Thinking about a well-preserved patient, who had recently been counselled about the non-availability of further cancer-directed treatment and who was refusing to accept this advice and shoving the low analgesic requirement (was on step 1 pain medications) and suspiciously low symptom burden in my face, I was forced to confront the reality of the situation.… — read more

Anti-emetics thought least likely to exacerbate Idiopathic Parkinson’s disease include Cyclizine, domperidone, hyoscine hydrobromide (risk of exacerbating delirium) and ondansetron (with the caveat that concurrent usage with apomorphine is contra-indicated). Anti dopamine receptor anti-emetics are known to exacerbate symptoms and risk the possibility of causing potentially fatal dopamine depletion syndrome. Small doses of levomepromazine, olanzapine… — read more

The following drugs, demonstrated to have limited utility in the N and V secondary to the following indications, have been proposed for use in refractory nausea and vomiting : a. Gabapentinoids – chemotherapy related nausea and vomiting, postoperative nausea. b. Mirtazapine – gastroparesis c. Inhaled Isopropyl alcohol – postoperative setting and emergency, Formulation- Taking more… — read more

Fever – Recurrent episodes of diaphoresis, flushing and high grade fever are a recognized symptom in advanced Huntington’s disease and are attributed to hypothalamic dysfunction. Infection, medication-related adverse effects and endocrine causes need to be excluded before making a diagnoses. Cooling measures (non-pharmacological) and antipyretics (paracetamol) are considered the interventions of choice. References Huntington’s Disease… — read more

For a patient on high opioid doses, or in situations such as pain crises, sepsis, significant neurotoxicity and renal or hepatic impairment, which carry with themselves clinically unacceptable risk of under or over dosing – opioid switching requires the presence of the following – trained and experienced staff who are expected to monitor and supervise… — read more

Envisaged with the aim to make specialist out-patient hospital care available outside the hospital setting, Neighbourhood health is a central pillar of the government’s plan to transform the NHS. As part of this endeavour, neighbourhood health centres are planned in every community. Amongst the measures outlined in the recently released reports, consisting of ten recommendations… — read more

Pegylated form of naloxone, authorised for use in adults with OIC when response to conventional therapy has been suboptimal. A review of patient population in existing RCTs brings out the following facts to the fore: a. Study population did not include those with Cancer-related pain. b. Population included younger subset (early 50s), mild hepatic or… — read more

Paper under review – Mücke, M., Welsch, P., Klose, P., Phillips, T., Radbruch, L., Petzke, F., & Häuser, W. (2026). Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews, 2026(1), CD012182. https://doi.org/10.1002/14651858.CD012182.pub3 Cannabis products did not convincingly improve pain by clinically meaningful margins as compared with placebo. Although small improvements were… — read more

Anaemia has been linked with higher levels of biomarkers such as phosphorylated tau 217, neurofilament light chain and glial fibrillary acid protein (GFAP) cross-sectionally and with a higher risk of developing dementia longitudinally in older adults aged 60 years and older. A combination of anaemia and elevated markers represented a higher cumulative risk. Anaemia was… — read more

Pharmacologically inevitable adverse effect related to differential receptor affinity, highlights higher affinity for H1 receptors, which show near maximal occupancy before meaningful alpha 2 blockade occurs. Dose reduction does not help and might worsen sedation which can be attributed to the inverse dose-sedation relationship, where H1 blockade dominates at low doses. Noradrenergic disinhibition predominates at… — read more