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Bimonte S, Di Gennaro P, Crispo A, Coluccia S, Luongo A, Amore A, Celentano E, Del Prato F, Schiavo D, Nocerino D, Cascella M, Cuomo A. Assessing Gender Differences for Non-Predictable Breakthrough Cancer Pain Phenomenon: A Secondary Analysis from IOPS-MS Study. J Pain Res 2024; 17:2861-2871. [PMID: 39253738 PMCID: PMC11382666 DOI: 10.2147/jpr.s445222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/09/2024] [Indexed: 09/11/2024] Open
Abstract
Purpose Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) subtype occurs in the absence of any specific activity. Evidence showed that gender differences exist in pain response sensitivity and clinical pain risk. This analysis aimed to signify the gender differences for the NP-BTcP phenomenon. Patients and Methods This is a secondary analysis of the Italian Oncologic Pain multiSetting-Multicentric Survey (IOPS-MS), the largest study on BTcP. The subset of NP-BTcP cases for non-gender-specific cancer was considered. Univariable and multivariate analyses were conducted to identify gender differences for the NP-BTcP profile about its intensity, number of episodes per day, and type. A metastatic status-stratified analysis was performed to compare gender with the main clinical variables among the population with NP-BTcP. Results Males exhibited a higher occurrence of BTcP in the thorax region compared to females (15% vs 11%, respectively, p = 0.03). Males also had a higher onset of BTcP, a higher BTcP therapy dosage (33% vs 28%, p = 0.04, mean: 201 vs 186, p = 0.02) and a lower Karnofsky score (mean: 46.9 vs 49.2, p = 0.03) compared to females. Similar gender differences were found for metastatic patients in the BTcP site (14% vs 8.5%, respectively; p = 0.01), peak onset (33% vs 27%, p = 0.02), BTcP therapy dosage (199 vs 185, p=0.04), and Karnofsky score (mean 47.5 vs 50.4, p = 0.009). Phenotype 2 was more characterized by non-metastatic males (41% vs 23%, p = 0.020) while non-metastatic females presence was predominant among others. Conclusion In this study, gender differences according to site, onset and dosage of BTcP were found. The phenotype characterization of BTcP needs to be further investigated for a possible useful function in the management of cancer-related pain in non-metastatic patients.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Alfonso Amore
- Melanoma and Sarcoma Surgery Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Del Prato
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Daniela Schiavo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Davide Nocerino
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Department of Medicine, University of Salerno, Salerno, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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Khatoon H, Faudzi SMM. Balancing acts: The dual faces of fentanyl in medicine and public health. Leg Med (Tokyo) 2024; 71:102507. [PMID: 39127024 DOI: 10.1016/j.legalmed.2024.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/14/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
Fentanyl is a potent synthetic opioid widely used in medicine for its effective analgesic properties, particularly in surgical procedures and in the treatment of severe, chronic pain. In recent decades, however, there has been a worrying increase in the illicit use of fentanyl, particularly in North America. This rise in illicit use is concerning because fentanyl is associated with polydrug abuse, which adds layers of complexity and dangerous. This review provides a comprehensive examination of fentanyl, focusing on its synthesis and medical use. It also discusses the significance of the piperidine ring in medicinal chemistry as well as the critical role of fentanyl in pain management and anesthesia. Furthermore, it addresses the challenges associated with the abuse potential of fentanyl and the resulting public health concerns. The study aims to strike a balance between the clinical benefits and risks of fentanyl by advocating for innovative uses while addressing public health issues. It examines the chemistry, pharmacokinetics and pharmacodynamics of fentanyl and highlights the importance of personalized medicine in the administration of opioids. The review underscores the necessity of continuous research and adaptation in both clinical use and public health strategies.
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Affiliation(s)
- Hena Khatoon
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Siti Munirah Mohd Faudzi
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; Natural Medicines and Product Research Laboratory, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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Greenfield K, Schoth DE, Hain R, Bailey S, Mott C, Rajapakse D, Harrop E, Renton K, Anderson AK, Carter B, Johnson M, Liossi C. A rapid systematic review of breakthrough pain definitions and descriptions. Br J Pain 2024; 18:215-226. [PMID: 38751563 PMCID: PMC11092936 DOI: 10.1177/20494637231208093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. Objective This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. Design This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). Data sources CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. Results We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients (n = 30), clinicians (n = 6), and experts (n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Conclusions Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.
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Affiliation(s)
| | - Daniel E Schoth
- School of Psychology, University of Southampton, Highfield, UK
| | - Richard Hain
- Paediatric Palliative Medicine, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | - Simon Bailey
- Sir James Spence Institute,Royal Victoria Infirmary, Newcastle upon Tyne,UK
| | - Christine Mott
- Acorns Children’s Hospice, Birmingham,UK
- Birmingham Children’s Hospital, Birmingham,UK
| | - Dilini Rajapakse
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emily Harrop
- Helen & Douglas House Hospices, Oxford, UK
- Oxford University Hospitals NHS Trust,John Radcliffe Hospital, Oxford, UK
| | - Kate Renton
- University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, UK
- Naomi House & Jacksplace, Winchester, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine,Edge Hill University, Ormskirk, UK
| | | | - Christina Liossi
- School of Psychology, University of Southampton, Highfield, UK
- Psychological Services Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Ji J, Guo J, Chi Y, Su F. Cancer Pain Management with Traditional Chinese Medicine: Current Status and Future Perspectives. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2024; 52:123-135. [PMID: 38281918 DOI: 10.1142/s0192415x24500058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Cancer pain, especially the moderate-to-severe pain experienced by patients with advanced cancer, is still one of the most challenging clinical problems. The current mainstream pharmacological treatment for cancer pain involves applying opioid medications and other pain-killing drugs. However, analgesic drugs have many adverse effects such as addiction, tolerance, and other formidable clinical and social issues. Thus, finding a new therapeutic approach to treat cancer pain is essential. Traditional Chinese medicine (TCM) has been increasingly applied in clinical practice because of its good efficacy and few side effects. However, its mechanisms of action in treating pain are still under investigation. The most important mechanism of cancer pain is that a large amount of pain-causing substances are secreted from cancer cells and promote their growth and invasion. The physical and chemical stimulations of these substances exist along with the cancer growth, leading to constantly increased pain sensation. Whether cancer pain can be alleviated by inhibiting cancer cells from releasing the substances and changing the microenvironment around the cancer mass, or even by eliminating pain-causing substances, is largely unknown. Based on TCM theory, this study reported that the aforementioned approach could effectively manage different cancer pains by tonifying qi, clearing and activating channels and meridians, and strengthening body resistance. The TCM therapies activate blood circulation, remove blood stasis, and nourish the heart. Commonly used Chinese herbal drugs include Corydalis yanhusuo, Angelica dahurica, and Ligusticum chuanxiong. Instead of using conventional analgesics to reduce pain, we should focus on using TCM modalities to alleviate cancer pain and increase the quality of life in patients suffering from cancer pain. TCM should provide us with a new strategy for managing cancer pain.
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Affiliation(s)
- Jiafu Ji
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Jingxuan Guo
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Yongliang Chi
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
| | - Fan Su
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong 250014, P. R. China
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Cornetta K, Nyariki S, Manji I, Kiplimo I, Korir M, Muinga E, Busakhala N, Elias H. Telehospice for Cancer Patients Discharged from a Tertiary Care Hospital in Western Kenya. J Pain Symptom Manage 2023; 65:378-387. [PMID: 36773732 PMCID: PMC10106447 DOI: 10.1016/j.jpainsymman.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
CONTEXT Worldwide, most patients lack access to hospice services. OBJECTIVES Assess the feasibility of telephone monitoring (Telehospice) in providing symptom management for patients discharged from a tertiary care hospital in Western Kenya. METHODS Inclusion criteria included adults with cancer no longer eligible for chemo-radiation and receiving opioid therapy. Thirty patients were enrolled in a weekly monitoring program assessing physical symptoms and patient and caregiver distress. The participants also had access to a 24-hour hotline. Symptom assessment included 18 questions with 8 from the African Palliative Outcome Scale. Participants were followed for eight weeks or until death or admission to an inpatient hospital or hospice. RESULTS The primary objective was participation in weekly calls, and we obtained 100% participation. A secondary objective was the use of "comfort kits" which contained 30 doses of six medications. Most patients utilized one or more of the provided medications, with high usage of bisacodyl, paracetamol, and omeprazole. While 12% of weekly calls and 24% of hotline calls led to medication changes, participants continued to express worry and there was only a modest decrease in pain scores despite having morphine available throughout the follow-up period. Family confidence in providing care and access to information remained high. At the end of the eight-weeks of observation, eight participants were alive, 10 died at home, and 12 were admitted to an in-patient facility. CONCLUSION Patient and family participation in Telehospice is feasible and may provide an interim solution to managing end-of-life patients who lack access to home hospice.
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Affiliation(s)
- Kenneth Cornetta
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya; Indiana University School of Medicine (K.C.), Indianapolis, Indiana.
| | - Sarah Nyariki
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital (I.M.), Eldoret, Kenya
| | - Ivan Kiplimo
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya
| | - Millicent Korir
- Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
| | - Esther Muinga
- Kenya Hospices and Palliative Care Association (E.M.), Nairobi, Kenya
| | - Naftali Busakhala
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
| | - Hussein Elias
- Academic Model Providing Access To Healthcare (K.C, S.N., I.K., N.B, H.E.), Eldoret, Kenya; Moi University School of Medicine (K.C., M.K., N.B., H.E.), Eldoret, Kenya
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Cuomo A, Boutis A, Colonese F, Nocerino D. High-rate breakthrough cancer pain and tumour characteristics - literature review and case series. Drugs Context 2023; 12:dic-2022-11-1. [PMID: 36926050 PMCID: PMC10012833 DOI: 10.7573/dic.2022-11-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Cancer pain requires careful comprehensive patient evaluation and an appropriate and personalized clinical approach by a trained multidisciplinary team. The proper assessment of breakthrough cancer pain (BTcP) is part of an all-inclusive multidimensional evaluation of the patient. The aim of this narrative review is to explore the relationship between high-rate BTcP, which strongly impacts health- related quality of life and tumour characteristics, in the face of novel approaches that should provide guidance for future clinical practice. The presentation of short, emblematic clinical reports also promotes knowledge of BTcP, which, despite the availability of numerous therapeutic approaches, remains underdiagnosed and undertreated. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.
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Affiliation(s)
- Arturo Cuomo
- IRCCS Istituto Nazionale Tumori Fondazione G Pascale, Napoli, Italy
| | - Anastasios Boutis
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | - Francesca Colonese
- Department Medical Oncology-ASST-Monza Ospedale San Gerardo, Monza, Italy
| | - Davide Nocerino
- IRCCS Istituto Nazionale Tumori Fondazione G Pascale, Napoli, Italy
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Rodríguez AT, Viejo MN, Maradey P, Canal-Sotelo J, Mancilla PG, Rivero SG, Casillas IR, Abián MH, Bermudo CL. Low-dose sublingual fentanyl improves quality of life in patients with breakthrough cancer pain in palliative care. Future Oncol 2022; 18:1717-1731. [PMID: 35137627 DOI: 10.2217/fon-2021-1639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This subanalysis of the CAVIDIOPAL study evaluated the impact of individualized management of breakthrough cancer pain (BTcP) with fentanyl on the quality of life (QoL) of advanced cancer patients in Spanish palliative care units. Patients & methods: This was a prospective, observational, multicenter study. The European Organization for Research and Treatment of Cancer's QLQ-C30 questionnaire was used at baseline (V0) and visit 28 (V28). Results: Ninety-five patients were mainly treated with 67-133 μg fentanyl, showing a notable reduction in intensity (visual analog scale: 8.0 [V0] to 4.6 [V28]), frequency and duration of BTcP episodes shortly after the first 1-2 weeks of treatment, with significantly improved QoL (global health status: 31.1 [V0] to 53.1 [V28]). Conclusion: Low-dose sublingual fentanyl effectively reduced BTcP in advanced cancer patients in palliative care units, significantly improving QoL. Clinical trial registration: NCT02840500 (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Pablo Maradey
- Hospital de Sant Joan de Déu, Palma de Mallorca, 07007, Spain
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Multidimensional Statistical Technique for Interpreting the Spontaneous Breakthrough Cancer Pain Phenomenon. A Secondary Analysis from the IOPS-MS Study. Cancers (Basel) 2021; 13:cancers13164018. [PMID: 34439173 PMCID: PMC8391336 DOI: 10.3390/cancers13164018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 01/09/2023] Open
Abstract
Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) is a subtype of BTcP that occurs in the absence of any specific activity. Since NP-BTcP has an important clinical impact, this analysis is aimed at characterizing the NP-BTcP phenomenon through a multidimensional statistical technique. This is a secondary analysis based on the Italian Oncologic Pain multiSetting-Multicentric Survey (IOPS-MS). A correlation analysis was performed to characterize the NP-BTcP profile about its intensity, number of episodes per day, and type. The multiple correspondence analysis (MCA) determined the identification of four groups (phenotypes). A univariate analysis was performed to assess differences between the four phenotypes and selected covariates. The four phenotypes represent the hierarchical classification according to the status of NP-BTcP: from the best (phenotype 1) to the worst (phenotype 4). The univariate analysis found a significant association between the onset time >10 min in the phenotype 1 (37.3%)' vs. the onset > 10 min in phenotype 4 (25.8%) (p < 0.001). Phenotype 1 was characterized by the gastrointestinal type of cancer (26.4%) with respect to phenotype 4, where the most frequent cancer affected the lung (28.8%) (p < 0.001). Phenotype 4 was mainly managed with rapid-onset opioids, while in phenotype 1, many patients were treated with oral, subcutaneous, or intravenous morphine (56.4% and 44.4%, respectively; p = 0.008). The ability to characterize NP-BTcP can offer enormous benefits for the management of this serious aspect of cancer pain. Although requiring validation, this strategy can provide many indications for identifying the diagnostic and therapeutic gaps in NP-BTcP management.
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Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115991. [PMID: 34204871 PMCID: PMC8199778 DOI: 10.3390/ijerph18115991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.
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Kwok CYL, Chan DNS, So WKW. Effect of a theory-driven educational intervention on the level of knowledge, attitudes, and assessment practices regarding breakthrough cancer pain (BTCP) management among medical nurses in Hong Kong. Eur J Oncol Nurs 2021; 52:101945. [PMID: 33813183 DOI: 10.1016/j.ejon.2021.101945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (β = 25.49, p < .001), attitude (β = 0.98 to 2.81, p < .01), and their perceived assessment practices (β = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.
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Affiliation(s)
- Carman Y L Kwok
- Haven of Hope Sister Annie Skau Holistic Centre, Hong Kong, SAR, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Prakash S, Gupta AK, Meena JP, Seth R. A review of the clinical applications of ketamine in pediatric oncology. Pediatr Blood Cancer 2021; 68:e28785. [PMID: 33128439 DOI: 10.1002/pbc.28785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022]
Abstract
Ketamine is a dissociative anesthetic agent with excellent analgesic properties and a favorable safety profile. The feasibility and efficacy of various routes of administration have been established, including intravenous (IV), intramuscular (IM), oral, intranasal, rectal, and transdermal routes. The advent of newer anesthetic agents has led to a decline in the use of ketamine as an anesthetic, but its utility in short-term sedation and analgesia has expanded. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The use of topical ketamine is largely in investigational stages. Medical use of ketamine is, to a great extent, free from significant long-term neurological side effects. The objective of this review is to provide a brief account of the pharmacology of ketamine and primarily focus on the clinical applications of ketamine in pediatric oncology.
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Affiliation(s)
- Satya Prakash
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Zhang P, Bu J, Wu X, Deng L, Chi M, Ma C, Shi X, Wang G. Upregulation of μ-Opioid Receptor in the Rat Spinal Cord Contributes to the α2-Adrenoceptor Agonist Dexmedetomidine-Induced Attenuation of Chronic Morphine Tolerance in Cancer Pain. J Pain Res 2020; 13:2617-2627. [PMID: 33116804 PMCID: PMC7573317 DOI: 10.2147/jpr.s274225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background Sustained morphine treatment for cancer pain has been limited due to analgesic tolerance. Opioid receptor internalization and desensitization mediated by downregulation of mu-opioid receptor (MOR) expression have been confirmed as one of the mechanisms of chronic morphine tolerance. In addition to the opiate system, the α2-adrenergic system is involved in the development of morphine tolerance. Several studies reported that co-administration of α2-adrenoceptor agonist dexmedetomidine inhibits morphine tolerance in normal or neuropathic pain animals. However, the effect of dexmedetomidine on morphine tolerance has not been studied in cancer pain. Therefore, we investigated the effect of intrathecal injection of dexmedetomidine on the development of morphine tolerance in cancer pain and on the expression of MOR in the spinal cord of morphine-tolerant cancer pain rats. Methods The model was established using a rat’s right hind paw injection of Walker 256 cancer cells. Subcutaneous morphine (10mg/kg) was administrated twice daily for 7 days; meanwhile, the rats received intrathecal α2-adrenoceptor agonist dexmedetomidine (10μ/kg) or antagonist MK-467 (0.25mg/kg) in test groups. Rats receiving drug vehicle served as the control group. Antinociception was detected by von Frey filaments and hot-plate tests. The expression of MOR in the spinal cord was examined through real-time reverse transcription polymerase chain reaction and Western blotting. The data were analyzed via analysis of variance followed by Student t-test with Bonferroni correction. Results Seven-day chronic morphine administration elicited notable analgesic tolerance in the rats with cancer pain. Co-administration of α2-adrenoceptor agonist dexmedetomidine enhanced morphine analgesia and attenuated morphine tolerance, which could be blocked by α2-adrenoceptor antagonist MK-467. Furthermore, pre-treatment of dexmedetomidine significantly upregulated MOR protein expression without a notable change in MOR mRNA expression in the spinal cord. Conclusion Our findings suggest that intrathecal injection of dexmedetomidine enhanced morphine analgesia and attenuated morphine tolerance in cancer pain, potentially by upregulating MOR expression in the spinal cord. The α2-adrenoceptor agonist may provide a more versatile analgesia option for morphine treatment for cancer pain.
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Affiliation(s)
- Pinyi Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jianlong Bu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Xiaohong Wu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Lin Deng
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Meng Chi
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Chao Ma
- Department of Anesthesiology, The Fourth Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiaoding Shi
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Guonian Wang
- Department of Anesthesiology, The Fourth Hospital of Harbin Medical University, Harbin, People's Republic of China
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Opioid receptors beyond pain control: The role in cancer pathology and the debated importance of their pharmacological modulation. Pharmacol Res 2020; 159:104938. [DOI: 10.1016/j.phrs.2020.104938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/24/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
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Acupuncture for Cancer-Induced Bone Pain in Animal Models: A Systemic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5606823. [PMID: 32802130 PMCID: PMC7414378 DOI: 10.1155/2020/5606823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 12/09/2022]
Abstract
Background Cancer-induced bone pain (CIBP) is a highly prevalent symptom, which afflicts vast majority of patients who suffer from cancer. The current treatment options failed to achieve satisfactory effect and the side effects were prominent. Recent randomized controlled trials (RCTs) of animal demonstrate the benefit of acupuncture for CIBP. We sought to determine if the pooled data from available RCTs supports the use of acupuncture for CIBP. Methods A literature search for randomized controlled trials was conducted in six electronic databases from inception to May 31, 2019. Meta-analysis was performed with Review Manager 5.3 software; the publication bias was assessed by Stata 12.0 software. We used random effects model for pooling data because heterogeneity is absolute among studies to some extent. Results Twenty-four trials were included in the review, of which 12 trials provided detailed data for meta-analyses. Preliminary evidence indicates that compared to wait list/sham group, acupuncture was effective on increasing paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). Compared to medicine, acupuncture was less effective on PWT, but as effective as medicine on PWL. Acupuncture can reinforce medicine's effect on PWT and PWL. Compared to the control group, acupuncture was superior to increase body weight (BW), decrease spinal cord glial fibrillary acidic protein (GFAP), and interleukin-1β (IL-1β). Furthermore, some studies showed acupuncture delay or partially reverse morphine tolerance. Three studies found acupuncture has no effect on PWT, but 2 of them found acupuncture could enhance small dose of Celebrex's effect on CIBP. Conclusions Acupuncture was superior to wait list/sham acupuncture on increasing PWT and has no less effect on increasing PWL compared to medicine; acupuncture improved the efficacy of drugs, increased the CIBP animals' body weight, and decreased their spinal cord GFAP and IL-1β. High-quality studies are necessary to confirm the results.
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Irman, Helianthi DR. The Roles of Battlefield Acupuncture and Electroacupuncture in a Patient with Cancer-Related Pain. Med Acupunct 2020; 32:234-240. [PMID: 32879650 DOI: 10.1089/acu.2020.1423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Pain is one of the most-frightening complications of cancer and disrupts quality of life. Cancer-related pain can be caused by primary cancer itself, metastases that occur, and interventions to treat cancer. Almost all cancer-related pain is pain with moderate-to-severe intensity. Thus, cancer-related pain management often involves administration of opioid analgesics. However, administration of opioid analgesics can cause side-effects that cause new problems for these patients. Several studies have shown that acupuncture can reduce cancer-related pain and data show that acupuncture therapy is safe and can provide clinically meaningful improvements when used in conjunction with standard therapy. Case: A 72-year-old female patient had pain throughout her body since 1 month prior to before being admitted to the hospital. She was unable to sleep at night often cried because she was unable to stand the pain. This was reduced by morphine 3 × /day. Because of the drug's side-effects, she slept more often during the day, could not sleep at night, and was constipated. She also had breakthrough pain, on an average of 2-3 × /day. She had a history of malignancy in the pleura, liver, lungs, and cervix. There was an increase in some tumor markers. Her baseline numeric rating scale (NRS) assessment was 4 with an oral morphine slow-release tablet 3 × 15 mg/day. Acupuncture therapy was performed at Battlefield Acupuncture points of the right ear and body acupuncture points (LI 4, LI 11, ST 36, SP 6, and LR 3) was treated with 3-Hz continuous-wave electroacupuncture for 30 minutes at each session. During this therapy, there were reductions in pain (baseline NRS 4 became 2), need for morphine, morphine side-effects, and frequency of breakthrough pain. There were no significant side-effects due to acupuncture. Conclusions: Acupuncture is an effective and safe therapeutic option for reducing cancer pain with minimal side-effects. Acupuncture can enable a reduced need for narcotic analgesics.
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Affiliation(s)
- Irman
- Department of Medical Acupuncture, Faculty of Medicine Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia
| | - Dwi Rachma Helianthi
- Department of Medical Acupuncture, Faculty of Medicine Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Central Jakarta, Indonesia
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Chiou TJ, Chao TC, Chao TY, Huang JS, Chang YF, Wang CH. A dose titration study of fentanyl buccal soluble film for breakthrough cancer pain in Taiwan. Cancer Rep (Hoboken) 2020; 2:e1179. [PMID: 32721110 DOI: 10.1002/cnr2.1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fentanyl buccal soluble film (FBSF), a new formulation of fentanyl, is developed for the treatment of breakthrough pain (BTP) in opioid-tolerant patients with cancer. AIMS This study aimed to assess the feasible dose range of FBSF required for Taiwanese population. METHODS AND RESULTS This was an open-label, multicenter, noncomparative study. Cancer patients who were aged 20 years or older and had a stable regimen equivalent to 60 to 1000 mg/day of oral morphine, 20 to 120 mg/day of intravenous morphine, or 25 to 300 μg/h of transdermal fentanyl for at least 1 week were enrolled. The primary endpoint was the feasible dose range of FBSF. Secondary endpoints included difference in pain intensity at 30 minutes (PID30), percentage of episodes requiring rescue medication, and overall satisfaction. Adverse events (AEs) and serious AEs (SAEs) were recorded for safety measurements. The final effective dose in the per-protocol (PP) population (n = 30) ranged from 200 to 800 μg, of which 26 subjects (86.7%) achieved an effective dose range of 200 to 400 μg. Among the 283 BTP episodes recorded in the maintenance period, the mean PID30 was 4.0, and only 13 events (4.6%) required rescue medication. For 63.6% of the BTP episodes, patients rated their satisfaction as good to excellent. Only 5% of AEs were considered drug-related. CONCLUSIONS Individualized dose titration is recommended for BTP management for patients' benefit. Overall, FBSF was effective and well tolerated and was positively correlated with patients' background opioid dose for persistent pain management.
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Affiliation(s)
- Tzeon-Jye Chiou
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chung Chao
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Oncology and Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsu-Yi Chao
- Division of Hematology & Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Jen-Seng Huang
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Fang Chang
- Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Cheng-Hsu Wang
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Camps Herrero C, Batista N, Díaz Fernández N, Escobar Álvarez Y, Gonzalo Gómez A, Isla Casado D, Salud A, Terrasa Pons J, Guillem Porta V. Breakthrough cancer pain: review and calls to action to improve its management. Clin Transl Oncol 2020; 22:1216-1226. [DOI: 10.1007/s12094-019-02268-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/08/2019] [Indexed: 02/04/2023]
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Prevalence and characterization of breakthrough pain in patients with cancer in Spain: the CARPE-DIO study. Sci Rep 2019; 9:17701. [PMID: 31776408 PMCID: PMC6881364 DOI: 10.1038/s41598-019-54195-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/04/2019] [Indexed: 01/22/2023] Open
Abstract
We aimed to evaluate the prevalence, characteristics and impact of breakthrough pain (BTP) in patients with cancer attending the main specialties involved in the diagnosis and management of BTP in Spain using a multicenter, observational, cross-sectional, multidisciplinary study. Investigators had to record all patients seen at the clinic during 1 month, determine whether the patients had cancer pain, and apply the Davies algorithm to ascertain whether the patients were suffering from BTP. Of the 3,765 patients with cancer, 1,117 (30%) had cancer-related pain, and of these patients, 539 had BTP (48%, 95%CI:45–51). The highest prevalence was found in patients from palliative care (61%, 95%CI:54–68), and the lowest was found in those from hematology (25%, 95%CI:20–31). Prevalence varied also according to sex and type of tumor. According to the Alberta Breakthrough Pain Assessment Tool duration, timing, frequency, location, severity, quality, causes, and predictability of the BTP varied greatly among these patients. BTP was moderate (Brief Pain Inventory [BPI]-severity median score = 5.3), and pain interference was moderate (BPI-interference median score = 6.1) with a greater interference with normal work, general activity, and enjoyment of life. Patients with BTP showed a mean ± standard deviation score of 28.5 ± 8.0 and 36.9 ± 9.5 in the physical and mental component, respectively, of the SF-12 questionnaire. In conclusion, prevalence of BTP among patients exhibiting cancer-related pain is high. Clinical presentation is heterogeneous, and therefore, BTP cannot be considered as a single entity. However, uniformly BTP has an important impact on a patient’s functionality, which supports the need for early detection and treatment.
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Kaplan S, Bergamasco A, Sergerie M, Castilloux AM, Moride Y. Effectiveness of Risk Minimization Measures for Fentanyl Buccal Tablet (FENTORA) in Canada: A Mixed-Methods Evaluation Using Surveys, Medical Chart Records and Web Surveillance. Drug Saf 2019; 43:163-177. [PMID: 31691255 DOI: 10.1007/s40264-019-00882-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fentanyl buccal tablet (FBT), a potent opioid, was approved in Canada in 2013 for breakthrough pain in opioid-tolerant adult cancer patients. Additional risk minimization measures (aRMMs), consisting of communications to patients and healthcare providers (HCPs), were implemented from November 2014 through September 2015. OBJECTIVES The aim of this study was to assess the effectiveness of FBT aRMMs as measured by prescriber knowledge, understanding, and behavior regarding key safety concerns (off-label use, use in non-opioid-tolerant patients, misuse/abuse/diversion, and drug-drug interaction) and to evaluate illicit FBT use. METHODS The study included three components: (1) a knowledge and understanding (KAU) survey of FBT prescribers conducted in two waves: November 2016-February 2017 and April-September 2018; (2) a retrospective prescription study of medical records of patients treated with FBT by a subgroup of prescribers from the KAU survey; and (3) Web surveillance of illicit FBT use in Canada using the search term FENTORA (May 2014-September 2018). The aRMMs were considered effective if the lower bound of the 95% confidence interval indicated that at least 65% of respondents met or partly met the knowledge objective for each key safety concern. RESULTS KAU survey: Of 46 eligible HCPs, 97.8% met or partly met the knowledge objective on use in breakthrough pain cancer patients, 97.8% on use in opioid-tolerant patients, 89.1% on dose and titration, 100% on abuse/addiction, and 58.7% on drug-drug interaction. Retrospective prescription study: Of 22 FBT-treated patients identified from 14 HCPs, 45.5% had cancer, 50.0% recorded a breakthrough pain indication, and 36.4% reported opioid tolerance; however, only 13.6% of patients were prescribed FBT according to the approved indication. Web surveillance: Of 932 FBT posts in Canada, only 40 (4.3%) mentioned illicit use. CONCLUSIONS The aRMMs as measured by the prescriber KAU were effective for most key safety messages; however, not all key messages of the aRMMs were stringently followed in routine practice.
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Affiliation(s)
- Sigal Kaplan
- Teva Pharmaceutical Industries Ltd, Netanya, Israel.
| | | | | | | | - Yola Moride
- YOLARX Consultants, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Yan XB. Breakthrough Cancer Pain. FROM CONVENTIONAL TO INNOVATIVE APPROACHES FOR PAIN TREATMENT 2019. [DOI: 10.5772/intechopen.84581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Camps Herrero C, Antón Torres A, Cruz-Hernández JJ, Carrato A, Constenla M, Díaz-Rubio E, Feyjoo Saus M, Garcia-Foncillas J, Gascón P, Guillem V. Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts. J Pain Res 2019; 12:2349-2358. [PMID: 31534359 PMCID: PMC6681159 DOI: 10.2147/jpr.s203903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients. Patients and methods A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3. Results In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl. Conclusion These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.
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Affiliation(s)
- Carlos Camps Herrero
- Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain
| | - Antonio Antón Torres
- Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Alfredo Carrato
- Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eduardo Díaz-Rubio
- Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Jesus Garcia-Foncillas
- Jefe de Servicio de Oncología Médica, Hospital Universitario "Fundación Jiménez Díaz", Madrid, Spain
| | - Pere Gascón
- Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Vicente Guillem
- Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
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Caraceni A, Shkodra M. Cancer Pain Assessment and Classification. Cancers (Basel) 2019; 11:cancers11040510. [PMID: 30974857 PMCID: PMC6521068 DOI: 10.3390/cancers11040510] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
More than half of patients affected by cancer experience pain of moderate-to-severe intensity, often in multiple sites, and of different etiologies and underlying mechanisms. The heterogeneity of pain mechanisms is expressed with the fluctuating nature of cancer pain intensity and clinical characteristics. Traditional ways of classifying pain in the cancer population include distinguishing pain etiology, clinical characteristics related to pain and the patient, pathophysiology, and the use of already validated classification systems. Concepts like breakthrough, nociceptive, neuropathic, and mixed pain are very important in the assessment of pain in this population of patients. When dealing with patients affected by cancer pain it is also very important to be familiar to the characteristics of specific pain syndromes that are usually encountered. In this article we review methods presently applied for classifying cancer pain highlighting the importance of an accurate clinical evaluation in providing adequate analgesia to patients.
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Affiliation(s)
- Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Department, Fondazione IRCCS-Istituto Nazionale dei Tumori (INT), 20133 Milan, Italy.
| | - Morena Shkodra
- Palliative Care, Pain Therapy and Rehabilitation Department, Fondazione IRCCS-Istituto Nazionale dei Tumori (INT), 20133 Milan, Italy.
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Abstract
PURPOSE OF REVIEW The goal of this review is to provide a broad overview of the current understanding of mechanisms underlying bone and joint pain. RECENT FINDINGS Bone or joint pathology is generally accompanied by local release of pro-inflammatory cytokines, growth factors, and neurotransmitters that activate and sensitize sensory nerves resulting in an amplified pain signal. Modulation of the pain signal within the spinal cord and brain that result in net increased facilitation is proposed to contribute to the development of chronic pain. Great strides have been made in our understanding of mechanisms underlying bone and joint pain that will guide development of improved therapeutic options for these patients. Continued research is required for improved understanding of mechanistic differences driving different components of bone and/or joint pain such as movement related pain compared to persistent background pain. Advances will guide development of more individualized and comprehensive therapeutic options.
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Affiliation(s)
- Joshua Havelin
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, 04043, USA
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, 04469, USA
| | - Tamara King
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, 04043, USA.
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, 04469, USA.
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, 11 Hills Beach Rd., Biddeford, ME, 04005, USA.
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Madariaga Muñoz MC, Villegas Estévez F, Jiménez López AJ, Cabezón Álvarez A, Soler López B. Evaluation of Quality of Life and Satisfaction of Patients with Neuropathic Pain and Breakthrough Pain: Economic Impact Based on Quality of Life. PAIN RESEARCH AND TREATMENT 2018; 2018:5394021. [PMID: 30254760 PMCID: PMC6145165 DOI: 10.1155/2018/5394021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study objective was to assess the quality of life and satisfaction with treatment of patients with chronic neuropathic pain (CNP) who experience breakthrough pain (BTP) and to assess its economic impact. DESIGN Cross-sectional observational study. SETTING Fifteen pain units from Spanish hospitals completed the study. PARTICIPANTS A total of 124 patients with adequately controlled CNP who experienced BTP were enrolled into the study. INTERVENTION No interventions were required. MAIN OUTCOME MEASURES Quality of life was assessed using the SF12 v2 questionnaire, the results of which were used to calculate the estimated costs per patient and month and the SF-6D Health Utility Index. Patient satisfaction with treatment received for CNP and for BTP was assessed using a 10-point visual analogue scale. Other associated symptoms were analyzed using the ESAS (Edmonton Symptom Assessment System). RESULTS Patients had a mean age of 60.2 years (95% CI 58.4-63.3), and 46.8% (58) were males. 18.9% (23) experienced their first episode of BTP. A severe impairment of the physical component of SF12v2 was noted, with 94% of patients below the mean score of the population, while 88% had values lower than normal for the mental component. Mean cost per patient and month was $679 and was significantly greater in males ($763 versus $606), 4.96 times greater than in healthy population, and approximately double the cost of patients with CNP in Spain. CONCLUSIONS Occurrence of BTP in patients with CNP causes a substantial increase in healthcare costs which is significantly greater in older males.
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Yen TY, Chiou JF, Chiang WY, Su WH, Huang MY, Hu MH, Wu SC, Lai YL. Proportional dose of rapid-onset opioid in breakthrough cancer pain management: An open-label, multicenter study. Medicine (Baltimore) 2018; 97:e11593. [PMID: 30045291 PMCID: PMC6078661 DOI: 10.1097/md.0000000000011593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The management of breakthrough pain (BTP) in cancer patients is a challenge. It is clinically useful to evaluate the effectiveness of rapid-onset opioid at a starting dose in proportional to the background opioid regimen. This open-label, multicenter, noncomparative study aimed to assess the efficacy and safety of proportional doses of fentanyl buccal soluble film (FBSF) in patients with breakthrough cancer pain. METHODS Thirty patients aged 20 to 70, experiencing 1 to 3 BTP per day, receiving regimens equivalent to 60 to 360 mg/day of oral morphine or 25 to 150 μg/h of transdermal fentanyl ≥1 week, were prospectively recruited. FBSF was administered proportionally based on their current opioid regimen for baseline pain. The percentage of patients requiring dose titration was evaluated. For each BTP episode, changes in pain intensity at 30 minutes (PID30) after dosing, patient's satisfaction, the percentage of episodes requiring rescue medication, and adverse events (AEs) were recorded. RESULTS The percentage of patients who required dose titration was 21.4% (6/28) and 12.0% (3/25) in the full analysis set and per-protocol populations, respectively. The average PID30 was 3.9, and a pain score ≤3 was achieved in 95.1% of the events. Eight out of 367 (2.2%) BTP episodes needed rescue medication. The majority of subjects (75.8%) rated their experience of pain management as good to excellent. A total of 6 drug-related AEs were reported by 3 (10.7%) patients in the safety population. CONCLUSIONS FBSF dose in proportional to the regimen of opioid for baseline pain management is efficacious and well tolerated for the treatment of cancer patients with BTP.
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Affiliation(s)
- Tsung-Yu Yen
- Department of Radiation Oncology
- Hospice and Palliative Care Center, MacKay Memorial Hospital
| | - Jeng-Fong Chiou
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University
- Department of Radiation Oncology, Taipei Medical University Hospital
- Taipei Cancer Center, Taipei Medical University
- Cancer Center, Taipei Medical University Hospital, Taipei
| | | | - Wen-Hao Su
- Hospice and Palliative Care Center, MacKay Memorial Hospital
| | - Ming-Yuan Huang
- Hospice and Palliative Care Center, MacKay Memorial Hospital
| | - Ming-Hung Hu
- Division of Hematology and Oncology, Department of Medicine, Cardinal Tien Hospital
- School of Medicine, Fu Jen Catholic University, New Taipei
| | - Shen-Chi Wu
- Cancer Center, Taipei Medical University Hospital, Taipei
- Department of Hospice and Palliative Care, Taipei
| | - Yuen-Liang Lai
- Department of Radiation Oncology
- Hospice and Palliative Care Center, MacKay Memorial Hospital
- MacKay Medical College, New Taipei, Taiwan
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Kwon MY, Cho HN, Koo DH, Lee YG, Oh S, Lee SS. Initial titration with 200 μg fentanyl buccal tablets: a retrospective safety analysis in Korean cancer patients. Korean J Intern Med 2018; 33:577-584. [PMID: 28111431 PMCID: PMC5943645 DOI: 10.3904/kjim.2016.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/26/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS Managing breakthrough pain (BTP) is important for many cancer patients because of the rapid onset and unpredictable nature of the pain episodes. Fentanyl buccal tablets (FBTs) are a rapid-onset opioid indicated for BTP management. However, FBT titration is needed to optimize BTP management. In this study, we aimed to evaluate the safety and efficacy of initiating 200 μg FBTs in Korean cancer patients. METHODS A retrospective analysis of medical records was performed on all advanced cancer patients treated with FBTs for BTP between October 2014 and July 2015. Patients who received initial doses of 200 μg FBTs for at least 3 days and cases in which FBT was available at doses of 200, 400, and 800 μg were included. RESULTS A total of 56 patients with a median age of 62 years (range, 32 to 80) were analyzed, 61% of whom were male. The median and mean values of morphine equivalent daily doses were 60 mg/day (range, 15 to 540) and 114.8 ± 124.8 mg/day, respectively. The most frequent effective doses of FBT were 200 μg (41 patients, 74%) and 400 μg (12 patients, 21%). Three patients (5%) could not tolerate 200 μg of FBT and discontinued treatment. Nausea, vomiting, somnolence, and dizziness were the most frequent treatment-related adverse events (AEs), and all AEs were grade 1 (mild) or 2 (moderate). CONCLUSIONS FBT at the initial 200 μg dosage was well-tolerated and effective as a BTP management strategy in Korean cancer patients. Further prospective studies are needed to determine appropriate initiating doses of FBT in Korean patients with opioid tolerance.
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Affiliation(s)
- Mi-Young Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Ha-Na Cho
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Dong-Hoe Koo
- Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Dong-Hoe Koo, M.D. Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-8330 Fax: +82-2-2001-8360 E-mail:
| | - Yun-Gyoo Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sukjoong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Sei Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rodríguez MJ, de la Torre R, Ortega JL, Trinidad JM, Benítez D, Jiménez AJ, Sanz-Yagüe A, Soler B, Torres LM. Evaluation of the quality of care of elderly patients with chronic and breakthrough pain treated with opioids: SAND study. Curr Med Res Opin 2018; 34:701-709. [PMID: 28914555 DOI: 10.1080/03007995.2017.1380618] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the quality of care of elderly patients with treatment for chronic pain (CP) and breakthrough pain (BTP). METHODS A cross-sectional observational study was conducted in 20 pain units, selecting patients aged 70 years or older with baseline controlled CP in treatment with opioids and a diagnosis of BTP. Patients were classified as first episode of BTP or patient in follow-up. The patients completed the SF-12 quality of life questionnaire, Brief Pain Inventory, Lattinen Index, and Edmonton Symptoms Assessment Scale. The patient's satisfaction with the treatment was evaluated through a visual analogue scale (VAS). RESULTS A total of 199 patients were included with 67.7% women (132). There were 28.5% (55) attending the first visit for BTP and 71.5% (138) were on follow-up visits. On the physical component of the SF-12, 95% had a score below the mean for the Spanish general population and 44% had a score below the mean on the mental component. Worse scores were observed for women in the bodily pain dimension (p = .032) and in the overall physical component (p = .045). There were 62.9% (112) patients satisfied with the treatment for BTP. In the multivariate analysis, SF-12 physical component scores (p = .017) and patient's satisfaction with BTP treatment was better in follow-up visits (p = .031). CONCLUSIONS All clinical parameters compared between first visit for the treatment of BTP and follow-up visits were improved, so the quality of care was also considered improved. Elderly women and non-oncologic patients were observed to be the population with worse symptom control.
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Affiliation(s)
| | | | | | | | - Diego Benítez
- b Fundación Andaluza para el Tratamiento del Dolor , Sevilla , Spain
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care &Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
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He Y, Liu Y, May BH, Zhang AL, Zhang H, Lu C, Yang L, Guo X, Xue CC. Effectiveness of acupuncture for cancer pain: protocol for an umbrella review and meta-analyses of controlled trials. BMJ Open 2017; 7:e018494. [PMID: 29229658 PMCID: PMC5778333 DOI: 10.1136/bmjopen-2017-018494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The National Comprehensive Cancer Network guidelines for adult cancer pain indicate that acupuncture and related therapies may be valuable additions to pharmacological interventions for pain management. Of the systematic reviews related to this topic, some concluded that acupuncture was promising for alleviating cancer pain, while others argued that the evidence was insufficient to support its effectiveness. METHODS AND ANALYSIS This review will consist of three components: (1) synthesis of findings from existing systematic reviews; (2) updated meta-analyses of randomised clinical trials and (3) analyses of results of other types of clinical studies. We will search six English and four Chinese biomedical databases, dissertations and grey literature to identify systematic reviews and primary clinical studies. Two reviewers will screen results of the literature searches independently to identify included reviews and studies. Data from included articles will be abstracted for assessment, analysis and summary. Two assessors will appraise the quality of systematic reviews using Assessment of Multiple Systematic Reviews; assess the randomised controlled trials using the Cochrane Collaboration's risk of bias tool and other types of studies according to the Newcastle-Ottawa Scale. We will use 'summary of evidence' tables to present evidence from existing systematic reviews and meta-analyses. Using the primary clinical studies, we will conduct meta-analysis for each outcome, by grouping studies based on the type of acupuncture, the comparator and the specific type of pain. Sensitivity analyses are planned according to clinical factors, acupuncture method, methodological characteristics and presence of statistical heterogeneity as applicable. For the non-randomised studies, we will tabulate the characteristics, outcome measures and the reported results of each study. Consistencies and inconsistencies in evidence will be investigated and discussed. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of the overall evidence. ETHICS AND DISSEMINATION There are no ethical considerations associated with this review. The findings will be disseminated in peer-reviewed journals or conference presentations. PROSPERO REGISTRATION NUMBER CRD42017064113.
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Affiliation(s)
- Yihan He
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yihong Liu
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Brian H May
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Lin Zhang
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
| | - Haibo Zhang
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - ChuanJian Lu
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lihong Yang
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinfeng Guo
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Charlie Changli Xue
- China-Australia International Research Center for Chinese Medicine, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Improving Patient-reported Pain During Radiotherapy Through Nurse Involvement and Patient Education. Am J Clin Oncol 2017; 41:1028-1030. [PMID: 29215379 DOI: 10.1097/coc.0000000000000415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain management during radiotherapy helps assess quality of care. By establishing an intervention to address pain during on-treatment visits (OTVs), we aim to lower patient-reported pain scores. METHODS A total of 171 patients were included in the analysis: 58 were retrospectively reviewed to provide a control and 113 were prospectively enrolled and evaluated after the intervention. The intervention included (1) a pain management in-service performed with the resident physician and nurses, (2) distribution of pain management educational materials, and (3) nurse consultation for patients with a pain score ≥5 within 2 days of the in-service. Study aims were to reduce the number of pain scores ≥5 by 30% and increase the number of pain scores documented during every OTV to >90%. RESULTS Median patient age was 65 years. Before the intervention, the average DVPRS score at initial consultation was 2 (range, 0 to 9) and 98% of patients had scores documented during OTVs. Overall, 26% (44/171) of OTV scores measured ≥5. Following the intervention, average DVPRS score at initial consultation was 2 (range, 0 to 10) and 99% of scores were documented during OTVs. About 14% (49/341) of patient-reported scores were ≥5, representing an ~50% relative reduction (P=0.023). The number of patients with 2+ pain scores ≥5 was reduced from 21% (12/58) before the intervention to 11% (12/109) after the intervention (P=0.1068). CONCLUSION Involving nursing staff in the education and follow-up of patients with uncontrolled pain during radiotherapy led to an ~50% relative reduction in patient-reported DVPRS scores of 5+ during weekly OTVs.
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Cabezón-Gutiérrez L, Viloria-Jiménez MA, Pérez-Cajaraville J, Álamo-González C, López-Trigo JA, Gil-Gregorio P. [Breakthrough cancer pain in the elderly]. Rev Esp Geriatr Gerontol 2017; 52:271-277. [PMID: 27979661 DOI: 10.1016/j.regg.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/15/2016] [Accepted: 10/24/2016] [Indexed: 11/24/2022]
Abstract
Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.
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Affiliation(s)
| | | | | | | | - José Antonio López-Trigo
- Servicio de Geriatría, Hospital Quirón de Málaga, Málaga, España; Presidente de la Sociedad Española de Geriatría y Gerontología
| | - Pedro Gil-Gregorio
- Servicio de Geriatría, Hospital Clínico Universitario San Carlos, Madrid, España; Coordinador del Comité de Expertos del Dolor de la Sociedad Española de Geriatría y Gerontología
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Pilatti P, Lagni VB, Picasso MC, Puma K, Mestriner RJDS, Machado DDO, Mahmud SJ, Jardim GDS, Braga HA, Blatt CR, Zortéa K. Cuidados paliativos oncológicos em um serviço público de atenção domiciliar. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Identificar o perfil dos pacientes com câncer e em cuidados paliativos e suas demandas referentes ao atendimento multidisciplinar existente em um Serviço de Atenção Domiciliar. Métodos: Estudo transversal com coleta de dados secundários dos pacientes oncológicos em cuidados paliativos atendidos pelo Programa de Atenção Domiciliar do Grupo Hospitalar Conceição, no ano de 2013. Aprovado pelo Comitê de Ética e Pesquisa sob o número 13.203. Resultados: Foram acompanhados 63 pacientes com diagnóstico de neoplasia. Dentre esses, 71,5% (n=45) estavam em cuidados paliativos. As medianas do tempo de acompanhamento dos pacientes foram de 22 (3-146) dias e do número de visitas realizadas pela equipe foi 6 (1-34). Além das visitas semanais realizadas pelas equipes, os pacientes receberam assistência de nutricionista, fisioterapeuta e assistente social. Considerando as 45 internações, os principais cuidados foram controle da dor, curativos em feridas, controle glicêmico, e antibioticoterapia endovenosa. A principal intercorrência clínica foi a repassagem de cateter nasoenteral (n=5). A alta em condições estáveis de saúde ocorreu em 10 pacientes. Conclusão: O presente estudo permitiu a identificação das principais demandas dos pacientes em cuidados paliativos oncológicos atendidos por um serviço de Atenção Domiciliar. Observa-se na prática deste serviço que a maioria dos pacientes apresentou necessidade de cuidados complexos, mas possíveis de serem realizados no domicílio pela equipe de saúde e/ou cuidador capacitado.
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Havelin J, Imbert I, Sukhtankar D, Remeniuk B, Pelletier I, Gentry J, Okun A, Tiutan T, Porreca F, King TE. Mediation of Movement-Induced Breakthrough Cancer Pain by IB4-Binding Nociceptors in Rats. J Neurosci 2017; 37:5111-5122. [PMID: 28438966 PMCID: PMC5444195 DOI: 10.1523/jneurosci.1212-16.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 03/30/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023] Open
Abstract
Cancer-induced bone pain is characterized by moderate to severe ongoing pain that commonly requires the use of opiates. Even when ongoing pain is well controlled, patients can suffer breakthrough pain (BTP), episodic severe pain that "breaks through" the medication. We developed a novel model of cancer-induced BTP using female rats with mammary adenocarcinoma cells sealed within the tibia. We demonstrated previously that rats with bone cancer learn to prefer a context paired with saphenous nerve block to elicit pain relief (i.e., conditioned place preference, CPP), revealing the presence of ongoing pain. Treatment with systemic morphine abolished CPP to saphenous nerve block, demonstrating control of ongoing pain. Here, we show that pairing BTP induced by experimenter-induced movement of the tumor-bearing hindlimb with a context produces conditioned place avoidance (CPA) in rats treated with morphine to control ongoing pain, consistent with clinical observation of BTP. Preventing movement-induced afferent input by saphenous nerve block before, but not after, hindlimb movement blocked movement-induced BTP. Ablation of isolectin B4 (IB4)-binding, but not TRPV1+, sensory afferents eliminated movement-induced BTP, suggesting that input from IB4-binding fibers mediates BTP. Identification of potential molecular targets specific to this population of fibers may allow for the development of peripherally restricted analgesics that control BTP and improve quality of life in patients with skeletal metastases.SIGNIFICANCE STATEMENT We present a novel preclinical measure of movement-induced breakthrough pain (BTP) that is observed in the presence of morphine controlling ongoing pain. Blockade of sensory input before movement prevented BTP, whereas nerve block after movement failed to reverse BTP. These observations indicate that blocking peripheral sensory input may prevent BTP and targeting central sites may be required for pain relief once BTP has been initiated. Preventing sensory input from TRPV1-expressing fibers failed to alter movement-induced BTP. In contrast, preventing sensory input from isolectin B4 (IB4)-binding fibers blocked movement-induced BTP. Therefore, examining molecular targets on this population of nociceptive fibers may prove useful for developing an improved strategy for preventing BTP in cancer patients with skeletal metastases.
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Affiliation(s)
- Joshua Havelin
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine 04005, and
| | - Ian Imbert
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine 04005, and
| | | | | | - Ian Pelletier
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine 04005, and
| | - Jonathan Gentry
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine 04005, and
| | - Alec Okun
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona 85724
| | - Timothy Tiutan
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona 85724
| | - Frank Porreca
- Department of Cancer Biology, Arizona Cancer Center, and
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona 85724
| | - Tamara E King
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine 04005, and
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Viet CT, Dang D, Aouizerat BE, Miaskowski C, Ye Y, Viet DT, Ono K, Schmidt BL. OPRM1 Methylation Contributes to Opioid Tolerance in Cancer Patients. THE JOURNAL OF PAIN 2017; 18:1046-1059. [PMID: 28456745 DOI: 10.1016/j.jpain.2017.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/13/2017] [Accepted: 04/01/2017] [Indexed: 11/28/2022]
Abstract
Cancer patients in pain require high doses of opioids and quickly become opioid-tolerant. Previous studies have shown that chronic cancer pain as well as high-dose opioid use lead to mu-opioid receptor downregulation. In this study we explore downregulation of the mu-opioid receptor gene (OPRM1), as a mechanism for opioid tolerance in the setting of opioid use for cancer pain. We demonstrate in a cohort of 84 cancer patients that high-dose opioid use correlates with OPRM1 hypermethylation in peripheral leukocytes of these patients. We then reverse-translate our clinical findings by creating a mouse cancer pain model; we create opioid tolerance in the mouse cancer model to mimic opioid tolerance in the cancer patients. Using this model we determine the functional significance of OPRM1 methylation on cancer pain and opioid tolerance. We focus on 2 main cells within the cancer microenvironment: the cancer cell and the neuron. We show that targeted re-expression of mu-opioid receptor on cancer cells inhibits mechanical and thermal hypersensitivity, and prevents opioid tolerance, in the mouse model. The resultant analgesia and protection against opioid tolerance are likely due to preservation of mu-opioid receptor expression on the cancer-associated neurons. PERSPECTIVE We demonstrate that epigenetic regulation of OPRM1 contributes to opioid tolerance in cancer patients, and that targeted gene therapy could treat cancer-induced nociception and opioid tolerance in a mouse cancer model.
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Affiliation(s)
- Chi T Viet
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Dongmin Dang
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Bradley E Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, New York; School of Nursing, University of California, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, California
| | | | - Yi Ye
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Dan T Viet
- Bluestone Center for Clinical Research, New York University, New York, New York
| | - Kentaro Ono
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Brian L Schmidt
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York.
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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.
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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
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Chew CC, Ng S, Chee YL, Koo TW, Liew MH, Chee ELC, Modamio P, Fernández C, Mariño EL, Segarra I. Diclofenac sex-divergent drug-drug interaction with Sunitinib: pharmacokinetics and tissue distribution in male and female mice. Invest New Drugs 2017; 35:399-411. [DOI: 10.1007/s10637-017-0447-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/27/2017] [Indexed: 12/20/2022]
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Liu Q, Wang Y, Luo XJ, Wang NJ, Chen P, Jin X, Mu GX, Chai XM, Zhang YJ, Li YX, Yu JQ. A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial. Trials 2017; 18:13. [PMID: 28077162 PMCID: PMC5225628 DOI: 10.1186/s13063-016-1739-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of breakthrough pain in cancer patients is always a challenge for medical professions. Occurring in 80% of cancer patients with advanced disease, breakthrough pain significantly decreases both patient's and caregiver's quality of life. The aim of this study is to assess the analgesic efficacy of a fixed inhaled nitrous oxide/oxygen mixture for adult cancer patients with breakthrough pain. METHODS/DESIGN This is a randomized, placebo-controlled, double-blind study; it will be conducted in the General Hospital of Ningxia Medical University. The target study subjects are at least 18 years old, and are hospitalized cancer patients who are receiving routine opioids to control cancer-related pain but still experience breakthrough pain. A total of 240 patients will be recruited and randomly allocated between three treatment groups (A, B, C) and a control group (group D) in a ratio of 3:1. All treatment groups (A, B, C) will receive standard pain treatment (oral immediate-release morphine) plus a pre-prepared nitrous oxide/oxygen mixture, and the control group (D) will receive the standard pain treatment plus oxygen. Patients, doctors, nurses, and data collectors are all blind to the experiment. Assessments will be taken before treatment (T0), at 5 min (T1) and 15 min (T2) during treatment, and at 5 min after treatment (T3). The primary endpoint measures will be the percentage of patients whose pain is relieved at T1, T2, and T3. Secondary outcome measures will include the safety of treatment, adverse events, and satisfaction from both health professionals and patients. DISCUSSION This study aims to provide an effective and practical intervention for a fast breakthrough pain relief and to improve cancer patients' quality of life significantly. The Evidence-Based Medicine Working Group claim that a randomized, double-blind, placebo-controlled experimental intervention is the most appropriate design to demonstrate its efficacy, so this study could give a new approach to controlling breakthrough pain episodes. TRIAL REGISTRATION ChiCTR-INC-16008075 . Registered on 8 March 2016.
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Affiliation(s)
- Qiang Liu
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Yinchuan Guolong Hospital, 536 Chang Cheng Road, Xing Qing Area, Yinchuan, 750004 China
| | - Yu Wang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Xiang-Jiang Luo
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Ning-Ju Wang
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Ping Chen
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Xin Jin
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Department of Nursing, Ningxia People’s Hospital, 301 Zheng Yuan Street, Yinchuan, 750004 China
| | - Guo-Xia Mu
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Xiao-Min Chai
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yue-Juan Zhang
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Jian-Qiang Yu
- Department of Pharmacology, Pharmaceutical Institute of Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
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Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati RD, Mammucari M, Natoli S, Lazzari M, Dauri M, Airoldi M, Azzarello G, Bandera M, Blasi L, Cartenì G, Chiurazzi B, Costanzo BVP, Degiovanni D, Fusco F, Guardamagna V, Iaffaioli V, Liguori S, Lorusso V, Mameli S, Mattioli R, Mazzei T, Melotti RM, Menardo V, Miotti D, Moroso S, De Santis S, Orsetti R, Papa A, Ricci S, Sabato AF, Scelzi E, Sofia M, Tonini G, Aielli F, Valle A. Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS). Adv Ther 2017; 34:120-135. [PMID: 27873235 PMCID: PMC5216057 DOI: 10.1007/s12325-016-0440-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 11/29/2022]
Abstract
Introduction An ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here. Methods Thirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity. Results Background pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids. Conclusions These preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Funding Molteni Farmaceutici, Italy.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| | - Paolo Marchetti
- Molecular and Clinical Medicine, Medical Oncology, La Sapienza University of Rome, Rome, Italy
| | - Arturo Cuomo
- Anesthesiology, Resuscitation, and Pain Therapy Department, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute IRCCS Foundation, Milan, Italy
| | | | | | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Marzia Lazzari
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Mario Airoldi
- 2nd Medical Oncology Division, Città della Salute e della Scienza Hospital of Turin, Turin, Italy
| | - Giuseppe Azzarello
- Medical Specialties Department, Oncology and Oncologic Hematology, ASL 13 Mirano, Venice, Italy
| | - Mauro Bandera
- Medical Oncology Unit, Ospedale di Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Livio Blasi
- Medical Oncology Unit, ARNAS Ospedale Civico, Di Cristina, Benfratelli, Palermo, Italy
| | | | | | | | | | - Flavio Fusco
- Palliative Care Unit, Department of Primary and Community Care, ASL3 Genovese, Genoa, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Unit, European Oncology Institute IRCCS, Milan, Italy
| | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Naples, Italy
| | - Simeone Liguori
- Palliative Care and Pain Therapy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vito Lorusso
- Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Sergio Mameli
- Pain Therapy Unit, "A. Businco" Hospital, ASL 8, Cagliari, Italy
| | | | - Teresita Mazzei
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rita Maria Melotti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | | | - Danilo Miotti
- Palliative Care Unit, Salvatore Maugeri-IRCCS Foundation, Pavia, Italy
| | - Stefano Moroso
- Medical Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Remo Orsetti
- Pain Medicine Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Alfonso Papa
- Pain Relief, A.O. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Sergio Ricci
- Division of Medical Oncology, Department of Oncology, S. Chiara University Hospital, Pisa, Italy
| | - Alessandro Fabrizio Sabato
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency, Admission and Critical Area, Policlinic of Tor Vergata, Rome, Italy
| | - Elvira Scelzi
- Medical Oncology, Castelfranco Veneto Hospital, Treviso, Italy
| | - Michele Sofia
- Department of Palliative Care with Hospice and Pain Therapy Unit, "G.Salvini" Hospital, Garbagnate Milanese, Milan, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Dénommé F, Kroemer M, Montcuquet P, Nallet G, Thiery-Vuillemin A, Bazan F, Mouillet G, Villanueva C, Demarchi M, Stein U, Almotlak H, Chaigneau L, Curtit E, Meneveau N, Maurina T, Dobi E, Hon TNT, Cals L, Mansi L, Verlut C, Pana-Katatali H, Caubet M, Paillard MJ, Limat S, Pivot X, Nerich V. [Prevalence and management of pain in patients with metastatic cancer in Franche-Comté]. Bull Cancer 2016; 103:849-860. [PMID: 27692731 DOI: 10.1016/j.bulcan.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/15/2016] [Accepted: 08/29/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Pain management is a major public health problem, especially in oncology. In order to assess professional practice, the IRFC-FC conducted a survey amongst patients with metastatic osteophilic solid tumor in Franche-Comté. The aims were to assess the pain prevalence, and its characteristics, its management and its impact on patients' quality of life in patients in pain. METHODS An observational, prospective and multicenter survey was conducted using a self-report questionnaire. Patients with metastatic breast or prostate cancer managed in 5 day-hospitals of the IRFC-FC over a period of three months were included. RESULTS Two hundred thirty-three questionnaires were analyzed. Pain prevalence rate was 48.5%. Three quarters of patients in pain had chronic background pain, moderate to severe, with or without breakthrough pain. Considering their pain intensity and their analgesic therapy, 42.0% of patients seem to have an inadequate treatment. Eighty-five percent of treated patients reported to be compliant and felt that their pain was well managed despite a strong impact on their quality of life. CONCLUSION The setting of a specific clinical pathway is essential to secure the standardized, optimal and efficient management of patients in pain. The assessment of patient satisfaction and quality of life must be integrated in clinical practice to identify patients in pain for which the treatment is inappropriate.
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Affiliation(s)
- Fanny Dénommé
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Marie Kroemer
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France
| | - Philippe Montcuquet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Gilles Nallet
- Oncolie, réseau de cancérologie de Franche-Comté, pôle cancérologie, 2, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Antoine Thiery-Vuillemin
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Fernando Bazan
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Guillaume Mouillet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Cristian Villanueva
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Martin Demarchi
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Ulrich Stein
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Hamadi Almotlak
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Loïc Chaigneau
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Elsa Curtit
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Nathalie Meneveau
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Tristan Maurina
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Erion Dobi
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Thierry Nguyen Tan Hon
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Laurent Cals
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Laura Mansi
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Clotilde Verlut
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Héloïse Pana-Katatali
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Mathieu Caubet
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Marie-Justine Paillard
- CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Samuel Limat
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France
| | - Xavier Pivot
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France; CHRU de Besançon, service d'oncologie médicale, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - Virginie Nerich
- CHRU de Besançon, pôle pharmacie, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, interactions hôte-greffon-tumeur - ingénierie cellulaire et génique, Besançon, France.
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Mercadante S, Adile C, Cuomo A, Aielli F, Marinangeli F, Casuccio A. The use of low doses of a sublingual fentanyl formulation for breakthrough pain in patients receiving low doses of opioids. Support Care Cancer 2016; 25:645-649. [PMID: 27744534 DOI: 10.1007/s00520-016-3457-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to prospectively assess the efficacy and safety of low doses of sublingual fentanyl (SLF) for the treatment of breakthrough pain (BTP) in cancer patients in patients who were receiving low opioid doses for background analgesia. METHODS A sample of cancer patients presenting BTP episodes and receiving stable low doses of opioids for background pain (less than 60 mg of oral morphine equivalents) was selected to assess the efficacy and safety of low doses of SLF (67 μg). For each patient, data from four consecutive episodes were collected. For each episode, changes in pain intensity and adverse effects when pain got severe (T0), and 5, 10, and 15 min after SLF administration (T5-T30) were recorded. The occurrence of serious effects occurring within 2 h of SLF administration were also considered. RESULTS Fifty-one patients were recruited for the study. The mean age was 66.8 (SD 12.9). A mean of 3.3 episodes/patient were recorded. Four patients did not have episodes of BTP. 147 episodes were evaluated. Six episodes (4.1 %) required a rescue medication at T30. Pain intensity significantly decreased at T5, T10, T15 and T30 (p < 0.0005 in all cases). A high percentage of patients had a pain reduction of more than 33 and 50 % at T5, T10, T15 and T30. Adverse effects were mild and generally already present, due to basal opioid treatment or disease. No serious adverse effects were observed for the subsequent 2 h. CONCLUSION This study suggests that SLF given in low doses in patients receiving lower doses of opioids for background analgesia is safe and effective in clinical practice.
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Affiliation(s)
- Sebastiano Mercadante
- Pain relief and Palliative/supportive care unit, La Maddalena Cancer Center, Palermo, Italy.
| | - Claudio Adile
- Pain relief and Palliative/supportive care unit, La Maddalena Cancer Center, Palermo, Italy
| | - Arturo Cuomo
- Pain Therapy, National Cancer Institute "Pascale", Naples, Italy
| | - Federica Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Alessandra Casuccio
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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Mercadante S, Prestia G, Casuccio A. Nurse-based monitoring and management of breakthrough pain in an acute pain relief and palliative care unit. Hosp Pract (1995) 2016; 44:203-206. [PMID: 27477690 DOI: 10.1080/21548331.2016.1216715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the nurses' performance in assessing, treating, and documenting breakthrough pain (BTP) in a palliative care unit where traditionally there is continuous training. METHODS The study was performed in an acute palliative care unit. Once a week, a research nurse examined the documentation regarding all the episodes of BTP registered in a specific pain chart, designed by the institutional nurse board, as part of the routine nurse activity. RESULTS The charts of 50 consecutive eligible patients (32 M/18 F), were analysed. The mean number of episodes/patient was 3.3 (SD 1.61; range 1-7). 166 episodes occurred. The main BTP pain intensity was 7.06 (SD 0.82). In 7 episodes, pain intensity was not evaluated at T0. The pain intensity after 15 minutes after BTP medication was 3.01 (SD1.19). In 28 episodes, pain intensity was not evaluated at T15. The change in pain intensity was highly significant (P < 0.0005). BTP episodes were distributed normally through different day intervals. No relevant adverse event attributable to BTP medication was reported in the nurse diary. CONCLUSION Training in a research environment allows a good nurse capability in evaluating and treating BTP, and above all, providing documentation for each BTP episode. The theoretical work and recommendations around BTP need to be translated into day-to-day clinical practice.
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Affiliation(s)
| | - Giovanna Prestia
- b Palliative Care , Casa di Cura La Maddalena SpA Ringgold Standard Institution , Palermo , Italy
| | - Alessandra Casuccio
- c Hygiene , Universita degli Studi di Palermo Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche Ringgold Standard Institution , Palermo , Italy
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Mercadante S, Cuomo A. Breakthrough Cancer Pain: Ten Commandments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:531-536. [PMID: 27565269 DOI: 10.1016/j.jval.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 03/05/2016] [Indexed: 06/06/2023]
Abstract
The term "breakthrough cancer pain" (BTcP) was introduced about 25 years ago. Peaks of pain intensity reported in patients with cancer had been invariably examined in the past years, providing relevant information for a better knowledge of this phenomenon and its treatment. The aim of this critical review was to provide the golden rules, namely, the 10 commandments, for a correct diagnostic pathway of BTcP and a consequent personalized pharmacological treatment. These are as follows: 1) assessment of background analgesia, 2) drugs used for background analgesia, 3) BTcP is a frequent phenomenon, 4) characteristics of BTcP, 5) diagnosis of BTcP, 6) continuous assessment, 7) tailored pharmacological treatment of BTcP, 8) selection of BTcP medication, 9) dosing BTcP medications, and 10) education. These steps may help clinicians to recognize and treat BTcP adequately.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
| | - Arturo Cuomo
- Anesthesia, Intensive care and Pain Therapy, National Cancer Institute, "Pascale", Naples, Italy
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