach to pain medicine. Despite the unknown provenance of the proposed biomarkers, the results of the present study have the potential to aid in the practical development of personalized pain management strategies.