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Gao H, Dong G, Yao Y, Yang H. Identification and validation of aging-related genes in neuropathic pain using bioinformatics. Front Genet 2024; 15:1430275. [PMID: 39113685 PMCID: PMC11303200 DOI: 10.3389/fgene.2024.1430275] [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: 05/09/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
Background Neuropathic pain (NP) is a debilitating and refractory chronic pain with a higher prevalence especially in elderly patients. Cell senescence considered a key pathogenic factor in NP. The objective of this research is to discover genes associated with aging in peripheral blood of individuals with NP using bioinformatics techniques. Methods Two cohorts (GSE124272 and GSE150408) containing peripheral blood samples of NP were downloaded from the GEO database. By merging the two cohorts, differentially expressed aging-related genes (DE-ARGs) were obtained by intersection with aging-related genes. The potential biological mechanisms of DE-ARGs were further analyzed through GO and KEGG. Three machine learning methods, namely, LASSO, SVM-RFE, and Random Forest, were utilized to identify diagnostic biomarkers. A Nomogram model was developed to assess their diagnostic accuracy. The validation of biomarker expression and diagnostic effectiveness was conducted in three distinct pain cohorts. The CIBERSORT algorithm was employed to evaluate the immune cell composition in the peripheral blood of patients with NP and investigate its association with the expression of diagnostic biomarkers. Results This study identified a total of 24 DE-ARGs, mainly enriched in "Chemokine signaling pathway," "Inflammatory mediator regulation of TRP channels," "HIF-1 signaling pathway" and "FOXO signaling pathway". Three machine learning algorithms identified a total of four diagnostic biomarkers (CEBPA, CEACAM1, BTG3 and IL-1R1) with good diagnostic performance and the similar expression difference trend in different types of pain cohorts. The expression levels of CEACAM1 and IL-1R1 exhibit a positive correlation with the percentage of neutrophils. Conclusion Using machine learning techniques, our research identified four diagnostic biomarkers related to aging in peripheral blood, providing innovative approaches for the diagnosis and treatment of NP.
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Affiliation(s)
| | | | | | - Huayuan Yang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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2
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Giannelos N, Francq B, Curran D. Differential Utility Losses in Herpes Zoster Cases Between Vaccinated and Unvaccinated Subjects: A Meta-analysis of Three Clinical Trials. Clin Drug Investig 2024; 44:293-301. [PMID: 38662318 PMCID: PMC11088541 DOI: 10.1007/s40261-024-01355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Recombinant zoster vaccine (RZV) is approved in adults for the prevention of herpes zoster. The effect of RZV in moderating the severity of breakthrough cases of herpes zoster has been noted but not explicitly quantified before. In this study, a meta-analysis was undertaken to estimate differential utility losses between unvaccinated (Placebo) and vaccinated (RZV) subjects in breakthrough cases of herpes zoster from three RZV clinical trials. METHODS Differential utility losses between the two groups were estimated in units of quality-adjusted life-years (QALYs), leveraging aggregate patient data from the ZOE-50 (NCT01165177), ZOE-70 (NCT01165229), and ZOE-HSCT (NCT01610414) clinical trials. Differential utility losses and the ratio of mean utility losses were analyzed using random-effects and fixed-effects meta-regression models. RESULTS The mean QALY loss differences between the unvaccinated (Placebo) and vaccinated (RZV) groups were 0.008, 0.004, and 0.011 in the ZOE-50, ZOE-70, and ZOE-HSCT studies, respectively, yielding an overall estimated difference of 0.007 (95% confidence interval 0.002-0.012) QALYs. Quality-adjusted life-year loss in the vaccinated group was estimated to be 35.5% of the value in the placebo group. A sensitivity analysis estimated an overall difference of 0.005 (95% confidence interval 0.001-0.009) QALYs, corresponding to 48.6% of the QALY loss value in the placebo group. CONCLUSIONS Recombinant zoster vaccine is effective in alleviating disease severity in breakthrough cases of herpes zoster. The results may be useful in distinguishing QALY losses between vaccinated and unvaccinated cohorts in health economics studies, particularly cost-effectiveness analyses.
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Pickering G, Engelen S, Stupar M, Ganry H, Eerdekens M. Is the Capsaicin 179 mg (8% w/w) Cutaneous Patch an Appropriate Treatment Option for Older Patients with Peripheral Neuropathic Pain? J Pain Res 2024; 17:1327-1344. [PMID: 38560405 PMCID: PMC10981873 DOI: 10.2147/jpr.s435809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Capsaicin 179 mg (8% weight per weight) cutaneous patch ("capsaicin patch") is a recommended topical treatment for peripheral neuropathic pain (PNP). In older patients, topical treatments may be preferred over systemic treatments, but data specific to the older population are scarce. Methods We conducted pooled analyses of multiple clinical trials to evaluate efficacy and safety of capsaicin patch in older patients. The analysis of efficacy included four randomized, double-blind, 12-week studies with similar trial design comparing a single treatment of capsaicin 179 mg cutaneous patch vs low-dose control patch in post-herpetic neuralgia. For the safety evaluation, data were pooled from 18 interventional studies in which capsaicin patch was used in PNP with varying etiologies. Results Capsaicin patch had similar analgesic efficacy in elderly (n=582) and non-elderly patients (n=545) in terms of change from baseline to 2-12 weeks in the 11-point numeric pain rating scale (NPRS) score for average pain over the previous 24 hours. In both age groups, decrease in NPRS score was significantly greater with capsaicin patch vs control. Older patients treated with capsaicin patch were significantly more likely than those in the control group to achieve responder status (ie mean decrease in NPRS score from baseline to week 2-12 of at least 30% or ≥2 points): 36.1% vs 27.1% (odds ratio [OR] [95% CI] 1.52 [1.06, 2.18]; P=0.0231) and 33.1% vs 20.9% (OR [95% CI] 1.90 [1.30, 2.78]; P=0.0009) for active treatment vs control group, respectively. Similar proportions of non-elderly patients (n=2,311) and elderly patients (n=537) treated with capsaicin patch experienced treatment-emergent adverse events (TEAEs) (81.6% and 78.1%, respectively) and serious TEAEs (8.2% and 7.2%), with application-site reactions the most common TEAEs in both groups. Conclusion The capsaicin patch was equally efficacious and well tolerated in older patients as in younger patients.
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Affiliation(s)
- Gisèle Pickering
- Faculty of Medicine Inserm 1107, Clinical Pharmacology Centre, CPC/CIC Inserm 1405 University Hospital, Clermont-Ferrand, France
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Elder NM, Heavey SF, Tyler KR. Emergency Department Pain Management in the Older Adult. Clin Geriatr Med 2023; 39:619-634. [PMID: 37798068 DOI: 10.1016/j.cger.2023.05.012] [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: 10/07/2023]
Abstract
Pain assessment and management in older adults is complex and requires evaluation and consideration of the type of pain, the acuity of the condition, comorbidities, and medications. Many older adults do not receive appropriate therapy for painful conditions in the emergency department (ED). This brief review article is focused on pharmacologic agents, drug-drug interactions, drug-disease interactions, and approaches in the management of painful conditions seen in older adults in the emergency department. Recommendations for specific painful conditions such as fragility fractures are discussed.
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Affiliation(s)
- Natalie M Elder
- University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Sean F Heavey
- University of California Davis, 4150 V Street, Sacramento, CA 95817, USA
| | - Katren R Tyler
- University of California Davis, 4150 V Street, Sacramento, CA 95817, USA.
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Rutkowski K, Wyszatycki M, Ejdys K, Hawryluk NM, Stompór M. Pain and Its Management in Patients Referred to a Geriatric Outpatient Clinic. J Pers Med 2023; 13:1366. [PMID: 37763134 PMCID: PMC10532457 DOI: 10.3390/jpm13091366] [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: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: A major problem affecting geriatric patients is pain. In addition to pain, a significant problem of old age is dementia and depression, which can hinder the diagnosis and treatment of pain. The aim of this study was to analyse the prevalence of pain in patients treated in a geriatric outpatient clinic and the treatment used. (2) Methods: The analysis was based on the records of 937 patients who visited the Geriatric Outpatient Clinic in Dobre Miasto between 2015 and 2020. Based on records containing data dating back to their first visit to the hospital, patients' experiences of pain, the presence of depressive symptoms and dementia, and the pharmacological treatment used for pain (analgesics and coanalgesics) were analysed. (3) Results: Pain complaints were reported by 311 patients (33.2% of the study group), 76% of the complaints were from females. The mean age of the patients was 78 years (SD = 8.45). At least one analgesic drug was taken by 107 patients (34.4%). The most commonly used analgesics were opioids (63 patients, 58.87%), especially tramadol. Of the potential coanalgesics, the largest number of patients used an antidepressant. (4) Conclusions: Despite the widespread prevalence of pain among the elderly, only about one-third of them were taking pain medication, mainly in the form of weak opioids. Patients with symptoms of dementia were found to report pain less frequently.
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Affiliation(s)
- Krzysztof Rutkowski
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
| | - Mateusz Wyszatycki
- Marie Sklodowska-Curie Specialist Hospital in Zgierz, 95-100 Zgierz, Poland
| | - Krystian Ejdys
- Students’ Scientific Group, Department of Cardiology, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Natalia Maria Hawryluk
- The Nicolaus Copernicus Municipal Polyclinical Hospital in Olsztyn, 10-045 Olsztyn, Poland
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Małgorzata Stompór
- Department of Family Medicine and Infectious Diseases, Medical Faculty, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
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Ferreira ACL, Pereira DS, da Silva SLA, Carvalho GA, Pereira LSM. Validity and reliability of the short form brief pain inventory in older adults with nociceptive, neuropathic and nociplastic pain. Geriatr Nurs 2023; 52:16-23. [PMID: 37192570 DOI: 10.1016/j.gerinurse.2023.04.011] [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: 02/12/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the validity and reliability of the Short Form Brief Pain Inventory (SF-BPI) for community-dwelling Brazilian older adults with chronic neuropathic, nociceptive and nociplastic pain. METHODS Cross-sectional psychometric testing was conducted in a convenience sample, n=114 (66.5 ± 4.9 years). RESULTS The 2-factor structure of the SF-BPI was ratified by confirmatory factor analysis. Convergent validity was found between the SF-BPI and the Present Pain Intensity (PPI). There was good overall internal consistency (Cronbach's α: 0.87). Test-retest reliability was excellent for pain intensity and interference scores of the SF-BPI (ICC: 0.90 and 0.96, respectively), as well as inter-rater reliability for both dimensions (ICC: 0.77). CONCLUSION The findings support the validity and reliability of the SF-BPI for community-dwelling older adults with chronic pain and may contribute to health professionals having a brief multidimensional assessment for more effective therapeutic approaches in this population.
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Affiliation(s)
- Ana Carolina Lopes Ferreira
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil; Sarah Network of Rehabilitation Hospitals, Avenida Amazonas, 5953, Gameleira, Belo Horizonte, Minas Gerais, CEP 30180-001, Brazil.
| | - Daniele Sirineu Pereira
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Silvia Lanziotti Azevedo da Silva
- Department of Collective Health/School of Medicine, Federal University of Juiz de Fora, Av. Eugênio do nascimento s/n°, Dom Bosco, Juiz de Fora, Minas Gerais, CEP 36038-330, Brazil
| | - Guilherme Almeida Carvalho
- Sarah Network of Rehabilitation Hospitals, Avenida Amazonas, 5953, Gameleira, Belo Horizonte, Minas Gerais, CEP 30180-001, Brazil
| | - Leani Souza Máximo Pereira
- Department of Physiotherapy, Postgraduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
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7
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Li AHY, Bhatia A, Gulati A, Ottestad E. Role of peripheral nerve stimulation in treating chronic neuropathic pain: an international focused survey of pain medicine experts. Reg Anesth Pain Med 2023; 48:312-318. [PMID: 37080584 DOI: 10.1136/rapm-2022-104073] [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: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 04/22/2023]
Abstract
Interventional pain management (IPM) options for refractory neuropathic pain (NP) have recently increased with availability of peripheral nerve stimulation (PNS) equipment and expertise. Given a lack of high-quality evidence and guidelines on this topic, we sought to understand the perception of physicians with expertise in treating NP regarding IPM and the role of PNS. We emailed a survey in March 2022 to international NP experts including pain medicine physicians, researchers, and leaders of 11 professional pain societies. No representatives from vendors of PNS systems were included in the design of the survey nor as respondents. Among 24 respondents (67% of those contacted), the distal common peroneal, tibial, and sural nerves were most frequently targeted (60%) with PNS. Persistent postsurgical pain of more than 3 months was the most common indication for PNS (84%). The aggregate NP treatment algorithm in order of median rank was non-opioid medications as first line, IPM including epidural/perineural steroid injections tied with transcutaneous electrical nerve stimulation as second line, pulsed radiofrequency (RF) tied with RF ablation/denervation as third line, temporary then permanent PNS as fourth line, followed by spinal cord stimulation, opioids, cryoablation, botulinum, peripheral nerve field stimulation, intrathecal targeted drug delivery, and others. Before offering PNS, 12 respondents (50%) indicated their preference for trialing non-neuromodulation treatments for 1-3 months. Twenty-two respondents (92%) agreed PNS should be offered early in the treatment of neuropathic pain. The most common barriers to PNS use were cost, lack of high-quality evidence in support of its use, lack of exposure to PNS in training programs, and lack of familiarity with the use of ultrasound guidance. PNS appears to have an increasing role in the treatment of NP but more research is needed on the outcomes of PNS to elucidate its role.
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Affiliation(s)
- Alice Huai-Yu Li
- Department of Anesthesia, Stanford University, Stanford, California, USA
| | - Anuj Bhatia
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amit Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Einar Ottestad
- Anesthesiology and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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8
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 358] [Impact Index Per Article: 179.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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9
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Roberts L, Lanes S, Kyte J, Grady J, Holdship J, Carey C, Cooney K, Ramessur S. Acute pain assessments and records: a pilot study of digital transformation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:541-548. [PMID: 35648661 DOI: 10.12968/bjon.2022.31.10.541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pain is a leading cause of disability worldwide. Pain assessments are an essential part of evidence-based care and management. Among comparable care providers, there is variation in how nurses document assessments as well as the content in them, and there is a notable associated administrative burden. AIMS This study evaluated the impact and significance of a new, structured, digitised pain assessment form from quality, safety and efficiency standpoints. METHODS Samples of pain assessments were examined at three consecutive stages: first, the pre-existing form was used, then the new structured form was introduced and, finally, the structured form was taken away and nurses went back to completing the original form. Assessments were scored by two clinical analysts against 18 clinically defined pain-related characteristics and factors. The time taken to extract and interpret the assessments was also recorded. Statistically significant changes were assessed using Welch's t-tests and Fisher's exact tests. FINDINGS There was a significant improvement in data quality using the new structured form compared with the pre-existing template, including an increase in the capture of five safety-related variables. Less time was needed to extract and interpret data with the new form. CONCLUSION Intelligent structured forms are highly effective for documenting pain assessments, and offer notable benefits in quality, safety, and efficiency.
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Affiliation(s)
- Luke Roberts
- Senior Terminologies and Data Services Manager, Clinical Analytics Department; Guy's and St Thomas' NHS Foundation Trust, London
| | - Sadie Lanes
- Trainee Transformation Analyst, Clinical Analytics Department; Guy's and St Thomas' NHS Foundation Trust, London
| | - Jemma Kyte
- Advanced Nurse Practitioner, Inpatient Pain Service; Guy's and St Thomas' NHS Foundation Trust, London
| | - Joanne Grady
- Clinical Nurse Specialist, Inpatient Pain Service; Guy's and St Thomas' NHS Foundation Trust, London
| | - Jonathan Holdship
- Senior Data Scientist, Acute Pain Department; Guy's and St Thomas' NHS Foundation Trust, London
| | - Caroline Carey
- Senior Transformation Change Analyst, Acute Pain Department; Guy's and St Thomas' NHS Foundation Trust, London
| | - Katrina Cooney
- Chief Nursing Information Officer, Chief Nurse's Office; Guy's and St Thomas' NHS Foundation Trust, London
| | - Suneil Ramessur
- Deputy Service Lead Theatres, Anaesthesia and Perioperative, Inpatient Pain Service; Guy's and St Thomas' NHS Foundation Trust, London
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10
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Virnes RE, Tiihonen M, Karttunen N, van Poelgeest EP, van der Velde N, Hartikainen S. Opioids and Falls Risk in Older Adults: A Narrative Review. Drugs Aging 2022; 39:199-207. [PMID: 35288864 PMCID: PMC8934763 DOI: 10.1007/s40266-022-00929-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
Pain treatment is important in older adults but may result in adverse events such as falls. Opioids are effective for nociceptive pain but the evidence for neuropathic pain is weak. Nevertheless, both pain and opioids may increase the risk of falls. This narrative literature review aims to summarize the existing knowledge on the opioid-related fall risk in older adults, including the pharmacokinetics and pharmacodynamics, and assist clinicians in prescribing and deprescribing opioids in older persons. We systematically searched relevant literature on opioid-related fall risk in older adults in PubMed and Scopus in December 2020. We reviewed the literature and evaluated fall-related adverse effects of opioids, explaining how to optimally approach deprescribing of opioids in older adults. Opioid use increases fall risk through drowsiness, (orthostatic) hypotension and also through hyponatremia caused by weak opioids. When prescribing, opioids should be started with low dosages if possible, keeping in mind their metabolic genetic variation. Falls are clinically significant adverse effects of all opioids, and the risk may be dose dependent and highest with strong opioids. The risk is most prominent in older adults prone to falls. To reduce the risk of falls, both pain and the need for opioids should be assessed on a regular basis, and deprescribing or changing to a lower dosage or safer alternative should be considered if the clinical condition allows. Deprescribing should be done by reducing the dosage gradually and by assessing and monitoring the pain and withdrawal symptoms at the same time. Weighing the risks and benefits is necessary before prescribing opioids, especially to older persons at high risk of falls. Clinical decision tools assist prescribers in clinical decisions regarding (de-) prescribing.
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Affiliation(s)
- Roosa-Emilia Virnes
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland. .,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
| | - Niina Karttunen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Eveline P van Poelgeest
- Department of Internal Medicine, Geriatrics, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Natalie van der Velde
- Department of Internal Medicine, Geriatrics, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
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11
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Voute M, Morel V, Pickering G. Topical Lidocaine for Chronic Pain Treatment. Drug Des Devel Ther 2021; 15:4091-4103. [PMID: 34616143 PMCID: PMC8487862 DOI: 10.2147/dddt.s328228] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 12/21/2022] Open
Abstract
Topical lidocaine is widely used in current practice for a variety of pain conditions. This literature review shows that its limited absorption and relative lack of systemic adverse events are an attractive analgesic option for a number of vulnerable patients. Topical lidocaine has been approved by health authorities for the treatment of post-herpetic neuralgia in a number of countries, and studies present some degree of evidence of its efficacy and safety in postsurgical pain, diabetic peripheral neuropathy, carpal tunnel syndrome, chronic lower back pain and osteoarthritis. Topical lidocaine may be a great alternative alone or in addition to systemic drugs and non-pharmacological approaches for an optimized pain management and in multimodal analgesia.
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Affiliation(s)
- Marion Voute
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique - Centre d'Investigation Clinique, CIC Inserm 1405, Clermont-Ferrand, F-63000, France
| | - Véronique Morel
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique - Centre d'Investigation Clinique, CIC Inserm 1405, Clermont-Ferrand, F-63000, France
| | - Gisèle Pickering
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique - Centre d'Investigation Clinique, CIC Inserm 1405, Clermont-Ferrand, F-63000, France.,Université Clermont Auvergne, Inserm 1107, Clermont-Ferrand, F-63000, France
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12
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Serrano Afonso A, Carnaval T, Videla Cés S. Combination Therapy for Neuropathic Pain: A Review of Recent Evidence. J Clin Med 2021; 10:jcm10163533. [PMID: 34441829 PMCID: PMC8396869 DOI: 10.3390/jcm10163533] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 12/19/2022] Open
Abstract
Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new independent review to assess whether more and better-quality evidence has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded randomized controlled trials involving only adult participants and comparing combination therapy (CT: ≥2 drugs) with a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze.
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Affiliation(s)
- Ancor Serrano Afonso
- Department of Anesthesiology, Resuscitation and Pain Management, Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain
- Correspondence:
| | - Thiago Carnaval
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain;
| | - Sebastià Videla Cés
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain;
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13
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Pedowitz EJ, Abrams RMC, Simpson DM. Management of Neuropathic Pain in the Geriatric Population. Clin Geriatr Med 2021; 37:361-376. [PMID: 33858616 DOI: 10.1016/j.cger.2021.01.008] [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] [Indexed: 11/16/2022]
Abstract
Neuropathic pain is common in the geriatric population. Diagnosis requires a thorough history and physical examination to differentiate it from other types of pain. Once diagnosed, further workup is required to elucidate the cause, including potential reversible causes of neuropathy. When treating neuropathic pain in the elderly, it is important to consider patients' comorbidities and other medications to avoid drug-drug interactions and iatrogenic effects given the physiologic changes of drug metabolism in the elderly. Nonsystemic therapies and topical medications should be considered. Systemic medications should be started at low dose and titrated up slowly with frequent monitoring for adverse effects.
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Affiliation(s)
- Elizabeth J Pedowitz
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg, 10th Floor, New York, NY 10029, USA.
| | - Rory M C Abrams
- Department of Neurology, Division of Neuromuscular Diseases and Clinical Neurophysiology Laboratories, Icahn School of Medicine at Mount Sinai, 1000 Tenth Avenue, 10th Floor Suite 10C, New York, NY 10019, USA
| | - David M Simpson
- Department of Neurology Division of Neuromuscular Diseases and Clinical Neurophysiology Laboratories, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg, 2nd Floor, Box 1052, New York, NY 10029, USA
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14
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Giovannini S, Coraci D, Brau F, Galluzzo V, Loreti C, Caliandro P, Padua L, Maccauro G, Biscotti L, Bernabei R. Neuropathic Pain in the Elderly. Diagnostics (Basel) 2021; 11:diagnostics11040613. [PMID: 33808121 PMCID: PMC8066049 DOI: 10.3390/diagnostics11040613] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Correspondence: ; Tel.: +39-063015-4341
| | - Daniele Coraci
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio Brau
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Galluzzo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Pietro Caliandro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Luca Padua
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Biscotti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Presiding Officer of Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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15
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Abstract
Central post-stroke pain is a chronic neuropathic pain syndrome following a cerebrovascular accident. The development of central post-stroke pain is estimated to occur in 8 to 55% of stroke patients and is described as constant or intermittent neuropathic pain accompanied by dysesthesia of temperature and/or pressure sensations. These pain and sensory deficits are within the area of the body corresponding to the stroke lesion. The onset of pain is usually gradual, though it can develop either immediately after stroke or years after. Given the diversity in its clinical presentation, central post-stroke pain is a challenging diagnosis of exclusion. Furthermore, central post-stroke pain is often resistant to pharmacological treatment options and a clear therapeutic algorithm has not been established. Based on current evidence, amitriptyline, lamotrigine, and gabapentinoids should be used as first-line pharmacotherapy options when central post-stroke pain is suspected. Other drugs, such as fluvoxamine, steroids, and Intravenous infusions of lidocaine, ketamine, or even propofol, can be considered in intractable cases. In addition, interventional therapies such as motor cortex stimulation or transcranial magnetic stimulation have been shown to provide relief in difficult-to-treat patients.
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Affiliation(s)
- Hanwool Ryan Choi
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Adem Aktas
- Division of Neurorehabilitation, Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael M Bottros
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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16
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Thomson J, New PW. Pharmacological management of stroke in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julia Thomson
- Department of Medicine Rehabilitation and Aged Services Program, Kingston Centre Monash Health Clayton Australia
| | - Peter Wayne New
- Department of Medicine Rehabilitation and Aged Services Program, Kingston Centre Monash Health Clayton Australia
- Rehabilitation Services Caulfield Hospital Alfred Health Victoria Australia
- Epworth‐Monash Rehabilitation Medicine Unit Monash Medical School Monash University Parkville Australia
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Parkville Australia
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17
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Marttinen MK, Kautiainen H, Haanpää M, Pohjankoski H, Hintikka J, Kauppi MJ. Analgesic purchases among older adults - a population-based study. BMC Public Health 2021; 21:256. [PMID: 33517898 PMCID: PMC7849135 DOI: 10.1186/s12889-021-10272-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
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Affiliation(s)
- Maiju K Marttinen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland. .,Department of Anesthesiology, Intensive Care and Pain Medication, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Puijonlaaksontie 2, 70200, Kuopio, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Porkkalankatu 1, 00180, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00270, Helsinki, Finland
| | - Heini Pohjankoski
- Department of Paediatrics, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Markku J Kauppi
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Rheumatology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
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18
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Changing Functional Signatures of Microglia along the Axis of Brain Aging. Int J Mol Sci 2021; 22:ijms22031091. [PMID: 33499206 PMCID: PMC7865559 DOI: 10.3390/ijms22031091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
Microglia, the innate immune cells of the brain, are commonly perceived as resident macrophages of the central nervous system (CNS). This definition, however, requires further specification, as under healthy homeostatic conditions, neither morphological nor functional properties of microglia mirror those of classical macrophages. Indeed, microglia adapt exceptionally well to their microenvironment, becoming a legitimate member of the cellular brain architecture. The ramified or surveillant microglia in the young adult brain are characterized by specific morphology (small cell body and long, thin motile processes) and physiology (a unique pattern of Ca2+ signaling, responsiveness to various neurotransmitters and hormones, in addition to classic “immune” stimuli). Their numerous physiological functions far exceed and complement their immune capabilities. As the brain ages, the respective changes in the microglial microenvironment impact the functional properties of microglia, triggering further rounds of adaptation. In this review, we discuss the recent data showing how functional properties of microglia adapt to age-related changes in brain parenchyma in a sex-specific manner, with a specific focus on early changes occurring at middle age as well as some strategies counteracting the aging of microglia.
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19
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Short-Course Systemic and Topical Non-Steroidal Anti-Inflammatory Drugs: Impact on Adverse Renal Events in Older Adults with Co-Morbid Disease. Drugs Aging 2020; 38:147-156. [PMID: 33251568 DOI: 10.1007/s40266-020-00824-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Prolonged systemic non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with adverse renal outcomes among older adults. However, there is scant data regarding the renal safety of topical and short-course systemic NSAIDs. We aimed to evaluate the risk of acute adverse renal outcomes among older adults prescribed topical and short-term systemic NSAIDs. METHODS We conducted a retrospective cohort study of all older adults, age 60 years and above, who received prescriptions between July 2015 and December 2017 from the largest tertiary hospital and a major public primary care institution in Singapore. Data from 6 months before until 30 days after the first prescription were retrieved from electronic medical records. The primary outcome was the incidence of acute kidney injury (serum creatinine increased >26.5 µmol/L or >50% from baseline) and/or hyperkalemia within 30 days. A multi-variate analysis taking into account age, sex, co-morbidities, baseline-estimated glomerular filtration rate and serum potassium, NSAID route of administration, and concurrent renin-angiotensin-aldosterone system blocker and diuretic prescription was performed to evaluate factors associated with the primary outcome. RESULTS We identified 12,773 older adults with incident prescriptions: 3982 (31.2%) received short-course systemic NSAIDs, 3784 (29.6%) received topical NSAIDs, and 5007 (39.2%) did not receive any NSAID. Both short-course systemic NSAIDs (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.41-1.80, p < 0.001) and topical NSAIDs (adjusted OR 1.48, 95% CI 1.31-1.67, p < 0.001), compared with the no-NSAID group, were independently associated with the primary outcome. Among older adults with co-morbid conditions and prescribed NSAIDs, topical NSAIDs had a reduced odds of 30-day incident acute kidney injury and/or hyperkalemia in diabetes mellitus (adjusted OR 0.78, 95% CI 0.65-1.06, p = 0.007), chronic kidney disease (adjusted OR 0.74, 95% CI 0.60-0.90, p = 0.003), and cardiovascular disease (adjusted OR 0.54, 95% CI 0.37-0.79, p < 0.001), compared with short-course systemic NSAIDs. CONCLUSIONS NSAIDs increased the risk of acute adverse renal events. Topical NSAIDs, compared with short-course systemic NSAIDs, were associated with a reduced incidence of acute kidney injury and/or hyperkalemia among older adults with additional risk factors.
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20
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Moisset X, Bouhassira D, Couturier JA, Alchaar H, Conradi S, Delmotte MH, Lantéri-Minet M, Lefaucheur JP, Mick G, Piano V, Pickering G, Piquet E, Regis C, Salvat E, Attal N. Traitements pharmacologiques et non pharmacologiques de la douleur neuropathique : une synthèse des recommandations françaises. ACTA ACUST UNITED AC 2020. [DOI: 10.3166/dea-2020-0113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Les douleurs neuropathiques (DN) restent très difficiles à soulager. Plusieurs recommandations ont été proposées au cours de ces dernières années, mais aucune n’a pris en compte à ce jour l’ensemble des approches thérapeutiques disponibles. Nous avons réalisé une revue systématique portant sur toutes les études concernant le traitement des DN périphériques et centrales de l’adulte et de l’enfant, publiées jusqu’en janvier 2018 et avons évalué la qualité des études et le niveau de preuve des traitements au moyen du système GRADE. Les principaux critères d’inclusion étaient l’existence d’une DN chronique (≥ 3 mois), une méthodologie contrôlée et randomisée, un suivi supérieur ou égal à trois semaines, un nombre de patients supérieur ou égal à dix par groupe et une évaluation en double insu pour les traitements pharmacologiques. Sur la base du GRADE, nous recommandons en première intention les antidépresseurs inhibiteurs mixtes de recapture des monoamines (duloxétine et venlafaxine), les antidépresseurs tricycliques, la gabapentine pour toute DN, et les emplâtres de lidocaïne 5 % et la stimulation électrique transcutanée pour les DN périphériques localisées. Nous recommandons en deuxième intention la prégabaline, le tramadol (avec les précautions d’emploi afférentes aux opioïdes) et certaines associations pharmacologiques (antidépresseurs et gabapentine ou prégabaline) pour toute DN, et les patchs de haute concentration de capsaïcine (8 %) et la toxine botulique de type A (en milieu spécialisé) pour les DN périphériques localisées. Nous recommandons en troisième intention la stimulation magnétique transcrânienne répétitive à haute fréquence du cortex moteur (en milieu spécialisé) et les opioïdes forts (en l’absence d’alternative et en respectant les précautions d’emploi afférentes aux opioïdes) pour toute douleur neuropathique, et la stimulation médullaire pour les douleurs radiculaires chroniques postchirurgicales et la polyneuropathie diabétique douloureuse. La psychothérapie (thérapie cognitivocomportementale et thérapie de pleine conscience) peut être recommandée en deuxième intention en association avec les traitements précédents.
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21
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Dannenberger N, Devot J, Wary B, Guillaumé C. Collectif Doloplus : déjà vingt-cinq ans au service de la douleur des plus âgés. REVUE DE L'INFIRMIÈRE 2020; 69:40-42. [PMID: 32993906 DOI: 10.1016/s1293-8505(20)30241-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Collectif Doloplus: twenty-five years supporting the fight against pain in the elderly. Speech and communication disorders among the elderly can be an obstacle in the detection and evaluation of pain. In these conditions, the Doloplus and Algoplus (heteroassessment) behavioural scales should be used. This article provides an overview of the guidelines for using these two scales and the role each has in daily practice. It also shows the impact a high-quality evaluative approach can have on the care provided.
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Affiliation(s)
- Nathalie Dannenberger
- Pôle de gériatrie, groupement 0 hospitalier de la région Mulhouse-Sud Alsace, 68100 Mulhouse, France; Association Doloplus, centre hospitalo-universitaire Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Joëlle Devot
- Association Doloplus, centre hospitalo-universitaire Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Centre hospitalier de Calais, 1601, boulevard des Justes, 62100 Calais, France
| | - Bernard Wary
- Association Doloplus, centre hospitalo-universitaire Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Cyril Guillaumé
- Association Doloplus, centre hospitalo-universitaire Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Service douleur et soins palliatifs, centre hospitalo-universitaire Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
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22
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A global agenda for older adult immunization in the COVID-19 era: A roadmap for action. Vaccine 2020; 39:5240-5250. [PMID: 32703743 PMCID: PMC7332930 DOI: 10.1016/j.vaccine.2020.06.082] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/29/2022]
Abstract
Given our global interconnectedness, the COVID-19 pandemic highlights the urgency of building a global system that can support both routine and pandemic/epidemic adult immunization. As such, a framework to recommend vaccines and build robust platforms to deliver them to protect the rapidly expanding demographic of older adults is needed. Adult immunization as a strategy has the broad potential to preserve and improve medical, social, and economic outcomes, including maintaining functional ability that benefits older adults, their families, communities, and countries. While we will soon have multiple vaccines against COVID-19, we must recognize that we already have a variety of vaccines against other pathogens that can keep adults healthier. They can prevent simultaneous co-infection with COVID-19, and may favorably impact- the outcome of a COVID-19 illness. Further, administering a vaccine against COVID-19 requires planning now to determine delivery strategies impacting how older adults will be immunized in a timely manner. A group of international experts with various backgrounds from health and aging disciplines met to discuss the evidence case for adult immunization and crucial knowledge gaps that must be filled in order to implement effective policies and programs for older adult immunization. This group, coming together as the International Council on Adult Immunization (ICAI), outlined a high-level roadmap to catalyze action, provide policy guidance, and envision a global adult immunization platform that can be adapted by countries to fit their local contexts. Further meetings centered around the value of adult immunization, particularly in the context of COVID-19. There was agreement that programs to deliver existing influenza, pneumococcal, herpes zoster vaccines, and future COVID-19 vaccines to over a billion older adults who are at substantially higher risk of death and disability due to vaccine-preventable diseases are more urgent than ever before. Here we present a proposed framework for delivering routine and pandemic vaccines. We call upon the global community and governments to prioritize action for integrating robust adult immunization programs into the public health agenda.
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23
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Curran D, Oostvogels L, Heineman T, Matthews S, McElhaney J, McNeil S, Diez-Domingo J, Lal H, Andrews C, Athan E, Berglund J, Campora L, de Looze F, Korhonen T, Leung E, Levin M, Volpi A, Johnson RW. Quality of Life Impact of an Adjuvanted Recombinant Zoster Vaccine in Adults Aged 50 Years and Older. J Gerontol A Biol Sci Med Sci 2020; 74:1231-1238. [PMID: 29955836 PMCID: PMC6625590 DOI: 10.1093/gerona/gly150] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Indexed: 12/30/2022] Open
Abstract
Background To determine the efficacy of an adjuvanted recombinant zoster vaccine in reducing the herpes zoster (HZ) burden of illness, HZ burden of interference with activities of daily living, and HZ impact on quality of life. Methods The assessments were integrated in two Phase III trials, ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229). HZ burden of illness and HZ burden of interference with activities of daily living were assessed by the Zoster Brief Pain Inventory (ZBPI) instrument and quality of life by the EuroQol-5 Dimension (EQ-5D) utility index and the SF-36 health survey. We report the ZOE-50 results and a pooled analysis of patients aged 70 years and older from the trials combined. Results The estimated vaccine efficacy in reducing HZ burden of illness and HZ burden of interference was greater than 90% in both the ZOE-50 and the pooled ZOE-70 analysis. In confirmed HZ cases, adjuvanted recombinant zoster vaccine reduced the maximal ZBPI worst-pain score in the pooled ZOE-70 analysis (p = .032) and the maximal ZBPI average-pain scores in both the ZOE-50 (p = .049) and the pooled ZOE-70 analysis (p = .043). In breakthrough HZ cases, trends for diminished loss of quality of life compared with placebo-recipient HZ cases were observed, with differences up to 0.14 on the EQ-5D index at time points during the 4 weeks following HZ onset. Conclusions Adjuvanted recombinant zoster vaccine reduced the HZ burden of illness significantly, particularly due to its very high vaccine efficacy in preventing HZ. For breakthrough HZ cases, the results suggest that the adjuvanted recombinant zoster vaccine mitigated severity of HZ-related pain, burden of interference with activities of daily living, and recipients’ utility loss.
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Affiliation(s)
| | | | | | | | - Janet McElhaney
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Canada
| | | | | | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Johan Berglund
- Department of Medical Radiation Physics, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Ferdinandus de Looze
- AusTrials Pty Ltd, Sherwood, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | | | | | - Myron Levin
- Department of Pediatrics.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Abstract
The prevalence of neuropathic pain in the older population has been reported to be very high and is most commonly localized to a circumscribed area. Treatment failure is frequent in neuropathic pain and is accompanied by central side effects with recommended oral drugs acting on the central nervous system. A number of topical pharmaceuticals are available on prescription and also sold over the counter. This review in persons aged older than 60 years shows the efficacy of lidocaine 5% and capsaicin 8% for localized neuropathic pain while results with other pharmaceuticals are rather inconsistent. Local application of drugs has a very limited systemic effect and the pharmacological advantages of local over systemic treatment are particularly interesting in older persons who often have comorbidities and take multiple medications. However, more information is needed on the efficacy and safety of lidocaine 5% and capsaicin 8% in older old persons and on the long-term effects of these pharmaceuticals. These studies should also pave the way for research and development in the field of topical analgesics with a satisfactory level of evidence-based medicine.
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Affiliation(s)
- Gisèle Pickering
- Clinical Pharmacology Department, CPC/CIC Inserm 1405, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. .,Centre de Pharmacologie Clinique, CPC/CIC Inserm 1405, Bâtiment 3C, CHU Clermont-Ferrand, 58 rue Montalembert, BP 69, 63003, Clermont-Ferrand Cedex 1, France.
| | - Camille Lucchini
- Clinical Pharmacology Department, CPC/CIC Inserm 1405, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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25
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Moisset X, Bouhassira D, Avez Couturier J, Alchaar H, Conradi S, Delmotte MH, Lanteri-Minet M, Lefaucheur JP, Mick G, Piano V, Pickering G, Piquet E, Regis C, Salvat E, Attal N. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris) 2020; 176:325-352. [PMID: 32276788 DOI: 10.1016/j.neurol.2020.01.361] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.
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Affiliation(s)
- X Moisset
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - D Bouhassira
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
| | - J Avez Couturier
- Service de Neuropédiatrie, Consultation Douleur Enfant, CIC-IT 1403, CHU de Lille, Lille, France
| | - H Alchaar
- 73, boulevard de Cimiez, Nice, France
| | - S Conradi
- CETD, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - M H Delmotte
- GHU, Paris site Ste-Anne, Structure Douleurs, 1, rue Cabanis, Paris 14, France
| | - M Lanteri-Minet
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - J P Lefaucheur
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France; Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - G Mick
- Centre d'Évaluation et Traitement de la Douleur du Voironnais, Centre Hospitalier de Voiron, Laboratoire P2S, Université de Lyon, Lyon, France
| | - V Piano
- Centre Hospitalier de Draguignan, Service Algologie 4(e), route de Montferrat, 83007 Draguignan cedex, France
| | - G Pickering
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
| | - E Piquet
- Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - C Regis
- CETD, CHU Montpellier, Montpellier, France
| | - E Salvat
- Centre d'Évaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - N Attal
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
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26
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Management of neuropathic pain induced by surgery: Review of the literature by a group of experts specialized in pain management, anesthesia and surgery. J Visc Surg 2019; 157:43-52. [PMID: 31668838 DOI: 10.1016/j.jviscsurg.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic postsurgical neuropathic pain (CPSNP) is frequent. While prevalence varies considerably according to type of operation and means of evaluation, it can reach 37% following breast surgery. Identification of risk factors related to the procedure and to the patient and taking into account the development of new, minimally invasive surgical techniques is increasingly nerve-sparing and reduces the likelihood of injury. CPSNP diagnosis in daily practice is facilitated by simple and quickly usable tools such as the NP4 4-question test. Management is based on pharmacological (analgesics, antiepileptics, antidepressants, local anesthetics) and non-pharmacological (kinesitherapy, neurostimulation, psychotherapy) approaches. In light of the present review of the literature, the authors, who constitute an expert group specialized in pain management, anesthesia and surgery, express their support for topical treatments (lidocaine, capsaicin) in treatment of localized postsurgical neuropathic pain in adults.
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27
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Alcántara Montero A, Ibor Vidal PJ, Alonso Verdugo A, Trillo Calvo E. [Update in the pharmacological treatment of neuropathic pain]. Semergen 2019; 45:535-545. [PMID: 31337589 DOI: 10.1016/j.semerg.2019.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/25/2019] [Accepted: 05/27/2019] [Indexed: 01/15/2023]
Abstract
We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain.
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Affiliation(s)
- A Alcántara Montero
- Centro de Salud Manuel Encinas, Consultorio de Malpartida de Cáceres, Cáceres, España; Grupo de Trabajo de Dolor de SEMERGEN.
| | - P J Ibor Vidal
- Centro de Salud Guillem de Castro, Valencia, España; Grupo de Trabajo de Dolor de SEMERGEN
| | - A Alonso Verdugo
- Centro de Salud Guadalajara Periférico, Guadalajara, España; Grupo de Trabajo de Dolor de SEMERGEN
| | - E Trillo Calvo
- Centro de Salud de Calamocha, Teruel, España; Grupo de Trabajo de Dolor de SEMERGEN
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28
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Medioni J, Pickering G, Delorme C, Lansaman T, Lanteri-Minet M, Legras A, Navez M, Prudhomme M, Serrie A, Viel É, Perrot S. [Drug management of cancer-related peripheral neuropathic pain: A systematic review of the literature]. Bull Cancer 2019; 106:784-795. [PMID: 31202559 DOI: 10.1016/j.bulcan.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/07/2019] [Accepted: 04/26/2019] [Indexed: 12/23/2022]
Abstract
The objective of the present systematic literature review was to provide an update on medical treatment of neuropathic pain in cancer patients. The number of cancer patients is steadily increasing. Pain is frequent in cancer patients. Few studies have focused on medical treatment of pain, and especially of neuropathic pain, in current or former cancer patients. The present systematic review of all studies published between December 2012 and August 2018 was intended to estimate the scale of this lack. In all, 27 articles were identified on a systematic PubMed search and from the authors' personal knowledge, confirming that scant data have been published. The heterogeneity of cancer patients, of cancer, and of pain go some way toward explaining this scarcity. Guidelines, founded mainly on results from non-cancer patients, recommend tricyclic antidepressants and antiepileptic drugs; local treatments have the advantage of good systemic tolerance. Larger-scale studies taking account of the etiology of neuropathic pain, its characteristics (strictly neuropathic or mixed) and patient characteristics (awaiting treatment, under treatment, recent or non-recent survivor, or in terminal phase) along the care pathway are needed to improve knowledge. The results of the present literature analysis can help future research.
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Affiliation(s)
- Jacques Medioni
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital européen Georges-Pompidou, faculté de médecine Paris Descartes, centre d'essais précoces en cancérologie (CEPEC), service de cancérologie médicale, 75015 Paris, France.
| | - Gisèle Pickering
- CHU de Clermont-Ferrand, université Clermont-Auvergne, centre de pharmacologie clinique, CIC Inserm 1405, 60003 Clermont-Ferrand, France
| | - Claire Delorme
- Centre hospitalier de Bayeux, centre d'évaluation et traitement de la douleur (CETD) et réseau régional douleur, 14400 Bayeux, France
| | - Thibaud Lansaman
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Raymond-Poincaré, université de Versailles Saint-Quentin, service de médecine physique et de réadaptation, 92380 Paris, France
| | - Michel Lanteri-Minet
- CHU de Nice, fédération hospitalo-universitaire InovPain, université Côte-d'Azur, département d'évaluation et traitement de la douleur, 06000 Nice, France; Université d'Auvergne, Inserm/UdA, U1107, Neuro-Dol, 60003 Clermont-Ferrand, France
| | - Antoine Legras
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Malou Navez
- CHU de Saint-Étienne, centre d'évaluation et traitement de la douleur (CETD), 41000 Saint-Priest-en-Jarez, France
| | - Michel Prudhomme
- CHU de Nîmes, département de chirurgie viscérale, 30029 Nîmes, France
| | - Alain Serrie
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Lariboisière-Fernand-Widal, universités Paris Descartes-Paris Diderot, service de médecine de la douleur et de médecine palliative, Inserm UMR-S 1144, 75010 Paris, France
| | - Éric Viel
- CHU de Nîmes, faculté de médecine Montpellier-Nîmes, centre d'évaluation et de traitement de la douleur, 30029 Nîmes, France
| | - Serge Perrot
- Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Cochin, université Paris Descartes, centre d'évaluation et de traitement de la douleur, Inserm U987, 75014 Paris, France
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Abstract
PURPOSE OF REVIEW Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. RECENT FINDINGS A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicate adequately, that is, in patients with dementia. A recently developed electronic tool assessing automated facial expression and clinical behavioral indicators may help to solve this problem. The discussion about benefits and harms of opioids in elderly goes on. Although some authors underline the lack of efficacy together with the potential problems, such as, abuse, others report a beneficial effect in terms of pain relief, functional activities and disability. In addition, opioids have become an important treatment option in patients with restless legs syndrome. Various topical treatment options (i.e. capsaicin patch) and nonpharmacological interventions have been proven to be beneficial in elderly. SUMMARY Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain.
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30
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Stompór M, Grodzicki T, Stompór T, Wordliczek J, Dubiel M, Kurowska I. Prevalence of Chronic Pain, Particularly with Neuropathic Component, and Its Effect on Overall Functioning of Elderly Patients. Med Sci Monit 2019; 25:2695-2701. [PMID: 31018630 PMCID: PMC6475124 DOI: 10.12659/msm.911260] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of chronic pain among the elderly is high (estimated at 25–85%) and may adversely affect their everyday functioning, although it is often unrecognized. Material/Methods The aim of this study was to assess the prevalence of chronic pain, especially with the neuropathic component, and its effect on overall functioning of elderly patients. We enrolled 145 subjects older than 60 years (nursing home residents, or patients of outpatient geriatric clinic). Information on co-morbidities, functional and mental status, and medications was obtained using a questionnaire. Chronic pain was defined as lasting >3 months and the presence of neuropathic component was detected using the DN4 Questionnaire (Douleur Neuropathique en Questions). Results The mean age of patients was 76±9.68 years. Chronic pain was reported by 78% of participants and 32% reported neuropathic pain with neuropathic component (DN4 score ≥4 points). Patients complaining of chronic pain significantly more often presented mood disorders and lower satisfaction with life (particularly those with the highest pain intensity), with no difference in functional status according to the ADL (Activities of Daily Living) tool. Participants with chronic pain were treated with paracetamol (45%), non-steroidal anti-inflammatory drugs (25%), and opioids (24%). Conclusions The prevalence of chronic pain, particularly with neuropathic component, in the elderly population seems to be higher than expected based on previous reports, and its treatment appears to be ineffective. This problem requires further research and dissemination of knowledge on the diagnosis and treatment of chronic pain among health care workers caring for elderly patients on a daily basis.
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Affiliation(s)
- Małgorzata Stompór
- Department of Cardiology and Cardiac Surgery, Medical Faculty, Collegium Medicum, University of Warmia and Masuria, Olsztyn, Poland.,Department of Internal Medicine and Gerontology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Tomasz Stompór
- Department of Internal Medicine, Medical Faculty, Collegium Medicum, University of Warmia and Masuria, Olsztyn, Poland
| | - Jerzy Wordliczek
- Department of Intensive Interdisciplinary Care, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Marzena Dubiel
- Assisted Living Residence "Na Wzgórzu", Głogoczów, Poland
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Meehan AJ, Maher AB, Brent L, Copanitsanou P, Cross J, Kimber C, MacDonald V, Marques A, Peng L, Queirós C, Roigk P, Sheehan KJ, Skúladóttir SS, Hommel A. The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs 2019; 32:3-26. [DOI: 10.1016/j.ijotn.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation. Pain Res Manag 2018; 2018:5237040. [PMID: 29973967 PMCID: PMC6008740 DOI: 10.1155/2018/5237040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/06/2018] [Accepted: 04/10/2018] [Indexed: 01/21/2023]
Abstract
Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.
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Doherty TM, Connolly MP, Del Giudice G, Flamaing J, Goronzy JJ, Grubeck-Loebenstein B, Lambert PH, Maggi S, McElhaney JE, Nagai H, Schaffner W, Schmidt-Ott R, Walsh E, Di Pasquale A. Vaccination programs for older adults in an era of demographic change. Eur Geriatr Med 2018; 9:289-300. [PMID: 29887922 PMCID: PMC5972173 DOI: 10.1007/s41999-018-0040-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Populations are aging worldwide. This paper summarizes some of the challenges and opportunities due to the increasing burden of infectious diseases in an aging population. RESULTS Older adults typically suffer elevated morbidity from infectious disease, leading to increased demand for healthcare resources and higher healthcare costs. Preventive medicine, including vaccination can potentially play a major role in preserving the health and independence of older adults. However, this potential of widespread vaccination is rarely realized. Here, we give a brief overview of the problem, discuss concrete obstacles and the potential for expanded vaccination programs to promote healthy aging. CONCLUSION The increasing healthcare burden of infectious diseases expected in aging populations could, to a large extent, be reduced by achieving higher vaccination coverage among older adults. Vaccination can thus contribute to healthy aging, alongside healthy diet and physical exercise. The available evidence indicates that dedicated programs can achieve substantial improvements in vaccination coverage among older adults, but more research is required to assess the generalizability of the results achieved by specific interventions (see Additional file 1).
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Affiliation(s)
| | - Mark P Connolly
- Global Market Access Solutions, St-Prex, Switzerland
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Division of Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
| | - Jorg J Goronzy
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | | | - Stefania Maggi
- CNR Institute of Neuroscience, Aging Branch, Padua, Italy
| | | | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | | | | | - Edward Walsh
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Zhang YL, Chen DJ, Yang BL, Liu TT, Li JJ, Wang XQ, Xue GY, Liu ZX. Microencapsulated Schwann cell transplantation inhibits P2X3 receptor expression in dorsal root ganglia and neuropathic pain. Neural Regen Res 2018; 13:1961-1967. [PMID: 30233070 PMCID: PMC6183027 DOI: 10.4103/1673-5374.238715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Schwann cell transplantation is a promising method to promote neural repair, and can be used for peripheral nerve protection and myelination. Microcapsule technology largely mitigates immune rejection of transplanted cells. We previously showed that microencapsulated olfactory ensheathing cells can reduce neuropathic pain and we hypothesized that microencapsulated Schwann cells can also inhibit neuropathic pain. Rat Schwann cells were cultured by subculture and then microencapsulated and were tested using a rat chronic constriction injury (CCI) neuropathic pain model. CCI rats were treated with Schwann cells or microencapsulated Schwann cells and were compared with sham and CCI groups. Mechanical withdrawal threshold and thermal withdrawal latency were assessed preoperatively and at 1, 3, 5, 7, 9, 11 and 14 days postoperatively. The expression of P2X3 receptors in L4-5 dorsal root ganglia of the different groups was detected by double-label immunofluorescence on day 14 after surgery. Compared with the chronic constriction injury group, mechanical withdrawal threshold and thermal withdrawal latency were higher, but the expression of P2X3 receptors was remarkably decreased in rats treated with Schwann cells and microencapsulated Schwann cells, especially in the rats transplanted with microencapsulated Schwann cells. The above data show that microencapsulated Schwann cell transplantation inhibits P2X3 receptor expression in L4-5 dorsal root ganglia and neuropathic pain.
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Affiliation(s)
- Ya-Ling Zhang
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, Jiangxi Province, China
| | - De-Jian Chen
- First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Bao-Lin Yang
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, Jiangxi Province, China
| | - Tao-Tao Liu
- Fourth Clinical Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Jia-Juan Li
- Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiu-Qi Wang
- Queen Mary College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Guo-Yong Xue
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, Jiangxi Province, China
| | - Zeng-Xu Liu
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, Jiangxi Province, China
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Consensus multidisciplinaire d’experts en douleur et gériatrie : utilisation des antalgiques dans la prise en charge de la douleur de la personne âgée (hors anesthésie). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.douler.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Matsuoka H, Ishiki H, Iwase S, Koyama A, Kawaguchi T, Kizawa Y, Morita T, Matsuda Y, Miyaji T, Ariyoshi K, Yamaguchi T. Study protocol for a multi-institutional, randomised, double-blinded, placebo-controlled phase III trial investigating additive efficacy of duloxetine for neuropathic cancer pain refractory to opioids and gabapentinoids: the DIRECT study. BMJ Open 2017; 7:e017280. [PMID: 28851798 PMCID: PMC5724096 DOI: 10.1136/bmjopen-2017-017280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Management of patients with cancer suffering from neuropathic pain refractory to opioids and gabapentinoids remains an important challenge. Duloxetine is one of the choices after first-line treatment fails. The efficacy of duloxetine has been reported in patients with non-cancer disease and in chemotherapy-induced peripheral neuropathy, but no randomised clinical trials have examined its effects on neuropathic cancer pain refractory to first-line treatment. The objective of this study is to assess the analgesic efficacy of duloxetine in patients suffering from neuropathic cancer pain refractory to opioids and gabapentinoids. METHODS AND ANALYSIS A multi-institutional, prospective, randomised, double-blind, placebo-controlled, two-parallel trial is planned. The inclusion criteria are adult patients with cancer suffering from neuropathic cancer pain refractory to opioids and gabapentinoids, patients with a Numerical Rating Scale (NRS) pain score of 4 or higher and patients with a total Hospital Anxiety and Depression Scale score of less than 20. Patients with chemotherapy-induced peripheral neuropathy are excluded. The study will take place at 14 sites across Japan. Participants will be randomised (1:1 allocation ratio) to a duloxetine intervention group or a placebo control group. Evaluations will be made at baseline (T0 randomisation), day 0 (T1), day 3 (T2) and day 10 (T3). The primary endpoint is defined as the difference in NRS score for pain intensity (average over the previous 24 hours) at T3 between the duloxetine and placebo groups. A sample size of 70 patients will be examined between July 2015 and March 2018. ETHICS AND DISSEMINATION Ethics approval was obtained at all participating sites.The results of this study will be submitted for publication in international peer-reviewed journals and the key findings presented at international scientific conferences. TRIAL REGISTRATION NUMBER UMIN000017647; Pre-results. PROTOCOL VERSION 2.2, 26 April 2017.
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Affiliation(s)
- Hiromichi Matsuoka
- Palliative Care Center, Cancer Center, Kindai University Hospital, Osaka, Japan
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Atsuko Koyama
- Palliative Care Center, Cancer Center, Kindai University Hospital, Osaka, Japan
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Ariyoshi
- Department of Palliative Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Japanese Organization for Research and Treatment of Cancer (JORTC), NPO, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Department of Clinical Trial Data Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Starostzik C. [Not Available]. MMW Fortschr Med 2016; 158:26. [PMID: 27757895 DOI: 10.1007/s15006-016-8814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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