1
|
Shrestha S, Gan SH, Paudyal V, KC B, Sapkota S. Current practices, gaps, and opportunities on the role of clinical pharmacists in cancer pain management: Perspectives from Nepal. J Oncol Pharm Pract 2023; 29:2049-2056. [PMID: 37847760 PMCID: PMC10687799 DOI: 10.1177/10781552231205025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, UK
| | - Bhuvan KC
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal
- Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
| |
Collapse
|
2
|
Serra S, Spampinato MD, Riccardi A, Guarino M, Fabbri A, Orsi L, De Iaco F. Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach. J Clin Med 2023; 12:4357. [PMID: 37445392 DOI: 10.3390/jcm12134357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.
Collapse
Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy
| | | | | | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, Italy
| | - Andrea Fabbri
- Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, Italy
| | - Luciano Orsi
- Palliative Care Physician and Scientific Director of "Rivista Italiane di Cure Palliative", 26013 Crema, Italy
| | - Fabio De Iaco
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, Italy
| |
Collapse
|
3
|
Ma LT, Bai Y, Cao P, Ren KX, Chen J, Zhang T, Fan BY, Qiao Y, Yan HY, Wang JJ, Li YQ, Zheng J. The analgesic effects of β-elemene in rats with neuropathic pain by inhibition of spinal astrocytic ERK activation. Mol Pain 2022; 18:17448069221121562. [PMID: 35976914 PMCID: PMC9393702 DOI: 10.1177/17448069221121562] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neuropathic pain takes a heavy toll on individual well-being, while current therapy is far from desirable. Herein, we assessed the analgesic effect of β-elemene, a chief component in the traditional Chinese medicine Curcuma wenyujin, and explored the underlying mechanisms at the level of spinal dorsal horn (SDH) under neuropathic pain. A spared nerve injury (SNI)-induced neuropathic pain model was established in rats. Intraperitoneal injection (i.p.) of β-elemene was administered for 21 consecutive days. Mechanical allodynia was explored by von Frey filaments. The activation of the mitogen-activated protein kinase (MAPK) family (including ERK, p38, and JNK) in spinal neurons, astrocytes, and microglia was evaluated using immunostaining 29 days after SNI surgery. The expression of GFAP, Iba-1, p-ERK, p-JNK, and p-p38 within the SDH was measured using immunoblotting. The levels of proinflammatory cytokines (including TNF-α, IL-1β, and IL-6) were measured with ELISA. The levels of oxidative stress indicators (including MDA, SOD, and GSH-PX) were detected using biochemical tests. Consecutive i.p. administration of β-elemene relieved SNI-induced mechanical allodynia (with an EC50 of 16.40 mg/kg). SNI significantly increased the expression of p-ERK in spinal astrocytes but not microglia on day 29. β-elemene reversed spinal astrocytic ERK activation and subsequent upregulation of proinflammatory cytokines in SNI rats, with no effect on the expression of p38 and JNK in spinal glia. β-elemene also exerted antioxidative effects by increasing the levels of SOD and GSH-PX and decreasing the level of MDA. Our results suggest that SNI induces robust astrocytic ERK activation within the SDH in the late phase of neuropathic pain. β-elemene exerts remarkable analgesic effects on neuropathic pain, possibly by inhibiting spinal astrocytic ERK activation and subsequent neuroinflammatory processes. Our findings suggest that β-elemene might be a promising analgesic for the treatment of chronic pain.
Collapse
Affiliation(s)
- Li-Tian Ma
- Department of Traditional Chinese Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China.,Department of Gastroenterology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Peng Cao
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Kai-Xi Ren
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jing Chen
- Department of Anatomy, Histology and Embryology, Preclinical School of Medicine, Air Force Medical University, Xi'an, China
| | - Ting Zhang
- Department of Anatomy, Histology and Embryology, Preclinical School of Medicine, Air Force Medical University, Xi'an, China
| | - Bo-Yuan Fan
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Yu Qiao
- Laser Medical Center, Hainan Hospital, PLA General Hospital, Sanya, China
| | - Hong-Yu Yan
- 36674The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing-Jie Wang
- Department of Gastroenterology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yun-Qing Li
- Department of Anatomy, Histology and Embryology, Preclinical School of Medicine, Air Force Medical University, Xi'an, China.,Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.,Department of Anatomy, College of Basic Medicine, Dali University, Dali, China
| | - Jin Zheng
- Department of Traditional Chinese Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
4
|
Brouns AJWM, Hendriks LEL, van der Noort V, van de Borne BEEM, Schramel FMNH, Groen HJM, Biesma B, Smit HJM, Dingemans AMC. Efficacy of Ibandronate Loading Dose on Rapid Pain Relief in Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: The NVALT-9 Trial. Front Oncol 2020; 10:890. [PMID: 32670872 PMCID: PMC7326766 DOI: 10.3389/fonc.2020.00890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Approximately 80% of non-small cell lung cancer (NSCLC) patients with bone metastases have cancer induced bone pain (CIBP). Methods: The NVALT-9 was an open-label, single arm, phase II, multicenter study. Main inclusion criterion: bone metastasized NSCLC patients with uncontrolled CIBP [brief pain inventory [BPI] ≥ 5 over last 7 days]. Patients were treated with six milligram ibandronate intravenously (day 1–3) once a day. Main exclusion criteria: active secondary malignancy, systemic anti-tumor treatment and radiotherapy ≤4 weeks before study start, previous bisphosphonate treatment. Statistics: Simon's Optimal two-stage design with a 90% power to declare the treatment active if the pain response rate is ≥ 80% and 95% confidence to declare the treatment inactive if the pain response rate is ≤ 60%. If pain response is observed in ≤ 12 of the first 19 patients further enrollment will be stopped. Primary endpoint: bone pain response, defined as 25% decrease in worst pain score (PSc) over a 3-day period (day 5–7) compared to baseline PSc with maximum of 25% increase in mean analgesic consumption during the same period. Secondary endpoints: BPI score, quality of life, toxicity and World Health Organization Performance Score. Results: Of the 19 enrolled patients in the first stage, 18 were evaluable for response. All completed ibandronate treatment according to protocol. In 4 (22.2%), a bone pain response was observed. According to the stopping rule, further enrollment was halted. Discussion: Ibandronate loading doses lead to insufficient pain relief in NSCLC patients with CIBP.
Collapse
Affiliation(s)
- Anita J W M Brouns
- Department of Pulmonary Diseases, Zuyderland Medical Center, Sittard-Geleen, Netherlands.,Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | | | | | | | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, Netherlands
| | - Bonne Biesma
- Department of Pulmonary Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Hans J M Smit
- Department of Pulmonary Diseases, Rijnstate Hospital, Arnhem, Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands.,Department of Pulmonary Diseases, Erasmus MC, Rotterdam, Netherlands
| |
Collapse
|
5
|
Vieira CMP, Fragoso M, Ferreira M, Pereira FF, Pereira D, Medeiros R. The history of cancer pain and bone-targeted agents: 10 most commonly asked questions. Cancer Manag Res 2018; 11:37-46. [PMID: 30588109 PMCID: PMC6302803 DOI: 10.2147/cmar.s174731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of pain and skeletal complications of metastatic bone disease is high and an important factor, which contributes to decreased quality of life and low survival rate. Bone-targeted agents are well-established therapies to reduce the skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications is still controversial. The objective of this review is to summarize the existing evidence about the use of bone-targeted agents in the treatment of metastatic bone pain, trying to answer to the 10 most commonly asked questions in this matter. To achieve this goal, authors did a research of reviews published between January 2001 and January 2018, using the terms MeSH: “cancer pain” and bisphosphonates. The source used was the PubMed (NLM) database. The search yielded 36 reviews, but only 16 met the inclusion criteria. Even with the introduction of a new class of drugs, bisphosphonates and specially zoledronic acid are the most commonly used drugs in most oncology centers. Bisphosphonates and denosumab appear to be beneficial in preventing skeletal morbidity but their analgesic role and impact on quality of life and survival are not so well established.
Collapse
Affiliation(s)
- Cláudia Margarida Pereira Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal, .,Research Center, Molecular Oncology Group Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal, .,Faculty of Medicine, University of Porto, Porto, Portugal,
| | - Maria Fragoso
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal, .,Unit of Study and Treatment of Pain, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
| | - Marta Ferreira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal,
| | - Filipa Ferreira Pereira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal,
| | - Deolinda Pereira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal,
| | - Rui Medeiros
- Research Center, Molecular Oncology Group Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal, .,Faculty of Medicine, University of Porto, Porto, Portugal, .,Biomedical Research Center, Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal.,Research Department, Portuguese League Against Cancer, Porto, Portugal
| |
Collapse
|
6
|
Tanaka R, Ishikawa H, Sato T, Shino M, Omae K, Sato T, Osaka I. Safety profile of prophylactic rescue dosing of immediate-release oral opioids in cancer patients. J Pharm Health Care Sci 2018; 4:25. [PMID: 30214820 PMCID: PMC6130058 DOI: 10.1186/s40780-018-0121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate prophylactic rescue dosing of opioids is considered effective for cancer pain relief, but no study has reported the safety of such prophylactic rescue. We compared the safety of prophylactic rescue dosing of immediate-release oral opioids with that of regular rescue dosing. METHODS The study included 103 cancer patients who used either immediate-release morphine syrup or immediate-release oxycodone powder at Shizuoka Cancer Center between January and December 2016. Patients were divided into those who mostly used (prophylactic group) and those who never used (regular group) prophylactic rescue doses of opioids and compared the incidence of adverse events (AEs). We also investigated whether the prophylactic rescue dose negatively interfered with its objective activity, such as meals. RESULTS Incidence of each AE in the prophylactic versus regular groups was as follows: somnolence, 20.6% versus 14.3%; nausea, 22.1% versus 17.1%; constipation, 19.1% versus 20.0%; urinary retention, 1.5% versus 2.9%; delirium, 4.4% versus 8.6%; and pruritus, 0% versus 2.9%. No serious AE associated with prophylactic rescue dosing was observed. No significant difference was observed in the incidence of any AE between the two groups (p > 0.05, Fisher's exact test). No AE interfered with the objective activity of the prophylactic rescue dose. CONCLUSION Incidence of AEs associated with prophylactic rescue dosing is not different from that associated with regular rescue dosing. In addition, the prophylactic rescue dose did not adversely affect its objective activity, suggesting the safety of appropriate prophylactic rescue dosing was similar to that of regular rescue dosing. TRIAL REGISTRATION The study approval number in the institution; H29-J30-29-1-3. Registered June 5, 2017.
Collapse
Affiliation(s)
- Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Hiroshi Ishikawa
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Tetsu Sato
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Michihiro Shino
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit of Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Tetsumi Sato
- Department of Palliative Medicine, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Iwao Osaka
- Department of Palliative Medicine, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| |
Collapse
|
7
|
Yan YY, Li CY, Zhou L, Ao LY, Fang WR, Li YM. Research progress of mechanisms and drug therapy for neuropathic pain. Life Sci 2017; 190:68-77. [PMID: 28964813 DOI: 10.1016/j.lfs.2017.09.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/09/2017] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
Neuropathic pain is maladaptive pain caused by injury or dysfunction in peripheral and central nervous system, and remains a worldwide thorny problem leading to decreases in physical and mental quality of people's life. Currently, drug therapy is the main treatment regimen for resolving pain, while effective drugs are still unmet in medical need, and commonly used drugs such as anticonvulsants and antidepressants often make patients experience adverse drug reactions like dizziness, somnolence, severe headache, and high blood pressure. Thus, in this review we overview the anatomical physiology, underlying mechanisms of neuropathic pain to provide a better understanding in the initiation, development, maintenance, and modulation of this pervasive disease, and inspire research in the unclear mechanisms as well as potential targets. Furthermore, we summarized the existing drug therapies and new compounds that have shown antalgic effects in laboratory studies to be helpful for rational regimens in clinical treatment and promotion in novel drug discovery.
Collapse
Affiliation(s)
- Yun-Yi Yan
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Cheng-Yuan Li
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Lin Zhou
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Lu-Yao Ao
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Wei-Rong Fang
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China.
| | - Yun-Man Li
- State Key Laboratory of Natural Medicines, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China.
| |
Collapse
|
8
|
Parás-Bravo P, Paz-Zulueta M, Alonso-Blanco MC, Salvadores-Fuentes P, Alconero-Camarero AR, Santibañez M. Association among presence of cancer pain, inadequate pain control, and psychotropic drug use. PLoS One 2017; 12:e0178742. [PMID: 28594871 PMCID: PMC5464574 DOI: 10.1371/journal.pone.0178742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 05/18/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. MATERIALS AND METHODS In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). RESULTS The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49-6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77-15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91-11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74-21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). CONCLUSION The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.
Collapse
Affiliation(s)
| | - María Paz-Zulueta
- Department of Nursing, University of Cantabria, Santander, Spain
- * E-mail:
| | | | - Paloma Salvadores-Fuentes
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Division of Physical Therapy, University “Rey Juan Carlos”, Madrid, Spain
| | | | | |
Collapse
|
9
|
Lara-Solares A, Ahumada Olea M, Basantes Pinos ADLÁ, Bistre Cohén S, Bonilla Sierra P, Duarte Juárez ER, Símon Escudero OA, Santacruz Escudero JG, Flores Cantisani JA. Latin-American guidelines for cancer pain management. Pain Manag 2017; 7:287-298. [PMID: 28326952 DOI: 10.2217/pmt-2017-0006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cancer is a major public health issue. Poor pain management has devastating consequences that seriously affect quality of life, diminish functionality and place a huge emotional burden on patients and their relatives. A group of Latin American opinion leaders were invited to participate in a meeting to discuss areas associated with cancer pain. The expert panel reviewed the latest literature to draft region-specific guidelines for effective pain management. The guidelines make recommendations on tailoring treatment to the specific type of pain and provide local physicians with the state-of-the art findings in the field. Management should be with pharmacological approaches (nonopioid, adjuvant and opioid analgesics, as well as oncologic therapies and interventional procedures) and nonpharmacological approaches.
Collapse
Affiliation(s)
- Argelia Lara-Solares
- Department of Pain Medicine & Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - Marisol Ahumada Olea
- CR Alivio Dolor & CP INCANCER, Asociación Chilena para el Estudio del Dolor (ACHED), Asociación Latino Americana de Cuidados Paliativos (ALCP), Santiago de Chile, Chile
| | | | | | | | - Eva Rossina Duarte Juárez
- Palliative Care & Symptoms Control Service, Institutode Cancerología, Palliative Medicine Unit, Hospital 'Nuestra Señora del Pilar', GuatemalaCity, Guatemala
| | - Omar A Símon Escudero
- Department of Oncolgy, Surgical Oncology Service, Hospital Nacional 'Daniel Alcides Carrión', Cancer Pain Therapy and Palliative Care, ADAMO (Atención Ambulatoria del Adulto Mayor y Paciente Oncológico), Dirección Regional de Salud (DIRESA) Callao, Lima, Perú
| | | | | |
Collapse
|
10
|
Machado-Alba JE, Gaviria-Mendoza A, Vargas-Mosquera CA, Gil-Restrepo AF, Romero-Zapata LC. Opioid Prescribing Patterns and Costs in a Large Group of Patients in Colombia. J Pain Palliat Care Pharmacother 2017; 31:57-65. [PMID: 28287359 DOI: 10.1080/15360288.2016.1276504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The potential for development of tolerance and dependence and the risk of side effects of opioids make it necessary to monitor their prescribing patterns in order to decrease the morbidity and mortality associated with their continued use. The objective of this study was to determine prescription patterns of opioid medication in a group of patients through a cross-sectional study on a population database of 3.5 million people. Patients with three months of continuous opioid use were identified. Pharmacological, co-medication and cost variables were analyzed. We conducted a multivariate analysis. A total of 7,457 patients were included; 72.1% were women, the mean age was 65.1 years, and 3.8% had a diagnosis of cancer. 10.2% of the patients received opioids in combination therapy. The most prescribed opioids were codeine (57.7%), tramadol (30.9%), and hydrocodone (10.4%). The great majority of patients (91.8%) received pharmacological co-medication with antihypertensive agents (54.4%), statins (38.2%) and acetaminophen (35.4%). The use of other analgesics such as acetaminophen (OR: 1.45, 95% CI: 1.22 -1.75) or nonsteroidal anti-inflammatory drugs (OR: 1.98, 95% CI: 1.60 -2.44) was associated with increased risk of receiving opioids in combination therapy. Prescribing habits of weak agonists and short-acting opioids predominate, mainly in monotherapy and at lower than recommended doses.
Collapse
|
11
|
Siebenhuener K, Eschmann E, Kienast A, Schneider D, Minder CE, Saller R, Zimmerli L, Blaser J, Battegay E, Holzer BM. Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions? PLoS One 2017; 12:e0168987. [PMID: 28046033 PMCID: PMC5207693 DOI: 10.1371/journal.pone.0168987] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions. Methods and Findings We conducted a retrospective study with all multimorbid inpatients aged ≥18 years admitted to the Department of Internal Medicine of University Hospital Zurich in 2011 (n = 1,039 patients). Data were extracted from the electronic health records and reviewed. We identified 433 hospitalizations of patients with chronic pain and analyzed their combinations of chronic conditions (multimorbidity). We then classified all analgesic prescriptions according to the World Health Organization (WHO) analgesic ladder. Furthermore, we used a Swiss drug-drug interactions knowledge base to identify potential interactions between opioids and other drug classes, in particular coanalgesics and other concomitant drugs. Chronic pain was present in 38% of patients with multimorbidity. On average, patients with chronic pain were aged 65.7 years and had a mean number of 6.6 diagnoses. Hypertension was the most common chronic condition. Chronic back pain was the most common painful condition. Almost 90% of patients were exposed to polypharmacotherapy. Of the chronic pain patients, 71.1% received opioids for moderate to severe pain, 43.4% received coanalgesics. We identified 3,186 potential drug-drug interactions, with 17% classified between analgesics (without coanalgesics). Conclusions Analgesic drugs-related DDIs, in particular opioids, in multimorbid patients are often complex and difficult to assess by using DDI knowledge bases alone. Drug-multimorbidity interactions are not sufficiently investigated and understood. Today, the scientific literature is scarce for chronic pain in combination with multiple coexisting medical conditions and medication regimens. Our work may provide useful information to enable further investigations in multimorbidity research within the scope of potential interactions and chronic pain.
Collapse
Affiliation(s)
- Klarissa Siebenhuener
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
| | - Emmanuel Eschmann
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Kienast
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Schneider
- Maennedorf Hospital, Department of Internal Medicine, Canton Zurich, Switzerland
| | | | - Reinhard Saller
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Institute of Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- Cantonal Hospital, Internal Medicine, Olten, Switzerland
| | - Jürg Blaser
- Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging,’ University of Zurich, Zurich, Switzerland
| | - Barbara M. Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland
- * E-mail:
| |
Collapse
|
12
|
Abdollahi H, Ghaemi-Jandabi M, Azizi H, Semnanian S. The role of orexin type-1 receptors in the development of morphine tolerance in locus coeruleus neurons: An electrophysiological perspective. Brain Res 2016; 1646:91-97. [DOI: 10.1016/j.brainres.2016.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
|
13
|
Terpos E, Kleber M, Engelhardt M, Zweegman S, Gay F, Kastritis E, van de Donk NWCJ, Bruno B, Sezer O, Broijl A, Bringhen S, Beksac M, Larocca A, Hajek R, Musto P, Johnsen HE, Morabito F, Ludwig H, Cavo M, Einsele H, Sonneveld P, Dimopoulos MA, Palumbo A. European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica 2016; 100:1254-66. [PMID: 26432383 DOI: 10.3324/haematol.2014.117176] [Citation(s) in RCA: 224] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A).
Collapse
Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Martina Kleber
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany Clinic for Internal Medicine, University Hospital Basel, Switzerland
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Gay
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | | | - Benedetto Bruno
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Orhan Sezer
- Department of Hematology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Annemiek Broijl
- Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Sara Bringhen
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Meral Beksac
- Department of Hematology, Ankara University, Turkey
| | - Alessandra Larocca
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine OU, Ostrava, Czech Republic
| | - Pellegrino Musto
- Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy
| | | | - Fortunato Morabito
- Department of Hematology, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy
| | - Heinz Ludwig
- Department of Medicine I, Center of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology and Medical Oncology, University of Bologna, Italy
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würburg, Würzburg, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Antonio Palumbo
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | | |
Collapse
|
14
|
Morphine, a potential antagonist of cisplatin cytotoxicity, inhibits cisplatin-induced apoptosis and suppression of tumor growth in nasopharyngeal carcinoma xenografts. Sci Rep 2016; 6:18706. [PMID: 26729257 PMCID: PMC4700493 DOI: 10.1038/srep18706] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/24/2015] [Indexed: 12/21/2022] Open
Abstract
Morphine is an opioid analgesic drug often used for pain relief in cancer patients. However, there is growing evidence that morphine may modulate tumor growth, progression and metastasis. In this study, we evaluated whether morphine modulates cisplatin-induced apoptosis in human nasopharyngeal carcinoma CNE-2 cells and whether morphine affects the antitumor activity of cisplatin on tumor growth in human nasopharyngeal carcinoma CNE-2 xenografts in nude mice. We showed that a pretreatment with morphine (1 μg/ml) inhibited the sensitivity of CNE-2 cells to cisplatin by inhibiting cisplatin-induced CNE-2 cell apoptosis, decreasing caspase-3 activity and increasing the Bcl-2/Bax ratio. However, a high dose of morphine (1000 μg/ml) had the opposite effect. We also showed that at a low dose, morphine enhances chemoresistance in an in vivo nasopharyngeal carcinoma (NPC) model by inhibiting cisplatin-induced apoptosis and decreasing neovascularization. Taken together, our results indicate that a low dose of morphine may lead to chemoresistance of cisplatin in NPC models in vitro and in vivo by inhibiting cisplatin-induced apoptosis and decreasing neovascularization.
Collapse
|
15
|
Affiliation(s)
- Eric E. Prommer
- Division of Hematology/Oncology, Veterans Integrated Palliative Care Program, Veterans Integrated Palliative Care, David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
16
|
Pautex S, Vogt-Ferrier N, Zulian GB. Breakthrough pain in elderly patients with cancer: treatment options. Drugs Aging 2015; 31:405-11. [PMID: 24817569 DOI: 10.1007/s40266-014-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of pain is high in the elderly and increases with the occurrence of cancer. Pain treatment is challenging because of age-related factors such as co-morbidities, and over half of the patients with cancer pain experience transient exacerbation of pain that is known as breakthrough pain (BTP). As with background pain, BTP should be properly assessed before being treated. The first step to be taken is optimizing around-the-clock analgesia with expert titration of the painkiller. Rescue medication should then be provided as per the requested need, while at the same time preventing identified potential precipitating factors. In the elderly, starting treatment with a lower dose of analgesics may be justified because of age-related physiological changes such as decreased hepatic and renal function. Whenever possible, oral medication should be provided prior to a painful maneuver. In the case of unpredictable BTP, immediate rescue medication is mandatory and the subcutaneous route is preferred unless patient-controlled analgesia via continuous drug infusion is available. Recently, transmucosal preparations have appeared in the medical armamentarium but it is not yet known whether they represent a truly efficient alternative, although their rapid onset of activity is already well recognized. Adjuvant analgesics, topical analgesics, anesthetic techniques and interventional techniques are all valid methods to help in the difficult management of pain and BTP in elderly patients with cancer. However, none has reached a satisfying scientific level of evidence as to nowadays make the development of undisputed best practice guidelines possible. Further research is therefore on the agenda.
Collapse
Affiliation(s)
- Sophie Pautex
- Community Palliative Care Unit, Division of Primary Care, Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | | | | |
Collapse
|
17
|
Abstract
INTRODUCTION Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. AREAS COVERED The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended. EXPERT OPINION There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines.
Collapse
Affiliation(s)
- Stephan A Schug
- Professor, Chair of Anaesthesiology, The University of Western Australia, School of Medicine and Pharmacology, Pharmacology, Pharmacy and Anaesthesiology Unit , Perth , Australia
| | | |
Collapse
|
18
|
Ghaemi-Jandabi M, Azizi H, Semnanian S. Blockade of orexin type 1 receptors inhibits the development of morphine tolerance in lateral paragigantocellularis nucleus: An electrophysiological approach. Brain Res 2014; 1578:14-22. [DOI: 10.1016/j.brainres.2014.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/06/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
|
19
|
Abstract
Pain is a significant and alarming symptom of cancer seriously affecting the activity and quality of life of patients. Recent research proved that inadequate analgesia shortens life expectancy. Therefore, pain relief is not only a possibility but a professional, ethical and moral commitment to relieve patients from suffering, as well as ensure their adequate quality of life and human dignity. Proper pain relief can be achieved with medical therapy in most of the cases and the pharmacological alternatives are available in Hungary. Yet medical activity regarding pain relief is far from the desired. This paper gives a short summary of the guidelines on medical pain management focusing particularly on the use of opioids.
Collapse
Affiliation(s)
- Péter Heigl
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Aneszteziológiai és Intenzív Terápiás Intézet Pécs Rákóczi út 2. 7623
| |
Collapse
|
20
|
Ali N, Moiz B, Silat H, Rehan A, Adil S. Improved outcome of myeloma related bone pain with oral analgesics and bisphosphonate therapy: A single-center experience from Pakistan. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
21
|
Kanbayashi Y, Hatano Y, Hata Y, Morita T, Fukui K, Hosokawa T. Predictive factors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital using ordered logistic regression analysis. J Palliat Med 2013; 16:1020-5. [PMID: 23888304 DOI: 10.1089/jpm.2013.0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the fact that many cancer patients worldwide die in general hospitals, there are few reports of the analysis of delirium in terminally ill cancer patients in this setting. PURPOSE This study aimed to identify predictive factors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital. METHODS Participants were 182 consecutively admitted terminally ill cancer patients who died in a Japanese general hospital between April 2009 and March 2011. Variables present one week before death were extracted from the clinical records for regression analysis of factors potentially related to agitation severity of delirium. The prevalence and agitation severity of delirium were evaluated retrospectively. Multivariate ordered logistic regression analysis was performed to identify predictive factors. RESULTS Male sex [odds ratio (OR)=2.125, 95% confidence interval (CI)=1.111-4.067; P=0.0227]; total bilirubin (T-bil) [OR=1.557, CI=1.082-2.239; P=0.017]; antibiotics [OR=0.450, CI=0.219-0.925; P=0.0298]; nonsteroidal antiinflammatory drugs (NSAIDs) [OR=2.608, CI=1.374-4.950; P=0.0034]; and hematological malignancy [OR=3.903, CI=1.363-11.179; P=0.0112] were found to be statistically significant predictors for agitation severity of hyperactive delirium. CONCLUSIONS Our study indicates that male sex, T-bil, antibiotic therapy, NSAID therapy, and hematological malignancy are significant predictors for agitation severity of hyperactive delirium in terminally ill cancer patients in a general hospital setting.
Collapse
Affiliation(s)
- Yuko Kanbayashi
- 1 Hospital Pharmacy, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Letarte N. L’éducation thérapeutique d’un patient atteint de douleur. ACTUALITES PHARMACEUTIQUES 2012. [DOI: 10.1016/s0515-3700(12)71354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
23
|
Vignaroli E, Bennett MI, Nekolaichuk C, De Lima L, Wenk R, Ripamonti CI, Bruera E. Strategic Pain Management: The Identification and Development of the IAHPC Opioid Essential Prescription Package. J Palliat Med 2012; 15:186-91. [DOI: 10.1089/jpm.2011.0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ernesto Vignaroli
- Palliative Care Unit, Hospital Tornu, Buenos Aires, Argentina
- Programa Argentino de Medicina Paliativa, FEMEBA Foundation, Buenos Aires, Argentina
| | - Michael I. Bennett
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
- International Association for Hospice and Palliative Care, Houston, Texas
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas
| | - Roberto Wenk
- Programa Argentino de Medicina Paliativa, FEMEBA Foundation, Buenos Aires, Argentina
- International Association for Hospice and Palliative Care, Houston, Texas
| | - Carla I. Ripamonti
- International Association for Hospice and Palliative Care, Houston, Texas
- Supportive Care in Cancer Unit of the IRCCS Foundation, Milan, Italy
- Istituto per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Eduardo Bruera
- International Association for Hospice and Palliative Care, Houston, Texas
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| |
Collapse
|
24
|
|
25
|
Ozdemir E, Bagcivan I, Gursoy S, Altun A, Durmus N. Effects of fluoxetine and LY 365265 on tolerance to the analgesic effect of morphine in rats. ACTA ACUST UNITED AC 2011; 98:205-13. [DOI: 10.1556/aphysiol.98.2011.2.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
26
|
TH-030418: a potent long-acting opioid analgesic with low dependence liability. Naunyn Schmiedebergs Arch Pharmacol 2011; 384:125-31. [DOI: 10.1007/s00210-011-0652-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
|
27
|
|
28
|
Abstract
BACKGROUND Long-term pain is a debilitating condition that is costly to treat and has a significant impact on patient quality of life. Classical opioids have been used for the treatment of pain for centuries and are one of the most effective drug classes available for acute severe pain and long-term pain. However, concerns regarding adverse effects, tolerance to analgesic effects and the potential for addiction have resulted in a reluctance to prescribe and use opioids for the management of long-term non-cancer pain. Adverse events, including gastrointestinal side effects such as constipation, nausea and vomiting, and central nervous system side effects such as sedation are responsible for as many as one in five patients discontinuing opioid treatment, often leading to inadequate pain relief and poor patient quality of life. Therefore, new analgesic therapies are needed that are associated with fewer adverse effects, whilst providing sustainable pain relief for patients with long-term pain. OBJECTIVE AND METHODS To provide an overview of the historical development, uses, mechanisms of action, receptor affinities and side-effect profiles of classical opioids. In addition, recent developments and novel approaches for long-term, severe pain treatment are also reviewed. RESULTS A number of treatment strategies were identified: co-administration with opioid-sparing analgesics to reduce side effects and/or risk of dependence, the use of peripheral opioid antagonists and novel delivery mechanisms to reduce side effects, the development of non-opioid agents that reduce side effects and enhance analgesia such as glial cell modulators, and the development of novel agents with combined µ-receptor and monoaminergic activity within the same molecule. CONCLUSIONS Despite these recent advances, there have been very few completely novel drug developments. Hence, there remains a continuing need for innovative therapeutic strategies for the treatment of long-term pain. The most promising alternatives appear to be the use of traditional opioids together with peripheral opioid antagonists, combining opioids with glial cell modulators, and the use of novel agents with µ-receptor agonist and noradrenaline reuptake inhibitor activity within the same molecule (MOR-NRI compounds).
Collapse
Affiliation(s)
- Karsten Ahlbeck
- Department of Anesthesiology, Surgical Services and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
29
|
Liang SY, Li CC, Wu SF, Wang TJ, Tsay SL. The prevalence and impact of pain among Taiwanese oncology outpatients. Pain Manag Nurs 2011; 12:197-205. [PMID: 22117751 DOI: 10.1016/j.pmn.2010.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 10/17/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to report the prevalence and impact of pain among Taiwanese oncology outpatients who had experienced moderate pain. Ninety-two cancer outpatients in two teaching hospitals in the Taipei area of Taiwan were enrolled in a descriptive cross-sectional study. Outpatients aged ≥18 years who had been prescribed opioid analgesics for cancer-related pain completed the Brief Pain Inventory-Chinese questionnaire. Results of this study highlighted an important issue: undertreatment of cancer pain in the Taiwanese outpatients. Patients in this study reported that in the preceding 24 hours they had experienced a mean worst pain of 6.91 (SD 2.06, range 0-10). The average pain intensity in the preceding 24 hours was 5.21 (SD 1.69, range 0-10). Around 50% of the patients had pain most of the time and 25% of the patients had pain all of the time. In the preceding 24 hours the average pain relief experienced was 62.6% (SD 22.2%, range 0%-100%). Only 10.9% of patients experienced good pain relief (defined as 90%-100% of pain relief in the past 24 hours), whereas 45.7% experienced poor pain relief (defined as 0%-60% of pain relief in the past 24 hours). The mean pain interference with the patients' daily activities was 5.69 (SD 2.33, range 0-10). The findings of this study indicate the need for better programmatic efforts to improve relief of cancer pain in Taiwanese outpatients.
Collapse
Affiliation(s)
- Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
30
|
Professional survey on knowledge and clinical patterns of pain management in Spanish medical oncology. Clin Transl Oncol 2010; 12:819-24. [PMID: 21156412 DOI: 10.1007/s12094-010-0603-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Cancer pain is still not treated adequately. The barriers impeding its appropriate treatment include lack of knowledge, erroneous beliefs and inappropriate attitudes with regard to pain, which are sustained by some or all of those involved in the problem. The present study shows the results of an exploratory survey using a large sample of specialists in clinical oncology. Its main objective is to evaluate daily analgesic practices and compliance with clinical guidelines in order to identify areas that should be improved in this particular therapeutic field. Information collection from the responders was in the form of a self-administered written questionnaire, structured in three thematic areas: clinical patterns and resources used in pain treatment in clinical practice, pain and pain-relief therapy, and theoretical knowledge and decision-making in clinical practice. The study identified those skills that most need improvement in the treatment of pain (scientific and technical knowledge and clinical decision-making capacity of professionals) in order to reduce the unjustified variability in current clinical practice.
Collapse
|
31
|
Eisenberg E, Vielvoye-Kerkmeer APE, van Mansom I, Roelofs EG, Stevens AM. Nurses’ Knowledge about Pain Management with Opioids for Dying Patients United Kingdom Nursing Perspective. J Pain Palliat Care Pharmacother 2010. [DOI: 10.3109/15360288.2010.503729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Elon Eisenberg
- Dr. Ans P. E. Vielvoye-Kerkmeer is pain consultant and anaesthesiologist, Dr. Inge van Mansom is an old age and palliative care specialist, and Dr. Els G. Roelofs is a general practitioner and palliative care specialist, WWZ Sint Elisabeth Gasthuishof, Leiden, The Netherlands. Anna-Marie Stevens is a Macmillan nurse consultant in cancer palliative care at The Royal Marsden NHS Foundation Trust, London, UK
| | - Ans P. E. Vielvoye-Kerkmeer
- Dr. Ans P. E. Vielvoye-Kerkmeer is pain consultant and anaesthesiologist, Dr. Inge van Mansom is an old age and palliative care specialist, and Dr. Els G. Roelofs is a general practitioner and palliative care specialist, WWZ Sint Elisabeth Gasthuishof, Leiden, The Netherlands. Anna-Marie Stevens is a Macmillan nurse consultant in cancer palliative care at The Royal Marsden NHS Foundation Trust, London, UK
| | - Inge van Mansom
- Dr. Ans P. E. Vielvoye-Kerkmeer is pain consultant and anaesthesiologist, Dr. Inge van Mansom is an old age and palliative care specialist, and Dr. Els G. Roelofs is a general practitioner and palliative care specialist, WWZ Sint Elisabeth Gasthuishof, Leiden, The Netherlands. Anna-Marie Stevens is a Macmillan nurse consultant in cancer palliative care at The Royal Marsden NHS Foundation Trust, London, UK
| | - Els G. Roelofs
- Dr. Ans P. E. Vielvoye-Kerkmeer is pain consultant and anaesthesiologist, Dr. Inge van Mansom is an old age and palliative care specialist, and Dr. Els G. Roelofs is a general practitioner and palliative care specialist, WWZ Sint Elisabeth Gasthuishof, Leiden, The Netherlands. Anna-Marie Stevens is a Macmillan nurse consultant in cancer palliative care at The Royal Marsden NHS Foundation Trust, London, UK
| | - Ann-Marie Stevens
- Dr. Ans P. E. Vielvoye-Kerkmeer is pain consultant and anaesthesiologist, Dr. Inge van Mansom is an old age and palliative care specialist, and Dr. Els G. Roelofs is a general practitioner and palliative care specialist, WWZ Sint Elisabeth Gasthuishof, Leiden, The Netherlands. Anna-Marie Stevens is a Macmillan nurse consultant in cancer palliative care at The Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
32
|
Stevens MJ, Atkinson C, Broadbent AM. The malignant psoas syndrome revisited: case report, mechanisms, and current therapeutic options. J Palliat Med 2010; 13:211-6. [PMID: 20053159 DOI: 10.1089/jpm.2009.0193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The malignant psoas syndrome (MPS) is a rare and challenging cancer pain state that is often refractory to rational polymodal analgesic therapy. We describe the first case of cervix cancer-related MPS due to extrinsic psoas muscle infiltration and review the therapeutic trajectory and outcome. The anatomic determinants, pain mechanisms, and current and proposed novel treatment strategies for MPS are discussed.
Collapse
Affiliation(s)
- Mark John Stevens
- Department of Palliative Medicine, Hope Health Care, Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
33
|
Cao F, Gao F, Xu AJ, Chen ZJ, Chen SS, Yang H, Yu HH, Mei W, Liu XJ, Xiao XP, Yang SB, Tian XB, Wang XR, Tian YK. Regulation of spinal neuroimmune responses by prolonged morphine treatment in a rat model of cancer induced bone pain. Brain Res 2010; 1326:162-73. [DOI: 10.1016/j.brainres.2010.02.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/15/2022]
|
34
|
Porreca F, Ossipov MH. Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options. PAIN MEDICINE 2009; 10:654-62. [PMID: 19302436 DOI: 10.1111/j.1526-4637.2009.00583.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Frank Porreca
- Department of Pharmacology, University of Arizona, Tuscon, Arizona 85724, USA.
| | | |
Collapse
|
35
|
Nayebi AM, Rezazadeh H, Parsa Y. Effect of fluoxetine on tolerance to the analgesic effect of morphine in mice with skin cancer. Pharmacol Rep 2009; 61:453-8. [DOI: 10.1016/s1734-1140(09)70086-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 04/20/2009] [Indexed: 01/23/2023]
|
36
|
Borgsteede SD, Deliens L, Zuurmond WWA, Schellevis FG, Willems DL, Van der Wal G, van Eijk JTM. Prescribing of pain medication in palliative care. A survey in general practice. Pharmacoepidemiol Drug Saf 2009; 18:16-23. [DOI: 10.1002/pds.1678] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Bianchi F, Ginggen A, Tardy Y. Stability and compatibility of drug mixtures in an implantable infusion system. Anaesthesia 2008; 63:972-8. [DOI: 10.1111/j.1365-2044.2008.05516.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
38
|
Metastatic bone pain: treatment options with an emphasis on bisphosphonates. Support Care Cancer 2008; 16:1105-15. [PMID: 18682990 DOI: 10.1007/s00520-008-0487-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 07/02/2008] [Indexed: 12/21/2022]
Abstract
INTRODUCTION One of the key targets for metastatic cancer cells is the skeleton. Once metastatic cells are established within the bone matrix, skeletal integrity becomes increasingly compromised. Bone lesions lead to various complications, including bone pain, fractures and spinal cord compression. MECHANISMS OF BONE PAIN Bone pain is debilitating and affects quality of life of the patient. In addition, it increases the use of health care resources. Many patients with metastatic bone disease experience substantial bone pain despite state-of-the-art systemic analgesic treatment. Incident pain is the predominant pain syndrome. TREATMENT OPTIONS FOR BONE PAIN Typically, this syndrome requires moderate baseline analgesia with increased on-demand doses. Other techniques for treating bone pain, including radiation therapy, neuraxial application of analgesics, nerve blocks and local stabilisation procedures, should be considered. In addition, therapy with bisphosphonates targeting bone-specific pain is an important strategy. This review discusses the various management options for bone pain arising from metastatic bone disease.
Collapse
|
39
|
Abstract
Breakthrough pain (BTP) in patients with cancer lacks a consensus definition and is subsequently inadequately diagnosed and assessed, therefore making it more challenging to manage. Cancer pain is generally moderate to severe in intensity and persistent in nature. Despite the problematic definition of BTP, it is generally described as having similar intensity, but may also be transitory and variable in predictability. Most breakthrough analgesia fails to be effective in the time required for BTP. No useful analgesia is therefore provided but drug adverse effects escalate. Cancer pain management relies on the WHO analgesic ladder. The frequency of BTP and its inadequate management means that it has significant adverse effects on patients, their families and those involved in their care. This article outlines a systematic, clinical and evidence-based approach to managing BTP in patients with cancer that emphasizes a holistic approach and an understanding of multidimensional 'total pain'. Guidelines for managing BTP are presented and areas of developing research are identified.
Collapse
|
40
|
Abstract
This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
Collapse
Affiliation(s)
- John D Markman
- Neuromedicine Pain Management Center, Department of Neurosurgery and Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 670 Rochester, New York 14642, USA.
| | | |
Collapse
|
41
|
Duce Tello S, Rollán Arribas B, López Martínez E, Camarasa Pérez J. Uso de los opioides en pacientes con dolor oncológico. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73956-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
42
|
Lin X, Li Q, Wang YJ, Ju YW, Chi ZQ, Wang MW, Liu JG. Morphine inhibits doxorubicin-induced reactive oxygen species generation and nuclear factor kappaB transcriptional activation in neuroblastoma SH-SY5Y cells. Biochem J 2007; 406:215-21. [PMID: 17542780 PMCID: PMC1948956 DOI: 10.1042/bj20070186] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Morphine is recommended as a first-line opioid analgesic in the pain management of cancer patients. Accumulating evidence shows that morphine has anti-apoptotic activity, but its impact on the therapeutic applications of antineoplastic drugs is not well known. The present study was undertaken to test the hypothesis that morphine might antagonize the pro-apoptotic activity of DOX (doxorubicin), a commonly used antitumour drug for the treatment of neuroblastoma, in cultured SH-SY5Y cells. In the present study we demonstrated that morphine suppressed DOX-induced inhibition of cell proliferation and programmed cell death in a concentration-dependent, and naloxone as well as pertussis toxin-irreversible, manner. Further studies showed that morphine inhibited ROS (reactive oxygen species) generation, and prevented DOX-mediated caspase-3 activation, cytochrome c release and changes of Bax and Bcl-2 protein expression. The antioxidant NAC (N-acetylcysteine) also showed the same effects as morphine on DOX-induced ROS generation, caspase-3 activation and cytochrome c release and changes in Bax (Bcl-2-associated X protein) and Bcl-2 protein expression. Additionally, morphine was found to suppress DOX-induced NF-kappaB (nuclear factor kappaB) transcriptional activation via a reduction of IkappaBalpha (inhibitor of nuclear factor kappaB) degradation. These present findings support the hypothesis that morphine can inhibit DOX-induced neuroblastoma cell apoptosis by the inhibition of ROS generation and mitochondrial cytochrome c release, as well as by blockade of NF-kappaB transcriptional activation, and suggests that morphine might have an impact on the antitumour efficiency of DOX.
Collapse
Affiliation(s)
- Xin Lin
- *State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Qing Li
- †Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yu-Jun Wang
- †Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Ya-Wen Ju
- *State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Zhi-Qiang Chi
- *State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Min-Wei Wang
- †Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Jing-Gen Liu
- *State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- To whom correspondence should be addressed (email )
| |
Collapse
|
43
|
E10-04: Management in advanced lung cancer:pain control. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000283024.41767.4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Soares LG, Chan VW. The rationale for a multimodal approach in the management of breakthrough cancer pain: a review. Am J Hosp Palliat Care 2007; 24:430-9. [PMID: 17582029 DOI: 10.1177/1049909107302297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Breakthrough pain has been described differently in various countries, and not surprisingly, recommendations for its management vary according to the institution. Usually when breakthrough pain occurs, the patient's pain has already been managed according to the World Health Organization 3-step ladder for cancer pain. After this point, the treatment choice is usually based on clinical judgment, the physician's personal experience with interventional procedures, and local resources available. Opioids remain the mainstay of the management of breakthrough cancer pain. However, the combination of radio-oncology, adjuvant drugs, and interventional pain procedures can improve pain relief. This review addresses those questions and proposes a multimodal approach to manage breakthrough cancer pain.
Collapse
Affiliation(s)
- Luiz Guilherme Soares
- Department of Anesthesia & Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
| | | |
Collapse
|
45
|
Abstract
This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
Collapse
Affiliation(s)
- John D Markman
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | | |
Collapse
|
46
|
Abstract
OBJECTIVE To review strategies for treating patients with breakthrough pain (BTP). DESIGN This review is based on expert consensus recommendations for treating BTP and is supplemented by recent clinical studies and the author's clinical experience. RESULTS Breakthrough pain is severe or excruciating pain of rapid onset that can disable or even immobilize the patient. Patients with BTP should be assessed after baseline persistent pain has been stabilized with around-the-clock (ATC) analgesics. Clues about the cause and pattern of BTP may be identified from a patient history, preferably including a pain diary. Effective treatment can greatly improve the patient's quality of life and should be tailored for each patient, taking into consideration the cause and type of the BTP episodes. Short-acting opioid analgesics are the primary treatment. The absorption characteristics, onset of action, and duration of effect vary among the available opioid compounds based on their lipophilicity. The dose and/or dosing frequency of the ATC analgesic should be adjusted for patients with end-of-dose BTP. Short-acting oral opioids are useful when given preemptively in patients with predictable incident BTP, while rapid-onset transmucosal lipophilic opioids are most effective for patients with unpredictable incident or idiopathic BTP. Regardless of the subtype of BTP, nonpharmacologic strategies are often helpful in alleviating pain and anxiety and should be used to supplement pharmacologic intervention for BTP. CONCLUSION Breakthrough pain can often be successfully treated by tailoring opioid therapy based on the subtype of BTP. These characteristics of BTP will determine the most appropriate opioid compound (i.e., hydrophilic vs lipophilic) and most effective mode of drug delivery.
Collapse
|
47
|
Mandalà M, Moro C, Labianca R, Cremonesi M, Barni S. Optimizing use of opiates in the management of cancer pain. Ther Clin Risk Manag 2006; 2:447-53. [PMID: 18360655 PMCID: PMC1936364 DOI: 10.2147/tcrm.2006.2.4.447] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cancer pain is often suboptimally managed. The underestimation and undertreatment continues to be a problem despite the availability of consensus-based guidelines. Most patients with cancer develop pain. The prevalence and severity of pain among cancer patients varies according to primary and metastatic sites and stage of disease. Opioid therapy is the cornerstone of management of severe chronic pain in the field of cancer patients and in general in palliative care medicine. Since this class of drugs is the cornerstone of the treatment, optimizing its use may be useful in clinical practice. For this purpose we focused on 4 distinct issues: 1) How to implement the use the opioids in cancer patients; 2) How to optimise the use of morphine in cancer patients; 3) The management of side effects and opioid switching; 4) What is the role of other potent opioids. A holistic approach including an appropriate use of opioids may improve pain control in most cancer patients, particularly for those with advanced disease.
Collapse
Affiliation(s)
- Mario Mandalà
- Unit of Medical Oncology, Ospedali Riuniti di BergamoBergamo, Italy
| | - Cecilia Moro
- Unit of Medical Oncology, Ospedali Riuniti di BergamoBergamo, Italy
| | - Roberto Labianca
- Unit of Medical Oncology, Ospedali Riuniti di BergamoBergamo, Italy
| | - Marco Cremonesi
- Division of Medical Oncology, Treviglio HospitalBergamo, Italy
| | - Sandro Barni
- Division of Medical Oncology, Treviglio HospitalBergamo, Italy
| |
Collapse
|
48
|
Barakzoy AS, Moss AH. Efficacy of the World Health Organization Analgesic Ladder to Treat Pain in End-Stage Renal Disease. J Am Soc Nephrol 2006; 17:3198-203. [PMID: 16988057 DOI: 10.1681/asn.2006050477] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pain is the one of the most common symptoms experienced by patients with ESRD; it impairs their quality of life and is undertreated. Most pain clinicians believe that the pain management approach of the World Health Organization (WHO) three-step analgesic ladder is applicable to the treatment of patients with ESRD, but this approach has not been validated for them. A cohort of 45 hemodialysis patients were assessed for type and severity of pain using the Short-Form McGill Pain Questionnaire and then treated during a 4-wk period according to the WHO analgesic ladder. Mean age was 65 +/- 12.5 yr, and 22 (49%) patients had diabetic nephropathy as the cause of ESRD. Initial pain was rated severe by 34 (76%) patients. There was no difference in initial pain rating by gender, age, race, or type of pain. Forty percent of patients reported nociceptive pain, 31% neuropathic, and 29% both. Adequate analgesia was achieved in 43 (96%) of 45 patients. The mean pain score decreased from 7.8 +/- 1.2 to 1.6 +/- 1.3 (P < 0.001). Patients who were 65 yr and older had higher posttreatment scores than those who were younger than 65 (2.1 +/- 1.4 versus 0.94 +/- 0.93; P = 0.002) and more medication adverse effects. It is concluded that the use of the WHO three-step analgesic ladder leads to effective pain relief in hemodialysis patients. Older patients will need more careful pain management to achieve the same results as younger patients. Further studies are needed to confirm these results in a larger, more diverse dialysis population.
Collapse
Affiliation(s)
- Ahmad S Barakzoy
- Section of Nephrology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9022, USA
| | | |
Collapse
|
49
|
Niscola P, Scaramucci L, Romani C, Giovannini M, Maurillo L, del Poeta G, Cartoni C, Arcuri E, Amadori S, De Fabritiis P. Opioids in pain management of blood-related malignancies. Ann Hematol 2006; 85:489-501. [PMID: 16572325 DOI: 10.1007/s00277-005-0062-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 12/01/2005] [Indexed: 10/24/2022]
Abstract
Opioids are basic analgesics used in the treatment of moderate to severe pain in patients affected by blood-related malignancies. They should be sequentially administered according to the World Health Organisation scale for cancer pain. Initial treatment and titration with opioids should be based on immediate-release preparations, to be administered at appropriate intervals in order to relieve pain and to satisfy the individual opioid requirement. Once a relatively good pain control has been achieved, a slow release formulation at equivalent doses can be given. Most patients can be adequately managed using oral formulation opioids. However, a small group, such as those presenting severe mucositis or requiring a rapid pain relief, should be managed by intravenous continuous infusion and/or by a patient-controlled analgesia system; while for patients in the community, there are distinct advantages to using the subcutaneous route. Other available routes of administration for opioids, can be used in selected circumstances, including rectal, transdermal, epidural, intrathecal and intramuscular. The invasive neuraxial route has a very limited role in patients with haematological malignancies, given the high risk of infection and bleeding. Through a close observation and a careful management, opioid-related side effects can be effectively prevented and treated. This article reviews the principles of opioid therapy and how opioids can be adapted for patients with pain due to haematological malignancies.
Collapse
Affiliation(s)
- Pasquale Niscola
- Hematology Division, Sant'Eugenio Hospital, Tor Vergata University, Via dell'Umanesimo 10, 00144, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|