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Navarro-López V, Cardozo-Burgos L, Urbe-Murguizu U, Cancelas-Felgueras MD, Del-Valle-Gratacós M. Transcranial direct current stimulation in the management of pain in oncology patients. A systematic review and meta-analysis with meta-regression of randomized controlled trials. Disabil Rehabil 2024:1-11. [PMID: 39340309 DOI: 10.1080/09638288.2024.2399227] [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: 02/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE To evaluate the efficacy of transcranial direct current stimulation (tDCS) in pain management in subjects with oncologic process. MATERIAL AND METHODS Several databases were searched in December 2023. Randomized Controlled Trials that evaluated the application of tDCS on pain in adults with oncologic process were selected. Random-effects meta-analysis with 95%CI were used to quantify the change scores in pain between tDCS and control groups. RESULTS Six trials with 482 participants were included. There were significant differences in favor of tDCS in pain intensity in surgical oncology patients compared to sham stimulation (p < 0.001). Non-surgical patients showed no significant effect. Meta-regression analysis in this group of patients showed that the timing of the evaluation moderated the effect of tDCS on pain (p= .042), with longer time after tDCS being associated with greater pain reduction. CONCLUSIONS The application of a-tDCS for at least 20 min, with a current density higher than 0.057 mA/cm2, applied over M1, left DLPFC, or the insula area, between 2-5 sessions appears to be an effective and safe treatment of pain in surgical oncology patients compared to sham. The tDCS appears to be more effective for high-intensity pain, and in the long term.
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Affiliation(s)
- Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Thompson J. The WHO guidelines: the new and the old. Curr Opin Support Palliat Care 2024:01263393-990000000-00088. [PMID: 39250736 DOI: 10.1097/spc.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE OF THE REVIEW The original World Health Organisation (WHO) cancer pain guidelines were published in 1986 and used globally. Updated guidance was released in 2018. This review compares the 'old' with the 'new' with a closer look at the relevance of the WHO analgesic ladder in the current climate. RECENT FINDINGS The new guidelines provide a more evidence based, rigorously developed document including recommendations relating to radiotherapeutic management. There is a more detailed focus on safe opioid prescribing, opioid stewardship and the importance of integrating pain management expertise early on in the cancer journey. There remains a lack of evidence for certain therapies despite their widespread use particularly in relation to adjuvants. The pitfalls of the original renowned analgesic ladder are highlighted including a recognition that omitting 'step 2' is safe, feasible and cost effective. SUMMARY The new guidelines offer more detailed recommendations relevant to clinical practice with a strong focus on safety of opioid prescribing making it relevant in the current climate. The original WHO analgesic ladder is no longer recommended as a strict protocol for cancer pain management.
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Affiliation(s)
- Jo Thompson
- Supportive & Palliative Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
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Jamora KE, Castillo MRL, Calaguas MJC. Assessment of the prevalence of pain, adequacy of pain management and influencing factors in patients undergoing radiotherapy. Ecancermedicalscience 2022; 16:1483. [PMID: 36819795 PMCID: PMC9934969 DOI: 10.3332/ecancer.2022.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 12/04/2022] Open
Abstract
Pain is prevalent among patients with cancer who are being treated with radiotherapy. However, the prevalence of pain varies across regions, and pain management is affected by several factors. This cross-sectional study aims to determine the prevalence of pain, assess the adequacy of pain management and identify factors affecting pain in patients undergoing radiotherapy. A total of 94 patients were included in the study. The prevalence of pain was determined through the Brief Pain Inventory tool, while the adequacy of pain management was assessed through the Pain Management Index. Demographic, clinical and treatment-related factors were obtained and analysed for association with the presence of pain and the adequacy of pain management. Of the 94 patients, 59 (62.8%) experienced pain while 35 (47.2%) did not. The mean pain intensity score of patients was 3.6 (standard deviation: 2.3). Most patients (67.8%) experienced mild pain with low pain interference (67.8%) on daily functions. Of the 59 patients who experienced pain, 34 (57.6%) had inadequate pain relief while 25 (42.2%) had adequate pain control. Being admitted at the hospital during radiotherapy was significantly associated with adequate pain relief. Use of analgesic was also significantly associated with pain management, with a higher rate of weak and strong opioid use in those with adequately treated pain. In this single-institution study, the prevalence of pain was high. Pain management was inadequate in more than half of the patients experiencing pain. A disparity in the prescription of analgesics, particularly opioids, was observed. Patients with inadequate pain management were less likely to receive opioids, which likely reflects the presence of several barriers that limit its access to patients.
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Affiliation(s)
- Kurl E Jamora
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Philippines
| | - Michelle Regina L Castillo
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Philippines
| | - Miriam Joy C Calaguas
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Philippines
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4
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Hao D, Fiore M, Di Capua C, Gulati A. Ultrasound-Guided Peripheral Nerve Blocks: A Practical Review for Acute Cancer-Related Pain. Curr Pain Headache Rep 2022; 26:813-820. [PMID: 36168092 DOI: 10.1007/s11916-022-01089-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Ultrasound-guided regional techniques, including catheter-based approaches, are a subset of interventional therapies that have gained interest as an option for managing acute cancer-related pain. The authors sought to review the available published evidence and to discuss practical recommendations for expanding access to such therapies. RECENT FINDINGS In a MEDLINE/Pubmed search of ultrasound-guided peripheral nerve blocks and peripheral nerve catheters for specific anatomic targets, a total of 28 case reports and case series were identified. Included studies described improved analgesia and reduced opioid requirements with highly variable duration of effect. Current level of evidence remains limited. Pain is a symptom that markedly impacts the quality of life of cancer patients and ultrasound-guided regional techniques are a promising therapeutic option albeit with a limited evidence base. Practical recommendations offered for coordinating access to such therapies in the inpatient, emergency department, and outpatient settings may expand interest and facilitate higher quality research.
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Affiliation(s)
- David Hao
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael Fiore
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher Di Capua
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amitabh Gulati
- Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, USA
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Uehara Y, Matsumoto Y, Kosugi T, Sone M, Nakamura N, Mizushima A, Miyashita M, Morita T, Yamaguchi T, Satomi E. Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey. Palliat Care 2022; 21:166. [PMID: 36154936 PMCID: PMC9511722 DOI: 10.1186/s12904-022-01056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain. Methods A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists. Results The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure. Conclusions Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.
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Affiliation(s)
- Yuko Uehara
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. .,Department of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshifumi Kosugi
- Department of Palliative Care, Saga-ken Medical Centre Koseikan, Saga, Japan; 400 Kasemachinakabaru, Saga, Saga, 840-8571, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology/Interventional Radiology Center, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Naoki Nakamura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan; 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan; 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Abstract
PURPOSE OF REVIEW Despite the rapid advance in anti-cancer treatment in recent years, the treatment to cancer-related pain remains largely unchanged. One systemic review has shown that approximately 32% of patient with cancer-related pain were undertreated. While in patients responding to strong opioids, long-term use of opioids will lead to many undesired side effects such as constipation, tolerance, and addiction. The goals of this review are to re visit the current algorism of cancer pain management and bring attention to the emerging interventional pain management techniques. RECENT FINDINGS Peripheral nerve stimulation (PNS) has been successfully used to treat certain types of chronic non-cancer pain with long-term analgesic effect. PNS has also brought some promising results in treating localized cancer-related pain in a pilot study. More studies are needed to advance the novel and safe treatment of cancer-related pain. Incorporating interventional techniques such as PNS properly can optimize the current treatment strategy and improve outcomes.
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Extraoral photobiomodulation for prevention of oral and oropharyngeal mucositis in head and neck cancer patients: interim analysis of a randomized, double-blind, clinical trial. Support Care Cancer 2021; 30:2225-2236. [PMID: 34708311 PMCID: PMC8550910 DOI: 10.1007/s00520-021-06625-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022]
Abstract
Purpose To assess the safety and efficacy of prophylactic extraoral photobiomodulation (PBM) for the prevention of oral and oropharyngeal mucositis (OM) on clinical outcomes and survival in patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC). Methods OOPSCC patients who received radiotherapy (RT) were prospectively randomized to two groups: prophylactic extraoral PBM and placebo. OM grade (NCI), pain (VAS), analgesia, and anti-inflammatory prescriptions were assessed weekly. Quality of life questionnaires (QoL) were performed at the first and last day of RT. Following RT, participants were evaluated quarterly for oncological outcomes follow-up. Results Fifty-five patients met the inclusion criteria. The first occurrence of OM was observed at week 1, for the placebo group (p = 0.014). Later, OM onset and severity was observed for the PBM group, with first occurrence at week 2 (p = 0.009). No difference in severe OM incidence was observed (p > 0.05). Lower mean pain score was noted at week 7 for the PBM group (2.1) compared to placebo group (4.5) (p = 0.009). Less analgesics (week 3; p = 0.009/week 7; p = 0.02) and anti-inflammatory prescription (week 5; p = 0.0346) were observed for the PBM group. Better QoL scores were observed for the PBM group at last day of RT (p = 0.0034). No difference in overall survival among groups was observed in 1 year of follow-up (p = 0.889). Conclusion Prophylactic extraoral PBM can delay OM onset, reduce pain, and reduce analgesic and anti-inflammatory prescription requirements. Extraoral PBM was associated with better QoL. There was no evidence of PBM impact on oncological outcomes. Trial registration TRN:RBR-4w4swx (date of registration: 01/20/2020). Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06625-8.
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8
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Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial. Anesthesiology 2021; 135:686-698. [PMID: 34398950 DOI: 10.1097/aln.0000000000003936] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Neurolytic splanchnic nerve block is used to manage pancreatic cancer pain. However, its impact on survival and quality of life remains controversial. The authors' primary hypothesis was that pain relief would be better with a nerve block. Secondarily, they hypothesized that analgesic use, survival, and quality of life might be affected. METHODS This randomized, double-blind, parallel-armed trial was conducted in five Chinese centers. Eligible patients suffering from moderate to severe pain conditions were randomly assigned to receive splanchnic nerve block with either absolute alcohol (neurolysis) or normal saline (control). The primary outcome was pain relief measured on a visual analogue scale. Opioid consumption, survival, quality of life, and adverse effects were also documented. Analgesics were managed using a protocol common to all centers. Patients were followed up for 8 months or until death. RESULTS Ninety-six patients (48 for each group) were included in the analysis. Pain relief with neurolysis was greater for the first 3 months (largest at the first month; mean difference, 0.7 [95% CI, 0.3 to 1.0]; adjusted P < 0.001) compared with placebo injection. Opioid consumption with neurolysis was lower for the first 5 months (largest at the first month; mean difference, 95.8 [95% CI, 67.4 to 124.1]; adjusted P < 0.001) compared with placebo injection. There was a significant difference in survival (hazard ratio, 1.56 [95% CI, 1.03 to 2.35]; P = 0.036) between groups. A significant reduction in survival in neurolysis was found for stage IV patients (hazard ratio, 1.94 [95% CI, 1.29 to 2.93]; P = 0.001), but not for stage III patients (hazard ratio, 1.08 [95% CI, 0.59 to 1.97]; P = 0.809). No differences in quality of life were observed. CONCLUSIONS Neurolytic splanchnic nerve block appears to be an effective option for controlling pain and reducing opioid requirements in patients with unresectable pancreatic cancer. EDITOR’S PERSPECTIVE
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Lau J, Mazzotta P, Fazelzad R, Ryan S, Tedesco A, Smith AJ, Sud A, Furlan AD, Zimmermann C. Assessment tools for problematic opioid use in palliative care: A scoping review. Palliat Med 2021; 35:1295-1322. [PMID: 34000897 PMCID: PMC8267087 DOI: 10.1177/02692163211015567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Screening for problematic opioid use is increasingly recommended in patients receiving palliative care. AIM To identify tools used to assess for the presence or risk of problematic opioid use in palliative care. DESIGN Scoping review. DATA SOURCES Bibliographic databases (inception to January 31, 2020), reference lists, and grey literature were searched to find primary studies reporting on adults receiving palliative care and prescription opioids to manage symptoms from advanced cancer, neurodegenerative diseases, or end-stage organ diseases; and included tools to assess for problematic opioid use. There were no restrictions based on study design, location, or language. RESULTS We identified 42 observational studies (total 14,431 participants) published between 2009 and 2020 that used questionnaires (n = 32) and urine drug tests (n = 21) to assess for problematic opioid use in palliative care, primarily in US (n = 38) and outpatient palliative care settings (n = 36). The questionnaires were Cut down, Annoyed, Guilty, and Eye-opener (CAGE, n = 8), CAGE-Adapted to Include Drugs (CAGE-AID, n = 6), Opioid Risk Tool (n = 9), Screener and Opioid Assessment for Patients with Pain (SOAPP; n = 3), SOAPP-Revised (n = 2), and SOAPP-Short Form (n = 5). Only two studies' primary objectives were to evaluate a questionnaire's psychometric properties in patients receiving palliative care. There was wide variation in how urine drug tests were incorporated into palliative care; frequency of abnormal urine drug test results ranged from 8.6% to 70%. CONCLUSION Given the dearth of studies using tools developed or validated specifically for patients receiving palliative care, further research is needed to inform clinical practice and policy regarding problematic opioid use in palliative care.
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Affiliation(s)
- Jenny Lau
- Division of Palliative Care, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Paolo Mazzotta
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Suzanne Ryan
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada
| | - Alissa Tedesco
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Andrew J Smith
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Medical Psychiatry Alliance, Toronto, ON, Canada
| | - Andrea D Furlan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute for Work and Health, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, University of Toronto, Toronto, ON, Canada
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10
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Rezaei Haddad A, Hayley J, Mostofi A, Brown M, Pereira E. Stereotactic Radiofrequency Thalamotomy for Cancer Pain: A Systematic Review. World Neurosurg 2021; 151:225-234.e6. [PMID: 33905910 DOI: 10.1016/j.wneu.2021.04.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
Pain is a common occurrence in patients with cancer, which, in some cases, is not adequately controlled with medical analgesia. Thalamotomy is a treatment option in such circumstances, but synthesis of historical evidence and thalamic stratified data are lacking. We therefore sought to systematically review evidence supporting radiofrequency thalamotomy for intractable cancer pain. This review was performed using multiple electronic databases and a (PICO) patient/problem, intervention, comparison, outcome search with the terms "radiofrequency thalamotomy" and "cancer pain." Of 22 full-text studies assessed for eligibility, 14 were included for review. Articles were excluded in which radiofrequency ablation was not used, chronic implantation was used, or the study did not include patients with cancer pain. Thirteen case series and 1 case report were included. Thalamic targets included ventral posterior, central lateral, dorsomedial, centromedian, centromedian/parafascicular, centromedian and anterior pulvinar, pulvinar, limitans, suprageniculate and posterior nuclei. Patient characteristics, operative methods, lesioning parameters, patient follow-up, and outcomes were variably reported across the studies. Where relevant outcome data were available, 97% of patients experienced initial pain relief and 79% experienced significant lasting relief. Adverse events were typically transient. We conclude that radiofrequency thalamotomy for cancer pain is well tolerated and can produce significant relief from intractable cancer pain. No superiority of thalamic target could be determined.
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Affiliation(s)
- Ali Rezaei Haddad
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom; St. George's University Hospital, London, United Kingdom.
| | - James Hayley
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom; St. George's University Hospital, London, United Kingdom
| | - Matthew Brown
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom; St. George's University Hospital, London, United Kingdom
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11
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Palmier NR, Leme AFP, De Rossi T, Telles GP, Morais-Faria K, Kowalski LP, Marta GN, Brandão TB, Arany PR, Migliorati CA, Santos-Silva AR, Prado-Ribeiro AC. Salivary alpha-1-antitrypsin and macrophage migration inhibitory factor may be potential prognostic biomarkers for oncologic treatment-induced severe oral mucositis. Support Care Cancer 2020; 29:2939-2946. [PMID: 33009579 DOI: 10.1007/s00520-020-05805-2] [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: 06/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
AIMS Evaluate the abundance of the selected targets, alpha-1-antitrypsin (A1AT) and macrophage migration inhibitory factor (MIF), and correlate these findings with the risk of developing severe oral mucositis (OM). MATERIALS AND METHODS Head and neck squamous cell carcinoma (HNSCC) patients submitted to radiotherapy (RT) or chemoradiotherapy (CRT) were assessed. OM grade and pain were evaluated daily during treatment. Two protein targets, A1AT and MIF, were evaluated, using selected reaction monitoring-mass spectrometry (SRM-MS), in whole saliva, collected prior to oncologic treatment. The results obtained from the targeted proteomic analysis were correlated with OM clinical outcomes. RESULTS A total of 27 patients were included, of whom 21 (77.8%) had locally advanced disease (clinical stage III or IV). Most patients (70.4%) received CRT. OM grades 2 (40.8%) and 3 (33.3%) were the most prevalent during RT with a mean highest reported OM-related pain of 3.22 through the visual analogue scale (VAS). The abundance of A1AT and MIF correlated significantly with severe (grades 3 or 4, p < 0.02) compared with moderate-low (grades 1 or 2, p < 0.04) OM grade. CONCLUSIONS There is a correlation between the abundance of salivary A1AT and MIF and oncologic treatment-induced OM. The correlation of MIF expression with severe OM appears to be compatible with its physiological pro-inflammatory role. These results open up great possibilities for the use of salivary MIF and A1AT levels as prognostic markers for effective therapeutic interventions, such as photobiomodulation therapy, patient-controlled analgesia, or personalized medicaments.
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Affiliation(s)
| | | | - Tatiane De Rossi
- Brazilian Biosciences National Laboratory, LNBio, CNPEM, Campinas, Brazil
| | | | - Karina Morais-Faria
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Central Institute, Hospital das Clínicas of the University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.,Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, Sao Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil.,Oral Medicine Department, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Praveen R Arany
- Oral Biology and Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
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12
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Solving the deficit of cancer pain management skills by education programs. Support Care Cancer 2020; 29:1843-1848. [PMID: 32779009 DOI: 10.1007/s00520-020-05651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suboptimal cancer pain management is a worldwide problem. We examined whether an educational program on cancer pain management implemented during training could benefit primary care physicians. METHODS We enrolled all the primary care physicians who visited the oncology ward at a medical center for the first time. Educational classes on cancer pain management were conducted. The participants' abilities in cancer pain management were measured in a pretest before the classes and approximately 2 weeks later in the first posttest. The second posttest was conducted on participants who visited the oncology ward again. All 3 tests had the same set of questions and were scored on a scale of 0 to 100. RESULTS In total, 247 participants were enrolled. Less than 10% of them considered their previous education on cancer pain management adequate. The test scores increased significantly from the pretest to the first posttest (mean 65.6 vs. 89.7, p < 0.001). The participants' self-reported cancer pain management abilities, on a scale of 0 to 100, also improved significantly (mean 57.8 vs. 75.5, p < 0.001). The pretest scores were not associated with the participants' self-reported abilities or their perceptions about the adequacy of previous training on cancer pain management. The mean score on the second posttest, conducted 234.5 days after the program, on an average, remained similar to that of the first posttest (p = 0.254). CONCLUSION A specific educational program on cancer pain management provided to primary care physicians improved their pain management skills substantially, with persistent effects.
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de Pauli Paglioni M, Faria KM, Palmier NR, Prado-Ribeiro AC, E Dias RB, da Graça Pinto H, Treister NS, Epstein JB, Migliorati CA, Santos-Silva AR, Brandão TB. Patterns of oral mucositis in advanced oral squamous cell carcinoma patients managed with prophylactic photobiomodulation therapy-insights for future protocol development. Lasers Med Sci 2020; 36:429-436. [PMID: 32627112 DOI: 10.1007/s10103-020-03091-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/28/2020] [Indexed: 02/01/2023]
Abstract
To characterize oral sites affected by radiation-induced oral mucositis (OM) and related clinical outcomes in oral cancer patients subjected to prophylactic photobiomodulation therapy (PBMT). This study included advanced oral squamous cell carcinoma (OSCC) patients treated with prophylactic PBMT for OM. The site distribution of OM, OM grading (CTCAE NCI, Version 4.0, 2010), OM-related pain (VAS), analgesic protocol (WHO Analgesic Ladder), and use of enteral nutrition were evaluated weekly during treatment. Data analysis was performed using descriptive statistics expressed as median values and percentages. A total of 145 OSCC patients were included. OM most frequently affected the lateral border of the tongue (44.1%), buccal mucosa (37.2%), and labial mucosa (33.8%). Keratinized oral mucosa sites, including the tongue dorsum (6.21%), retromolar trigone (8.3%), and hard palate (2.76%), were less frequently affected. Peak OM scores were observed at weeks 5, 6, and 7, with severe OM (NCI grades 3 and 4) rates of 11%, 20%, and 25%, respectively. The cumulative occurrence of severe OM was 23%, which developed as early as week 3 and as late as week 7. The highest mean value of OM-related pain (2.7) was observed at the sixth week, and 13.8% of the patients required feeding support. This study showed, compared with studies that did not provide PBMT, reduced severity of mucositis, reduced pain and analgesic use, and reduced tube feeding in patients treated with PBMT. OM involving keratinized and non-keratinized surfaces should be included in the prophylactic PBMT to reduce severe OM in future studies.
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Affiliation(s)
- Mariana de Pauli Paglioni
- Oral Diagnosis Departament, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Karina Morais Faria
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil.
| | - Natália Rangel Palmier
- Oral Diagnosis Departament, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Carolina Prado-Ribeiro
- Oral Diagnosis Departament, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.,Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Reinaldo Brito E Dias
- Department of Bucomaxillofacial Prosthesis, University of São Paulo Dental School, São Paulo, Brazil
| | - Henrique da Graça Pinto
- Department of Bucomaxillofacial Prosthesis, University of São Paulo Dental School, São Paulo, Brazil
| | - Nathaniel Simon Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joel B Epstein
- City of Hope National Medical Center, Duarte, CA, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Hospital System, Los Angeles, CA, USA
| | | | - Alan Roger Santos-Silva
- Oral Diagnosis Departament, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Thais Bianca Brandão
- Oral Diagnosis Departament, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.,Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
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14
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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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15
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Alveolar Osteitis: A Review of Current Concepts. J Oral Maxillofac Surg 2020; 78:1288-1296. [PMID: 32348729 DOI: 10.1016/j.joms.2020.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of the present review was to explore the pathogenesis and etiology of alveolar osteitis (AO) to obtain a more intuitive understanding of the clinical prevention and management of the condition. The different treatment modalities were discussed through both the mechanistic understanding of AO and the evidence regarding the different modes of prevention and management. MATERIALS AND METHODS The Ovid Medline, PubMed, and Cochrane Central Register online databases were used to complete an advanced search using the MeSH term "dry socket," generating 756 results. RESULTS A total of 8 studies on the prevention of AO were included, with 66 studies included for review of the reported data overall. The information was categorized into incidence, etiology and pathogenesis, prevention, and management. The relevant background information and evidence for each category were summarized. CONCLUSIONS Understanding of the pathogenesis and etiology of AO has improved in recent years, which has been helpful for developing effective evidence-based treatment and prevention of the condition. Clinicians should be aware of the complexity and multifactorial nature of the etiology of AO and the current concepts regarding the prevention and treatment of AO.
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16
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Poolman M, Makin M, Briggs J, Scofield K, Campkin N, Williams M, Sharma ML, Laird B, Mayland CR. Percutaneous cervical cordotomy for cancer-related pain: national data. BMJ Support Palliat Care 2020; 10:429-434. [PMID: 32220943 PMCID: PMC7691804 DOI: 10.1136/bmjspcare-2019-002057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 11/23/2022]
Abstract
Objectives Percutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC. Methods Analysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods. Results Data on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events. Conclusions PCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.
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Affiliation(s)
- Marlise Poolman
- Bangor Institute for Health and Medical Research, Bangor University, Bangor, Gwynedd, UK
| | | | - Jess Briggs
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Nick Campkin
- Queen Alexander Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Michael Williams
- Queen Alexander Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Manohar Lal Sharma
- Department of Pain Medicine, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Barry Laird
- St Columba's Hospice, Edinburgh, UK.,Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK .,Palliative Care Institute, University of Liverpool, Liverpool, Merseyside, UK
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17
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Byeon GJ, Park J, Choi YM, Ri HS, Yoon JU, Choi EJ. Celiac Plexus Neurolysis for the Treatment of Patients with Terminal Cancer at a Tertiary University Hospital in Korea. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:5-10. [PMID: 37496890 PMCID: PMC10332707 DOI: 10.14475/kjhpc.2020.23.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/28/2019] [Accepted: 10/24/2019] [Indexed: 07/28/2023]
Abstract
Purpose The aim of this study was to investigate celiac plexus neurolysis (CPN) for the treatment of cancerous upper abdominal pain in a tertiary university hospital in Korea. Methods At the tertiary university hospital in Korea, electronic medical records of cancer patients who underwent CPN and died in the hospital from November 2009 to June 2018 were retrospectively analyzed. Results The total number of subjects was 51. The 17 patients were from the Department of Gastroenterology (33.0%), followed by 11 patients from the Department of Hemato-oncology (21.6%), 11 patients from the Department of Anesthesia and Pain Medicine (21.6%), 9 patients from the Department of General Surgery (17.6%). The diagnosis was pancreatic cancer in 15 patients (29.4%), stomach cancer in 8 patients (15.7%), hepatobiliary cancer in 20 patients (39.2%), colon cancer in 1 patient (2.0%), esophageal cancer in 2 patient (3.9%) and intra-abdominal metastasis in 5 patients (9.8%). The mean survival time after the surgery was 66.4±55.0 days. The pain intensity before and 1 week after the procedure significantly decreased, but the amounts of opioids consumed before and 1 week after the procedure were not statistically significant. Side effects occurred after the procedure including temporary localized pain in 24 patients (47.0%), hypotension in 12 (23.5%), and diarrhea in 6 (11.8%). Conclusion CPN is an effective and safe procedure for reducing upper abdominal pain caused by cancer, and it is necessary to perform CPN within the appropriate time by establishing a system of interdepartmental cooperation.
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Affiliation(s)
- Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - JuYeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yun-Mi Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Su Ri
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eun-Ji Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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18
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Al-Masri D, Wilbur K, Elazzazy S, Hassan AA, Wilby KJ. Law, Culture, and Fear: A Qualitative Study of Health Professionals' Perceptions of Narcotic Use Related to Cancer Pain. J Pain Palliat Care Pharmacother 2020; 34:55-62. [PMID: 32091944 DOI: 10.1080/15360288.2019.1704340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Studies have shown barriers to appropriate narcotic use in the Middle East have negatively impacted patient outcomes. This study aimed to explore health professionals' perspectives regarding opioid use for cancer patients in Qatar. Eight focus groups were conducted with physicians, pharmacists, and nurses. An eight-question topic guide framed discussions and targeted contextual barriers and cultural beliefs. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis was used to identify the following themes: narcotic use process, patient-related factors, and healthcare professional-related factors. Laws and regulations were identified as major barriers to appropriate narcotic access, prescribing, and administration. Government-imposed restrictions on permitted dispensed quantities and associated paperwork impeded continuity of patient care and pain relief. The influence of a patient's culture underpinned patient-related barriers, including fear of addiction and family members discouraging opioid use. Fear of prescribing for patient addiction and accusation of inappropriate prescribing by authorities were identified as health professional-related barriers. Facilitators included patient and provider education, as well as the availability of specialized teams to assess and treat cancer-related pain. Findings show narcotic utilization is not simply influenced by a single factor or subset of factors but by a multitude of factors that can be both independent and interrelated.
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Affiliation(s)
- Dania Al-Masri
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kerry Wilbur
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Shereen Elazzazy
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Azza A Hassan
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Kyle J Wilby
- Dania Al-Masri, BSc(Pharm), MSc(Pharm), is with the College of Pharmacy, Qatar University, Doha, Qatar; Kerry Wilbur, BSc(Pharm), ACPR, PharmD, MPH, is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Shereen Elazzazy, BSc(Pharm), PharmD, is with the Department of Pharmacy - Clinical Services, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Azza A. Hassan, MB BCh, MSc, MD, is with the Supportive & Palliative Care Unit, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Kyle J. Wilby, BSP, ACPR, PharmD, PhD, is with the School of Pharmacy, University of Otago, Dunedin, New Zealand
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Choi HR, Song IA, Oh TK. Association of Opioid Use in the Week Before Death Among Patients With Advanced Lung Cancer Having Sepsis. Cancer Control 2020; 26:1073274819871326. [PMID: 31452400 PMCID: PMC6712763 DOI: 10.1177/1073274819871326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Opioid use can induce immunosuppression; however, it is unclear whether opioid use increases infections in patients with advanced cancers. This study assessed the association between opioid use in the week before death and mortality among patients with advanced lung cancer having sepsis. Data on opioid usage in the week before death, general information, and clinical information of the patients were collected retrospectively. The primary outcome was the association between opioid use in the week before death and mortality after sepsis. The study included 980 patients who died of advanced lung cancer between January 2003 and June 2017 (sepsis related: 413, unrelated to sepsis: 567). The average morphine equivalent daily dose in the final week was higher in the sepsis group (313.5 ± 510.5 mg) than in the nonsepsis group (125.2 ± 246.9 mg, P < .001). A significant association was found between the average morphine equivalent daily dose in the final week and mortality due to sepsis (odds ratio: 1.02, 95% confidence interval: 1.01-1.02, P < .001). This was especially evident when the dose was increased by 10 mg in the final week. Furthermore, older age, male sex, and a lower body mass index were associated with an increased risk of mortality after developing sepsis. Opioid use in the week before death may be associated with mortality for patients with advanced lung cancer having sepsis.
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Affiliation(s)
- Hey-Ran Choi
- 1 Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - In-Ae Song
- 2 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tak Kyu Oh
- 2 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Lau J, Flamer D, Murphy-Kane P. Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review. Can J Anaesth 2020; 67:235-246. [PMID: 31571119 DOI: 10.1007/s12630-019-01482-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022] Open
Abstract
Pain is a common symptom associated with advanced cancer. An estimated 66.4% of people with advanced cancer experience pain from their disease or treatment. Pain management is an essential component of palliative care. Opioids and adjuvant therapies are the mainstay of cancer pain management. Nevertheless, a proportion of patients may experience complex pain that is not responsive to conventional analgesia. Interventional analgesia procedures may be appropriate and necessary to manage complex, cancer-related pain. This narrative review uses a theoretical case to highlight core principles of palliative care and interventional anesthesia, and the importance of collaborative, interdisciplinary care. An overview and discussion of pragmatic considerations of peripheral nervous system interventional analgesic procedures and neuraxial analgesia infusions are provided.
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Affiliation(s)
- Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, ON, Canada.
- Acute Palliative Care Unit, Princess Margaret Cancer Center, Toronto, ON, Canada.
- Division of Palliative Care, Department of Family and Community Medicine, Toronto, ON, Canada.
| | - David Flamer
- Department of Anesthesia and Pain Medicine, University Health Network, Toronto, ON, Canada
- Toronto Western Hospital, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Patricia Murphy-Kane
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Acute Palliative Care Unit, Princess Margaret Cancer Center, Toronto, ON, Canada
- Department of Nursing, Princess Margaret Cancer Center, Toronto, ON, Canada
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21
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Morais-Faria K, Palmier NR, de Lima Correia J, de Castro Júnior G, Dias RB, da Graça Pinto H, Lopes MA, Ribeiro ACP, Brandão TB, Santos-Silva AR. Young head and neck cancer patients are at increased risk of developing oral mucositis and trismus. Support Care Cancer 2020; 28:4345-4352. [PMID: 31912359 DOI: 10.1007/s00520-019-05241-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate cancer treatment-related toxicities in young head and neck cancer (HNC) patients. MATERIAL AND METHODS A total of 44 patients were included in the present retrospective cohort study, which was designed to access oral toxicities of cancer treatment in young (< 45 years of age, Group I, n = 22) and old (> 58 years of age, Group II, n = 22) HNC patients with similar tumor stage and treatment protocols. Oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis were assessed during days 7th, 21st, and 35th of head and neck radiotherapy (HNRT) according to previously validated scales (World Health Organization criteria and the National Cancer Institute and Common Terminology Criteria for Adverse Events version 4.0). RESULTS Patients from both groups showed high incidence and severity of oral toxicities by the end of the HNRT with OM (81.9% (Group I); 63.6% (Group II)) and xerostomia (72.6% (Group I); 77.2% (Group II)) being the most prevalent toxicities. No differences regarding xerostomia, dysphagia, dysgeusia, and radiodermatitis incidences or severity could be observed between groups. However, higher incidences and severity of OM at 21st and 35th fractions (odds ratio = 2.22 and 5.71, respectively) and trismus at 21st and 35th fractions (odds ratio = 6.17 and 14.5, respectively) were observed throughout the treatment in young patients when compared to older patients (p < 0.01 and p < 0.05, respectively). CONCLUSION Young HNC patients are more affected by cancer treatment-related OM and trismus despite the similarities in clinical staging and treatment protocols with elderly patients.
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Affiliation(s)
- Karina Morais-Faria
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Natalia Rangel Palmier
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | - Jaqueline de Lima Correia
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | - Gilberto de Castro Júnior
- Clinical Oncology Service, São Paulo State Cancer Institute (ICESP), School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Reinaldo Brito Dias
- Department of Maxillofacial Surgery, Prosthesis and Traumatology, USP, São Paulo, Brazil
| | | | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil
| | | | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil. .,Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, UNICAMP, 901, Av. Limeira, Areão, Piracicaba, São Paulo, 13414-903, Brazil.
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Ramanjulu R, Thota RS, Ahmed A, Jain P, Salins N, Bhatnagar S, Chatterjee A, Bhattacharya D. Indian Society for Study of Pain, Cancer Pain Special Interest Group Guidelines on Pharmacological Management of Cancer Pain (Part I). Indian J Palliat Care 2020; 26:173-179. [PMID: 32874030 PMCID: PMC7444573 DOI: 10.4103/0973-1075.285692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group guidelines on pharmacological management of cancer pain in adults provides a structured, step-wise approach which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub drafts addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website, and circulated by E-mail to all the ISSP and Indian Association of Palliative Care (IAPC) members. We recommend that analgesics for cancer pain management should follow the World Health Organization three-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of first choice for moderate-to-severe cancer pain.
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Affiliation(s)
- Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Cytecare Hospital, Bengaluru, Karnataka, India
| | - Raghu S Thota
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arif Ahmed
- Department of Anaesthesia, Critical Care and Pain Management, CK Birla Hospital for Women, Gurugram, Haryana, India
| | - Parmanand Jain
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sushma Bhatnagar
- Department of Onco-anaesthesia and Palliative Medicine, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Chatterjee
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dipasri Bhattacharya
- Department of Anaesthesiology, Critical Care and Pain, R. G. Kar Medical College, Kolkata, West Bengal, India
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Klint Å, Bondesson E, Rasmussen BH, Fürst CJ, Schelin MEC. Dying With Unrelieved Pain-Prescription of Opioids Is Not Enough. J Pain Symptom Manage 2019; 58:784-791.e1. [PMID: 31319106 DOI: 10.1016/j.jpainsymman.2019.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
CONTEXT Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain. OBJECTIVES We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study. METHODS Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011-2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved pain. RESULTS Unrelieved pain during the final week of life was reported for 25% of the patients with pain, despite prescription of opioids PRN in 97% of cases. Unrelieved pain was common both among patients dying of cancer and of nonmalignant chronic diseases. Statistically significant risk factors for unrelieved pain included hospital death (RR = 1.84, 95% CI 1.79-1.88) compared with dying in specialist palliative care, absence of an EoL conversation (RR = 1.42, 95% CI 1.38-1.45), and dying of cancer in the bones (RR = 1.13, 95% CI 1.08-1.18) or lung (RR = 1.10, 95% CI 1.06-1.13) compared with nonmalignant causes. CONCLUSION Despite almost complete prescription of opioids PRN for patients with pain, patients die with unrelieved pain. Health care providers, hospitals in particular, need to focus more on pain in dying patients. An EoL conversation is one achievable intervention.
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Affiliation(s)
- Åsa Klint
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Skåne University Hospital, Region Skåne, Lund, Sweden.
| | - Elisabeth Bondesson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Birgit H Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department for Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria E C Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Varrassi G, Alon E, Bagnasco M, Lanata L, Mayoral-Rojals V, Paladini A, Pergolizzi JV, Perrot S, Scarpignato C, Tölle T. Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus. Adv Ther 2019; 36:2618-2637. [PMID: 31485978 PMCID: PMC6822819 DOI: 10.1007/s12325-019-01053-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks. To date, mechanisms associated with inflammatory pain are not completely understood because of their complex nature and the involvement of both peripheral and central mechanisms. This Expert Consensus document is intended to update clinicians about evolving areas of clinical practice and/or available treatment options for the management of patients with inflammatory pain. METHOD An international group of experts in pain management covering the pharmacology, neurology and rheumatology fields carried out an independent qualitative systematic literature search using MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines. CONCLUSIONS Increasing clinicians' knowledge of the available pharmacologic options to treat different pain mechanisms offers the potential for safe, individualized treatment decisions. We hope that it will help implement the needed changes in the management of inflammatory pain by providing the best strategies and new insights to achieve the ultimate goal of managing the disease and obtaining optimal benefits for patients. FUNDING Dompé Farmaceutici SPA and Paolo Procacci Foundation.
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Rome, Italy.
- President of World Institute of Pain (WIP), Winston-Salem, NC, USA.
| | - Eli Alon
- University of Zurich, Zurich, Switzerland
| | - Michela Bagnasco
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | - Luigi Lanata
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | | | | | | | - Serge Perrot
- Descartes University and Cochin-Hotel Dieu Hospital, Paris, France
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Austin P, Lovell M, Siddall P. The Efficacy of Virtual Reality for Persistent Cancer Pain: A Call for Research. J Pain Symptom Manage 2019; 58:e11-e14. [PMID: 31323287 DOI: 10.1016/j.jpainsymman.2019.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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Ruiz-López D, Alonso-Babarro A. Consumo de opioides en la Comunidad de Madrid (España) entre 2004 y 2014. Rev Clin Esp 2019; 219:367-374. [DOI: 10.1016/j.rce.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
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Viswanathan A, Vedantam A, Hess KR, Ochoa J, Dougherty PM, Reddy AS, Koyyalagunta D, Reddy S, Bruera E. Minimally Invasive Cordotomy for Refractory Cancer Pain: A Randomized Controlled Trial. Oncologist 2019; 24:e590-e596. [PMID: 30796153 DOI: 10.1634/theoncologist.2018-0570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Up to 30% of patients with cancer continue to suffer from pain despite aggressive supportive care. The present study aimed to determine whether cordotomy can improve cancer pain refractory to interdisciplinary palliative care. MATERIALS AND METHODS In this randomized controlled trial, we recruited patients with refractory unilateral somatic pain, defined as a pain intensity (PI) ≥4, after more than three palliative care evaluations. Patients were randomized to percutaneous computed tomography-guided cordotomy or continued interdisciplinary palliative care. The primary outcome was 33% improvement in PI at 1 week after cordotomy or study enrollment as measured by the Edmonton Symptom Assessment Scale. RESULTS Sixteen patients were enrolled (nine female, median age 58 years). Six of seven patients (85.7%) randomized to cordotomy experienced >33% reduction in PI (median preprocedure PI = 7, range 6-10; 1 week after cordotomy median PI = 1, range 0-6; p = .022). Zero of nine patients randomized to palliative care achieved a 33% reduction in PI. Seven patients (77.8%) randomized to palliative care elected to undergo cordotomy after 1 week. All of these patients experienced >33% reduction in PI (median preprocedure PI = 8, range 4-10; 1 week after cordotomy median PI = 0, range 0-1; p = .022). No patients were withdrawn from the study because of adverse effects of the intervention. CONCLUSION These data support the use of cordotomy for pain refractory to optimal palliative care. The findings of this study justify a large-scale randomized controlled trial of percutaneous cordotomy. IMPLICATIONS FOR PRACTICE This prospective clinical trial was designed to determine the improvement in pain intensity in patients randomized to either undergo cordotomy or comprehensive palliative care for medically refractory cancer pain. This study shows that cordotomy is effective in reducing pain for medically refractory cancer pain, and these results can be used to design a large-scale comparative randomized controlled trial that could provide the evidence needed to include cordotomy as a treatment modality in the guidelines for cancer pain management.
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Affiliation(s)
- Ashwin Viswanathan
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jewel Ochoa
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila S Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Suresh Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Edwards Z, Ziegler L, Craigs C, Blenkinsopp A, Bennett MI. Pharmacist educational interventions for cancer pain management: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:336-345. [PMID: 30707465 DOI: 10.1111/ijpp.12516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/20/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Educational interventions by pharmacists for patients with cancer pain aim to improve pain management, but little is known about the different components of interventions and their effectiveness. Our aim was to assess the benefit of pharmacist delivered educational interventions for patients with cancer pain. A systematic review and meta-analysis of experimental trials testing pharmacist delivered educational interventions for cancer pain was carried out to identify the components of interventions and effectiveness at improving pain-related outcomes for patients with cancer. A literature review was conducted in EMBASE, MEDLINE, CINAHL, PsycINFO, ASSIA, Web of Science and CENTRAL from inception until January 2018 searching for educational interventions involving a pharmacist for patients with cancer pain. Four studies were included involving 944 patients. Meta-analysis was carried out where possible. KEY FINDINGS Meta-analysis of three of the four studies found that mean pain intensity in the intervention group was reduced by 0.76 on a 0-10 scale (95% confidence interval), although only two of the studies used validated measures of pain. Improvements in knowledge, side effects and patient satisfaction were seen although with less reliable measures. SUMMARY Pharmacist educational interventions for patients with cancer pain have been found to show promise in reducing pain intensity. Studies were few and of varying quality. Further, good quality studies should be carried out in this area and these should be comprehensively reported. Trials measuring patient self-efficacy and patient satisfaction are needed before the impact of the pharmacist delivered interventions on these outcomes can be established.
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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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Association Between Opioid Use and Survival Time in Patients With Unresectable Pancreatic Cancer: 10 Years of Clinical Experience. Pancreas 2018; 47:837-842. [PMID: 29939907 DOI: 10.1097/mpa.0000000000001094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with pancreatic cancer generally experience increasing pain as their disease progresses, making the titration of opioids difficult. This study aimed to determine a correlation between prescribed opioid doses and survival time in patients with unresectable pancreatic cancer. METHODS This retrospective observational cohort study in a tertiary care institution reviewed the medical records of patients diagnosed with unresectable pancreatic cancer and treated over a 10-year period. RESULTS We screened 1152 patients with unresectable pancreatic cancer, and 566 were eligible for inclusion in this study. There was a statistically significant negative correlation between initial opioid dose and survival time from initial opioid dose (correlation coefficient, -0.184; P < 0.01) and survival time from initial pancreatic cancer diagnosis (correlation coefficient, -0.177; P < 0.01). In addition, there were 0.8% and 0.6% increases in initial opioid dosage (morphine equivalent daily dose) and rate of increasing opioid dose (morphine equivalent daily dose per month), respectively, associated with the risk of early death (≤180 days, P < 0.05). CONCLUSIONS Correlations between patient survival, initial opioid dose, final opioid dose, and the rate of increase of opioid dosage could provide useful information for clinicians treating unresectable pancreatic cancer patients.
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Abahussin AA, West RM, Wong DC, Ziegler LE. PROMs for Pain in Adult Cancer Patients: A Systematic Review of Measurement Properties. Pain Pract 2018; 19:93-117. [DOI: 10.1111/papr.12711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Asma A. Abahussin
- Leeds institute of Health Sciences; School of Medicine; University of Leeds; Leeds U.K
- Biomedical Technology Department; College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
| | - Robert M. West
- Leeds institute of Health Sciences; School of Medicine; University of Leeds; Leeds U.K
| | - David C. Wong
- Leeds institute of Health Sciences; School of Medicine; University of Leeds; Leeds U.K
| | - Lucy E. Ziegler
- Leeds institute of Health Sciences; School of Medicine; University of Leeds; Leeds U.K
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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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García-Mata J, Álamo C, de Castro J, Contreras J, Gálvez R, Jara C, Llombart A, Pérez C, Sánchez P, Traseira S, Cruz JJ. A survey of perceptions, attitudes, knowledge and practices of medical oncologists about cancer pain management in Spain. Clin Transl Oncol 2018; 20:1061-1071. [PMID: 29721765 DOI: 10.1007/s12094-017-1826-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/23/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To monitor oncologists' perspective on cancer pain management. METHODS An anonymized survey was conducted in two waves. First, over a convenience sample of oncologists known to be particularly concerned with the management of pain. Second, using a random sample of oncologists. RESULTS In total, 73 and 82 oncologists participated in the first and second wave, respectively. Many oncologists reported to have good knowledge of analgesic drugs (95.9%), the mechanism of action of opioids (79.5%), and good skills to manage opioid-related bowel dysfunction (76.7%). Appropriate adjustment of background medication to manage breakthrough pain was reported by 95.5% of oncologists. Additionally, 87.7% (68.3% in the second wave, p = 0.035) of oncologists reported suitable opioid titration practices, and 90.4% reported to use co-adjuvant medications for neuropathic pain confidently. On the other hand, just 9.6% of oncologists participated in multidisciplinary pain management teams, and merely 30.3 and 27.1% reported to routinely collaborate with the Pain Clinics or involve other staff, respectively. Only 26.4% of the oncologists of the second wave gave priority to pain pathophysiology to decide therapies, and up to 75.6% reported difficulties in treating neuropathic pain. Significantly less oncologists of the second wave (82.9 vs. 94.5%, p = 0.001) used opioid rotation routinely. CONCLUSIONS Unlike in previous surveys, medical oncologists reported in general good knowledge and few perceived limitations and barriers for pain management. However, multi-disciplinary management and collaboration with other specialists are still uncommon. Oncologists' commitment to optimize pain management seems important to improve and maintain good practices.
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Affiliation(s)
- Jesús García-Mata
- Medical Oncology Department, Santa María Nai Hospital, Orense, Spain
| | - Cecilio Álamo
- Department of Pharmacology, University of Alcalá de Henares, Madrid, Spain
| | | | - Jorge Contreras
- Radiotherapeutic Oncology Department, Carlos Haya Hospital, Málaga, Spain
| | - Rafael Gálvez
- Pain Clinic and Palliative Care Unit, Virgen de las Nieves Hospital, Granada, Spain
| | - Carlos Jara
- Medical Oncology Department, Alcorcón Hospital, Madrid, Spain
| | - Antonio Llombart
- Medical Oncology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | | | - Pedro Sánchez
- Medical Oncology Department, Specialty Hospital, Jaén, Spain
| | - Susana Traseira
- Medical Department, Mundipharma Pharmaceuticals, Madrid, Spain
| | - Juan-Jesús Cruz
- Hospital Universitario de Salamanca-Universidad de Salamanca (USAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
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Gupta N, Dattatri R, Bharati SJ, Bhatnagar S. Ultrasound-Guided Real-Time Pterygopalatine Block for Analgesia in an Oral Cancer Patient. Indian J Palliat Care 2018; 24:112-114. [PMID: 29440818 PMCID: PMC5801616 DOI: 10.4103/ijpc.ijpc_150_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Oral cancers are one of the most common cancers in India. These patients have pain during the course of the disease. Various drugs including opioid and nonsteroidal anti-inflammatory drug have been used to manage pain. However, these are associated with side effects such as constipation and vomiting. An early interventional block may decrease the requirement for analgesics and improve the overall quality of life. We describe a case of oral carcinoma successfully managed with ultrasound-guided pterygopalatine block.
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Affiliation(s)
- Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, AIIMS, New Delhi, India
| | - Rohini Dattatri
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, AIIMS, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, AIIMS, New Delhi, India
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Cornman-Homonoff J, Holzwanger DJ, Lee KS, Madoff DC, Li D. Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain. Semin Intervent Radiol 2017; 34:376-386. [PMID: 29249862 DOI: 10.1055/s-0037-1608861] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Daniel J Holzwanger
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kyungmouk S Lee
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - David C Madoff
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - David Li
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Improving cancer patient emergency room utilization: A New Jersey state assessment. Cancer Epidemiol 2017; 51:15-22. [DOI: 10.1016/j.canep.2017.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023]
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Kostev K, Von Vultée C, Usinger DM, Reese JP. Tramadol prescription patterns in patients followed by general practitioners and orthopedists in Germany in the year 2015. Postgrad Med 2017; 130:37-41. [PMID: 29157058 DOI: 10.1080/00325481.2018.1407205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of this study was to analyze tramadol prescription patterns in acute pain patients followed by general practitioners and orthopedists in Germany. METHODS This study included patients ≥18 years diagnosed with acute pain who received at least one tramadol prescription each in one of 1,129 general or 179 orthopedic practices in Germany between January and December 2015 (index date). Patients were excluded if they had received a prescription for another analgesic in the year prior to the index date, had a follow-up of less than 15 months after the index date, or were prescribed tramadol for a period of more than three months. The main outcome of this retrospective study was the share of patients receiving tramadol in combination therapy. Combination therapy was defined as the prescription of tramadol in conjunction with at least one other analgesic during the same medical visit. RESULTS The present study included a total of 8,766 individuals. Overall, 1,492 (22.0%) of tramadol patients seen by general practitioners and 370 (18.7%) of those seen by orthopedists received tramadol in combination with other analgesics. Although this proportion was similar throughout the different subgroups in orthopedic practices, it was considerably higher in patients >80 years and in those with private health insurance coverage in general practices. CONCLUSIONS Approximately one of five tramadol patients was prescribed tramadol in combination therapy. Further research is needed to gain a better understanding of the demographic and clinical factors that have an effect on tramadol prescription patterns in Germany.
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Affiliation(s)
- Karel Kostev
- a Epidemiology , QuintilesIMS , Frankfurt am Main , Germany
| | | | | | - Jens-Peter Reese
- d Institute of Health Service Research and Clinical Epidemiolgy and Coordinating Center for Clinical Trials , Philipps-University , Marburg , Germany
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Davidson JGS, Guthrie DM. The Influence of Physical and Psychosocial Factors on Disruptive Pain Among Seriously Ill Home Care Patients. J Palliat Care 2017; 32:61-68. [PMID: 28845743 DOI: 10.1177/0825859717724686] [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: 11/15/2022]
Abstract
OBJECTIVES To estimate the prevalence and correlates of disruptive pain in a sample of seriously ill home care patients in the Canadian province of Ontario. METHODS The design was a cross-sectional analysis of secondary data from 2757 patients aged 65+. RESULTS Overall, 69.0% (n = 1902) had any level of pain and 41.6% (n = 1146) indicated that their pain disrupted their usual activities. In the univariate analysis of demographics, the risk of disruptive pain decreased significantly with increasing age ( P < .0001) and was significantly less common among men ( P = .0015). Multivariate analysis showed that unsteady gait (relative risk [RR] = 1.37; 95% confidence interval [CI], 1.18-1.59), arthritis (RR = 1.35; 95% CI, 1.23-1.49), symptoms of depression (RR = 1.24; 95% CI, 1.13-1.37), and declines in social activity that the patient rated as distressing (RR = 1.19; 95% CI, 1.08-1.31) were independently associated with disruptive pain. CONCLUSION Disruptive pain is highly prevalent in this group, and the key factors associated with this outcome represent physical as well as psychosocial domain areas.
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Affiliation(s)
- Jacob G S Davidson
- 1 Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Dawn M Guthrie
- 1 Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.,2 Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Wiffen PJ, Derry S, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral paracetamol (acetaminophen) for cancer pain. Cochrane Database Syst Rev 2017; 7:CD012637. [PMID: 28700092 PMCID: PMC6369932 DOI: 10.1002/14651858.cd012637.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Non-opioid drugs are commonly used to treat mild to moderate cancer pain, and are recommended for this purpose in the WHO cancer pain treatment ladder, either alone or in combination with opioids.A previous Cochrane review that examined the evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain was withdrawn in 2015 because it was out of date; the date of the last search was 2005. This review, and another on NSAIDs, updates the evidence. OBJECTIVES To assess the efficacy of oral paracetamol (acetaminophen) for cancer pain in adults and children, and the adverse events reported during its use in clinical trials. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to March 2017, together with reference lists of retrieved papers and reviews, and two online study registries. SELECTION CRITERIA We included randomised, double-blind, studies of five days' duration or longer, comparing paracetamol alone with placebo, or paracetamol in combination with an opioid compared with the same dose of the opioid alone, for cancer pain of any intensity. Single-blind and open studies were also eligible for inclusion. The minimum study size was 25 participants per treatment arm at the initial randomisation. DATA COLLECTION AND ANALYSIS Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality and potential bias. We did not carry out any pooled analyses. We assessed the quality of the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS Three studies in adults satisfied the inclusion criteria, lasting up to one week; 122 participants were randomised initially, and 95 completed treatment. We found no studies in children. One study was parallel-group, and two had a cross-over design. All used paracetamol as an add-on to established treatment with strong opioids (median daily morphine equivalent doses of 60 mg, 70 mg, and 225 mg, with some participants taking several hundred mg of oral morphine equivalents daily). Other non-paracetamol medication included non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, or neuroleptics. All studies were at high risk of bias for incomplete outcome data and small size; none was unequivocally at low risk of bias.None of the studies reported any of our primary outcomes: participants with pain reduction of at least 50%, and at least 30%, from baseline; participants with pain no worse than mild at the end of the treatment period; participants with Patient Global Impression of Change (PGIC) of much improved or very much improved (or equivalent wording). What pain reports there were indicated no difference between paracetamol and placebo when added to another treatment. There was no convincing evidence of paracetamol being different from placebo with regards to quality of life, use of rescue medication, or participant satisfaction or preference. Measures of harm (serious adverse events, other adverse events, and withdrawal due to lack of efficacy) were inconsistently reported and provided no clear evidence of difference.Our GRADE assessment of evidence quality was very low for all outcomes, because studies were at high risk of bias from several sources. AUTHORS' CONCLUSIONS There is no high-quality evidence to support or refute the use of paracetamol alone or in combination with opioids for the first two steps of the three-step WHO cancer pain ladder. It is not clear whether any additional analgesic benefit of paracetamol could be detected in the available studies, in view of the doses of opioids used.
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Key Words
- adult
- humans
- acetaminophen
- acetaminophen/administration & dosage
- administration, oral
- analgesics, non‐narcotic
- analgesics, non‐narcotic/administration & dosage
- analgesics, opioid
- analgesics, opioid/administration & dosage
- anti‐inflammatory agents, non‐steroidal
- anti‐inflammatory agents, non‐steroidal/administration & dosage
- antidepressive agents, tricyclic
- antidepressive agents, tricyclic/administration & dosage
- antipsychotic agents
- antipsychotic agents/administration & dosage
- cancer pain
- cancer pain/drug therapy
- drug therapy, combination
- patient preference
- quality of life
- randomized controlled trials as topic
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Affiliation(s)
| | | | | | - Ewan D McNicol
- Tufts Medical CenterDepartment of Anesthesiology and Perioperative MedicineBostonMAUSA
| | - Rae Frances Bell
- Haukeland University HospitalRegional Centre of Excellence in Palliative CareBergenNorway
| | - Daniel B Carr
- Tufts University School of MedicinePain Research, Education and Policy (PREP) Program, Department of Public Health and Community MedicineBostonMassachusettsUSA
| | | | - Bee Wee
- Churchill HospitalNuffield Department of Medicine and Sir Michael Sobell HouseOld RoadHeadingtonOxfordUKOX3 7LJ
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Derry S, Wiffen PJ, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults. Cochrane Database Syst Rev 2017; 7:CD012638. [PMID: 28700091 PMCID: PMC6369931 DOI: 10.1002/14651858.cd012638.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Non-opioid drugs are commonly used to treat cancer pain, and are recommended for this purpose in the World Health Organization (WHO) cancer pain treatment ladder, either alone or in combination with opioids.A previous Cochrane review that examined the evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol, alone or combined with opioids, for cancer pain was withdrawn in 2015 because it was out of date; the date of the last search was 2005. This review, and another on paracetamol, updates the evidence. OBJECTIVES To assess the efficacy of oral NSAIDs for cancer pain in adults, and the adverse events reported during their use in clinical trials. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to April 2017, together with reference lists of retrieved papers and reviews, and two online study registries. SELECTION CRITERIA We included randomised, double-blind, single-blind, or open-label studies of five days' duration or longer, comparing any oral NSAID alone with placebo or another NSAID, or a combination of NSAID plus opioid with the same dose of the opioid alone, for cancer pain of any pain intensity. The minimum study size was 25 participants per treatment arm at the initial randomisation. DATA COLLECTION AND ANALYSIS Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality and potential bias. We did not carry out any pooled analyses. We assessed the quality of the evidence using GRADE and created a 'Summary of findings' table. MAIN RESULTS Eleven studies satisfied inclusion criteria, lasting one week or longer; 949 participants with mostly moderate or severe pain were randomised initially, but fewer completed treatment or had results of treatment. Eight studies were double-blind, two single-blind, and one open-label. None had a placebo only control; eight compared different NSAIDs, three an NSAID with opioid or opioid combination, and one both. None compared an NSAID plus opioid with the same dose of opioid alone. Most studies were at high risk of bias for blinding, incomplete outcome data, or small size; none was unequivocally at low risk of bias.It was not possible to compare NSAIDs as a group with another treatment, or one NSAID with another NSAID. Results for all NSAIDs are reported as a randomised cohort. We judged results for all outcomes as very low-quality evidence.None of the studies reported our primary outcomes of participants with pain reduction of at least 50%, and at least 30%, from baseline; participants with Patient Global Impression of Change (PGIC) of much improved or very much improved (or equivalent wording). With NSAID, initially moderate or severe pain was reduced to no worse than mild pain after one or two weeks in four studies (415 participants in total), with a range of estimates between 26% and 51% in individual studies.Adverse event and withdrawal reporting was inconsistent. Two serious adverse events were reported with NSAIDs, and 22 deaths, but these were not clearly related to any pain treatment. Common adverse events were thirst/dry mouth (15%), loss of appetite (14%), somnolence (11%), and dyspepsia (11%). Withdrawals were common, mostly because of lack of efficacy (24%) or adverse events (5%). AUTHORS' CONCLUSIONS There is no high-quality evidence to support or refute the use of NSAIDs alone or in combination with opioids for the three steps of the three-step WHO cancer pain ladder. There is very low-quality evidence that some people with moderate or severe cancer pain can obtain substantial levels of benefit within one or two weeks.
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Affiliation(s)
| | | | | | - Ewan D McNicol
- Tufts Medical CenterDepartment of Anesthesiology and Perioperative MedicineBostonMAUSA
| | - Rae Frances Bell
- Haukeland University HospitalRegional Centre of Excellence in Palliative CareBergenNorway
| | - Daniel B Carr
- Tufts University School of MedicinePain Research, Education and Policy (PREP) Program, Department of Public Health and Community MedicineBostonMassachusettsUSA
| | | | - Bee Wee
- Churchill HospitalNuffield Department of Medicine and Sir Michael Sobell HouseOld RoadHeadingtonOxfordUKOX3 7LJ
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Abstract
BACKGROUND Pain is a common symptom with cancer, and 30% to 50% of all people with cancer will experience moderate to severe pain that can have a major negative impact on their quality of life. Opioid (morphine-like) drugs are commonly used to treat moderate or severe cancer pain, and are recommended for this purpose in the World Health Organization (WHO) pain treatment ladder. The most commonly-used opioid drugs are buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, tramadol, and tapentadol. OBJECTIVES To provide an overview of the analgesic efficacy of opioids in cancer pain, and to report on adverse events associated with their use. METHODS We identified systematic reviews examining any opioid for cancer pain published to 4 May 2017 in the Cochrane Database of Systematic Reviews in the Cochrane Library. The primary outcomes were no or mild pain within 14 days of starting treatment, withdrawals due to adverse events, and serious adverse events. MAIN RESULTS We included nine reviews with 152 included studies and 13,524 participants, but because some studies appeared in more than one review the number of unique studies and participants was smaller than this. Most participants had moderate or severe pain associated with a range of different types of cancer. Studies in the reviews typically compared one type of opioid or formulation with either a different formulation of the same opioid, or a different opioid; few included a placebo control. Typically the reviews titrated dose to effect, a balance between pain relief and adverse events. Various routes of administration of opioids were considered in the reviews; oral with most opioids, but transdermal administration with fentanyl, and buprenorphine. No review included studies of subcutaneous opioid administration. Pain outcomes reported were varied and inconsistent. The average size of included studies varied considerably between reviews: studies of older opioids, such as codeine, morphine, and methadone, had low average study sizes while those involving newer drugs tended to have larger study sizes.Six reviews reported a GRADE assessment (buprenorphine, codeine, hydromorphone, methadone, oxycodone, and tramadol), but not necessarily for all comparisons or outcomes. No comparative analyses were possible because there was no consistent placebo or active control. Cohort outcomes for opioids are therefore reported, as absolute numbers or percentages, or both.Reviews on buprenorphine, codeine with or without paracetamol, hydromorphone, methadone, tramadol with or without paracetamol, tapentadol, and oxycodone did not have information about the primary outcome of mild or no pain at 14 days, although that on oxycodone indicated that average pain scores were within that range. Two reviews, on oral morphine and transdermal fentanyl, reported that 96% of 850 participants achieved that goal.Adverse event withdrawal was reported by five reviews, at rates of between 6% and 19%. Participants with at least one adverse event were reported by three reviews, at rates of between 11% and 77%.Our GRADE assessment of evidence quality was very low for all outcomes, because many studies in the reviews were at high risk of bias from several sources, including small study size. AUTHORS' CONCLUSIONS The amount and quality of evidence around the use of opioids for treating cancer pain is disappointingly low, although the evidence we have indicates that around 19 out of 20 people with moderate or severe pain who are given opioids and can tolerate them should have that pain reduced to mild or no pain within 14 days. This accords with the clinical experience in treating many people with cancer pain, but overstates to some extent the effectiveness found for the WHO pain ladder. Most people will experience adverse events, and help may be needed to manage the more common undesirable adverse effects such as constipation and nausea. Perhaps between 1 in 10 and 2 in 10 people treated with opioids will find these adverse events intolerable, leading to a change in treatment.
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Affiliation(s)
| | - Bee Wee
- Churchill HospitalNuffield Department of Medicine and Sir Michael Sobell HouseOld RoadHeadingtonOxfordUKOX3 7LJ
| | | | - Rae Frances Bell
- Haukeland University HospitalRegional Centre of Excellence in Palliative CareBergenNorway
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Page ND. Integration of Specialized Pain Control Services in Palliative Care: A Nationwide Web-based Survey. Indian J Palliat Care 2017; 23:212-216. [PMID: 28503043 PMCID: PMC5412131 DOI: 10.4103/0973-1075.204233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Pain control is an important part of palliative care (PC), and conventional analgesics do not provide adequate pain relief to all patients. Many patients present with complex pain syndromes that require interventional pain control measures usually deployed by pain specialists. There is adequate integration of specialized pain control services with PC elsewhere, but information about the same in our country is lacking. Materials and Methods: An internet survey was conducted among palliative specialists regarding the need and availability of pain specialists for their patients suffering from complex pain syndromes. Their attitude toward integrating specialized pain control services in their practice was also explored. Results: Majority of palliative physicians came across situations where specialists in pain would control the patients’ pain better. There was a poor availability of such services, and when available, the cost was significant. It is heartening to note that though there is poor integration of specialized pain control services with palliation, palliative physicians acknowledge the need for pain specialists and their techniques for providing pain relief for their patients. Conclusions: Effective pain control is needed in palliation, barriers however exist, and there is a need to make pain specialists and interventional techniques more freely available.
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Derry S, Wiffen PJ, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012638] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
PURPOSE OF REVIEW Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment. The goals of this review are to draw attention to the critical role that regional anesthetic nerve blocks and interventional pain management techniques play in treating malignancy-related pain and emphasize the benefits provided by the aforementioned treatment strategies. RECENT FINDINGS A large proportion of cancer patients continues to struggle with an inadequately treated pain despite a strict adherence to the WHO analgesic step ladder. The previous pain treatment algorithm has been modified to include peripheral neural blockade, neuro-destructive techniques, neuromodulatory device use, and intrathecal drug delivery systems. The accumulated evidence highlights the opioid-sparing qualities and other benefits afforded by these modalities: decreasing medication-induced side effects, reducing economic burden of poor analgesia, and overall improvement in quality of life of the patients afflicted with a painful neoplastic disease. The rising prevalence of cancer-related pain syndromes is paralleled by an unmatched growth of innovative treatment strategies. Modified WHO analgesic ladder represents one of the greatest paradigm shifts within the domain of oncologic pain treatment. The cancer patient population requires a prompt and liberal, albeit judicious, delivery of unorthodox pain treatment options freed from the rigid bonds of conventional guidelines and standard practices.
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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: 79] [Impact Index Per Article: 9.9] [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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Singh H, Banipal RPS, Singh B. Assessment of Adequacy of Pain Management and Analgesic Use in Patients With Advanced Cancer Using the Brief Pain Inventory and Pain Management Index Calculation. J Glob Oncol 2016; 3:235-241. [PMID: 28717765 PMCID: PMC5493218 DOI: 10.1200/jgo.2016.004663] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose The objective of this cross-sectional, noninterventional, 6-month observational study was to assess the adequacy of pain management in patients with cancer admitted to the Oncology Department of Guru Gobind Singh Medical College in Faridkot, India. Methods and Materials A total of 348 patients with cancer were recruited for evaluation of the prevalence of inadequate cancer pain management using the Brief Pain Inventory Pain Management Index. Results The current study included 127 males (36.5%) and 221 females (63.5%). The most prevalent cancer type was genitourinary; 268 patients (77%) had inadequately managed pain. A significant correlation was observed between poorly managed pain and age groups, analgesic used, and body mass index. Conclusion Our observation of inadequate pain management among 77% of patients indicates that pain management was insufficient in three quarters of the patients in this study. Accumulating data regarding the inadequacy of cancer pain management is crucial to improve symptom management. Better management of pain not only alleviates pain symptoms but also increases the quality of life for patients with cancer.
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Affiliation(s)
- Harminder Singh
- All authors: Baba Farid University of Health Sciences, Faridkot, India
| | | | - Baltej Singh
- All authors: Baba Farid University of Health Sciences, Faridkot, India
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van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage 2016; 51:1070-1090.e9. [PMID: 27112310 DOI: 10.1016/j.jpainsymman.2015.12.340] [Citation(s) in RCA: 956] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022]
Abstract
CONTEXT Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade. OBJECTIVES The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer. METHODS A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence. RESULTS Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients. CONCLUSION Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.
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Affiliation(s)
- Marieke H J van den Beuken-van Everdingen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Laura M J Hochstenbach
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Health Services Research, Maastricht University (UM), Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; School of Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Research and Education, Center of Expertise for Chronic Organ Failure, CIRO+, Horn, The Netherlands
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van den Beuken-van Everdingen MH, de Graeff A, Jongen JL, Dijkstra D, Mostovaya I, Vissers KC. Pharmacological Treatment of Pain in Cancer Patients: The Role of Adjuvant Analgesics, a Systematic Review. Pain Pract 2016; 17:409-419. [DOI: 10.1111/papr.12459] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Marieke H.J. van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Anaesthesiology and Pain Management; Maastricht University Medical Centre; Maastricht the Netherlands
| | - Alexander de Graeff
- Department of Internal Medicine; University Medical Centre; Utrecht the Netherlands
| | - Joost L.M. Jongen
- Department of Neurology; Erasmus Medical Centre; Rotterdam the Netherlands
| | | | - Irina Mostovaya
- Knowledge Institute of Medical Specialists; Federation of Medical Specialists; Utrecht the Netherlands
| | - Kris C. Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboud University Medical Centre; Nijmegen the Netherlands
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