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Mütherig A, Scheffler G, Schuler US. [Pharmacological pain management in cancer patients]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:497-506. [PMID: 38597946 DOI: 10.1007/s00120-024-02347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Pharmacological pain therapy in cancer patients is based on guideline recommendations, which, however, do not fully coincide in all aspects due to varying weighting of evidence. The present article discusses current issues including the decreasing significance of the World Health Organization (WHO) analgesic ladder, with its distinction between step 2 and 3 being increasingly questioned. Risks of nonopioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in older populations, are discussed. Paracetamol may potentially reduce the effectiveness of immunotherapies. Aspects of administering analgesics via a feeding tube are considered. Recommendations for the treatment of episodic pain, transitioning between different opioids, and some relevant interactions are also discussed.
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Affiliation(s)
- Anke Mütherig
- Palliativ-Zentrum, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Gesine Scheffler
- Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Ulrich S Schuler
- Palliativ-Zentrum, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Dräger DL, Protzel C. [Pain therapy in urology-overview of current S3 guideline recommendations]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:462-468. [PMID: 38698261 DOI: 10.1007/s00120-024-02334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/05/2024]
Abstract
Dealing efficiently with patients suffering from pain is a central medical task. Pain, as an important function in developmental physiology, warns against damage to the body caused by external noxious agents as well as internal malfunctions and requires special attention in modern medicine. Peri- and postoperative pain is known to have a negative influence on postoperative convalescence. Treatment of tumor-related pain represents another relevant challenge in uro-oncology and palliative medicine. The updated guideline on perioperative pain therapy and palliative medicine for patients with incurable diseases or cancer is dedicated to these two topics.
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Affiliation(s)
- Desiree Louise Dräger
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Deutschland
- Arbeitskreis Schmerztherapie/Supportivtherapie/Palliativmedizin/Lebensqualität der DGU, Berlin, Deutschland
| | - Chris Protzel
- Klinik für Urologie, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19055, Schwerin, Deutschland.
- Arbeitskreis Schmerztherapie/Supportivtherapie/Palliativmedizin/Lebensqualität der DGU, Berlin, Deutschland.
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Watanabe A, Shimada N, Ishiki H, Fujiwara N, Nojima M, Tojo A. Differences in Fentanyl Requirements in Terminally Ill Cancer Patients. J Pain Palliat Care Pharmacother 2023; 37:26-33. [PMID: 36512675 DOI: 10.1080/15360288.2022.2149667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cancer pain is a significant issue in terminally ill cancer patients (TICPs). The fentanyl patch (FP) is used extensively for treating cancer pain, but FP requirements vary between patients. We aimed to identify determinants of FP requirements in TICPs and propose effective pain relief using a FP. In a retrospective chart review, we investigated cancer patients admitted to our hospital from April 2012 to July 2015 and used FP until death. The time course of FP use in TICPs until death was examined. The primary endpoint was the final dose of FP use (FDFP). In total, 79 patients were included the analysis. FDFP was inversely correlated with age (R= -0.262, p = 0.20; Spearman test). FDFP tended to be higher in males than in females and was significantly higher in patients with pancreatic cancer than in patients without pancreatic cancer (p = 0.017; Welch's test). FP adjustments were more frequent in the last 60 days of life in patients with pancreatic cancer than in patients with other malignancies (P for interaction = 0.002; mixed effect model). In conclusion, younger age, and pancreatic cancer were associated with higher FP requirements in TICPs. TICPs with pancreatic cancer required more frequent FP adjustment near death.
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Affiliation(s)
- Aya Watanabe
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Naoki Shimada
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroto Ishiki
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Noriko Fujiwara
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Nojima
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Aya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Bramati P, Bruera E. The end of the second step of the World Health Organization analgesic ladder? Ann Oncol 2022; 33:1212-1213. [DOI: 10.1016/j.annonc.2022.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
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Sodium aescinate alleviates bone cancer pain in rats by suppressing microglial activation via p38 MAPK/c-Fos signaling. Mol Cell Toxicol 2022. [DOI: 10.1007/s13273-022-00234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Management of cancer pain is challenging. Despite the poor evidence, opioid therapy still remains the cornerstone for the management of cancer-related pain. Opioids should be given according to the clinical presentation in the different stages of disease. There is no drug of choice, as most opioids are effective. Thus, the choice should be based on the individual characteristics of patients. Optimization of opioid therapy may allow individual treatment according to the patient's characteristics and pain syndromes, providing timely alternatives in the different stages of disease. While most patients respond to an appropriate treatment associated with a comprehensive assessment and symptom control, a high level of experience and knowledge is necessary in determining conditions to maximize the analgesic response, eventually adding adjuvants in some specific circumstances. Alternative opioids may improve the balance between analgesia and adverse effects in the presence of a poor response to the first opioid in a large number of patients. Finally, a selected population can benefit from some interventional procedures.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
- Regional Home Care Program, SAMOT, Palermo, Italy.
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M F, K D, M L, PS H, S A, R S, E V, D G, L G, R L, K M, GD M, L N, C R, A ST, A C, S K, Laird B. An international open-label randomised trial comparing a two-step approach versus the standard three-step approach of the WHO analgesic ladder in patients with cancer. Ann Oncol 2022; 33:1296-1303. [PMID: 36055465 DOI: 10.1016/j.annonc.2022.08.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Worldwide, cancer pain management follows the World Health Organization (WHO) three-step analgesic ladder. Using weak opioids (e.g. codeine) at step 2 is debatable with low-dose strong opioids being potentially better, particularly in low- and middle-income countries where weak opioids are expensive. We wanted to assess the efficiency, safety and cost of omitting step 2 of the WHO ladder. PATIENTS AND METHODS We carried out an international, open-label, randomised (1 : 1) parallel group trial. Eligible patients had cancer, pain ≥4/10 on a 0-10 numerical rating scale, required at least step 1 (paracetamol) of the WHO ladder and were randomised to the control arm (weak opioid, step 2 of the WHO ladder) or the experimental arm (strong opioid, step 3). Primary outcome was time to stable pain control (3 consecutive days with pain ≤3). Secondary outcomes included distress, opioid-related side-effects and costs. The primary outcome analysis was by intention to treat and the follow-up was for 20 days. RESULTS One hundred and fifty-three patients were randomised (76 control, 77 experimental). There was no statistically significant difference in time to stable pain control between the arms, P = 0.667 (log-rank test). The adjusted hazard ratio for the control arm was 1.03 (95% confidence interval 0.72-1.49). In the control arm, 38 patients (53%) needed to change to a strong opioid due to ineffective analgesia. The median time to change was day 6 (interquartile range 4-11). Compared to the control arm, patients in the experimental arm had less nausea (P = 0.009) and costs were less. CONCLUSION This trial provides some evidence that the two-step approach is an alternative option for cancer pain management.
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Mawatari H, Shinjo T, Morita T, Kohara H, Yomiya K. Revision of Pharmacological Treatment Recommendations for Cancer Pain: Clinical Guidelines from the Japanese Society of Palliative Medicine. J Palliat Med 2022; 25:1095-1114. [PMID: 35363057 DOI: 10.1089/jpm.2021.0438] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pain is one of the most common symptoms in cancer patients. The Japanese Society for Palliative Medicine (JSPM) first published its clinical guidelines for the management of cancer pain in 2010. Since then, more research on cancer pain management has been reported, and new drugs have become available in Japan. Thus, the JSPM has now revised the clinical guidelines using a validated methodology. Methods: This guideline was developed through a systematic review, discussion, and the Delphi method, following a formal guideline development process. Results: Thirty-five recommendations were created: 19 for the pharmacological management of cancer pain, 6 for the management of opioid-induced adverse effects, and 10 for pharmacological treatment procedures. Due to the lack of evidence that directly addressed our clinical questions, most of the recommendations had to be based on consensus among committee members and other guidelines. Discussion: It is critical to continue to build high-quality evidence in cancer pain management, and revise these guidelines accordingly.
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Affiliation(s)
- Hironori Mawatari
- Department of Palliative and Supportive Care, Yokohama Minami Kyosai Hospital, Yokohama City, Japan
| | - Takuya Shinjo
- Department of Palliative Medicine, Shinjo Clinic, Kobe City, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu City, Japan
| | - Hiroyuki Kohara
- Department of Palliative Medicine, Hiroshima Prefectural Hospital, Hiroshima City, Japan
| | - Kinomi Yomiya
- Department of Palliative Care, Saitama Cancer Center, Ina-machi, Japan
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Fujii H, Ueda Y, Hirose C, Ohata K, Sekiya K, Kitahora M, Sadaka S, Yamamoto S, Watanabe D, Kato-Hayashi H, Iihara H, Kobayashi R, Kaburaki M, Matsuhashi N, Takahashi T, Makiyama A, Yoshida K, Hayashi H, Suzuki A. Pharmaceutical intervention for adverse events improves quality of life in patients with cancer undergoing outpatient chemotherapy. J Pharm Health Care Sci 2022; 8:8. [PMID: 35236407 PMCID: PMC8889741 DOI: 10.1186/s40780-022-00239-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background The effect of pharmaceutical intervention to treat adverse events on quality of life (QOL) in outpatients receiving cancer chemotherapy is unclear. We investigated whether pharmaceutical intervention provided by pharmacists in collaboration with physicians improves QOL with outpatient cancer chemotherapy. Methods We conducted a single-center retrospective descriptive study of pharmaceutical intervention for patients receiving outpatient cancer chemotherapy at Gifu University Hospital between September 2017 and July 2020. We assessed patient QOL using the Japanese version of the EuroQol 5 Dimension5 Level (EQ-5D-5L). Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. We compared the EQ-5D-5L utility value and incidence of grade 2 or higher adverse events before and after pharmaceutical intervention. Results Our analysis included 151 patients who underwent 210 chemotherapy cycles. Pharmaceutical intervention significantly improved patients’ EQ-5D-5L utility values from 0.8197 to 0.8603 (P < 0.01). EQ-5D-5L utility values were significantly improved after pharmaceutical intervention for nausea and vomiting (pre-intervention 0.8145, post-intervention 0.8603, P = 0.016), peripheral neuropathy (pre-intervention 0.7798, post-intervention 0.7988, P = 0.032) and pain (pre-intervention 0.7625, post-intervention 0.8197, P = 0.035). Although not statistically significant, the incidence of grade 2 or higher adverse events, including nausea and vomiting, dermopathy, pain, oral mucositis, diarrhea and dysgeusia, tended to be lower post-intervention than pre-intervention. Conclusions Pharmaceutical intervention by pharmacists in collaboration with physicians may improve QOL in patients undergoing outpatient cancer chemotherapy.
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Affiliation(s)
- Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan. .,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan.
| | - Yukino Ueda
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Koichi Ohata
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kumiko Sekiya
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Mika Kitahora
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Shiori Sadaka
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Senri Yamamoto
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Hiroko Kato-Hayashi
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Miho Kaburaki
- Laboratory of Community Healthcare Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akitaka Makiyama
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hideki Hayashi
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan.,Laboratory of Community Healthcare Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan.,Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
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Furuno JP, Noble BN, Fromme EK, Hartung DM, Tjia J, Lynn M, Teno JM. Decreasing Trends in Opioid Prescribing on Discharge to Hospice Care. J Pain Symptom Manage 2021; 62:1026-1033. [PMID: 33848567 PMCID: PMC8502178 DOI: 10.1016/j.jpainsymman.2021.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/17/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life. OBJECTIVE We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care. METHODS This was a retrospective cohort study among adult (age ≥18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care). RESULTS Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period. CONCLUSIONS We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care.
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Affiliation(s)
- Jon P Furuno
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA.
| | - Brie N Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Erik K Fromme
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel M Hartung
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Mary Lynn
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Joan M Teno
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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High-temperature liquid chromatography for evaluation of the efficiency of multiwalled carbon nanotubes as nano extraction beds for removal of acidic drugs from wastewater. Greenness profiling and comprehensive kinetics and thermodynamics studies. J Chromatogr A 2021; 1639:461891. [PMID: 33513471 DOI: 10.1016/j.chroma.2021.461891] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
The retention behavior of a series of acidic drugs, namely ketoprofen (KET), naproxen (NAP), diclofenac (DIC), and ibuprofen (IBU), on the heat-resisting ZORBAX 300SB-C18 column, was studied thermodynamically using high-temperature liquid chromatography (HTLC). A perfect correlation of the compounds' lipophilicity and the calculated thermodynamic indicators evidenced its contribution to the retention behavior. Besides, the steric fitting has a subsidiary effect on IBU retention. Isocratic HTLC separation of the four compounds was achieved using an aqueous mobile phase containing 30% acetonitrile-0.2% acetic acid-0.2% triethylamine at 60 °C. This method has been utilized to monitor the adsorption efficiency of multiwalled carbon nanotubes (MWCNTs) for the removal of the four NSAIDs from water. Different variables affecting the remediation process have been optimized such as the time of contact, pH, ionic strength, temperature, and the mass of MWCNTs. The kinetics and thermodynamics of the adsorption were investigated. The adsorption was evidenced to take place via pseudo-second-order kinetics and the intraparticle diffusion is the rate-controlling step. The thermodynamic investigation showed that the adsorption process is exothermic and enthalpy-driven, and the adsorption is more extensive at a lower temperature. The MWCNTs showed excellent adsorption efficiency of about 76.4 to 97.6% at the optimum conditions. The obtained results are promising and encouraging for the full-scale application of MWCNTs for remediation of NSAIDs-related water pollution. The green analytical chemistry metric "AGREE" and the analytical eco-scale score tool confirmed that the developed protocol is greener and more favorable to the environment and user than most of the reported literature.
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12
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Bandieri E, Potenza L, Efficace F, Bruera E, Luppi M. Independent Research on Cancer Pain Management in the Setting of Early Palliative Care: A Flywheel to Counteract General Opioid Misuse and Abuse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197097. [PMID: 32998243 PMCID: PMC7579568 DOI: 10.3390/ijerph17197097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
The increased recognition of the high prevalence and important burden of cancer pain and the documentation of a large proportion of patients receiving inadequate analgesic treatment should have reinforced the need for evidence-based recommendations. The World health Organization (WHO) guidelines on cancer pain management—or palliative care—are traditionally based on a sequential, three-step, analgesic ladder according to pain intensity: nonopioids (paracetamol or nonsteroidal anti-inflammatory drugs) to mild pain in step I; weak opioids (eg, codeine or tramadol) to mild-moderate pain in step II; and strong opioids to moderate-severe pain in step. III. Despite the widespread use of this ladder, unrelieved pain continues to be a substantial concern in one third of patients with either solid or hematologic malignancies. The sequential WHO analgesic ladder, and in particular, the usefulness of step II opioids have been questioned but there are no universally used guidelines for the treatment of pain in patients with advanced cancer and not all guideline recommendations are evidence-based. The American Society of Clinical Oncology and the European Society of Medical Oncology have recommended the implementation of early palliative care (EPC), which is a novel model of care, consisting of delivering dedicated palliative service concurrent with active treatment as early as possible in the cancer disease trajectory. Improvement in cancer pain management is one of the several important positive effects following EPC interventions. Independent well-designed research studies on pharmacological interventions on cancer pain, especially in the EPC setting are warranted and may contribute to spur research initiatives to investigate the poorly addressed issues of pain management in non cancer patients.
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Affiliation(s)
- Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, 41012 Carpi, Italy;
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, 00182 Rome, Italy;
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, TA 77030, USA;
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- Correspondence:
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13
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Curseen KA, Taj J, Grant Q. Pain Management in Patients with Serious Illness. Med Clin North Am 2020; 104:415-438. [PMID: 32312407 DOI: 10.1016/j.mcna.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Managing pain in patients with serious illness can be complex. However, pain is often a prominent symptom in patients with malignant and nonmalignant serious illness and providers have to be adept at balancing effective pain management and safety. Clinicians should start with a standard pain assessment that lays important groundwork for developing a tailored multimodal approach to pain management. It is important to identify physical causes of pain and also existential causes. Opioids are not always appropriate but are still an important tool for managing pain. Basic opioid management and safe practices are essential when managing this population.
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Affiliation(s)
- Kimberly Angelia Curseen
- Internal Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, Emory Palliative Care Center, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA.
| | - Jabeen Taj
- Hospice and Palliative Medicine, Cardiac Palliative Care, Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, Emory University Hospital, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA
| | - Quintesia Grant
- Palliative and Supportive Care, Grady Memorial Hospital, Harbor Grace Hospice, Atlanta, GA, USA; Medicine, Division of Palliative Medicine, Family and Preventive Medicine Emory School of Medicine, 1821 Clifton Road, Northeast, Suite 1017, Atlanta, GA 30329, USA
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14
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Sanford NN, Sher DJ, Butler SS, Xu X, Ahn C, Aizer AA, Mahal BA. Prevalence of chronic pain among cancer survivors in the United States, 2010‐2017. Cancer 2019; 125:4310-4318. [DOI: 10.1002/cncr.32450] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Nina N. Sanford
- Department of Radiation Oncology University of Texas Southwestern Medical Center Dallas Texas
- Harold Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center Dallas Texas
| | - David J. Sher
- Department of Radiation Oncology University of Texas Southwestern Medical Center Dallas Texas
| | - Santino S. Butler
- Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts
| | - Xiaohan Xu
- Division of Biostatistics, Department of Clinical Sciences University of Texas Southwestern Medical Center Dallas Texas
- Department of Statistical Science Southern Methodist University Dallas Texas
| | - Chul Ahn
- Department of Clinical Sciences University of Texas Southwestern Medical Center Dallas Texas
- Harold Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center Dallas Texas
| | - Ayal A. Aizer
- Department of Radiation Oncology Brigham and Women's Hospital Boston Massachusetts
| | - Brandon A. Mahal
- McGraw/Patterson Center for Population Sciences Dana‐Farber Cancer Institute Boston Massachusetts
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15
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George B, Minello C, Allano G, Maindet C, Burnod A, Lemaire A. Opioids in cancer-related pain: current situation and outlook. Support Care Cancer 2019; 27:3105-3118. [PMID: 31127436 DOI: 10.1007/s00520-019-04828-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Despite progress in treatments, cancer pain remains underestimated, poorly assessed and under-treated. Prescribing strong opioids, because of their specificities, requires precision in management considering their pharmacology but also a clear understanding of recommendations. Some clinicians highlight the risk of addiction, excessive sedation and respiratory depression and their need for information. Our objective in this review is to suggest some clinical guidance for the positioning and daily use of opioids within cancer pain management. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Strong opioids may be initiated as soon as pain diagnosis is defined. Factors to consider are pain aetiology, opioid pharmacokinetics and pharmacodynamics, genetic polymorphism, physiology (age, gender, weight and pregnancy), comorbidities (especially renal, hepatic, cardiovascular diseases), chronobiology, environmental factors, medication interference and treatment adherence. Achieving the best-balanced opioid treatment for background pain is complex, mainly due to the variable benefit/risk ratio between individuals and the experience of breakthrough cancer pain. Opioid initiation alongside a dynamic reassessment of pain should be fully integrated into the patient's management to optimise analgesia. The efficacy and safety of a strong opioid treatment need to be re-evaluated and adapted to individuals constantly as it varies over time. CONCLUSIONS Cancer pain is multimorphic and permanently changing due to disease evolution, curative treatments and disruptive events (concomitant treatments, pain from associated disease, comorbidities and complications, modifications of the environment). Well-managed opioids are the cornerstone of a complex environment requiring multidisciplinary dynamic assessments integrated into the patient's care pathway.
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Affiliation(s)
| | - Christian Minello
- Anaesthesia-Intensive Care Department, Cancer Centre Georges François Leclerc, Dijon, France
| | - Gilles Allano
- Pain Management Unit, Mutualist Clinic of la Porte-de-Lorient, Lorient, France
| | - Caroline Maindet
- Pain Management Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexis Burnod
- Department of Supportive Care, Institut Curie, PSL Research University, Paris, France
| | - Antoine Lemaire
- Oncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes, France.
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16
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Liu X, Luo C, Dai H, Fang W. Consumption trends and prescription patterns of opioids from 2011 to 2016: a survey in a Chinese city. BMJ Open 2019; 9:e021923. [PMID: 30826755 PMCID: PMC6429741 DOI: 10.1136/bmjopen-2018-021923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 11/06/2018] [Accepted: 01/07/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Opioid consumption in China has been very less and has varied widely since 1995. The representatively high level of consumption in Mainland China has never been reported. Our aim was to describe the consumption trends and prescription patterns of opioids in Nanjing, a highly developed city of Mainland China, and compare the results with selected worldwide regions. METHODS Application data of opioids in 2011-2016 were extracted from the Jiangsu Medicine Information Institute. Six opioids were included. Consumption was expressed in terms of defined daily doses (DDDs), morphine equivalents (MEs) and expenditure. The correlation between consumption of opioids and gross domestic product (GDP), Human Development Index (HDI) and cancer incidence was analysed by Pearson's correlation test. RESULTS DDDs, expenditure and MEs of opioids were, respectively, 256.04, $599.24 and 13.07 g in 2011, and increased to 361.27, $1041.79 and 18.09 g in 2016. DDDs in Nanjing were 2.80-fold that in Mainland China, 1.42-fold that in East and South-East Asia, but only equivalent to 8.89% of the worldwide average level. From 2011 to 2016, the consumption had a linear correlation with GDP, HDI and cancer incidence (p<0.05). However, DDDs varied greatly in countries with similar GDP or HDI. Within 45 Asian countries, the GDP only contributed to 10.47% of change in DDDs, while the HDI contributed to 20.32%. Consumption of non-intravenous opioids or strong opioids always comprised majority of the total consumption. The opioids prescribed predominantly were fentanyl, oxycodone and morphine. Fentanyl and oxycodone account for most of the increase in consumption. CONCLUSION Opioid consumption has increased >40% from 2011 to 2016, with consumption of fentanyl and oxycodone accounting for most of that increase. The consumption in Nanjing was higher than the average Chinese level, but lower than the global average. An increase in pain control services might be needed, but this need should be highly regulated.
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Affiliation(s)
- Xiao Liu
- Department of Pharmacy, Qinghai provincial Peoples Hospital, Xining, Qinaghai, China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, China
| | - Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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17
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Alsirafy SA, Ibrahim NY, Abou-Elela EN. Opioid Consumption before and after the establishment of A Palliative Medicine Unit in An Egyptian Cancer Centre. J Palliat Care 2018. [DOI: 10.1177/082585971202800302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Opioid consumption before and after the establishment of a palliative medicine unit (PMU) in an Egyptian cancer centre was reviewed. A comparison of consumption during the year before the PMU was established to consumption during the third year after the PMU's establishment revealed that morphine consumption increased by 698 percent, fentanyl by 217 percent, and tramadol by 230 percent. Expressed in defined daily dose (DDD) and adjusted for 1,000 new cancer patients, consumption increased by 460 percent, from 4,678 DDD/1,000 new patients to 26,175 DDD/1,000 new patients. Expressed in grams of oral morphine equivalent (g OME), consumption increased by 644 percent, from 233 g OME/1,000 new patients to 1,731 g OME/1,000 new patients. The establishment of the PMU was associated with an increase in opioid consumption, especially morphine, which is an indicator of improvement in cancer pain control. The expression of opioid consumption in OME in addition to DDD may provide further information, especially when weak opioids are included in the analysis.
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Affiliation(s)
- Samy A. Alsirafy
- SA Alsirafy (corresponding author): Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, PO Box 99, Manial Al-Rodah, Cairo, 11553 Egypt
| | - Noha Y. Ibrahim
- NY Ibrahim, EN Abou-Elela: Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Enas N. Abou-Elela
- NY Ibrahim, EN Abou-Elela: Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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18
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Clark L. Is the World Health Organization analgesic ladder obsolete or is it relevant to contemporary veterinary practice? Vet Anaesth Analg 2018; 45:593-596. [DOI: 10.1016/j.vaa.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/18/2018] [Accepted: 03/20/2018] [Indexed: 11/15/2022]
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Zheng RJ, Fu Y, Zhu J, Xu JP, Xiang QF, Chen L, Zhong H, Li JY, Yu CH. Long-term low-dose morphine for patients with moderate cancer pain is predominant factor effecting clinically meaningful pain reduction. Support Care Cancer 2018; 26:4115-4120. [PMID: 29855773 DOI: 10.1007/s00520-018-4282-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 05/17/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Patients with cancer often experience pain that affects their daily activities and quality of life. The analgesic ladder recommended by the World Health Organization has proved insufficient for many, and its scientific basis has been questioned. This retrospective study investigated factors related to adherence to long-term opioid therapy for patients with moderate cancer pain, including an evaluation of low-dose morphine relative to tramadol. METHODS Clinical data were collected of patients with moderate cancer pain (n = 353) who received either low-dose morphine or tramadol and were followed for ≥ 27 weeks. Factors related to regime adherence were investigated, including the analgesia type, cancer therapy (antitumor therapy or palliative care), pain type (nociceptive, neuropathic, or mixed), and living distance to the hospital. Factors related to clinically meaningful pain reduction (≥ 30% reduction in pain from baseline) were also investigated. RESULTS Patients taking tramadol, receiving antitumor therapy, experiencing neuropathic pain, and living far from the hospital were more likely to change analgesic strategy compared with, respectively, patients receiving low-dose morphine, palliative care, experiencing nociceptive pain, and living nearby. Factors that increased the likelihood of adherence to the analgesic regime were also associated with the likelihood of clinically meaningful pain reduction. Among adverse effects, a significantly higher percentage of patients experienced constipation in the tramadol group compared with those given morphine. CONCLUSIONS Among patients with moderate cancer pain, long-term low-dose morphine was safe and more effective than tramadol for clinically meaningful pain reduction, and patients were less likely to change the analgesic strategy.
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Affiliation(s)
- Ru-Jun Zheng
- Thoracic Oncology Department of West China Hospital and Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan Fu
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jiang Zhu
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jiu-Ping Xu
- Uncertainty Decision-Making Laboratory, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiu-Fen Xiang
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lin Chen
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Hua Zhong
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jun-Ying Li
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Chun-Hua Yu
- Thoracic Oncology Department and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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20
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Fang W, Liu T, Gu Z, Li Q, Luo C. Consumption trend and prescription pattern of opioid analgesics in China from 2006 to 2015. Eur J Hosp Pharm 2018; 26:140-145. [PMID: 31428321 DOI: 10.1136/ejhpharm-2017-001460] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives To investigate the consumption trend and prescription pattern of opioids in China from 2006 to 2015, and compare the results with those of selected countries and regions, and identify the pain relief level of China. Methods Nine different opioid drugs were included in our survey, based on the whole population of China. Consumption of each type of opioid was calculated in grams in reports of the Chinese Food and Drug Administration and the International Narcotics Control Board. Then it was converted to the terms of defined daily doses and morphine equivalents. The correlation between consumption of opioids and gross domestic product, human development index and cancer incidence was analysed by Pearson's correlation test. Results Defined daily doses increased by 7.89% per year since 2006, and reached 91.05 in 2015. Morphine equivalents increased by 10.57% per year since 2006, and reached 7.24 g in 2015. The average defined daily doses and morphine equivalents were 85.44 and 5.70 g respectively in 2006-2015. Annual defined daily doses of China were lower than the global average. Consumption was related to gross domestic product, but not human development index and cancer incidence. Furthermore, defined daily doses varied greatly in countries with similar gross domestic product or the human development index. Strong opioids or non-intravenous opioids always constituted the majority of opioids, and sustained an increasing tendency in consumption. The predominantly prescribed opioids were fentanyl and morphine. Consumption of oxycodone had a tendency to increase, whereas pethidine tended to decrease. Conclusion Consumption of opioids has shown an increasing tendency and in the meantime the prescription pattern has changed, indicating the progress of pain relief in China, though it remained far lower than the average global level.
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Affiliation(s)
- Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tingting Liu
- Department of Pharmacy, Nanjing General Hospital, Nanjing, China
| | - Zhongsheng Gu
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Li
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Brant J, Keller L, McLeod K, Hsing Yeh C, Eaton L. Chronic and Refractory Pain: A Systematic Review of Pharmacologic Management in Oncology. Clin J Oncol Nurs 2017; 21:31-53. [DOI: 10.1188/17.cjon.s3.31-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Siebenhuener K, Eschmann E, Kienast A, Schneider D, Minder CE, Saller R, Zimmerli L, Blaser J, Battegay E, Holzer BM. Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions? PLoS One 2017; 12:e0168987. [PMID: 28046033 PMCID: PMC5207693 DOI: 10.1371/journal.pone.0168987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions. Methods and Findings We conducted a retrospective study with all multimorbid inpatients aged ≥18 years admitted to the Department of Internal Medicine of University Hospital Zurich in 2011 (n = 1,039 patients). Data were extracted from the electronic health records and reviewed. We identified 433 hospitalizations of patients with chronic pain and analyzed their combinations of chronic conditions (multimorbidity). We then classified all analgesic prescriptions according to the World Health Organization (WHO) analgesic ladder. Furthermore, we used a Swiss drug-drug interactions knowledge base to identify potential interactions between opioids and other drug classes, in particular coanalgesics and other concomitant drugs. Chronic pain was present in 38% of patients with multimorbidity. On average, patients with chronic pain were aged 65.7 years and had a mean number of 6.6 diagnoses. Hypertension was the most common chronic condition. Chronic back pain was the most common painful condition. Almost 90% of patients were exposed to polypharmacotherapy. Of the chronic pain patients, 71.1% received opioids for moderate to severe pain, 43.4% received coanalgesics. We identified 3,186 potential drug-drug interactions, with 17% classified between analgesics (without coanalgesics). Conclusions Analgesic drugs-related DDIs, in particular opioids, in multimorbid patients are often complex and difficult to assess by using DDI knowledge bases alone. Drug-multimorbidity interactions are not sufficiently investigated and understood. Today, the scientific literature is scarce for chronic pain in combination with multiple coexisting medical conditions and medication regimens. Our work may provide useful information to enable further investigations in multimorbidity research within the scope of potential interactions and chronic pain.
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Affiliation(s)
- Klarissa Siebenhuener
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
| | - Emmanuel Eschmann
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Kienast
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Schneider
- Maennedorf Hospital, Department of Internal Medicine, Canton Zurich, Switzerland
| | | | - Reinhard Saller
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Institute of Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Cantonal Hospital, Internal Medicine, Olten, Switzerland
| | - Jürg Blaser
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging,’ University of Zurich, Zurich, Switzerland
| | - Barbara M. Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- * E-mail:
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Fredheim O, Brelin S, Hjermstad M, Loge J, Aass N, Johannesen T, Skurtveit S. Prescriptions of analgesics during complete disease trajectories in patients who are diagnosed with and die from cancer within the five-year period 2005-2009. Eur J Pain 2016; 21:530-540. [DOI: 10.1002/ejp.956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/07/2022]
Affiliation(s)
- O.M.S. Fredheim
- Pain and Palliation Research Group; Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; Department of Pain and Complex Disorders; St. Olav University Hospital; Trondheim Norway
- Centre of Palliative Medicine; Surgical Division; Akershus University Hospital; Lørenskog Norway
| | - S. Brelin
- Department of Oncology; Regional Center for Excellence in Palliative Care; Oslo University Hospital, Ullevål; Norway
- Østfold Hospital Trust; Fredrikstad Norway
| | - M.J. Hjermstad
- Department of Oncology; Regional Center for Excellence in Palliative Care; Oslo University Hospital, Ullevål; Norway
- Department of Cancer Research and Molecular Medicine; Faculty of Medicine; European Palliative Care Research Center; Norwegian University of Science and Technology; Trondheim Norway
| | - J.H. Loge
- Department of Oncology; Regional Center for Excellence in Palliative Care; Oslo University Hospital, Ullevål; Norway
- Department of Behavioural Sciences in Medicine; Institute of Basic Medical Sciences; University of Oslo; Norway
| | - N. Aass
- Department of Oncology; Regional Center for Excellence in Palliative Care; Oslo University Hospital, Ullevål; Norway
- Faculty of Medicine; University of Oslo; Norway
| | | | - S. Skurtveit
- Faculty of Medicine; University of Oslo; Norway
- Division of Epidemiology; Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
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Carlson CL. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review. J Pain Res 2016; 9:515-34. [PMID: 27524918 PMCID: PMC4965221 DOI: 10.2147/jpr.s97759] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%-100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines - while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.
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Affiliation(s)
- Cathy L Carlson
- School of Nursing, Northern Illinois University, DeKalb, IL, USA
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25
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Lazzari M, Marcassa C, Natoli S, Carpenedo R, Caldarulo C, Silvi MB, Dauri M. Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation. Clin Interv Aging 2016; 11:641-9. [PMID: 27257377 PMCID: PMC4874636 DOI: 10.2147/cia.s105821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Chronic pain has a high prevalence in the aging population. Strong opioids also should be considered in older people for the treatment of moderate to severe pain or for pain that impairs functioning and the quality of life. This study aimed to assess the efficacy and safety of the direct switch to low-dose strong opioids (World Health Organization-Step III drugs) in elderly, opioid-naive patients. PATIENTS AND METHODS This was a single-center, retrospective, observational study in opioid-naive patients aged ≥75 years, with moderate to severe chronic pain (>6-month duration) and constipation, who initiated treatment with prolonged-release oxycodone/naloxone (OXN-PR). Patients were re-evaluated after 15, 30, and 60 days (T60, final observation). Response to treatment was defined as an improvement in pain of ≥30% after 30 days of therapy without worsening of constipation. RESULTS One-hundred and eighty-six patients (mean ± SD age 80.7±4.7 years; 64.5% women) with severe chronic pain (mean average pain intensity 7.1±1.0 on the 11-point numerical rating scale) and constipation (mean Bowel Function Index 64.1±24.4; 89.2% of patients on laxatives) were initiated treatment with OXN-PR (mean daily dose 11.3±3.5 mg). OXN-PR reduced pain intensity rapidly and was well tolerated; 63.4% of patients responded to treatment with OXN-PR. At T60 (mean daily OXN-PR dose, 21.5±9.7 mg), the pain intensity was reduced by 66.7%. In addition, bowel function improved (mean decrease of Bowel Function Index from baseline to T60, -28.2, P<0.0001) and the use of laxatives decreased. Already after 15 days and throughout treatment, ~70% of patients perceived their status as much/extremely improved. Only 1.6% of patients discontinued treatment due to adverse events. CONCLUSION Low-dose OXN-PR in elderly patients naive to opioids proved to be an effective option for the treatment of moderate to severe chronic pain. Large-scale trials are needed to improve clinical guidance in the assessment and treatment of pain in older people.
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Affiliation(s)
- Marzia Lazzari
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
| | - Claudio Marcassa
- Cardiology Division, Fondazione Maugeri IRCCS Veruno, Novara, Italy
| | - Silvia Natoli
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
| | - Roberta Carpenedo
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
| | - Clarissa Caldarulo
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
| | - Maria B Silvi
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
| | - Mario Dauri
- Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, Italy
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Besse K, Steegers M, Vernooij-Dassen M, Vissers K, Engels Y. Dutch Pain Specialists' Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study. Pain Pract 2016; 17:344-352. [PMID: 27106621 DOI: 10.1111/papr.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/06/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. METHODS A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. RESULTS Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). CONCLUSIONS Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.
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Affiliation(s)
- Kees Besse
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Monique Steegers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Myrra Vernooij-Dassen
- Department of IQ-Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.,Kalorama Foundation, Beek-Ubbergen, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Bandieri E, Romero M, Ripamonti CI, Artioli F, Sichetti D, Fanizza C, Santini D, Cavanna L, Melotti B, Conte PF, Roila F, Cascinu S, Bruera E, Tognoni G, Luppi M. Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain. J Clin Oncol 2015; 34:436-42. [PMID: 26644526 DOI: 10.1200/jco.2015.61.0733] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The WHO guidelines on cancer pain management recommend a sequential three-step analgesic ladder. However, conclusive data are lacking as to whether moderate pain should be treated with either step II weak opioids or low-dose step III strong opioids. PATIENTS AND METHODS In a multicenter, 28-day, open-label randomized controlled study, adults with moderate cancer pain were assigned to receive either a weak opioid or low-dose morphine. The primary outcome was the number of responder patients, defined as patients with a 20% reduction in pain intensity on the numerical rating scale. RESULTS A total of 240 patients with cancer (118 in the low-dose morphine and 122 in the weak-opioid group) were included in the study. The primary outcome occurred in 88.2% of the low-dose morphine and in 57.7% of the weak-opioid group (odds risk, 6.18; 95% CI, 3.12 to 12.24; P < .001). The percentage of responder patients was higher in the low-dose morphine group, as early as at 1 week. Clinically meaningful (≥ 30%) and highly meaningful (≥ 50%) pain reduction from baseline was significantly higher in the low-dose morphine group (P < .001). A change in the assigned treatment occurred more frequently in the weak-opioid group, because of inadequate analgesia. The general condition of patients, which was based on the Edmonton Symptom Assessment System overall symptom score, was better in the morphine group. Adverse effects were similar in both groups. CONCLUSION In patients with cancer and moderate pain, low-dose morphine reduced pain intensity significantly compared with weak opioids, with a similarly good tolerability and an earlier effect.
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Affiliation(s)
- Elena Bandieri
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Marilena Romero
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Carla Ida Ripamonti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Fabrizio Artioli
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Daniela Sichetti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Caterina Fanizza
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Daniele Santini
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Luigi Cavanna
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Barbara Melotti
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Pier Franco Conte
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Fausto Roila
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Stefano Cascinu
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Gianni Tognoni
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX
| | - Mario Luppi
- Elena Bandieri and Fabrizio Artioli, Unità Sanitaria Locale, Modena; Marilena Romero, Daniela Sichetti, Caterina Fanizza, and Gianni Tognoni, Fondazione Mario Negri Sud, Santa Maria Imbaro, Chieti; Carla Ida Ripamonti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, Milan; Daniele Santini, Unità di Oncologia Medica, Università Campus Bio-Medico, Rome; Luigi Cavanna, Ospedale di Piacenza, Piacenza; Barbara Melotti, Unità di Oncologia Medica, Ospedale Sant'Orsola-Malpighi, Bologna; Pier Franco Conte, Istituto Oncologico Veneto, IRCCS, Università di Padova, Padova; Fausto Roila, Ospedale "S.Maria", Terni; Stefano Cascinu, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona; Mario Luppi, Università degli Studi di Modena e Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy; and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX.
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Hesselbarth S, Hermanns K, Oepen P. Prolonged-release oxycodone/naloxone in opioid-naïve patients – subgroup analysis of a prospective observational study. Expert Opin Pharmacother 2015; 16:457-64. [DOI: 10.1517/14656566.2015.1001737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shinjo T, Morita T, Hirai K, Miyashita M, Shimizu M, Tsuneto S, Shima Y. Why people accept opioids: role of general attitudes toward drugs, experience as a bereaved family, information from medical professionals, and personal beliefs regarding a good death. J Pain Symptom Manage 2015; 49:45-54. [PMID: 24929030 DOI: 10.1016/j.jpainsymman.2014.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/03/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT Many surveys have evaluated patient-related barriers to pain management. OBJECTIVES To explore associations between a preference for opioids and general attitudes toward drugs, the experience and information received as a bereaved family, and beliefs regarding a good death. METHODS A cross-sectional survey, performed in 2010, of bereaved families of patients with cancer in palliative care units across Japan. Questionnaires were sent to 997 families. RESULTS A total of 66% of families responded. Of these, 224 responses were excluded because the family declined to participate in the study (n = 38), the patient was not receiving any opioid analgesics, and there were missing data (n = 164), or data were missing for the primary end points (n = 22). Thus, 432 responses were finally analyzed (43%). In total, 26%, 41%, and 31% of family members stated that they strongly want to receive, want to receive, or slightly want to receive opioids if needed in the future, respectively. Determinants associated with a preference for receiving opioid treatment were the following: a general appreciation of the drugs (P = 0.005), witnessing an improvement in the patient's quality of life as a result of pain relief (P = 0.003), information provided by medical professionals that the opioid could be discontinued if side effects developed (P = 0.042), and the belief that a good death was one that was free from pain and physical distress (P < 0.001). CONCLUSION More than 90% of bereaved families whose relatives were treated with opioid analgesics reported a preference to receive opioid analgesics for the treatment of cancer pain, if necessary, in the future.
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Affiliation(s)
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Kei Hirai
- Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Megumi Shimizu
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Multidisciplinary Cancer Treatment Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
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Lowe E, Hanchanale S, Hurlow A. Analgesic prescribing in palliative care. Br J Hosp Med (Lond) 2014; 75:703-7. [PMID: 25488534 DOI: 10.12968/hmed.2014.75.12.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.
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Affiliation(s)
- Emma Lowe
- ST5 in Palliative Medicine, St James's University Hospital, Leeds LS9 7TF
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Abstract
INTRODUCTION Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. AREAS COVERED The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended. EXPERT OPINION There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines.
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Affiliation(s)
- Stephan A Schug
- Professor, Chair of Anaesthesiology, The University of Western Australia, School of Medicine and Pharmacology, Pharmacology, Pharmacy and Anaesthesiology Unit , Perth , Australia
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Hirayama Y, Terui T, Kusakabe T, Koike K, Ono K, Kato J, Ishitani K. A survey of patients who were referred to our palliative care division from other hospitals and appeared to have obvious indications for cancer chemotherapies. Am J Hosp Palliat Care 2014; 31:804-7. [PMID: 24132795 DOI: 10.1177/1049909113505137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Higashi Sapporo Hospital is a cancer-specific hospital with palliative care doctors and certified oncologists. During case conferences held twice a week, we routinely evaluate the referred patients. In our case conferences, we selected patients who were referred to our palliative care division from other hospitals, with possible indications for cancer chemotherapies. We reviewed a total of 1215 patients who were referred to our palliative care division. We identified 18 cases as having indications for cancer chemotherapies. Among them, we identified 4 cases as having indications for standard cancer chemotherapies. All 4 patients tolerated the therapies well, responded to chemotherapy, and survived for more than 1 year. Conferences in which oncologists and palliative care doctors can discuss cases frequently and intimately are thought to be important.
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Affiliation(s)
- Yasuo Hirayama
- Department of Hematology and Oncology, Higashi Sapporo Hospital
| | - Takeshi Terui
- Department of Hematology and Oncology, Higashi Sapporo Hospital
| | | | - Kazuhiko Koike
- Division of Palliative Medicine, Higashi Sapporo Hospital
| | - Kaoru Ono
- Department of Hematology and Oncology, Higashi Sapporo Hospital Department of Medical Oncology and Hematology, Sapporo Medical University
| | - Junji Kato
- Department of Medical Oncology and Hematology, Sapporo Medical University
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Arslan D, Koca T, Akar E, Tural D, Ozdogan M. Cancer Pain Prevalence and its Management. Asian Pac J Cancer Prev 2014; 15:8557-62. [DOI: 10.7314/apjcp.2014.15.20.8557] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Matsumura C, Yamada M, Fujihara S, Chisaki Y, Takahashi K, Yano Y. Indication of Adequate Transdermal Fentanyl Dose in Opioid Switching From Oral Oxycodone in Patients With Cancer. Am J Hosp Palliat Care 2014; 33:109-14. [PMID: 25324418 DOI: 10.1177/1049909114554413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The present study aimed to examine affecting factors for conversion ratio and to predict adequate fentanyl dose for patients with cancer pain in opioid switching from oral oxycodone. METHODS Patient characteristics, biochemical parameters, daily oxycodone dose, and reasons for opioid switching were retrospectively collected. The effect of variables on the conversion ratio was analyzed by multiple regression analysis. RESULTS Regression analysis for the data from 122 patients suggested that the typical conversion ratio was 95:1; however, this ratio was significantly reduced in patients taking a daily oral morphine-equivalent dose of <45 mg/d and in patients with poor pain control to 52:1 and 64:1, respectively. CONCLUSION We should carefully and rapidly control pain in opioid switching based on the adequate dose indicated in this study.
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Affiliation(s)
- Chikako Matsumura
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan Department of Pharmacy, Osaka-fu Saiseikai Noe Hospital, Osaka, Japan
| | - Masami Yamada
- Department of Pharmacy, Osaka-fu Saiseikai Noe Hospital, Osaka, Japan
| | - Saki Fujihara
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Yugo Chisaki
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | | | - Yoshitaka Yano
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
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Gonçalves JAF, Silva P, Araújo P. Does Tramadol Have a Role in Pain Control in Palliative Care? Am J Hosp Palliat Care 2014; 32:631-3. [PMID: 24936098 DOI: 10.1177/1049909114539036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The effectiveness of the step II of the World Health Organization analgesic ladder including tramadol has been questioned recently. METHODS Retrospective study of patients treated with tramadol admitted as inpatients to one palliative care unit between November 1, 2009, and October 30, 2012. RESULTS In the study period, 730 patients were admitted and 66 (9%) of them met the criteria for inclusion; 45 (68%) continued medication with tramadol until discharge from the unit, while 21 (32%) had to switch to an opioid for moderate to severe pain. The reason for switching was uncontrolled pain in 16 (76%) patients, and for 5 (24%) patients, the switch was made for other reasons. CONCLUSION The data suggest that tramadol may have a role to play in the treatment of pain in palliative care.
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Affiliation(s)
| | - Paula Silva
- Palliative Care, Portuguese Institute of Oncology, Porto, Portugal
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Affiliation(s)
| | - Karen Neoh
- St Gemma's Academic Unit of Palliative Care
| | - Adam Hurlow
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Sigurdardottir KR, Oldervoll L, Hjermstad MJ, Kaasa S, Knudsen AK, Løhre ET, Loge JH, Haugen DF. How are palliative care cancer populations characterized in randomized controlled trials? A literature review. J Pain Symptom Manage 2014; 47:906-914.e17. [PMID: 24018205 DOI: 10.1016/j.jpainsymman.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
CONTEXT The difficulties in defining a palliative care patient accentuate the need to provide stringent descriptions of the patient population in palliative care research. OBJECTIVES To conduct a systematic literature review with the aim of identifying which key variables have been used to describe adult palliative care cancer populations in randomized controlled trials (RCTs). METHODS The data sources used were MEDLINE (1950 to January 25, 2010) and Embase (1980 to January 25, 2010), limited to RCTs in adult cancer patients with incurable disease. Forty-three variables were systematically extracted from the eligible articles. RESULTS The review includes 336 articles reporting RCTs in palliative care cancer patients. Age (98%), gender (90%), cancer diagnosis (89%), performance status (45%), and survival (45%) were the most frequently reported variables. A large number of other variables were much less frequently reported. CONCLUSION A substantial variation exists in how palliative care cancer populations are described in RCTs. Few variables are consistently registered and reported. There is a clear need to standardize the reporting. The results from this work will serve as the basis for an international Delphi process with the aim of reaching consensus on a minimum set of descriptors to characterize a palliative care cancer population.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Røros Rehabilitation Centre, Røros, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Gulati A, Joshi J, Baqai A. An overview of treatment strategies for cancer pain with a focus on interventional strategies and techniques. Pain Manag 2014; 2:569-80. [PMID: 24645889 DOI: 10.2217/pmt.12.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY As the incidence of cancer increases, considerations for pain treatments become more important and varied. While traditional views on pain therapy are successful in treating the majority of cancer-related pain, a continuum has developed to include interventional strategies in addition to pharmacologic management. Further improvements in understanding anatomy in the context of imaging and pathophysiology of cancer-pain syndromes direct our current interventional pain management options. We discuss the current interventional treatment options regularly used in the cancer-pain population.
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Affiliation(s)
- Amitabh Gulati
- Department of Anesthesiology & Critical Care, Board Certified in Anesthesiology & Pain Management, Memorial Sloan Kettering Cancer Center, M308, New York, NY, 10065, USA.
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Rostaing-Rigattieri S, Guerin J. Douleurs cancéreuses : bonnes pratiques cliniques de prise en charge, gestions des opioïdes forts. Presse Med 2014; 43:252-62. [DOI: 10.1016/j.lpm.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/07/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022] Open
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Nunes BC, Garcia JBDS, Sakata RK. Morphine as first medication for treatment of cancer pain. Braz J Anesthesiol 2014; 64:236-40. [PMID: 24998106 DOI: 10.1016/j.bjane.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES the medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder. METHOD sixty patients without opioid therapy, with ≥18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months. RESULTS the groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p=0.0088), drowsiness (p=0.0005), constipation (p=0.0071) and dizziness (p=0.0376) in the second visit and drowsiness (p=0.05) in the third. CONCLUSIONS the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.
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Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health 2013; 13:1229. [PMID: 24365383 PMCID: PMC3878786 DOI: 10.1186/1471-2458-13-1229] [Citation(s) in RCA: 407] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 12/11/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently published data confirming its clinical and socioeconomic impact, this paper argues that chronic pain should be ranked alongside other conditions of established priority in Europe. We outline strategies to help overcome barriers to effective pain care resulting in particular from deficiencies in education and access to interdisciplinary pain management services. We also address the confusion that exists between proper clinical and scientific uses of opioid medications and their potential for misuse and diversion, as reflected in international variations in the access to, and availability of, these agents. DISCUSSION As the economic costs are driven in part by the costs of lost productivity, absenteeism and early retirement, pain management should aim to fully rehabilitate patients, rather than merely to relieve pain. Accredited education of physicians and allied health professionals regarding state-of-the-art pain management is crucial. Some progress has been made in this area, but further provision and incentivization is required. We support a tiered approach to pain management, whereby patients with pain uncontrolled by non-specialists are able to consult a physician with a pain competency or a specialist in pain medicine, who in turn can recruit the services of other professionals on a case-by-case basis. A fully integrated interdisciplinary pain service should ideally be available to patients with refractory pain. Governments and healthcare systems should ensure that their policies on controlled medications are balanced, safeguarding public health without undue restrictions that compromise patient care, and that physician education programmes support these aims. SUMMARY Strategic prioritization and co-ordinated actions are required nationally and internationally to address the unacceptable and unnecessary burden of uncontrolled chronic pain that plagues European communities and economies. An appreciation of the 'return on investment' in pain management services will require policymakers to adopt a long-term, cross-budgetary approach.
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Affiliation(s)
- Harald Breivik
- Department of Pain Management and Research, University Hospital and University of Oslo, Oslo, Norway
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, Technion-Israel, Institute of Technology, Haifa, Israel
| | - Tony O’Brien
- Marymount University Hospice & Cork University Hospital, Cork, Ireland
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42
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Nunes BC, Garcia JBDS, Sakata RK. [Morphine as first medication for treatment of cancer pain]. Rev Bras Anestesiol 2013; 64:236-40. [PMID: 25096767 DOI: 10.1016/j.bjan.2013.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/10/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder. METHOD Sixty patients without opioid therapy, with ≥18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months. RESULTS The groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p=0.0088), drowsiness (p=0.0005), constipation (p=0.0071) and dizziness (p=0.0376) in the second visit and drowsiness (p=0.05) in the third. CONCLUSIONS The use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.
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Baek SK, Shin HW, Choi YJ, Zang DY, Cho DY, Ryoo HM, Baek JH, Kim SY, Song HS. Noninterventional observational study using high-dose controlled-release oxycodone (CR oxycodone) for cancer pain management in outpatient clinics. PAIN MEDICINE 2013; 14:1866-72. [PMID: 24010556 DOI: 10.1111/pme.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Efficacy, safety, and quality of life (QoL) for patients receiving larger doses of controlled-release oxycodone (CR oxycodone) in outpatient clinics are evaluated. METHODS The use of high-dose CR oxycodone and adjuvant drugs for pain management, pain intensity, parameters associated with quality of life, and adverse effects in cancer patients treated with high-dose CR oxycodone (≥80 mg/day) was prospectively observed for 8 weeks. Data from 486 cancer patients receiving high-dose CR oxycodone were collected from 44 hospitals during the period from February 2009 to March 2010. RESULTS Three hundred eighteen of the total 486 patients treated with high-dose CR oxycodone were followed up for 8 weeks. Pain intensity significantly improved from a mean numeric rating scale (NRS) 5.49 to NRS 4.33 (P < 0.0001). Dosage of CR oxycodone increased from a mean of 130.0 to a mean of 174.9 (P < 0.0001). QoL including activity, walking, and sleeping significantly improved after 8 weeks. At baseline, 138 complained of adverse effects, of which constipation (30.2%) was the most common followed by dry mouth (8.8%) and dizziness (8.2%). After 8 weeks, 128 patients complained of adverse effects such as constipation (27.0%), nausea (5.7%), dry mouth (5.7%), and dizziness (5.0%). After 8 weeks of high-dose CR oxycodone, adverse effects did not increase. CONCLUSION This study suggests that over an 8-week period, the use of high-dose CR oxycodone for cancer pain management is efficient, safe, and tolerable in outpatient clinics.
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Affiliation(s)
- Sun Kyung Baek
- Department of Hematology Oncology, Kyung Hee University Medical Center, Seoul, South Korea
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Maurer MA, Gilson AM, Husain SA, Cleary JF. Examining influences on the availability of and access to opioids for pain management and palliative care. J Pain Palliat Care Pharmacother 2013; 27:255-60. [PMID: 23901905 DOI: 10.3109/15360288.2013.816407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This commentary relates to the recently published essay in PLOS Medicine, entitled "Untreated Pain, Narcotics Regulation, and Global Health Ideologies." That essay describes regulatory and other systemic barriers preventing the accessibility of opioid analgesics and contributing to patients not receiving adequate pain relief. Four main points highlighted in the essay are discussed in this commentary: (1) the role of international treaties in medication availability; (2) the role of the International Narcotics Control Board in medication availability; (3) the role of regulatory policy in treating pain; and (4) the role of opioid analgesics in treating pain. Recent authoritative statements and activities suggest a strengthened infrastructure within which governments currently can work to improve the availability of controlled medicines to enhance patient pain and palliative care services.
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Affiliation(s)
- Martha A Maurer
- Pain & Policy Studies Group (PPSG) of the University of Wisconsin Carbone Cancer Center, Madison, Wisconsin 53706, USA.
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45
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Yamaguchi T, Shima Y, Morita T, Hosoya M, Matoba M. Clinical Guideline for Pharmacological Management of Cancer Pain: The Japanese Society of Palliative Medicine Recommendations. Jpn J Clin Oncol 2013; 43:896-909. [DOI: 10.1093/jjco/hyt099] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Simoff MJ, Lally B, Slade MG, Goldberg WG, Lee P, Michaud GC, Wahidi MM, Chawla M. Symptom Management in Patients With Lung Cancer. Chest 2013; 143:e455S-e497S. [DOI: 10.1378/chest.12-2366] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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47
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Abstract
Despite published guidelines and educational programs on the assessment and treatment of cancer-related pain, in any stage of oncological disease, unrelieved pain continues to be a substantial worldwide public health concern either in patients with solid and haematological malignancies. The proper and regular self-reporting assessment of pain is the first step for an effective and individualized treatment. Opioids are the mainstay of analgesic therapy and can be associated with non-opioids drugs such as paracetamol or non-steroidal anti-inflammatory drugs and to adjuvant drugs (for neuropathic pain and symptom control). The role and the utility of weak opioids (i.e. codeine, dihydrocodeine, tramadol) are a controversy point. Morphine has been placed by World Health Organization on its Essential Drug List. In the comparative study with other strong opioids (hydromorphone, oxycodone), there is no evidence to show superiority or inferiority with morphine as the first choice opioid. Oral methadone is a useful and safe alternative to morphine. Methadone presents the potential to control pain difficult to manage with other opioids. although the oral route of opioid administration is considered the one of choice, intravenous, subcutaneous, rectal, transdermal, sublingual, intranasal, and spinal routes must be used in particular situation. Transdermal opioids such as fentanyl and buprenorphine are best reserved for patients whose opioid requirements are stable. Switching from one opioid to another can improve analgesia and tolerability.
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Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy.
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48
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Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 23 Suppl 7:vii139-54. [PMID: 22997447 DOI: 10.1093/annonc/mds233] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
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49
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Nunes BC, Garcia JBS, Sakata RK. Morphine as the first drug for the treatment of cancer pain. J Palliat Med 2013; 15:963-4. [PMID: 22946573 DOI: 10.1089/jpm.2012.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
People are living to older age. Demographic pressures are driving change. Opiate analgesics are the most powerful known pain relievers. Persistent pain, both cancer and non-cancer types is frequent in older adults. The use of opioid analgesics is appropriate in the treatment of moderate to severe persistent pain. The challenge of prescribing opioids in older adults is to understand the factors involved in making appropriate choices and monitoring the beneficial effects of pain relief while managing the side-effects. This article will review the current concepts, evidence and controversies surrounding opiate use in the elderly. An approach is outlined which involves: pain assessment, screening for substance abuse potential, deciding whether you are able to treat your patient without help, starting treatment, monitoring effectiveness of pain control and managing opioid-associated side-effects. The goal of pain management using opioids is the attainment of improved function and quality of life.
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Affiliation(s)
- Allen R Huang
- Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
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