Douleurs cancéreuses par excès de nociception chez l'adulte: mise au point sur les recommandations concernant les traitements antalgiques médicamenteux

Potential inappropriate use of strong opioid analgesics in cancer outpatients during the last year of life in France and associated factors

AIMS

A better knowledge of opioid prescribing patterns would help to identify areas of potential improvement in cancer pain management. This study aimed to identify potential inappropriate use (PIU) of strong opioid analgesics in cancer outpatients in their last year of life.

METHODS

A retrospective cohort of cancer patients who died between 2011 and 2014 and were exposed as outpatient to a strong opioid analgesic in the last year of life was identified in the Echantillon Généraliste de Bénéficiaires (a 1/97th random sample of the French general population). Prescribing patterns of strong opioids were analysed and PIU was defined by at least 1 of these criteria: overlapping prescriptions; contraindicated prescriptions; lack of laxatives; potential drug interactions; prescription in patients hospitalized for opioid-related disorders. Factors associated with PIU were investigated through a multiple logistic regression model.

RESULTS

One third of the 2236 patients (median age 72 years [interquartile range: 61-82], 44.1% women) presented a PIU (insufficient laxative prescription [19.6% of patients], insufficient background treatment with transmucosal fentanyl [14.8%], overlapping prescriptions [2.6%]). The rate of PIU significantly decreased from 37.6% (2011) to 29.8% (2014). For patients with a duration of opioid use ≥3 months, factors associated with PIU were fentanyl prescription (adjusted odds ratio = 2.36; 95% confidence interval [1.86-3.00]) and previous use of strong opioid (adjusted odds ratio = 1.88; [1.50-2.36]).

CONCLUSION

In France, 1/3 of cancer patients exposed to strong opioids experienced PIU and this proportion tended to decrease over time. There is still room for progress in cancer pain management at the end of life.

Nutmeg oil alleviates chronic inflammatory pain through inhibition of COX-2 expression and substance P release in vivo

Background

Chronic pain, or sometimes referred to as persistent pain, reduces the life quality of patients who are suffering from chronic diseases such as inflammatory diseases, cancer and diabetes. Hence, herbal medicines draw many attentions and have been shown effective in the treatment or relief of pain.

Methods and Results

Here in this study, we used the CFA-injected rats as a sustainable pain model to test the anti-inflammatory and analgesic effect of nutmeg oil, a spice flavor additive to beverages and baked goods produced from the seed of Myristica fragrans tree.

Conclusions

We have demonstrated that nutmeg oil could potentially alleviate the CFA-injection induced joint swelling, mechanical allodynia and heat hyperanalgesia of rats through inhibition of COX-2 expression and blood substance P level, which made it possible for nutmeg oil to be a potential chronic pain reliever.

Striving to respond to palliative care patients' pain at home: a puzzle for family caregivers

PURPOSE/OBJECTIVES

to describe the types of pain patients in palliative care at home experience and how family caregivers assess them and intervene.

RESEARCH APPROACH

qualitative using grounded theory.

SETTING

family caregivers' homes.

PARTICIPANTS

24 family caregivers of patients with advanced cancer receiving palliative care at home.

METHODOLOGIC APPROACH

semistructured interviews and field notes. Data analysis used Strauss and Corbin's recommendations for open, axial, and selective coding.

MAIN RESEARCH VARIABLES

pain, pain management, family caregivers, palliative care, and home care.

FINDINGS

caregivers assessed different types of pain and, therefore, were experimenting with different types of interventions. Not all family caregivers were able to distinguish between the different pains afflicting patients, and, consequently, were not selecting the most appropriate interventions. This often led to poorly managed pain and frustrated family caregivers.

CONCLUSIONS

The accurate assessment of the types of pain the patient is experiencing, coupled with the most appropriate intervention for pain control, is critical for optimal pain relief as well as supporting the confidence and feelings of family caregivers who are undertaking the complex process of cancer pain management.

INTERPRETATION

nurses involved with patients receiving palliative care and their family caregivers should be aware of all types of pain experienced by the patient and how caregivers are managing the pain. Nurses should be knowledgeable about different pain relief interventions to help family caregivers obtain accurate information, understand their options, and administer these interventions safely and effectively.

[Administration of ketamine during induction and maintenance of anaesthesia in postoperative pain prevention]

INTRODUCTION

Carcinologic breast surgery is responsible of intermediary postoperative pain and needs 30% additional morphine. Now, morphine administration generates adverse effects. Publications about morphine saving effect of ketalar as antagonist of R-NMDA, administrated in perioperative increase are discussed.

OBJECTIVE

To evaluate the morphine saving effect of ketalar in carcinologic breast surgery.

PATIENTS AND METHOD

This phase III randomized and double-blind study includes 208 patients during 14 months. Surgery consisted in mastectomy with or without axillary lymph node dissection or lumpectomy with axillary lymph node dissection. Group K received ketalar at induction until the end of surgery. Group P (placebo) received physiologic serum in the same condition. During the postoperative first 48h, morphine's consumption and EN are measured.

RESULTS

No significant difference between two groups was observed. The EN evaluation and morphine consumption remained the same in the two groups. Our results did not find any benefit with use of ketamine between axillary lymph node dissection and no axillary lymph node dissection group.

CONCLUSION

Ketalar adjunction in our analgesic protocol did not induce significant morphine saving in carcinologic breast surgery.