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Pallmedpro @pallmedpro.bsky.social · 7d

Have you read Soliman et al.'s 2025 systematic review and meta-analysis in the management of neuropathic pain? How might it change your practice? www.thelancet.com/action/showP...

www.thelancet.com

Pallmedpro @pallmedpro.bsky.social · 7d

Good morning from the gallery! Looking forward to going live at 9 after our intro VT 🎬

Pallmedpro @pallmedpro.bsky.social · 14d

Our Resources Portal is now open to delegates on our 2025 course, who should now all have logins. We’ll be adding to it as the course gets underway, including enabling our practice question bank. Visit pallmed.pro/resources, or book your course place via pallmed.pro/book if you haven’t already!

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Pallmedpro @pallmedpro.bsky.social · 29d

Have you learned your controlled drug schedules? Knowing the relevant schedules and the legal restrictions placed upon common palliative care medicines can be helpful, along with how you may need to advise patients looking to take these medicines abroad. GOV.UK has more: www.gov.uk/guidance/con...

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Pallmedpro @pallmedpro.bsky.social · Sep 3

Breathlessness steals more than air — it steals agency. Currow & Johnson (2020) argue opioids, used well, can give it back. Start low, titrate slow, monitor closely. This is symptom control with purpose, not palliation by default.

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Pallmedpro @pallmedpro.bsky.social · Sep 3

Still hesitating over morphine for breathlessness? The evidence is stronger than many think. Currow & Johnson’s review dismantles myths, clarifies dosing, and reframes risk. Worth a re‑read before your next MDT. spcare.bmj.com/content/10/3...

Opioids for breathlessness: a narrative review

Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of managemen...

spcare.bmj.com

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Pallmedpro @pallmedpro.bsky.social · Sep 3

Opioids for chronic breathlessness ≠ “last resort”. Currow & Johnson (2020) remind us: low‑dose morphine can improve function & QoL when optimised, monitored, and individualised. Not about sedation — about living better, breathing easier.

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Pallmedpro @pallmedpro.bsky.social · Aug 31

Our revision flashcards are in the process of being updated for 2025-2026, with some great new content added. You'll be able to pre-order the 8th Edition from 15th September, for release on 1st October. Course delegates can claim a FREE update in October. pallmed.pro/flashcards

Palliative Medicine SCE Flashcards

pallmed.pro

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Pallmedpro @pallmedpro.bsky.social · Aug 28

🤔 MCA 2005 and Scotland’s AWI diverge on capacity assessment, scope of proxy authority, and how we justify decisions. Know the ground rules before you cross them. A clear overview from the Mental Welfare Commission: www.mwcscot.org.uk/adults-incap...

www.mwcscot.org.uk

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Pallmedpro @pallmedpro.bsky.social · Aug 28

⚖️ Same patient scenario, different nation, different paperwork. MCA 2005 gives LPAs broad health/welfare powers if capacity is lost. Scotland’s AWI splits decision‑making: welfare powers via guardianship/intervention orders, and healthcare decisions through statutory authority for clinicians.

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Pallmedpro @pallmedpro.bsky.social · Aug 28

🧠 Under the MCA 2005 (England & Wales), we decide for an adult lacking capacity by asking what’s in their ‘best interests’. In Scotland’s Adults with Incapacity Act, that phrase never appears. The focus shifts to benefit and least restrictive option, with statutory principles front and centre.

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Reposted by Pallmedpro

Pharmacopalliation @pharmacopalliation.bsky.social · Aug 27

💊💊ALFENTANIL💊💊
Alfentanil’s pKa ~6.5, much lower than fentanyl (~8.4) or morphine (~8.0)

At physiologic pH (7.4), ~90% of alfentanil exists in the unionised, lipid-soluble form → crosses the blood–brain barrier very rapidly

This explains why alfentanil has the fastest onset of action of any opioid

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Pallmedpro @pallmedpro.bsky.social · Aug 20

Did you know, that the half life of phenobarbitone is an average of 4 days?! The way we use it in palliative care needs to be proportionate, specialist-led, and congruent with known pharmacokinetics. @bmj.com Supportive and Palliative Care has more: spcare.bmj.com/content/earl... #palliativecare

Novel staggered loading of phenobarbitone for refractory seizures and agitation at the end of life

Background Seizures and agitation are distressing symptoms commonly encountered at the end of life and may require treatment with phenobarbitone when standard therapies fail. Current phenobarbitone do...

spcare.bmj.com

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Pallmedpro @pallmedpro.bsky.social · Aug 17

Fallon et al.’s 2018 randomised trial found oral ketamine no different to placebo in cancer-related neuropathic pain, but wondered if there could still be a role for it in cases where central sensitisation was observed (a population not specifically selected for) pmc.ncbi.nlm.nih.gov/articles/PMC...

Oral Ketamine vs Placebo in Patients With Cancer-Related Neuropathic Pain: A Randomized Clinical Trial

This multicenter randomized clinical trial compares oral ketamine with placebo for treating neuropathic pain in patients with cancer.

pmc.ncbi.nlm.nih.gov

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Pallmedpro @pallmedpro.bsky.social · Aug 17

Although an older study, this placebo-controlled double-blind RCT found no net benefit using SC ketamine in general cancer pain. 6 years later, Fallon et al. Looked more specifically at neuropathic cancer pain. pubmed.ncbi.nlm.nih.gov/22965960/

Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain - PubMed

Ketamine does not have net clinical benefit when used as an adjunct to opioids and standard coanalgesics in cancer pain.

pubmed.ncbi.nlm.nih.gov

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Pallmedpro @pallmedpro.bsky.social · Aug 14

The Dual Process Model of Grief:
Laughed during grief then felt guilty? Don’t. The Dual Process Model says we shift between loss-oriented coping (feeling, remembering) and restoration-oriented coping (adapting, rebuilding). This back-and-forth prevents burnout. Joy and sorrow can walk together

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Pallmedpro @pallmedpro.bsky.social · Aug 14

Worden’s Tasks of Mourning:
Grief isn’t just a wave to ride — it’s work. Worden’s 4 tasks: accept the loss, process the pain, adjust to life without them, and keep a lasting connection while moving forward. It’s not “getting over” someone — it’s living with love and loss in the same heart.

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Pallmedpro @pallmedpro.bsky.social · Aug 14

Grief, according to Kübler-Ross:
Heard grief has “5 stages” you must follow? Denial → anger → bargaining → depression → acceptance was never a rigid sequence. Kübler-Ross saw it in those facing terminal illness. You might skip, loop, or feel several at once. It’s a guide, not a timetable.

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Pallmedpro @pallmedpro.bsky.social · Aug 11

Follow us for your continuing professional development in palliative medicine.