1
|
Ehrlich O, Lackowski A, Glover TL, Vallerand AH. Use of Goals in Cancer Pain Management: A Systematic Review. J Pain Symptom Manage 2024; 68:e194-e205. [PMID: 38851545 DOI: 10.1016/j.jpainsymman.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/08/2024] [Accepted: 05/25/2024] [Indexed: 06/10/2024]
Abstract
CONTEXT Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management. OBJECTIVES Identify how pain goals are used in cancer pain management and types of goals researched. METHODS CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample. RESULTS Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only. CONCLUSION Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful.
Collapse
Affiliation(s)
- Olga Ehrlich
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA.
| | - Alyssa Lackowski
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA
| | - Toni L Glover
- School of Nursing, Oakland University, (O.E, A.L, T.L.G), Rochester, MI, USA
| | | |
Collapse
|
2
|
Langford AV, Schneider CR, Lin CC, Bero L, Collins JC, Suckling B, Gnjidic D. Patient-targeted interventions for opioid deprescribing: An overview of systematic reviews. Basic Clin Pharmacol Toxicol 2023; 133:623-639. [PMID: 36808693 PMCID: PMC10953356 DOI: 10.1111/bcpt.13844] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals. OBJECTIVE To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain. METHODS Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. FINDINGS Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions. CONCLUSIONS Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.
Collapse
Affiliation(s)
- Aili V. Langford
- Centre for Medicine Use and SafetyMonash UniversityParkvilleVictoriaAustralia
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNew South WalesAustralia
| | - Carl R. Schneider
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNew South WalesAustralia
| | - Chung‐Wei Christine Lin
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
- Sydney Musculoskeletal HealthThe University of SydneySydneyNew South WalesAustralia
| | - Lisa Bero
- School of Medicine, Colorado School of Public Health and Center for Bioethics and HumanitiesUniversity of Colorado Anschutz Medical CenterDenverColoradoUSA
| | - Jack C. Collins
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNew South WalesAustralia
| | - Benita Suckling
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNew South WalesAustralia
- Pharmacy DepartmentCaboolture Hospital, Queensland HealthBrisbaneAustralia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
3
|
Langford AV, Lin CC, Bero L, Blyth FM, Doctor J, Holliday S, Jeon YH, Moullin J, Murnion B, Nielsen S, Osman R, Penm J, Reeve E, Reid S, Wale J, Schneider CR, Gnjidic D. Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations. Med J Aust 2023; 219:80-89. [PMID: 37356051 DOI: 10.5694/mja2.52002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. MAIN RECOMMENDATIONS Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. CHANGES IN MANAGEMENT AS A RESULT OF THESE GUIDELINES To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
Collapse
Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of Sydney, Sydney, NSW
| | - Christine Cw Lin
- Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Aurora (CO), USA
| | | | - Jason Doctor
- University of Southern California, Los Angeles (CA), USA
| | | | | | | | - Bridin Murnion
- University of Sydney, Sydney, NSW
- Western Sydney Local Health District, Sydney, NSW
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | | | - Jonathan Penm
- University of Sydney, Sydney, NSW
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Emily Reeve
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of South Australia, Adelaide, SA
| | | | | | | | | |
Collapse
|
4
|
Lin G, Ye Z, Gao N, Hu X, Kong Q, Zhang X, Li J. The effect of anlotinib on the pharmacokinetic profile of oxycodone and the underlying mechanism. Chem Biol Interact 2022; 364:110044. [PMID: 35853539 DOI: 10.1016/j.cbi.2022.110044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/19/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Cancer patients experience pain during medical treatment. Therefore, anticancer drugs and painkillers are often prescribed together. This study aims to determine the interaction between anlotinib and oxycodone and reveal the underlying mechanism. METHODS UPLC-MS/MS, an efficient and sensitive method, was used for the simultaneous determination of oxycodone and oxycodone metabolites. Sprague-Dawley rats were given oxycodone with or without anlotinib. Then, UPLC-MS/MS was used to determine the blood concentration of oxycodone. To study the interaction mechanism, rat and human liver microsomes (HLMs) were used for determining enzyme kinetics. RESULTS Long-term administration of oxycodone combined with anlotinib resulted in significantly increased pharmacokinetic parameters AUC(0-t), AUC(0-∞), and Cmax for oxycodone, indicating that anlotinib inhibited oxycodone. In vitro kinetic measurements indicated that anlotinib inhibited the metabolism of oxycodone through a mixed mechanism. Further studies indicated that in HLMs, anlotinib strongly inhibited the metabolism of oxycodone. CONCLUSION This study showed that anlotinib inhibited the metabolism of oxycodone both in vitro and in vivo. It is recommended that the dose of oxycodone should be reconsidered when oxycodone is combined with anlotinib in clinical practice.
Collapse
Affiliation(s)
- Gaotong Lin
- Taizhou Cancer Hospital, Taizhou, Zhejiang, China
| | - Zhize Ye
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nanyong Gao
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoqin Hu
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qihui Kong
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaodan Zhang
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China; The Seventh People's Hospital of Wenzhou, Wenzhou, Zhejiang, China.
| | - Junwei Li
- Institute of Molecular Toxicology and Pharmacology, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
5
|
McNally GA, James FD, Gilliam-Harmon J, Atkins S, Klemanski D. Substance Use and Misuse: A Pilot Study to Improve Screening and Interventions at a Comprehensive Cancer Hospital. Clin J Oncol Nurs 2021; 25:601-604. [PMID: 34533522 DOI: 10.1188/21.cjon.601-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mounting evidence suggests patients diagnosed with cancer may be at increased risk for opioid misuse and diversion. Substance use disorders (SUDs), involving prescription medications and/or illegal substances, may significantly compromise the ability of healthcare professionals to deliver high-quality cancer care. A substance use screening pilot was conducted in ambulatory oncology clinics at a large cancer hospital in the midwestern United States. In this article, the authors present results from this quality improvement project. Future directions involve innovative methods to deliver addiction-specific knowledge to oncology healthcare providers and should focus on discussing screening results, as well as providing tailored recommendations using shared decision-making with patients and caregivers.
Collapse
Affiliation(s)
- Gretchen A McNally
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Fayona D James
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Jodi Gilliam-Harmon
- Franklin Medical Center in the Ohio Department of Mental Health and Addiction Services
| | - Saquena Atkins
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Dori Klemanski
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| |
Collapse
|