[If problems arise during palliative sedation: considerations in sedation in the terminal phase]. / Als problemen optreden bij palliatieve sedatie.

Palliative sedation is increasingly being utilised when patients are close to death. Despite clear guidelines, its implementation is often problematic. In this clinical lesson we describe two patients in whom sedation did not go according to plan. The first case concerns a relative overdose of the medication which resulted in agitation, and the second case concerns the premature initiation of palliative sedation which caused the period of sedation to last too long. Suggestions are made to prevent these problems occurring.

Clinical evaluation of pain treatment with electrostimulation: a study on TENS in patients with different pain syndromes.

OBJECTIVE: We evaluated the clinical efficacy and the unwanted side effects of transcutaneous electrical nerve stimulation (TENS) in a consecutive group of patients with intractable pain due to different pain syndromes. METHODS: Two hundred eleven patients with different pain syndromes, coded according to the International Association for the Study of Pain (IASP), were treated with TENS, using a standardized protocol. After a 6-month treatment period, an independent investigator estimated the effect of TENS in retrospect through assessment of patient files, standardized questionnaires, and diaries. In addition, a physical examination to determine the IASP code was performed, and unwanted side effects were evaluated. RESULTS: TENS showed a favorable response in the majority of patients with pain caused by peripheral nerve damage (53%), anginal pain resulting from ischemic heart disease (75%), and pain of the musculoskeletal system due to mechanical degenerative causes (69%). TENS employed in patients with prominent psychological and social distress, and for pain caused by central and autonomic dysfunction, alleviated pain in only 10-25% of the patients. Side effects occurred in 35% during the initial period of the treatment and were usually able to be resolved, especially with thorough supporting instructions during the initial treatment period. CONCLUSIONS: In this study, the beneficial effect of TENS appeared to be related to the etiology of the underlying pain. The effect of TENS was maintained for > 6 months in the majority of patients with an immediate favorable response. Supporting instructions are crucial for long-term success.