title: Pain management in hematological patients with major organ dysfunctions and comorbid illnesses.
abstract: BACKGROUND
  Organ dysfunctions and medical complications, such as renal failure, liver impairment, coagulation disorders, cardiovascular and respiratory illnesses, may hamper an adequate pain management in haematological patients.
  
  
  OBJECTIVE
  To summarize current knowledge on pain management in hematological patients presenting major organ dysfunctions and comorbidity. We also attempted to provide recommendations to optimize analgesia and to minimize side effects in the setting of medically compromised and frail haematological patients.
  
  
  METHODS
  A systematic search of the literature, using relevant key words, was conducted in PubMed.
  
  
  CONCLUSIONS
  Pain in hematological patients is a common symptom and is often multi-factorial. Most pharmacotherapeutic measures, including causal therapies, analgesics and adjuvant agents routinely applied in pain management, may also be used in the setting of clinical frailty and medical comorbidities; however, comprehensive clinical and functional patient's evaluations and a careful consideration of expected benefits and potential adverse events are required.
authors.affiliation: Hematology Unit, S. Eugenio Hospital, Rome, Italy. pniscola@gmail.com
authors.forename: Pasquale
authors.initials: P
authors.lastname: Niscola
authors.forename: Andrea
authors.initials: A
authors.lastname: Tendas
authors.forename: Marco
authors.initials: M
authors.lastname: Giovannini
authors.forename: Laura
authors.initials: L
authors.lastname: Scaramucci
authors.forename: Luca
authors.initials: L
authors.lastname: Cupelli
authors.forename: Michele
authors.initials: M
authors.lastname: Ferrannini
authors.forename: Gregorio Antonio
authors.initials: GA
authors.lastname: Brunetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Bondanini
authors.forename: Roberto
authors.initials: R
authors.lastname: Palumbo
authors.forename: Alessio
authors.initials: A
authors.lastname: Perrotti
authors.forename: Claudio
authors.initials: C
authors.lastname: Romani
authors.forename: Claudio
authors.initials: C
authors.lastname: Cartoni
authors.forename: Fabio
authors.initials: F
authors.lastname: Efficace
authors.forename: Paolo
authors.initials: P
authors.lastname: de Fabritiis
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D015897:Comorbidity; D006402:Hematologic Diseases / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*
chemical_list: D000277:Adjuvants, Pharmaceutic; D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal