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Painter JT, McLeroy-Charles K, Moore H, Harrington S, Dayer LE. Outpatient Patient Controlled Analgesia (PCA) for the Palliative Care Patient. J Pain Palliat Care Pharmacother 2024:1-6. [PMID: 39102589 DOI: 10.1080/15360288.2024.2383415] [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: 02/01/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
This study explores the under-researched domain of patient-controlled analgesia (PCA) for cancer pain management in adult outpatients, focusing on the transition from patient-controlled analgesia pumps (PCA pump) to oral medications. While existing literature primarily addresses the use of PCA in inpatient settings, this descriptive study investigates the initiation of outpatient PCA in palliative care patients. The retrospective chart review includes data from all admissions between July 1, 2014, and December 31, 2020. Among the 49 identified patients, 41 were admitted for cancer-related pain, with an indication for PCA such as insufficient pain relief, highly fluctuating pain, or inadequate response to other routes. Of these patients, 13 were successfully transitioned from outpatient PCA to oral opioids. The study underscores the effective use of PCA as a transitional tool following a pain crisis that necessitates inpatient admission. Future research avenues could explore healthcare utilization, length of stay, and required outpatient resources, such as home visits or telehealth, for optimal PCA use in outpatient settings.
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Affiliation(s)
- Jacob T Painter
- Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kennede McLeroy-Charles
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather Moore
- Division of Palliative Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Harrington
- Division of Palliative Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsey E Dayer
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Wang H, Kwok WH, Yao LQ, Liu XL, Bressington D, Chen ML, Huang HQ, Wang T, Tan JYB. An evidence-based breathing exercise intervention for chronic pain management in breast cancer survivors: A phase II randomized controlled trial. Eur J Oncol Nurs 2024; 71:102625. [PMID: 38897104 DOI: 10.1016/j.ejon.2024.102625] [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] [Received: 03/25/2024] [Revised: 05/17/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Explore the preliminary effects of a breathing exercise (BE) intervention on chronic pain among breast cancer survivors. METHODS This two-parallel-arm, open-label pilot randomized controlled trial recruited 72 breast cancer survivors who were randomly allocated to either the control or intervention group (n = 36 each). Both groups received usual care and a pain information booklet, while the intervention group received 4 weeks of additional BE. The primary clinical outcome was measured using the Brief Pain Inventory (BPI), with secondary clinical outcomes measured by the Hospital Anxiety and Depression Scale (HADS), Quality of Life Patient/Cancer Survivor Version in Chinese (QOLCSV-C), and Functional Assessment of Cancer Therapy- Breast (FACT-B) immediately post-intervention and at 4-week follow-up. Both adjusted and unadjusted Generalized Estimating Equation models were utilized to assess the BE's potential effects, with safety assessed through participant self-report. RESULTS Sixty-eight participants completed the study. Statistical significance was observed in BPI in both adjusted and unadjusted models at post-intervention and follow-up (p < 0.05). BE demonstrated positive effects on anxiety, depression and quality of life improvement across all measures and timepoints in both adjusted and unadjusted models (p < 0.05). The effect sizes were smaller in the adjusted model. Three mild transient discomforts were reported associated with BE practice including dizziness, tiredness and yawning, without requirement of medical treatment. No severe adverse events occurred. CONCLUSION This BE intervention appears effective in alleviating chronic pain, anxiety and depression, and improving quality of life for breast cancer survivors. Fully powered large-scale studies are required to confirm its effects.
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Affiliation(s)
- Haiying Wang
- School of Nursing (Brisbane Centre), Faculty of Health, Charles Darwin University, Brisbane, QLD, Australia; School of Nursing and Midwifery & Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Wai Hang Kwok
- School of Nursing and Midwifery, Edith Cowan University, WA, Australia; School of Nursing, Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, NT, Australia
| | - Li-Qun Yao
- College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou City, Fujian Province, China
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong SAR, China
| | - Daniel Bressington
- School of Nursing, Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, NT, Australia; Faculty of Nursing, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Meng-Ling Chen
- Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Hou-Qiang Huang
- Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, China
| | - Tao Wang
- School of Nursing (Brisbane Centre), Faculty of Health, Charles Darwin University, Brisbane, QLD, Australia.
| | - Jing-Yu Benjamin Tan
- School of Nursing and Midwifery & Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
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Schreiber T, Koopmann I, Brandstetter J, Talbot SR, Goldstein L, Hoffmann L, Schildt A, Joksch M, Krause B, Jaster R, Palme R, Zechner D, Vollmar B, Kumstel S. Evidence-Based Severity Assessment of Animal Models for Pancreatic Cancer. Biomedicines 2024; 12:1494. [PMID: 39062067 PMCID: PMC11275077 DOI: 10.3390/biomedicines12071494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Animal models are crucial to preclinical oncological research and drug development. Animal experiments must be performed in accordance with the 3R principles of replacement and reduction, if possible, and refinement where these procedures remain crucial. In addition, European Union legislations demand a continuous refinement approach, as well as pro- and retrospective severity assessment. In this study, an objective databased severity assessment was performed in murine models for pancreatic cancer induced by orthotopic, subcutaneous, or intravenous injection of Panc02 cells. Parameters such as body weight change, distress score, perianal temperature, mouse grimace scale, burrowing, nesting behavior, and the concentration of corticosterone in plasma and its metabolites in feces were monitored during tumor progression. The most important parameters were combined into a score and mapped against a reference data set by the Relative Severity Assessment procedure (RELSA) to obtain the maximum achieved severity for each animal (RELSAmax). This scoring revealed a significantly higher RELSAmax for the orthotopic model than for the subcutaneous and intravenous models. However, compared to animal models such as pancreatitis and bile duct ligation, the pancreatic cancer models are shown to be less severe. Data-based animal welfare assessment proved to be a valuable tool for comparing the severity of differently induced cancer models.
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Affiliation(s)
- Tim Schreiber
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Ingo Koopmann
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Jakob Brandstetter
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Steven R. Talbot
- Institute for Laboratory Animal Science, Preclinical Data Science, Hannover Medical School, 30625 Hannover, Germany;
| | - Lea Goldstein
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Lisa Hoffmann
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Anna Schildt
- Core Facility Multimodal Small Animal Imaging, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Markus Joksch
- Department of Nuclear Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (M.J.); (B.K.)
| | - Bernd Krause
- Department of Nuclear Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (M.J.); (B.K.)
| | - Robert Jaster
- Division of Gastroenterology, Department of Medicine II, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Rupert Palme
- Unit of Experimental Endocrinology, Department of Biological Sciences and Pathobiology, University of Veterinary Medicine, 1210 Vienna, Austria;
| | - Dietmar Zechner
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Brigitte Vollmar
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
| | - Simone Kumstel
- Rudolf-Zenker-Institute of Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (T.S.); (I.K.); (J.B.); (L.G.); (L.H.); (D.Z.); (B.V.)
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Fulcrand J, Delvoye-Heiremans J, Lemaire A. [Optimal pain management for cancer patients with chronic renal failure]. Bull Cancer 2024; 111:754-764. [PMID: 36732141 DOI: 10.1016/j.bulcan.2022.12.008] [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] [Received: 07/13/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023]
Abstract
The management of multimorphic cancer pain is a major supportive care in oncology, for which many national and international recommendations have recently been updated. Any cancer patient must benefit from access to supportive care from the diagnosis, throughout the entire care pathway. Chronic renal failure, from any etiology, requires special attention and constant attention to details from interdisciplinary caregivers' teams to propose the best analgesic therapeutic strategy, combining complementary and interventional approaches to treatments. Analgesic therapies, in particular opioids and antineuropathics, require specific precautions. A therapeutic alliance integrating clinical pharmacy as a supportive care in its own right, is a major asset allowing the optimization and securing of analgesic drug treatments, conditioning both their efficacy, their tolerance and therapeutic observance, in the goal of improving the patient's quality of life.
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Affiliation(s)
- Julie Fulcrand
- UF pharmacie clinique, pôle cancérologie & spécialités médicales, centre hospitalier de Valenciennes, Valenciennes, France
| | - Julie Delvoye-Heiremans
- UF pharmacie clinique, pôle cancérologie & spécialités médicales, centre hospitalier de Valenciennes, Valenciennes, France
| | - Antoine Lemaire
- Département interdisciplinaire de soins de support pour le patient oncologique, pôle cancérologie & spécialités médicales, centre hospitalier de Valenciennes, Valenciennes, France.
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5
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Aapro M, Fogli S, Morlion B, Danesi R. Opioid metabolism and drug-drug interaction in cancer. Oncologist 2024:oyae094. [PMID: 38780124 DOI: 10.1093/oncolo/oyae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
Concomitant use of multiple drugs in most patients with cancer may result in drug-drug interactions (DDIs), potentially causing serious adverse effects. These patients often experience unrelieved cancer-related pain (CRP) during and after cancer treatment, which can lead to a reduced quality of life. Opioids can be used as part of a multimodal pain management strategy when non-opioid analgesics are not providing adequate pain relief, not tolerated, or are contraindicated. However, due to their narrow therapeutic window, opioids are more susceptible to adverse events when a DDI occurs. Clinically relevant DDIs with opioids are usually pharmacokinetic, mainly occurring via metabolism by cytochrome P450 (CYP). This article aims to provide an overview of potential DDIs with opioids often used in the treatment of moderate-to-severe CRP and commonly used anticancer drugs such as chemotherapeutics, tyrosine kinase inhibitors (TKIs), or biologics. A DDI-checker tool was used to contextualize the tool-informed DDI assessment outcomes with clinical implications and practice. The findings were compared to observations from a literature search conducted in Embase and PubMed to identify clinical evidence for these potential DDIs. The limited results mainly included case studies and retrospective reviews. Some potential DDIs on the DDI-checker were aligned with literature findings, while others were contradictory. In conclusion, while DDI-checkers are useful tools in identifying potential DDIs, it is necessary to incorporate literature verification and comprehensive clinical assessment of the patient before implementing tool-informed decisions in clinical practice.
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Affiliation(s)
- Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, 1272 Genolier, Switzerland
| | - Stefano Fogli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa PI, Italy
| | - Bart Morlion
- Department of Cardiovascular Sciences, Section Anesthesiology and Algology, University of Leuven, 3000 Leuven, Belgium
| | - Romano Danesi
- Department of Oncology and Hemato-Oncology, University of Milano, 20122 Milano MI, Italy
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Reis PS, Kraychete DC, Pedreira EDM, Barreto ESR, Antunes Júnior CR, Alencar VB, Souza AKDN, Lins-Kusterer LEF, Azi LMTDA. Transdermal Opioids and the Quality of Life of the Cancer Patient: A Systematic Literature Review. Ann Pharmacother 2024:10600280241247363. [PMID: 38659244 DOI: 10.1177/10600280241247363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This systematic literature review aims to evaluate the effectiveness of transdermal opioids in managing cancer pain and their impact on the quality of life (QoL) of patients. DATA SOURCES A systematic literature review conducted following the PRISMA protocol, focusing on randomized clinical trials found in the Lilacs, Embase, PubMed, and SciELO databases over the last 20 years. STUDY SELECTION AND DATA EXTRACTION We included randomized clinical trials, published in English, Portuguese, or Spanish, which assessed the impact of transdermal opioids on the QoL. Data extraction was facilitated using the Rayyan app. DATA SYNTHESIS Six articles meeting the inclusion and exclusion criteria were analyzed. These studies covered a population ranging from 24 to 422 cancer patients experiencing moderate to severe pain. The risk of bias was assessed in each study, generally being categorized as uncertain or high. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The findings indicate that the analgesic effectiveness and side effects of transdermal formulations (specifically buprenorphine and fentanyl) for managing moderate to severe cancer pain are comparable to, or in some cases superior to, those of oral opioids traditionally employed. CONCLUSIONS Transdermal therapy was suggested to have several advantages over oral opioid therapy in enhancing cancer patients' QoL. These benefits span various dimensions, including pain management, physical functioning, mental health, vitality, overall patient improvement, anger/aversion, strength/activity, general QoL, cognitive and emotional functions, fatigue, and insomnia.
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7
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Zhang J, Ma K, Yan J, Pan P, Yin J, Lin F, Chen H, Zhao W, Chen M, Zhang Z, Liu M, Gu X, Liao X, Zhang C, Cheng W. Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey. J Pain Res 2024; 17:1413-1422. [PMID: 38618294 PMCID: PMC11015849 DOI: 10.2147/jpr.s452605] [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: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. Methods From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. Results A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Conclusion Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.
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Affiliation(s)
- Jing Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Ke Ma
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jun Yan
- Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Pingsheng Pan
- Department of Oncology, Fangta Hospital of Traditional Chinese Medicine in Songjiang District, Shanghai, People’s Republic of China
| | - Jiangshan Yin
- Department of Oncology, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai, People’s Republic of China
| | - Fuqing Lin
- Department of Anaesthesiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Weiwei Zhao
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Menglei Chen
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhe Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Minghui Liu
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoli Gu
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xinghe Liao
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Chenyue Zhang
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Wenwu Cheng
- Department of Integrated Therapy, Shanghai Cancer Center, Fudan University, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Chang CY, Jones BL, Hincapie-Castillo JM, Park H, Heldermon CD, Diaby V, Wilson DL, Lo-Ciganic WH. Association between trajectories of prescription opioid use and risk of opioid use disorder and overdose among US nonmetastatic breast cancer survivors. Breast Cancer Res Treat 2024; 204:561-577. [PMID: 38191684 DOI: 10.1007/s10549-023-07205-6] [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] [Received: 03/03/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To examine the association between prescription opioid use trajectories and risk of opioid use disorder (OUD) or overdose among nonmetastatic breast cancer survivors by treatment type. METHODS This retrospective cohort study included female nonmetastatic breast cancer survivors with at least 1 opioid prescription fill in 2010-2019 Surveillance, Epidemiology and End Results linked Medicare data. Opioid mean daily morphine milligram equivalents (MME) calculated within 1.5 years after initiating active breast cancer therapy. Group-based trajectory models identified distinct opioid use trajectory patterns. Risk of time to first OUD/overdose event within 1 year after the trajectory period was calculated for distinct trajectory groups using Cox proportional hazards models. Analyses were stratified by treatment type. RESULTS Four opioid use trajectories were identified for each treatment group. For 38,030 survivors with systemic endocrine therapy, 3 trajectories were associated with increased OUD/overdose risk compared with early discontinuation: minimal dose (< 5 MME; adjusted hazard ratio [aHR] = 1.73 [95% CI 1.43-2.09]), very low dose (5-25 MME; 2.67 [2.05-3.48]), and moderate dose (51-90 MME; 6.20 [4.69-8.19]). For 9477 survivors with adjuvant chemotherapy, low-dose opioid use was associated with higher OUD/overdose risk (aHR = 7.33 [95% CI 2.52-21.31]) compared with early discontinuation. For 3513 survivors with neoadjuvant chemotherapy, the differences in OUD/OD risks across the 4 trajectories were not significant. CONCLUSIONS Among Medicare nonmetastatic breast cancer survivors receiving systemic endocrine therapy or adjuvant chemotherapy, compared with early discontinuation, low-dose or moderate-dose opioid use were associated with six- to sevenfold higher OUD/overdose risk. Breast cancer survivors at high-risk of OUD/overdose may benefit from targeted interventions (e.g., pain clinic referral).
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Affiliation(s)
- Ching-Yuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Bobby L Jones
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | | | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Coy D Heldermon
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Wei-Hsuan Lo-Ciganic
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA.
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, USA.
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, USA.
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Costa AR, Tavares I, Martins I. How do opioids control pain circuits in the brainstem during opioid-induced disorders and in chronic pain? Implications for the treatment of chronic pain. Pain 2024; 165:324-336. [PMID: 37578500 DOI: 10.1097/j.pain.0000000000003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT Brainstem areas involved in descending pain modulation are crucial for the analgesic actions of opioids. However, the role of opioids in these areas during tolerance, opioid-induced hyperalgesia (OIH), and in chronic pain settings remains underappreciated. We conducted a revision of the recent studies performed in the main brainstem areas devoted to descending pain modulation with a special focus on the medullary dorsal reticular nucleus (DRt), as a distinctive pain facilitatory area and a key player in the diffuse noxious inhibitory control paradigm. We show that maladaptive processes within the signaling of the µ-opioid receptor (MOR), which entail desensitization and a switch to excitatory signaling, occur in the brainstem, contributing to tolerance and OIH. In the context of chronic pain, the alterations found are complex and depend on the area and model of chronic pain. For example, the downregulation of MOR and δ-opioid receptor (DOR) in some areas, including the DRt, during neuropathic pain likely contributes to the inefficacy of opioids. However, the upregulation of MOR and DOR, at the rostral ventromedial medulla, in inflammatory pain models, suggests therapeutic avenues to explore. Mechanistically, the rationale for the diversity and complexity of alterations in the brainstem is likely provided by the alternative splicing of opioid receptors and the heteromerization of MOR. In conclusion, this review emphasizes how important it is to consider the effects of opioids at these circuits when using opioids for the treatment of chronic pain and for the development of safer and effective opioids.
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Affiliation(s)
- Ana Rita Costa
- Department of Biomedicine, Unit of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
- IBMC-Institute of Molecular and Cell Biology, University of Porto, Porto, Portugal
- I3S- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal. Costa is now with the Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden and Science for Life Laboratory, Solna, Sweden
| | - Isaura Tavares
- Department of Biomedicine, Unit of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
- IBMC-Institute of Molecular and Cell Biology, University of Porto, Porto, Portugal
- I3S- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal. Costa is now with the Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden and Science for Life Laboratory, Solna, Sweden
| | - Isabel Martins
- Department of Biomedicine, Unit of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
- IBMC-Institute of Molecular and Cell Biology, University of Porto, Porto, Portugal
- I3S- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal. Costa is now with the Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden and Science for Life Laboratory, Solna, Sweden
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10
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Yang X, Liang B, Xue D, Liang J, Zaslawski C, Chen J. Global research trends in acupuncture for cancer pain: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e34739. [PMID: 37832094 PMCID: PMC10578673 DOI: 10.1097/md.0000000000034739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/24/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND In recent years, acupuncture has gained popularity in the management of cancer-related pain (CRP). This study aims to use bibliometric analysis to investigate the historical development, recent hotspots and research trends in this field. METHODS The Web of Science Core Collection database was selected as the data source for this study to retrieve and obtain literature related to acupuncture and CRP. Data analyses were performed with CiteSpace and VOSviewer to conduct the bibliometric analysis. RESULTS This bibliometric analysis was conducted from 2000 to 2022. A total of 664 publications were included in this work. The number of publications has steadily increased over the last 2 decades. The United States has the largest number of published articles (244 papers), while the People's Republic of China has the highest centrality (0.48). The primary research institutions were Memorial Sloan-Kettering Cancer Center, Kyung Hee University and Beijing University of Chinese Medicine. Mao Jun J. was the most prolific author, while Heather Greenlee was the most cited one. The most productive journal was Integrative Cancer Therapies. The most frequent keywords excluding the search subject were "electroacupuncture," "management," "quality of life," "breast cancer," "Aromatase inhibitor," "neuropathic pain," "mechanisms," and "protocol." CONCLUSION This study explored the application value of acupuncture in the management of CRP with bibliometric analysis, offering an intuitive understanding of this topic and revealing the hotspots and research trends.
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Affiliation(s)
- Xia Yang
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bing Liang
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Demin Xue
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Liang
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chris Zaslawski
- Faculty of Science, University of Technology, Sydney, New South Wales, Australia
| | - Ji Chen
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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11
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Szymoniuk M, Chin JH, Domagalski Ł, Biszewski M, Jóźwik K, Kamieniak P. Brain stimulation for chronic pain management: a narrative review of analgesic mechanisms and clinical evidence. Neurosurg Rev 2023; 46:127. [PMID: 37247036 PMCID: PMC10227133 DOI: 10.1007/s10143-023-02032-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
Chronic pain constitutes one of the most common chronic complaints that people experience. According to the International Association for the Study of Pain, chronic pain is defined as pain that persists or recurs longer than 3 months. Chronic pain has a significant impact on individuals' well-being and psychosocial health and the economy of healthcare systems as well. Despite the availability of numerous therapeutic modalities, treatment of chronic pain can be challenging. Only about 30% of individuals with non-cancer chronic pain achieve improvement from standard pharmacological treatment. Therefore, numerous therapeutic approaches were proposed as a potential treatment for chronic pain including non-opioid pharmacological agents, nerve blocks, acupuncture, cannabidiol, stem cells, exosomes, and neurostimulation techniques. Although some neurostimulation methods such as spinal cord stimulation were successfully introduced into clinical practice as a therapy for chronic pain, the current evidence for brain stimulation efficacy in the treatment of chronic pain remains unclear. Hence, this narrative literature review aimed to give an up-to-date overview of brain stimulation methods, including deep brain stimulation, motor cortex stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, cranial electrotherapy stimulation, and reduced impedance non-invasive cortical electrostimulation as a potential treatment for chronic pain.
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Affiliation(s)
- Michał Szymoniuk
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Jia-Hsuan Chin
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Łukasz Domagalski
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland.
| | - Mateusz Biszewski
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Jóźwik
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
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12
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Yeh PH, Yeh HW, Yang SF, Wang YH, Chou MC, Tsai PK, Yeh CB. No association of postoperative opioid usage with long-term surgery outcomes in patients with liver cancer: a population-based retrospective cohort study. Pain 2023; 164:848-854. [PMID: 36083196 DOI: 10.1097/j.pain.0000000000002776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hepatocellular carcinoma (HCC) is a fatal cancer worldwide, and surgical resection remains the standard treatment. Postoperative opioid prescription has been believed to affect cancer recurrence through complex biological pathways. We conducted a retrospective cohort study using the Longitudinal Health Insurance Database of Taiwan to evaluate the relationship between postoperative opioid use and long-term surgical outcomes of patients with HCC. This study had a retrospective cohort design. In total, 812 patients older than 20 years who underwent hepatectomy because of HCC were included. The exposure group comprised patients who used opioids during hospitalization postoperatively. The comparison group included those who never used opioids during hospitalization postoperatively. A Cox proportional hazards model was used to evaluate the overall survival or recurrence-free survival rate between the opioid group and the nonopioid group. A total of 530 patients received opioids postoperatively and 282 patients did not. The hazard ratios of overall survival and recurrence-free survival were 1.10 (95% confidence interval [CI], 0.85-1.41) and 1.15 (95% CI, 0.91-1.46), respectively. Total postoperative opioids were converted into oral morphine milligram equivalents and then divided into 3 equal subgroups: low dose, <40 mg; medium dose, 40 to 144 mg; and high dose, ≥145 mg. The hazard ratios of overall survival were 0.88 (95% CI, 0.63-1.24) for the low-dose group, 1.27 (95% CI, 0.92-1.74) for the medium-dose group, and 1.14 (95% CI, 0.83-1.58) for the high-dose group. Postoperative opioids do not affect overall and recurrence-free survival in patients undergoing hepatectomy or liver transplantation because of HCC. Cancer recurrence should not be a clinical concern regarding postoperative opioid prescription.
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Affiliation(s)
- Pin-Hung Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Anesthesiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Medical Education Department, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ping-Kun Tsai
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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13
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Batistaki C, Graczyk M, Janecki M, Lewandowska AA, Moutinho R, Vagdatli K. Relationship between breakthrough cancer pain, background cancer pain and analgesic treatment - case series and review of the literature. Drugs Context 2022; 11:dic-2022-9-4. [PMID: 36660261 PMCID: PMC9828877 DOI: 10.7573/dic.2022-9-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
The assessment and treatment of breakthrough cancer pain (BTcP) remain a major challenge in medicine due to its high impact on several aspects of health-related quality of life. BTcP should be carefully monitored in all cancer care settings by a multidisciplinary team to provide an appropriate and personalized clinical approach. The aim of this paper is to provide healthcare professionals involved in cancer pain management with a review of the relevant literature on the relationship between background cancer pain and BTcP which, by definition, occurs despite adequately controlled background cancer pain. The clinical cases presented contribute to a better understanding of this issue and underline its impact in daily clinical practice. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.
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Affiliation(s)
| | - Michal Graczyk
- Department of Palliative Care, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Marcin Janecki
- Department of Palliative Care and Palliative Medicine, Medical University of Silesia, Katowice, Poland
| | | | - Rita Moutinho
- Multidisciplinary Pain Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Porto, Portugal
| | - Kiriaki Vagdatli
- Anaesthesia Department General Hospital of Athens “G. Gennimatas”, Athens, Greece
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14
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Practical Considerations for the Use of Cannabis in Cancer Pain Management—What a Medical Oncologist Should Know. J Clin Med 2022; 11:jcm11175036. [PMID: 36078963 PMCID: PMC9457511 DOI: 10.3390/jcm11175036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/29/2022] Open
Abstract
Pain is a highly debilitating emotional and sensory experience that significantly affects quality of life (QoL). Numerous chronic conditions, including cancer, are associated with chronic pain. In the setting of malignancy, pain can be a consequence of the tumor itself or of life-saving interventions, including surgery, chemotherapy, and radiotherapy. Despite significant pharmacological advances and awareness campaigns, pain remains undertreated in one-third of patients. To date, opioids have been the mainstay of cancer pain management. The problematic side effects and unsatisfactory pain relief of opioids have revived patients’ and physicians’ interest in finding new solutions, including cannabis and cannabinoids. The medical use of cannabis has been prohibited for decades, and it remains in Schedule 1 of the Misuse of Drugs Regulations. Currently, the legal context for its usage has become more permissive. Various preclinical and observational studies have aimed to prove that cannabinoids could be effective in cancer pain management. However, their clinical utility must be further supported by high-quality clinical trials.
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15
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Azmanov H, Bayatra A, Ilan Y. Digital Analgesic Comprising a Second-Generation Digital Health System: Increasing Effectiveness by Optimizing the Dosing and Minimizing Side Effects. J Pain Res 2022; 15:1051-1060. [PMID: 35444460 PMCID: PMC9013915 DOI: 10.2147/jpr.s356319] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/02/2022] [Indexed: 12/30/2022] Open
Abstract
Opioids remain an essential part of the treatment of chronic pain. However, their use and increasing rates of misuse are associated with high morbidity and mortality. The development of tolerance to opioids and analgesics further complicates dosing and the need to reduce side effects. First-generation digital systems were developed to improve analgesics but are not always capable of making clinically relevant associations and do not necessarily lead to better clinical efficacy. A lack of improved clinical outcomes makes these systems less applicable for adoption by clinicians and patients. There is a need to enhance the therapeutic regimens of opioids. In the present paper, we present the use of a digital analgesic that consists of an analgesic administered under the control of a second-generation artificial intelligence system. Second-generation systems focus on improved patient outcomes measured based on clinical response and reduced side effects in a single subject. The algorithm regulates the administration of analgesics in a personalized manner. The digital analgesic provides advantages for both users and providers. The system enables dose optimization, improving effectiveness, and minimizing side effects while increasing adherence to beneficial therapeutic regimens. The algorithm improves the clinicians’ experience and assists them in managing chronic pain. The system reduces the financial burden on healthcare providers by lowering opioid-related morbidity and provides a market disruptor for pharma companies.
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Affiliation(s)
- Henny Azmanov
- Hebrew University, Faculty of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Areej Bayatra
- Hebrew University, Faculty of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Yaron Ilan
- Hebrew University, Faculty of Medicine, Hadassah Medical Center, Jerusalem, Israel
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16
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Lemaire A, Rodriguez J. Cancer pain is over! (If you want it). Support Care Cancer 2022; 30:5571-5575. [PMID: 35192059 DOI: 10.1007/s00520-022-06894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antoine Lemaire
- Oncology and Medical Specialties Department, Valenciennes General Hospital, Valenciennes, France.
| | - José Rodriguez
- Head & Neck Cancer Unit, Valenciennes General Hospital, Valenciennes, France
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17
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Marinangeli F, Saetta A, Lugini A. Current management of cancer pain in Italy: Expert opinion paper. Open Med (Wars) 2021; 17:34-45. [PMID: 34950771 PMCID: PMC8651060 DOI: 10.1515/med-2021-0393] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/20/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic pain and breakthrough cancer pain (BTcP) have a high prevalence in all cancer types and cancer stages, combined with a significant physical, psychological, and economic burden. Despite efforts to improve appropriate management of cancer pain, a poor assessment and guilty undertreatment are still reported in many countries. The purpose of this expert opinion paper is to contribute to reduce and clarify these issues with a multidisciplinary perspective in order to share virtuous paths of care. Methods Common questions about cancer pain assessment and treatment were submitted to a multidisciplinary pool of Italian clinicians and the results were subsequently discussed and compared with the findings of the published literature. Conclusion Despite a dedicated law in Italy and effective treatments available, a low percentage of specialists assess pain and BTcP, defining the intensity with validated tools. Moreover, in accordance with the findings of the literature in many countries, the undertreatment of cancer pain is still prevalent. A multidisciplinary approach, more training programs for clinicians, personalised therapy drug formulations, and virtuous care pathways will be essential to improve cancer pain management.
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Affiliation(s)
- Franco Marinangeli
- Department of Anesthesiology Intensive Care and Pain Treatment, University of L'Aquila, Località Coppito, Piazzale Salvatore Tommasi, 1-67100, L'Aquila, Italy
| | - Annalisa Saetta
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, 20089 Rozzano (Milan), Italy
| | - Antonio Lugini
- Department of Oncology, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
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18
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[The management of multimorphic cancer pain, from diagnosis to treatment]. Bull Cancer 2021; 109:537-547. [PMID: 34848047 DOI: 10.1016/j.bulcan.2021.08.013] [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: 05/11/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
Cancer pain remains a major public health issue. Despite progress in pain medicine thanks to the interest shown in early and timely supportive care, more than half the patients managed for cancer are in pain. One of the key factors in high quality multidisciplinary management throughout the care pathway is to assess more than just pain: it is necessary to assess the patient as a whole. Understanding the complexity of cancer pain - or the various types of pain - through the innovative multimorphic cancer pain model, effectively opens up new perspectives for a targeted, personalised, and multimodal approach. The subsequent treatment strategies, whether drug-based with opioids, or interventional, are codified by guidelines based on scientific evidence for the healthcare professionals and, ultimately, patients.
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19
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Bleicher J, Stokes SM, Brooke BS, Glasgow RE, Huang LC. Patient-centered Opioid Prescribing: Breaking Away From One-Size-Fits-All Prescribing Guidelines. J Surg Res 2021; 264:1-7. [PMID: 33744772 PMCID: PMC8222090 DOI: 10.1016/j.jss.2021.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Procedure-based opioid-prescribing guidelines have reduced the amount of opioids prescribed after surgery; however, many patients are still overprescribed opioids. The 24-h predischarge opioid consumption (PDOC) metric has been proposed to guide patient-centered prescribing. MATERIALS AND METHODS This is a single-institution, retrospective study of patients who underwent major abdominal surgery. We assessed the correlation between inpatient opioid use and discharge prescriptions using morphine milligram equivalents (MMEs). The adequacy of discharge prescriptions for individual patients was assessed using 2 models, one assuming constant opioid use (based on 24-h PDOC) and the other assuming a linear taper. RESULTS Of 596 included patients, gastric bypass and colectomy were the most common operations. Median length of stay was 3.5 d. Inpatient opioid use and discharge prescriptions were weakly correlated (r = 0.35). Patients with no opioid use 24 h before discharge (n = 133, 22.3%) were frequently discharged with opioid prescriptions. Patients with high opioid use (24-h PDOC >60 MME) were often discharged with prescriptions that would have lasted <48 h (164/200, 82%). Assuming constant opioid use, discharge prescriptions would have lasted patients a median of 5.1 d. With linear opioid tapering, 440 (72.9%) patients would have had leftover pills. A theoretical discharge prescription of 4 times 24-h PDOC would reduce the median prescription by 130 MMEs and allow a linear taper for 97.6% of patients. CONCLUSIONS At our institution, opioid prescribing was rarely patient-centered, with little correlation between patient's inpatient opioid use and discharge prescriptions. This leads to overprescribing for most patients and underprescribing for others.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Sean M Stokes
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah
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20
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Li DH, Su YF, Fan HF, Guo N, Sun CX. Acupuncture Combined with Three-Step Analgesic Drug Therapy for Treatment of Cancer Pain: A Systematic Review and Meta-Analysis of Randomised Clinical Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5558590. [PMID: 34349826 PMCID: PMC8328698 DOI: 10.1155/2021/5558590] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study was to systematically evaluate the efficacy and safety of acupuncture combined with the WHO three-step analgesic drug ladder for cancer pain. METHODS The Cochrane Library, PubMed, and CNKI Database of Systematic Reviews were searched. Using the Cochrane Register for Randomized Controlled Trials, the quality of the included literature was evaluated, and the meta-analysis was carried out with RevMan 5.3 software. RESULTS Compared with three-step analgesia alone, acupuncture combined with three-step analgesia for cancer pain increased pain relief response rates (RR = 1.12, 95% CI: 1.08∼1.17, P < 0.00001), reduced NRS score (SMD = -1.10, 95% CI: -1.86∼-0.35, P=0.004), reduced the rate of side effects (RR = 0.45, 95% CI: 0.38∼0.53, P < 0.00001), including nausea (P < 0.00001), vomiting (P=0.008), constipation (P < 0.00001), and dizziness (P=0.010), reduced the burst pain rate (SMD = -1.38; 95% CI: -2.44∼-0.32, P=0.01), shortened analgesia effect onset time (P=0.004), and extended the duration of response (P < 0.0001). CONCLUSION For the treatment of cancer pain, acupuncture combined with three-step analgesic drugs is better than using only three-step analgesic drugs.
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Affiliation(s)
- De-hui Li
- Hebei Province Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050011, China
| | - Yi-fan Su
- Hebei Province Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050011, China
- Graduate School of Hebei University of Chinese Medicine, Shijiazhuang 050091, China
| | - Huan-fang Fan
- Hebei Province Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050011, China
| | - Na Guo
- Hebei Province Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050011, China
| | - Chun-xia Sun
- Hebei Province Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050011, China
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Abstract
PURPOSE OF REVIEW An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options. RECENT FINDINGS The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated. SUMMARY All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
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Lemaire A. Beliefs and ignorance: two enemies of supportive care in cancer. Support Care Cancer 2020; 28:965-966. [PMID: 31897781 DOI: 10.1007/s00520-019-05263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Antoine Lemaire
- Oncology and medical specialties department, Valenciennes General Hospital, Valenciennes, France.
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