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Wong AKY, Wang D, Gordon I, Alexander M, Siew B, Yap N, Le B, Philip J. Opioid initiation timing and palliative care referrals in advanced cancer: retrospective study. BMJ Support Palliat Care 2024:spcare-2024-005028. [PMID: 38918048 DOI: 10.1136/spcare-2024-005028] [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: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Early opioid initiation is recommended for advanced cancer pain, however the timing of opioid commencement in relation to diagnosis has not been described, and the role of palliative care prescribers is unclear. This study aims to determine the timing of opioid initiation by prescriber and cancer type in relation to key timepoints in the cancer illness course (diagnosis, palliative care referral and death). METHODS This retrospective cohort study included patients at a quaternary cancer centre with incurable advanced cancer of five different subtype groups. Demographics, clinical characteristics, health service use and details of first slow and immediate release opioid prescription are reported. RESULTS Among 200 patients, median time to first immediate release opioid prescription was 23 days (IQR 1-82) and to slow release opioid prescription was 47 days (IQR 14-155). Most patients (95%, (n=190) were referred to palliative care (median time to referral 54 days (IQR 18-190)). Non-palliative care prescribers initiated slow release opioids for half the cohort (49%, n=97) prior to referral. Patients with pancreatic cancer had the shortest time to slow/immediate release opioid prescription (median 10 days (IQR 0-39) and 26 days (IQR 1-43) respectively) and shortest survival (median 136 days (IQR 82-214)). CONCLUSIONS Median time to opioid commencement was approximately 3 weeks after diagnosis. Despite early palliative care involvement, opioid initiation by non-palliative care clinicians was common and remains important. Timely palliative care referral for those with pancreatic cancer may include consideration of earlier complex pain presentations and shorter prognosis.
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Affiliation(s)
- Aaron Kee Yee Wong
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dorothy Wang
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ian Gordon
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Beverly Siew
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Natasha Yap
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brian Le
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Arefian M, Asgari-Mobarakeh K. Psychoeducational Intervention for Pain, Psychological Distress, Hope, and Post-traumatic Growth Among Breast Cancer Patients During Chemotherapy: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2024:S1524-9042(24)00153-X. [PMID: 38714424 DOI: 10.1016/j.pmn.2024.04.012] [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: 11/27/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Chemotherapy is associated with many side effects, including pain and psychological distress, which affect patients' physical and psychological health. AIM The aim of this study was to elucidate the efficacy of a pain management intervention (POLA) to promote pain, psychological distress, hope and post-traumatic growth in breast cancer patients, also, to undertake a preliminary evaluation of the intervention. METHODS A pilot randomized controlled trial was conducted in an Iranian hospital involving 42 breast cancer (BC) patients during chemotherapy. The intervention group received a 6-week group therapy (90 minutes per session) administered by a psychologist. Meanwhile, the comparison group received standard care. patients' Pain, psychological distress, hope and post-traumatic growth were measured at 3 time points (baseline, week 6, and 12 weeks postintervention). RESULTS The study design was found to be feasible, with a recruitment rate of 61.64% and an attrition rate of 6.66%. Compared to the control group, the intervention group showed a significant reduction in pain, psychological distress, depression, anxiety, and stress, as well as a notable improvement in hope and post-traumatic growth (p < .01). These differences remained significant at follow-up (p < 0.05). The study population found the intervention acceptable, as evidenced by a high attendance rate of 90% and adherence rate of 90.47%. CONCLUSION Psychoeducational intervention positively affects the pain, psychological distress, hope and post-traumatic growth of BC patients during chemotherapy.
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Affiliation(s)
- Mohsen Arefian
- Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Karim Asgari-Mobarakeh
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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3
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Korwisi B, Hay G, Forget P, Ryan D, Treede RD, Rief W, Barke A. Patients' perspective on the chronic pain classification in the 11th revision of the International Classification of Diseases (ICD-11): results from an international web-based survey. Pain 2024:00006396-990000000-00584. [PMID: 38709273 DOI: 10.1097/j.pain.0000000000003248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/09/2024] [Indexed: 05/07/2024]
Abstract
ABSTRACT The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) aims at improving the lives of persons with the lived experience of chronic pain by providing clearly defined and clinically useful diagnoses that can reduce stigma, facilitate communication, and improve access to pain management, among others. The aim of this study was to assess the perspective of people with chronic pain on these diagnoses. An international web-based survey was distributed among persons with the lived experience of chronic pain. After having seen an information video, participants rated the diagnoses on 8 endorsement scales (eg, diagnostic fit, stigma) that ranged from -5 to +5 with 0 representing the neutral point of no expected change. Overall ratings and differences between participants with chronic primary pain (CPP) and chronic secondary pain (CSP) were analyzed. N = 690 participants were included in the data analysis. The ratings on all endorsement scales were significantly higher than the neutral point of 0. The highest ratings were obtained for "openness" (2.95 ± 1.93) and "overall opinion" (1.87 ± 1.98). Participants with CPP and CSP did not differ in their ratings; however, those with CSP indicated an improved diagnostic fit of the new diagnoses, whereas participants with CPP rated the diagnostic fit of the new diagnoses similar to the fit of their current diagnoses. These results show that persons with the lived experience of chronic pain accept and endorse the new diagnoses. This endorsement is an important indicator of the diagnoses' clinical utility and can contribute to implementation and advocacy.
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Affiliation(s)
- Beatrice Korwisi
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
| | - Ginea Hay
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Patrice Forget
- Epidemiology Group and Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Anaesthesia Department, NHS Grampian, Aberdeen, United Kingdom
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
| | - Deirdre Ryan
- Societal Impact of Pain (SIP) Platform, Brussels, Belgium
- Pain Alliance Europe (PAE), Brussels, Belgium
| | - Rolf-Detlef Treede
- Mannheim Center for Translational Neuroscience (MCTN), Department of Neurophysiology, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
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4
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Chang P, Amaral LJ, Asher A, Clauw D, Jones B, Thompson P, Warner AS. A perspective on a precision approach to pain in cancer; moving beyond opioid therapy. Disabil Rehabil 2024; 46:2174-2183. [PMID: 37194659 DOI: 10.1080/09638288.2023.2212916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/07/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Cancer-related pain is primarily treated with opioids which while effective can add significant patient burden due to side effects, associated stigma, and timely access. The purpose of this perspective discussion is to argue for a precision approach to pain in cancer based on a biopsychosocial and spiritual model which we argue can offer a higher quality of life while limiting opioid use. CONCLUSIONS Pain in cancer represents a heterogenous process with multiple contributing and modulating factors. Specific characterization of pain as either nociceptive, neuropathic, nociplastic, or mixed can allow for targeted treatments. Additional assessment of biopsychosocial and spiritual issues can elucidate further points of targeted intervention which can lead to overall greater pain control.
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Affiliation(s)
- Philip Chang
- Philip Chang - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Arash Asher
- Arash Asher - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Bronwen Jones
- Bronwen Jones - Cedars Sinai Medical Center, Los Angeles, CA
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Pérez C, Ochoa D, Sánchez N, Ballesteros AI, Santidrián S, López I, Mondéjar R, Carnaval T, Villoria J, Colomer R. Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors. Cancers (Basel) 2024; 16:1581. [PMID: 38672663 PMCID: PMC11049399 DOI: 10.3390/cancers16081581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer survival is becoming more common which means that there is now a growing population of cancer survivors, in whom pain may be common. However, its prevalence has hardly been addressed systematically. We aimed to assess the prevalence and explore the pathophysiology and impact of pain on health outcomes in cancer survivors. We conducted a retrospective-prospective cohort study in cancer-free patients diagnosed with cancer at least five years before the study start date. We used multivariable regression to establish the association of patients' cancer characteristics with pain, and then the association of patients' pain features with health outcomes and related symptoms. Between March and July 2021, 278 long-term cancer survivors were evaluated. Almost half of them (130/278, 46.8%) had pain, of whom 58.9% had a probable neuropathic component, but only 18 (13.8%) were taking specific drugs for neuropathic pain. A history of surgery-related pain syndrome in breast cancer patients was more than twice as frequent in the pain cohort. Post-chemotherapy and post-radiotherapy pain syndromes were uncommon. Pain was associated with lower QoL, emotional functioning, professional performance, and disability scores. Pain is a frequent health determinant in cancer survivors. Referral to specialised pain services may be a reasonable move in some cases.
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Affiliation(s)
- Concepción Pérez
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Dolores Ochoa
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Noelia Sánchez
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Ana Isabel Ballesteros
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
| | - Sheila Santidrián
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Isabel López
- Pain Clinic, Hospital de La Princesa, 28006 Madrid, Spain; (D.O.); (N.S.); (S.S.); (I.L.)
| | - Rebeca Mondéjar
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
| | - Thiago Carnaval
- Department of Design and Biometrics, Medicxact, S.L., 28430 Alpedrete, Spain; (T.C.); (J.V.)
| | - Jesús Villoria
- Department of Design and Biometrics, Medicxact, S.L., 28430 Alpedrete, Spain; (T.C.); (J.V.)
| | - Ramón Colomer
- Department of Clinical Oncology, Hospital de la Princesa, 28006 Madrid, Spain; (A.I.B.); (R.M.); (R.C.)
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Wang Y, Hu C, Hu J, Liang Y, Zhao Y, Yao Y, Meng X, Xing J, Wang L, Jiang Y, Xiao X. Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model. Heliyon 2024; 10:e28489. [PMID: 38560243 PMCID: PMC10981129 DOI: 10.1016/j.heliyon.2024.e28489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. Methods Clinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. Results The study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907-0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. Conclusions A nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.
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Affiliation(s)
- Ying Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - ChanChan Hu
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Junhui Hu
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yunwei Liang
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanwu Zhao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yinhui Yao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xin Meng
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Jing Xing
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Lingdi Wang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Yanping Jiang
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
| | - Xu Xiao
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, PR China
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Austin PD, Lee W, Costa DSJ, Ritchie A, Lovell MR. Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials. Heliyon 2024; 10:e29193. [PMID: 38623224 PMCID: PMC11016720 DOI: 10.1016/j.heliyon.2024.e29193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise. Design A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout. Results Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms. Conclusions Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.
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Affiliation(s)
- Philip D. Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Wei Lee
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel SJ. Costa
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Melanie R. Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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Riviere P, Morgan KM, Deshler LN, Huang X, Marienfeld C, Coyne CJ, Rose BS, Murphy JD. Opioid tapering in older cancer survivors does not increase psychiatric or drug hospitalization rates. J Natl Cancer Inst 2024; 116:606-612. [PMID: 37971959 PMCID: PMC10995846 DOI: 10.1093/jnci/djad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Opioid tapering in the general population is linked to increases in hospitalizations or emergency department visits related to psychiatric or drug-related diagnoses. Cancer survivors represent a unique population with different opioid indications, prescription patterns, and more frequent follow-up care. This study sought to describe patterns of opioid tapering among older cancer survivors and to test the hypothesis of whether older cancer survivors face increased risks of adverse events with opioid tapering. METHODS Using the Surveillance, Epidemiology and End Results Medicare-linked database, we identified 15 002 Medicare-beneficiary cancer survivors diagnosed between 2010 and 2017 prescribed opioids consistently for at least 6 months after their cancer diagnosis. Tapering was defined as a binary time-varying event occurring with any monthly oral morphine equivalent reduction of 15% or more from the previous month. Primary diagnostic billing codes associated with emergency room or hospital admissions were used for the composite endpoint of psychiatric- or drug-related event(s). RESULTS There were 3.86 events per 100 patient-months, with 97.8% events being mental health emergencies, 1.91% events being overdose emergencies, and 0.25% involving both. Using a generalized estimating equation for repeated measure time-based analysis, opioid tapering was not statistically associated with acute events in the 3-month posttaper period (odds ratio [OR] = 1.02; P = .62) or at any point in the future (OR = 0.96; P = .46). CONCLUSIONS Opioid tapering in older cancer survivors does not appear to be linked to a higher risk of acute psychiatric- or drug-related events, in contrast to prior research in the general population.
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Affiliation(s)
- Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Kylie M Morgan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Leah N Deshler
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Huang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Carla Marienfeld
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Christopher J Coyne
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brent S Rose
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
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9
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Eyni S, Mousavi SE, Sepahvand H. Acceptance of Chronic Pain in Cancer Patients in Iran: the Role of Anxiety Sensitivity, Emotional Suppression, and Learned Helplessness. Pain Manag Nurs 2024; 25:e144-e151. [PMID: 38355335 DOI: 10.1016/j.pmn.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/15/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Acceptance of pain is one of the most significant topics in the field of chronic pain due to its influence on the adaptation and response of people. Also, chronic pain and pain caused by the progress of cancer have a high prevalence in all stages and types of cancer. AIMS The present study aimed to predict the acceptance of chronic pain in patients with cancer based on anxiety sensitivity and emotional suppression with the mediating role of learned helplessness. METHODS The current research method was descriptive-correlation and structural equation modeling. A number of patients with cancer (400), admitted to the oncology department of Imam Khomeini Hospital in Ardabil City of Iran in the second half of 2022, were selected as the convenience sample and responded to McCracker et al.'s chronic pain acceptance scale, Rees et al.'s anxiety sensitivity scale, Roger and Nasho's emotional control questionnaire, and Quinles and Nielson's learned helplessness questionnaire. RESULTS Based on the obtained results, the causal relationship between anxiety sensitivity, emotional suppression, learned helplessness, and acceptance of chronic pain in patients with cancer was confirmed based on various fit indices. Anxiety sensitivity, emotional suppression, and learned helplessness had a direct effect on the acceptance of chronic pain in patients with cancer. Moreover, anxiety sensitivity and emotional suppression through learned helplessness had indirect effects on pain acceptance in patients with cancer (p < .05). CONCLUSIONS Thus, anxiety sensitivity, emotional suppression, and learned helplessness play an essential role in the level of pain acceptance in patients with cancer, and targeting these three components through psychological treatments can be effective in the level of pain acceptance in these patients.
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Affiliation(s)
- Sanaz Eyni
- Department of Psychology, University of Kurdistan, Sanandaj, Iran.
| | - Seyede Elham Mousavi
- Department of Educational Science, Psychological Counseling and Guidance Branch, Ataturk University, Erzurum, Turkey
| | - Hassan Sepahvand
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
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10
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de Valois B, Young T, Zollman C, Appleyard I, Ben-Arye E, Cummings M, Green R, Hoffman C, Lacey J, Moir F, Peckham R, Stringer J, Veleber S, Weitzman M, Wode K. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer 2024; 32:229. [PMID: 38483623 PMCID: PMC10940387 DOI: 10.1007/s00520-024-08386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. METHODS A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. RESULTS These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential. CONCLUSION These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.
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Affiliation(s)
- Beverley de Valois
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
| | - Teresa Young
- Supportive Oncology Research Team (SORT), East and North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | | | | | - Mike Cummings
- British Medical Acupuncture Society, London Office, London, UK
| | - Ruth Green
- Imaging, Royal National Orthopaedic NHS Trust, Stanmore, Middlesex, UK
| | | | - Judith Lacey
- Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse Comprehensive Cancer Hospital, Sydney, NSW, Australia
| | | | | | | | - Susan Veleber
- Integrative Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Matthew Weitzman
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathrin Wode
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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11
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Narvaez Tamayo MA, Aguayo C, Atencio E, Garcia JB, Cabrera C, Castañeda C, Castroman P, Elizeche G, Gomez P, Guaycochea S, Guerrero M, Guillen R, Pereira CL, López G, Macias J, Martinez B, Mejia F, Orrillo E, Oliveira JO, Piedimonte F, Samayoa F, Toro M. Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus. Pain Manag 2024; 14:139-151. [PMID: 38379521 DOI: 10.2217/pmt-2023-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.
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Affiliation(s)
- Marco A Narvaez Tamayo
- Specialist in Anesthesiology & Pain Medicine, Coordinator of the Pain Unit, Hospital Obrero Nro. 1-Hospital Materno Infantil, Caja Nacional de Salud. La Paz, Bolivia, President of the Latin American Federation of Associations for the Study of Pain (FEDELAT), President of the Bolivian Pain Association
| | - Carlos Aguayo
- Specialist in Anesthesiology, Head of the Pain Unit, Hospital Clínico FUSAT. Rancagua, Chile. President of the Chilean Association for the Study of Pain & Palliative Care
| | - Elias Atencio
- Specialist in Anesthesiology, Head of the Algiology Service, Complejo Hospitalario 'Dr. Arnulfo Arias Madrid', Panamá. Former President of the Latin American Federation of Associations for the Study of Pain (FEDELAT)
| | - Joao Batista Garcia
- Specialist in Anesthesiology, Pain Medicine & Palliative Care, Universidad Federal de São Luís, Brasil
| | - Carmen Cabrera
- Specialist in Anesthesiology, Pain Medicine & Interventional Medicine, Pain Therapy & Palliative Care Service.Hospital Alberto Sabogal Sologuren-Essalud, Bellavista, Perú
| | - Celina Castañeda
- Specialist in Anesthesiology & Palliative Medicine, Teacher at the Faculty of Medicine of the Universidad Autónoma del Estado de México, Undersecretary of Health, Tlaxcala State, México
| | - Pablo Castroman
- Specialist in Anesthesiology, Associate Professor of Anesthesiology, Pain Therapy Service, Department & Chair of Anesthesiology, Hospital de Clínicas, University of Medicine, Universidad de la República, Uruguay, Relevium Co-Founder, Pain Medicine, Montevideo, Uruguay
| | - Graciela Elizeche
- Specialist in Anesthesiology, Founder & former President of the Paraguayan Association for the Study & Treatment of Pain, Paraguay
| | - Patricia Gomez
- Specialist in Anesthesiology, Pain Management & Palliative Care, Associate Professor, Anesthesia Unit, Department of Surgery, Universidad Nacional de Colombia. Bogotá D.C., Colombia
| | - Santiago Guaycochea
- Specialist in Internal Medicine & Medical Clinic, Head of Pain Medicine, Sanatorio Otamendi. Buenos Aires, Argentina, President of the Argentine Association for the Study of Pain
| | - Marixa Guerrero
- Specialist in Anesthesiology, Epidemiology, Pain Medicine & Palliative Care, General Director of Oncology Clinic Colsubsidio 127, Bogota, Colombia, Member of the Board of Directors of the Colombian Association for the Study of Pain, Coordinator of the Epidemiology Committee of Latin American Federation of Associations for the Study of Pain (FEDELAT)
| | - Rocio Guillen
- Specialist in Anesthesiology, Interventional Medicine, Pain Medicine & Palliative Care, Pain Clinic of the Instituto Nacional de Cancerología, México, Director General of Clínica Alive 'Vive sin Dolor', Ciudad de México, México, Former President of the Mexican Association for the Study & Treatment of Pain, Member of the Latin American Federation of Associations for the Study of Pain (FEDELAT)
| | - Carla Leal Pereira
- Specialist in Anesthesiology, Technical supervisor, Pain service. Hospital São Luiz/Rede D'Or. Brasil. Director General of the Pain Service in MedDor - São Paulo/Brasil, Fiscal Council Brazilian Society for the Study of Pain, Brasil, Member of the Latin American Federation of Associations for the Study of Pain (FEDELAT)
| | - Guillermo López
- Specialist in Anesthesiology & Resuscitation, Adjunct Professor of Anesthesiology Postgraduate, Universidad de Cuenca. Director of the UnitDolor AMETS, Hospital Universitario del Río, Cuenca, Ecuador
| | - Jacqueline Macias
- Specialist in Anesthesiology & Pain Treatment, RELIF Director 'Centro de Tratamiento del Dolor y Medicina Paliativa', Past President of the Ecuadorian Society for the Study & Treatment of Pain, Ecuador
| | - Bethania Martinez
- Specialist in Anesthesiology, Pain Management & Palliative Care, Interventional Pain & Palliative Care Unit (UNIDOLOR SRL), Santo Domingo, Dominican Republic
| | - Felipe Mejia
- Specialist in Anesthesiology, Fellow in Interventionism in Pain & Palliative Care. Program Director of Dolor Neurocentro Pereira Colombia, President of Colombian Association for the Study of Pain, Colombia
| | - Enrique Orrillo
- Neurology Specialist, Professor & Coordinator of the Diploma in Chronic Pain at the Universidad Nacional Mayor de San Marcos de Lima, Perú, President of the Peruvian Association for the Study of Pain
| | - José O Oliveira
- Neurosurgery Specialist, Neurosurgery Service of Hospital Servidor Público Estadual, President of the Brazilian Society for the Study of Pain, Brasil
| | - Fabian Piedimonte
- Specialist in Neurosurgery, Professor of the Faculty of Medicine, Universidad de Buenos Aires, President of the CENIT Foundation for Research in Neurosciences, Argentina
| | - Francisco Samayoa
- Specialist in Anesthesiology, Associate Professor, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras, Career Coordinator of the Postgraduate Course in Anesthesiology, Resuscitation & Pain, President of the Honduran Society of Anesthesiology, Resuscitation & Pain, Honduras
| | - Martin Toro
- Specialist in Anesthesiology, Professor of Pain Medicine & Regional Anesthesia.Universidad Central de Venezuela, President of the Venezuelan Association for the Study of Pain, Venezuela
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12
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Fialho MFP, Brum ES, Becker G, Oliveira SM. TRPV4 Activation and its Intracellular Modulation Mediated by Kinin Receptors Contribute to Painful Symptoms Induced by Anastrozole. Mol Neurobiol 2024; 61:1627-1642. [PMID: 37740866 DOI: 10.1007/s12035-023-03654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Anastrozole, an aromatase inhibitor, induces painful musculoskeletal symptoms, which affect patients' quality of life and lead to therapy discontinuation. Efforts have been made to understand the mechanisms involved in these painful symptoms to manage them better. In this context, we explored the role of the Transient Receptor Potential Vanilloid 4 (TRPV4), a potential transducer of several nociceptive mechanisms, in anastrozole-induced musculoskeletal pain in mice. Besides, we evaluated the possible sensibilization of TRPV4 by signalling pathways downstream, PLC, PKC and PKCε from kinin B2 (B2R) and B1 (B1R) receptors activation in anastrozole-induced pain. Anastrozole caused mechanical allodynia and muscle strength loss in mice. HC067047, TRPV4 antagonist, reduced the anastrozole-induced mechanical allodynia and muscle strength loss. In animals previously treated with anastrozole, the local administration of sub-nociceptive doses of the TRPV4 (4α-PDD or hypotonic solution), B2R (Bradykinin) or B1R (DABk) agonists enhanced the anastrozole-induced pain behaviours. The sensitizing effects induced by local injection of the TRPV4, B2R and B1R agonists in animals previously treated with anastrozole were reduced by pre-treatment with TRPV4 antagonist. Furthermore, inhibition of PLC, PKC or PKCε attenuated the mechanical allodynia and muscle strength loss induced by TRPV4, B2R and B1R agonists. The generation of painful conditions caused by anastrozole depends on direct TRPV4 activation or indirect, e.g., PLC, PKC and PKCε pathways downstream from B2R and B1R activation. Thus, the TRPV4 channels act as sensors of extracellular and intracellular changes, making them potential therapeutic targets for alleviating pain related to aromatase inhibitors use, such as anastrozole.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Gabriela Becker
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria, RS, 97105-900, Brazil.
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13
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Ju J, Li Z, Jia X, Peng X, Wang J, Gao F. Interleukin-18 in chronic pain: Focus on pathogenic mechanisms and potential therapeutic targets. Pharmacol Res 2024; 201:107089. [PMID: 38295914 DOI: 10.1016/j.phrs.2024.107089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
Chronic pain has been proven to be an independent disease, other than an accompanying symptom of certain diseases. Interleukin-18 (IL-18), a pro-inflammatory cytokine with pleiotropic biological effects, participates in immune modulation, inflammatory response, tumor growth, as well as the process of chronic pain. Compelling evidence suggests that IL-18 is upregulated in the occurrence of chronic pain. Antagonism or inhibition of IL-18 expression can alleviate the occurrence and development of chronic pain. And IL-18 is located in microglia, while IL-18R is mostly located in astrocytes in the spinal cord. This indicates that the interaction between microglia and astrocytes mediated by the IL-18/IL-18R axis is involved in the occurrence of chronic pain. In this review, we described the role and mechanism of IL-18 in different types of chronic pain. This review provides strong evidence that IL-18 is a potential therapeutic target in pain management.
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Affiliation(s)
- Jie Ju
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Li
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqian Jia
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoling Peng
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Wang
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Gao
- Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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14
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Cornall G, Zhao E, Luckett T, Erciyas E, Monck D, Glare P, Wang A, Lee YC. Management of pain in cancer patients- lessons from practices during the COVID-19: a qualitative study of cancer care providers' perspectives. BMC Health Serv Res 2024; 24:232. [PMID: 38388905 PMCID: PMC10885360 DOI: 10.1186/s12913-024-10710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has impacted health systems globally and affected managing many chronic conditions, including cancer. This study aimed to explore the perceptions of multi-disciplinary cancer care providers on how cancer pain management was affected by the COVID-19 pandemic. METHODS Participants were eligible if they were cancer care providers of any specialty and discipline from two tertiary hospitals in Australia. Data were collected using semi-structured interviews to explore cancer care providers' perspectives on cancer pain management within COVID-19. Thematic analysis of interview transcripts used an integrated approach that started with inductive coding before coding deductively against a behaviour framework called the COM-B Model, which proposes that 'capability', 'motivation' and 'opportunity' are requisites for any behaviour. RESULTS Twenty-three providers participated. Five themes were developed and interpreted from the analysis of data, namely: "Telehealth enables remote access to cancer pain management but also created a digital divide", "Access to cancer pain management in the community is compromised due to the pandemic", "COVID-19 negatively impacts hospital resource allocation", "Patients were required to trade off cancer pain management against other health priorities" and "Hospital restrictions result in decreased social and psychological support for patients with cancer pain". CONCLUSIONS The landscape of cancer pain management in the Australian health system underwent substantial shifts during the COVID-19 pandemic, with lasting impacts. Cancer care providers perceived the pandemic to have significant adverse effects on pain management across multiple levels, with repercussions for patients experiencing cancer-related pain. A more adaptive health system model needs to be established in the future to accommodate vulnerable cancer patients.
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Affiliation(s)
- Georgina Cornall
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Emma Zhao
- Sydney Nursing School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia.
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
| | - Ertugrul Erciyas
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - David Monck
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Glare
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Andy Wang
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia
| | - Yi-Ching Lee
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
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15
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Szallasi A. Targeting TRPV1 for Cancer Pain Relief: Can It Work? Cancers (Basel) 2024; 16:648. [PMID: 38339399 PMCID: PMC11154559 DOI: 10.3390/cancers16030648] [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: 12/01/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic intractable pain affects a large proportion of cancer patients, especially those with metastatic bone disease. Blocking sensory afferents for cancer pain relief represents an attractive alternative to opioids and other drugs acting in the CNS in that sensory nerve blockers are not addictive and do not affect the mental state of the patient. A distinct subpopulation of sensory afferents expresses the capsaicin receptor TRPV1. Intrathecal resiniferatoxin, an ultrapotent capsaicin analog, ablates TRPV1-expressing nerve endings exposed to the cerebrospinal fluid, resulting in permanent analgesia in women with cervical cancer metastasis to the pelvic bone. High-dose capsaicin patches are effective pain killers in patients with chemotherapy-induced peripheral neuropathic pain. However, large gaps remain in our knowledge since the mechanisms by which cancer activates TRPV1 are essentially unknown. Most important, it is not clear whether or not sensory denervation mediated by TRPV1 agonists affects cancer progression. In a murine model of breast cancer, capsaicin desensitization was reported to accelerate progression. By contrast, desensitization mediated by resiniferatoxin was found to block melanoma growth. These observations imply that TRPV1 blockade for pain relief may be indicated for some cancers and contraindicated for others. In this review, we explore the current state of this field and compare the analgesic potential of TRPV1 antagonism and sensory afferent desensitization in cancer patients.
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Affiliation(s)
- Arpad Szallasi
- Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary
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16
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Hamilton M, Christine Lin CW, Arora S, Harrison M, Tracy M, Nickel B, Shaheed CA, Gnjidic D, Mathieson S. Understanding general practitioners' prescribing choices to patients with chronic low back pain: a discrete choice experiment. Int J Clin Pharm 2024; 46:111-121. [PMID: 37882955 PMCID: PMC10831024 DOI: 10.1007/s11096-023-01649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although NSAIDs are recommended as a first line analgesic treatment, opioids are very commonly prescribed to patients with low back pain (LBP) despite risks of harms. AIM This study aimed to determine factors contributing to general practitioners' (GPs') prescribing choices to patients with chronic LBP in a primary care setting. METHOD This discrete choice experiment (DCE) presented 210 GPs with hypothetical scenarios of a patient with chronic LBP. Participants chose their preferred treatment for each choice set, either the opioid, NSAID or neither. The scenarios varied by two patient attributes; non-specific LBP or LBP with referred leg pain (sciatica) and number of comorbidities. The three treatment attributes also varied, being: the type of opioid or NSAID, degree of pain reduction and number of adverse events. The significance of each attribute in influencing clinical decisions was the primary outcome and the degree to which GPs preferred the alternative based on the number of adverse events or the amount of pain reduction was the secondary outcome. RESULTS Overall, GPs preferred NSAIDs (45.2%, 95% CI 38.7-51.7%) over opioids (28.8%, 95% CI 23.0-34.7%), however there was no difference between the type of NSAID or opioid preferred. Additionally, the attributes of pain reduction and adverse events did not influence a GP's choice between NSAIDs or opioids for patients with chronic LBP. CONCLUSION GPs prefer prescribing NSAIDs over opioids for a patient with chronic low back pain regardless of patient factors of comorbidities or the presence of leg pain (i.e. sciatica).
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Affiliation(s)
- Melanie Hamilton
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- The Centre for Health Evaluation and Outcomes Sciences (CHEOS) at St. Paul's Hospital, Vancouver, Canada
| | - Marguerite Tracy
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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17
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Wirz S, Keßler J, Hofbauer H. [Tumor-associated pain]. Schmerz 2024; 38:57-69. [PMID: 38206419 DOI: 10.1007/s00482-023-00782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Tumor-associated pain has a high prevalence and is still a challenging aspect of pain medicine. Treatment-related etiologies often coexist with pain caused by the oncological disease itself. For cancer pain as well, a pathophysiologically oriented analysis of nociceptive, nociplastic and neuropathic pain is advisable for planning a tailored treatment. The analgesic three-step ladder of the World Health Organization (WHO) should be customized in this context, incorporating antineuropathic or antihypersensitizing pharmacological approaches as well as minimally invasive techniques. Psycho-oncological and exercise therapy interventions should be considered. In cases of long-term courses of treatment or following curative oncological treatment, chronically persistent or chronic tumor-associated pain can occur, necessitating multimodal therapeutic approaches analogue to noncancer pain conditions. Close integration with palliative medicine enhances the therapeutic effectiveness during the transition from nonpalliative to palliative treatment phases.
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Affiliation(s)
- Stefan Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, Cura Krankenhaus - eine Betriebsstätte der GFO Kliniken Bonn, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.
| | - Jens Keßler
- Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie, Sektion Schmerzmedizin, Universität Heidelberg, Im Neuenheimer Feld 131, 69120, Heidelberg, Deutschland.
| | - Hannes Hofbauer
- Sektion Schmerztherapie, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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18
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Moloney NA, Lenoir D. Assessment of neuropathic pain following cancer treatment. Anat Rec (Hoboken) 2024; 307:309-319. [PMID: 36700536 DOI: 10.1002/ar.25161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 01/27/2023]
Abstract
Neuropathic cancer pain (NCP) is prevalent affecting up to 58% of those with persistent pain following cancer treatment. Neuropathic pain can develop from malignancy, after neural tissue insult during surgery and/or exposure to radiation or neurotoxic agents used as part of cancer treatment regimens. Pain following cancer treatment is commonly under-treated and one barrier identified is poor recognition of pain and inadequate assessment. Recognition of the presence of NCP is important to inform pain management, which is challenging to treat and warrants the use of specific treatments to target neuropathic mechanisms. In this review, approaches for screening and classifying NCP are described. These include screening questionnaires and the application of the updated neuropathic pain grading system in a cancer context. The evidence from neuropathic pain related assessments in cancer populations is provided and highlighted under different neuropathic pain grades. Recommendations for assessment in practice are provided.
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Affiliation(s)
- Niamh A Moloney
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Dorine Lenoir
- Pain in Motion International Research Group, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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19
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Vande Vyvere T, De Groote A, De Groef A, Haenen V, Tjalma W, Van Dyck P, Meeus M. Morphological and functional brain changes in chronic cancer-related pain: A systematic review. Anat Rec (Hoboken) 2024; 307:285-297. [PMID: 36342941 DOI: 10.1002/ar.25113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to perform a systematic review of the available literature on morphological and functional brain changes measured by modern neuroimaging techniques in patients suffering from chronic cancer-related pain. A systematic search was conducted in PubMed, Embase, and Web of Science using different keyword combinations. In addition, a hand search was performed on the reference lists and several databases to retrieve supplementary primary studies. Eligible articles were assessed for methodological quality and risk of bias and reviewed by two independent researchers. The search yielded only four studies, three of which used MRI and one PET-CT. None of the studies measured longitudinal morphological (i.e., gray or white matter) changes. All studies investigated functional brain changes and found differences in specific brain regions and networks between patients with chronic cancer-related pain and pain-free cancer patients or healthy volunteers. Some of these alterations were found in brain networks that also show changes in non-cancer populations with chronic pain (e.g., the default mode network and salience network). However, specific findings were inconsistent, and there was substantial variation in imaging methodology, analysis, sample size, and study quality. There is a striking lack of research on morphological brain changes in patients with chronic cancer-related pain. Moreover, only a few studies investigated functional brain changes. In the retrieved studies, there is some evidence that alterations occur in brain networks also involved in other chronic non-cancer pain syndromes. However, the low sample sizes of the studies, finding inconsistencies, and methodological heterogeneity do not allow for robust conclusions.
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Affiliation(s)
- Thijs Vande Vyvere
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - Amber De Groote
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
| | - An De Groef
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Wiebren Tjalma
- Department of Gynecological Oncology, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Antwerp University Hospital, Antwerp, Belgium
| | - Pieter Van Dyck
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Pain in Motion International Research Group (PiM), Antwerp, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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20
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Becker G, Atuati SF, Oliveira SM. G Protein-Coupled Receptors and Ion Channels Involvement in Cisplatin-Induced Peripheral Neuropathy: A Review of Preclinical Studies. Cancers (Basel) 2024; 16:580. [PMID: 38339331 PMCID: PMC10854671 DOI: 10.3390/cancers16030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Cisplatin is a platinum-based chemotherapy drug widely used to treat various solid tumours. Although it is effective in anti-cancer therapy, many patients develop peripheral neuropathy during and after cisplatin treatment. Peripheral neuropathy results from lesions or diseases in the peripheral somatosensory nervous system and is a significant cause of debilitation and suffering in patients. In recent years, preclinical studies have been conducted to elucidate the mechanisms involved in chemotherapy-induced peripheral neuropathic pain, as well as to promote new therapeutic targets since current treatments are ineffective and are associated with adverse effects. G-protein coupled receptors and ion channels play a significant role in pain processing and may represent promising targets for improving the management of cisplatin-induced neuropathic pain. This review describes the role of G protein-coupled receptors and ion channels in cisplatin-induced pain, analysing preclinical experimental studies that investigated the role of each receptor subtype in the modulation of cisplatin-induced pain.
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21
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Singh S, Dhiraaj S, Shamshery C, Singh S, Singh A, Kumar RA, Mishra P. Incidence of Different Characters of Neuropathic Pain in Cancer Patients Coming to Tertiary Care Centre in North India Over A Period of 1 Year - An Observational Study. Indian J Palliat Care 2024; 30:27-33. [PMID: 38633685 PMCID: PMC11021066 DOI: 10.25259/ijpc_199_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/29/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives Pain is classified as nociceptive, neuropathic, or nociplastic. Neuropathic pain presents as variable phenotypes (characters) based on specific aetiology and pathophysiology. This study aimed to find out among cancer patients the incidence of different phenotypes of neuropathic pain and form specific phenotypic clusters based on the underlying neurophysiology and association of sensory profile with various organ systems - A prospective observational study. Materials and methods The Institutional Ethical Committee clearance (IEC code: 2020-49-MD-EXP-15) https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=44886&EncHid=88651.15716&userName=CTRI/2020/09/027964 approval was obtained. After written and informed consent, patients of age group 18-80 years, registering in the pain and palliative outpatient department or radiotherapy department with complaints of pain and not taking any anti-neuropathic pain medications, were enrolled. They were assessed using Leeds assessment of neuropathic symptoms and signs (LANSS) pain score, and a score of >12 was eligible for assessment of neuropathic pain phenotypes. Results Out of 210 cancer patients complaining of pain, a neuropathic component with LANSS >12 was found in 73 (34.76%). The most predominant phenotypes, allodynia> tingling> pricking = burning, were found in 72.60%, 56.16%, and 43.84% of patients, respectively. Phenotypes were clustered into Nodes 1 and 2 based on clinically significant separation of phenotypes. Node 1 had neuropathic pain of spontaneous origin found predominantly in gastrointestinal tract (GIT) and genitourinary tract (GUT) cancers. Node 2 had stimulus-evoked negative and positive characters which occurred in head and neck, thoracic, and spinal metastatic cancers. Conclusion Careful patient assessment reveals the incidence of neuropathic pain in 34.76%; allodynia and tingling astable the most prominent phenotypes. Broadly, sensory characters were clustered into spontaneous and stimulus-evoked sensations with GIT and GUT cancers presenting with Node 1 symptoms.
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Affiliation(s)
- Shipra Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Dhiraaj
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chetna Shamshery
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anjali Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajput Abhishek Kumar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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22
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Björkstrand FK, Duarte J, McCracken LM, Perrin S. Access to psychological treatment for chronic cancer-related pain in Sweden. Scand J Pain 2024; 24:sjpain-2023-0074. [PMID: 38452308 DOI: 10.1515/sjpain-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/30/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Cancer-related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least 3 months, affecting >40% of cancer survivors. Evidence-based treatments, including pain-focused cognitive behavioral therapy (CBT), are available, but it appears that cancer patients/survivors are often poorly informed about CRP or the potential benefits of CBT for such pain. This study examined current experience of Swedish cancer patients/survivors in relation to CRP. METHODS Participants (N = 276; 83% female; mean age = 55.5 years, SD = 11.9) were recruited to an online survey via cancer websites in Sweden, and they provided information about their history of chronic CRP and whether they received information about or treatment for CRP from a healthcare professional. RESULTS Participants had a history of breast (36%), gynecological (12%), lung (10%), colon (8%), and other forms of cancer (36%). A majority (74%) reported a history of chronic CRP and being prescribed analgesic medications (70%). Less than half (47%) received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these, only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (standard deviation 2.6). CONCLUSIONS Greater efforts are needed to raise awareness among cancer patients/survivors and healthcare providers about the risk of CRP and evidence-based interventions, including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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Affiliation(s)
| | - Joana Duarte
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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23
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Ikander T, Raunkiær M, Voetmann C, Pedersen CV, Jarlbaek L. Cancer-related pain experienced in daily life is difficult to communicate and to manage - for patients and for professionals. Scand J Pain 2024; 24:sjpain-2023-0107. [PMID: 38776518 DOI: 10.1515/sjpain-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES The aim of this study was to gain qualitative insight into cancer patients' experiences, explanations, and management strategies regarding their cancer-related pain (CP). METHODS Seventeen patients with CP were interviewed using a semi-structured interview approach. Braun and Clarke's thematic analysis method was used to analyze the transcribed interviews. The patients all participated in cancer rehabilitation courses arranged by the research clinic at The Danish Knowledge Centre for Rehabilitation and Palliative Care. RESULTS Three themes were identified: (1) Explaining CP: Patients found it difficult to explain how they experienced their pain. They lacked words, and they frequently used invasive metaphors such as "Pain feels like a heart attack" (2). Strategies and barriers to the management of CP: Initiatives provided by healthcare professionals (HCPs) were perceived as insufficient, and the patients missed guidance in both pharmacological and non-pharmacological approaches to pain management. Several saw medicine as unnatural for their body, and they focused on side effects and the medicine affecting their quality of life. (3) Responsibility for managing CP: A lack of responsiveness from the HCPs and taking on responsibility for pain management were experienced by several of the patients. The patients expressed uncertainty about whom to contact for help with the management of their CP. CONCLUSION The patients' difficulties in explaining, understanding, and communicating their pain and pain management contributed to insufficient pain management. They were also uncertain about who had the responsibility to help them to achieve pain relief. These results share the evidence drawn from studies on patients with chronic non-cancer pain. This qualitative study highlights the need for having more focus on a common language and shared understanding between patients and HCPs. It also underpins the importance of HCPs to assume their responsibility to help patients manage their pain conditions.
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Affiliation(s)
- Tine Ikander
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Raunkiær
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Cecilie Voetmann
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Caroline V Pedersen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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24
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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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25
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Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [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: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
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Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
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26
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [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: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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27
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de Munter J, Dodlek N, Khmaladze A, Parreira ST, Ullgren H, de Man R, de Jong FA, Oldenmenger WH. The role of cancer nurses in cancer-related pain management in Europe. Palliat Care Soc Pract 2023; 17:26323524231216996. [PMID: 38106339 PMCID: PMC10725126 DOI: 10.1177/26323524231216996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Cancer pain is a common symptom in patients with cancer and can largely affect their quality of life. Pain management is important to minimize the impact of pain on daily activities. Cancer nurses are significantly involved in all steps of pain management and contribute to the success of therapy through their knowledge and expertise. While they generally play an important role in the screening, assessment, diagnosis, treatment and follow-up of patients and their (pain) symptoms, this varies from country to country in Europe. An important aspect is their role in educating patients and their families about what pain is, what impact it can have, how it can be treated pharmacologically or non-pharmacologically and what effects or problems can occur during treatment. While there is a great discrepancy between education and training opportunities for cancer nurses in different European countries, there is a continued need for education and training in pain management. Cancer is increasingly becoming a chronic disease, and the management of pain in cancer survivors will be crucial to maintain an adequate quality of life. With this, the crucial role of cancer nurses is becoming even more important.
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Affiliation(s)
| | | | | | | | - Helena Ullgren
- Department of Oncology and Pathology, Karolinska Institute, ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - Rik de Man
- Mundipharma Pharmaceuticals B.V., Leusden, The Netherlands
| | | | - Wendy H. Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
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28
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Nafees A, Khan M, Chow R, Fazelzad R, Hope A, Liu G, Letourneau D, Raman S. Evaluation of clinical decision support systems in oncology: An updated systematic review. Crit Rev Oncol Hematol 2023; 192:104143. [PMID: 37742884 DOI: 10.1016/j.critrevonc.2023.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
With increasing reliance on technology in oncology, the impact of digital clinical decision support (CDS) tools needs to be examined. A systematic review update was conducted and peer-reviewed literature from 2016 to 2022 were included if CDS tools were used for live decision making and comparatively assessed quantitative outcomes. 3369 studies were screened and 19 were included in this updated review. Combined with a previous review of 24 studies, a total of 43 studies were analyzed. Improvements in outcomes were observed in 42 studies, and 34 of these were of statistical significance. Computerized physician order entry and clinical practice guideline systems comprise the greatest number of evaluated CDS tools (13 and 10 respectively), followed by those that utilize patient-reported outcomes (8), clinical pathway systems (8) and prescriber alerts for best-practice advisories (4). Our review indicates that CDS can improve guideline adherence, patient-centered care, and care delivery processes in oncology.
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Affiliation(s)
- Abdulwadud Nafees
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Maha Khan
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Ronald Chow
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Institute of Biomedical Engineering, Faculty of Applied Sciences & Engineering, University of Toronto, Toronto, Canada; Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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29
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Løhre ET, Jakobsen G, Solheim TS, Klepstad P, Thronæs M. Breakthrough and Episodic Cancer Pain from a Palliative Care Perspective. Curr Oncol 2023; 30:10249-10259. [PMID: 38132380 PMCID: PMC10742182 DOI: 10.3390/curroncol30120746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/23/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative care unit with average and/or worst PI ≥ 1 on the 11-point numeric rating scale were included. Average and worst PI at admission and average PI at discharge were collected. We examined how the difference and ratio between worst and average PI and average PI at admission, were associated with average PI development during hospitalization. Positive differences between worst and average PI at admission were defined as pain flares. Ninety out of 131 patients had pain flares. The reduction in average PI for patients with flares was 0.9 and for those without, 1.9 (p = 0.02). Patients with large worst minus average PI differences reported the least improvement, as did those with large worst/average PI ratios. Patients with pain flares and average PI ≤ 4 at admission had unchanged average PI during hospitalization, while those with pain flares and average PI > 4 experienced pain reduction (2.1, p < 0.001). Large pain flares, in absolute values and compared to background PI, were associated with inferior pain relief.
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Affiliation(s)
- Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
| | - Gunnhild Jakobsen
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Pål Klepstad
- Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Morten Thronæs
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.T.L.)
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
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30
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Conti L, Marzorati C, Grasso R, Ferrucci R, Priori A, Mameli F, Ruggiero F, Pravettoni G. Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study. JMIR Res Protoc 2023; 12:e49508. [PMID: 37971805 PMCID: PMC10690524 DOI: 10.2196/49508] [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: 05/31/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions. OBJECTIVE We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain. METHODS A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment. RESULTS The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025. CONCLUSIONS We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49508.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberta Ferrucci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- ASST Santi Paolo e Carlo San Paolo University Hospital, Milan, Italy
- Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Mameli
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ruggiero
- Neurophysiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Owusu-Agyemang P, Feng L, Cata JP. Race, Ethnicity, and Sustained Opioid Use After Major Abdominal Surgery for Cancer. J Pain Res 2023; 16:3759-3774. [PMID: 37954473 PMCID: PMC10638919 DOI: 10.2147/jpr.s427411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Sustained opioid use is a well-known complication after surgery. Our objective was to determine whether there is any association between a patient's race or ethnicity and the sustained use of opioids in the year following surgery. Opioid use over the initial 3, 6, and 12 postoperative months was categorized as "sustained early", persistent, and chronic, respectively. Patients and Methods Single-institution retrospective study of adults (≥18 years) who had undergone open abdominal surgery for cancer. Multivariable logistic regression was used to evaluate the association between race/ethnicity and opioid use. Results Of the 3523 patients included in the study, 2543 (72.2%) were non-Hispanic (NH) White, 476 (13.5%) were Hispanic or Latino, 262 (7.4%) were NH-Black, 186 (5.3%) were Asian, and 56 (1.6%) belonged to other racial or ethnic groups. The overall rates of sustained early, persistent, and chronic opioid use were 15.9%, 7.1%, and 2.6%, respectively. In the multivariable analysis, patient race/ethnicity was associated with sustained early postoperative opioid use (p-value=0.037), with Hispanics/Latinos having significantly higher odds than NH-Whites (OR = 1.382 [95% CI: 1.057-1.808]; p = 0.018). However, neither persistent nor chronic opioid use was associated with race/ethnicity (p = 0.697 and p = 0.443, respectively). Conclusion In this retrospective study of adults who had undergone open abdominal surgery, patient race/ethnicity was not consistently associated with the development of sustained opioid use over the first 12 postoperative months.
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Affiliation(s)
- Pascal Owusu-Agyemang
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
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Obaid A, Hroub AA, Rifai AA, Alruzzieh M, Radaideh M, Tantawi Y. Barriers to Effective Cancer Pain Management, Comparing the Perspectives of Physicians, Nurses, and Patients. Pain Manag Nurs 2023; 24:498-505. [PMID: 37573153 DOI: 10.1016/j.pmn.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Pain associated with cancer is one of the most significant concerns for patients, families, and health care providers. Various barriers may hinder optimal pain management. AIM The study was conducted in specialized cancer center in Jordan and aimed to explore the barriers to effective cancer pain management from the perspectives of physicians, nurses, and patients. METHODS A quantitative descriptive cross-sectional design was used, with a total sample of 185 participants (55 Physicians, 70 Nurses, and 60 Patients) who completed a demographic datasheet and the Arabic-Barrier Questionnaire II (BQII). RESULTS The overall BQII of patient score was 2.4 (standard deviation [SD] = 0.7). The harmful effects of pain medications were the highest barrier 2.7 (SD = 1.0), followed by the physiologic effect 2.4 (SD = 0.9), and the communication 2.4 (SD = 1.1) subscales. Nurses and physicians reported an overall BQII of 1.9 (SD = 1.1) and 1.8 (SD = 0.9), respectively. One-way analysis of variance showed that the perspectives of patients, physicians, and nurses differed significantly in the overall BQII F(2, 182) = 6.81, p < .01, communication F(2, 182) = 10.55, p < .01, and harmful effects F(2, 182) = 7.26, p < .01. Multiple pairwise comparisons also showed that the patients significantly perceived higher communication barriers, more concerns of analgesic harmful effects, and higher overall barriers than nurses and physicians. CONCLUSIONS Significant differences were found in the perspectives of patients, physicians, and nurses toward pain management barriers in the overall barriers, communication, and harmful effect. It is recommended to develop awareness programs for patients about pain management, barriers, use of analgesia, and communication. Nurses and physicians are advised to discuss mutual concerns and pay more attention to overcoming patient concerns.
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Affiliation(s)
- Abdullah Obaid
- Nursing Department, King Hussein Cancer Center, Amman, Jordan; Nursing Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmad Al Hroub
- Nursing Department, King Hussein Cancer Center, Amman, Jordan
| | - Anwar Al Rifai
- Nursing Department, King Hussein Cancer Center, Amman, Jordan.
| | | | | | - Yazan Tantawi
- Nursing Department, King Hussein Cancer Center, Amman, Jordan
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Barke A, Korwisi B. Making chronic pain count: empirical support for the ICD-11 classification of chronic pain. Curr Opin Anaesthesiol 2023; 36:589-594. [PMID: 37552003 DOI: 10.1097/aco.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW The purpose is to review the evidence that has been collected with regard to the new classification of chronic pain. In 2022, the World Health Assembly endorsed the 11 th revision of the International Classification of Diseases and Related Health Problems (ICD-11), and with it a new classification of chronic pain. RECENT FINDINGS The evidence from the formative field testing indicated that the categories were clearly delineated and the coverage of chronic pain excellent (<3% in remainder categories). Official WHO field tests showed that the classification works well within the technical parameters WHO classifications must conform to and outperformed the ICD-10 diagnoses in all respects. International field tests, in which clinicians diagnosed consecutive patients in settings of medium and high resources, showed substantial interrater reliability (κ = 0.596 to κ = 0.783) for the diagnoses and the clinicians rated their clinical utility as very high. Studies using complete hospital records demonstrated that with the information they contain, retrospective coding of the new diagnoses is possible and provides much more meaningful information than the ICD-10 diagnoses. SUMMARY The evidence supports the use of the new classification and highlights its informational gains - using it will contribute to making chronic pain count in many contexts.
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Affiliation(s)
- Antonia Barke
- Division of Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Essen, Germany
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Liao H, Lei Y. Application of ERAS concept in clinical nursing of patients with advanced cancer pain of gynecological malignant tumors. Front Oncol 2023; 13:1173333. [PMID: 37817768 PMCID: PMC10561091 DOI: 10.3389/fonc.2023.1173333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/09/2023] [Indexed: 10/12/2023] Open
Abstract
Gynecological malignant tumors refer to malignant tumors of organs and tissues centered on the uterus, ovaries, and fallopian tubes. Among gynecological tumors, endometrial cancer is the most malignant, accounting for more than 80% of malignant tumors in the female reproductive tract. Common symptoms are vaginal bleeding and pain. This article aims to explore the application and analysis of the concept of ERAS (Enhanced Recovery After Surgery) in the clinical care of patients with advanced cancer pain from gynecological malignancies. ERAS aims to reduce complications, shorten hospitalization time, reduce medical costs, and enable patients to recover quickly by adopting a series of perioperative management measures for patients. This article analyzes the pain caused by late-stage cancer, proposes an ERAS multimodal analgesia method, and uses image fusion technology to detect cancer patients. This article finally conducts an experimental exploration of the clinical nursing of the ERAS concept in the treatment of advanced cancer pain in gynecological malignancies. The results of this study showed that in terms of pain impact score, before treatment, the score of group M was 39.07 and the score of group N was 38.92, and the difference was not statistically significant. The score after ERAS concept treatment was 58.14, and the score after traditional treatment was 43.79, with a significant difference. Research shows that the pain impact score after treatment is significantly better than before treatment, and the improvement effect of ERAS concept treatment is more obvious.
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Affiliation(s)
- Haijing Liao
- Gynaecology Second area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Gynaecology One area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Yuanxiu Lei
- Gynaecology One area, First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
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Bhondoekhan F, Marshall BDL, Shireman TI, Trivedi AN, Merlin JS, Moyo P. Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD. JAMA Netw Open 2023; 6:e2333251. [PMID: 37698860 PMCID: PMC10498328 DOI: 10.1001/jamanetworkopen.2023.33251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/03/2023] [Indexed: 09/13/2023] Open
Abstract
Importance Nonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care. Objective To assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD. Design, Setting, and Participants This retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023. Exposures Race and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other. Main Outcomes and Measures The main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed. Results Among 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT. Conclusions and Relevance In this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.
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Affiliation(s)
- Fiona Bhondoekhan
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jessica S. Merlin
- CHAllenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Armoogum J, Foster C, Llewellyn A, Harcourt D, McCabe C. 'I think it affects every aspect of my life, really': Cancer survivors' experience of living with chronic pain after curative cancer treatment in England, UK. PLoS One 2023; 18:e0290967. [PMID: 37656690 PMCID: PMC10473538 DOI: 10.1371/journal.pone.0290967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/19/2023] [Indexed: 09/03/2023] Open
Abstract
AIM To explore cancer survivors' experiences of living with chronic pain after curative cancer treatment in England, UK. METHODS A qualitative study using telephone interviews with adult cancer survivors experiencing chronic pain after curative cancer treatment. Interview data was analysed using a reflexive thematic approach [1-3]. FINDINGS Nineteen participants: 14 female, 5 male, mean age 62.4 years, 1.5-48 years since cancer diagnosis, eight tumour groups represented. Six participants (31.6%) developed chronic pain more than ten years after completing cancer treatment (range 0-25 years). Five themes were generated which highlighted the experience of chronic pain after cancer treatment for cancer survivors: 1) 'Hear me… believe me…. Please'. Survivors felt that they had not been listened to when they tried to talk about their chronic pain after cancer treatment, nor at times, believed. 2) 'Expectation versus reality'. Survivors had anticipated returning to pre cancer quality of life yet living in chronic pain prevented them from doing so. 3) 'They don't understand…. We don't understand'. Cancer survivors did not feel informed or prepared for the risk or reality of chronic pain after cancer treatment and this compounded the difficulties of coping with and managing their pain. They felt health care professionals lacked knowledge and understanding of chronic pain after cancer. 4) 'Negotiating the maze'. Cancer survivors encountered unclear and limited pathways for support, often bouncing from one support team to another. Identifying and accessing services was a challenge, and the responsibility of this was often left to the survivor. 5) 'Validate my pain, validate me'. Palpable relief and benefit was felt when health care professionals diagnosed and acknowledged their chronic pain after cancer treatment. CONCLUSIONS Cancer survivors can feel ill prepared for the risk of chronic pain after cancer treatment and can experience challenges accessing support from healthcare professionals and clinical services.
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Affiliation(s)
- Julie Armoogum
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Alison Llewellyn
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
| | - Diana Harcourt
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Candida McCabe
- College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
- Dorothy House Hospice, Winsley, United Kingdom
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Li S, Brimmers A, van Boekel RL, Vissers KC, Coenen MJ. A systematic review of genome-wide association studies for pain, nociception, neuropathy, and pain treatment responses. Pain 2023; 164:1891-1911. [PMID: 37144689 PMCID: PMC10436363 DOI: 10.1097/j.pain.0000000000002910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
ABSTRACT Pain is the leading cause of disability worldwide, imposing an enormous burden on personal health and society. Pain is a multifactorial and multidimensional problem. Currently, there is (some) evidence that genetic factors could partially explain individual susceptibility to pain and interpersonal differences in pain treatment response. To better understand the underlying genetic mechanisms of pain, we systematically reviewed and summarized genome-wide association studies (GWASes) investigating the associations between genetic variants and pain/pain-related phenotypes in humans. We reviewed 57 full-text articles and identified 30 loci reported in more than 1 study. To check whether genes described in this review are associated with (other) pain phenotypes, we searched 2 pain genetic databases, Human Pain Genetics Database and Mouse Pain Genetics Database. Six GWAS-identified genes/loci were also reported in those databases, mainly involved in neurological functions and inflammation. These findings demonstrate an important contribution of genetic factors to the risk of pain and pain-related phenotypes. However, replication studies with consistent phenotype definitions and sufficient statistical power are required to validate these pain-associated genes further. Our review also highlights the need for bioinformatic tools to elucidate the function of identified genes/loci. We believe that a better understanding of the genetic background of pain will shed light on the underlying biological mechanisms of pain and benefit patients by improving the clinical management of pain.
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Affiliation(s)
- Song Li
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annika Brimmers
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Regina L.M. van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke J.H. Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
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Marshall VK, Chavez M, Efre A, Lake PW, Rigg KK, Lubrano B, Pabbathi S, Rajasekhara S, Tyson DM. Barriers to Adequate Pain Control and Opioid Use Among Cancer Survivors: Implications for Nursing Practice. Cancer Nurs 2023; 46:386-393. [PMID: 37607374 PMCID: PMC10232667 DOI: 10.1097/ncc.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cancer survivors can experience long-term negative effects from cancer and its treatment. Pain is one of the most common and distressing symptoms that cancer survivors experience. Opioids are often prescribed for pain; however, cancer survivors who have completed active treatment may have unique challenges with regard to pain management. OBJECTIVE The aim of this study was to explore barriers to pain management and perceptions of opioid use among cancer survivors. METHODS This research was an exploratory pilot study using in-depth qualitative interviews with adult cancer survivors who were recruited from community-based survivorship organizations. Data were analyzed using applied thematic analysis techniques. RESULTS Participants (n = 25) were mostly women (96%), diagnosed with breast cancer (88%) and stages I to III disease (84%), with a mean age of 56.2 years. Three themes on barriers to adequate pain control emerged: (1) taking just enough to take the edge off: self-medicating behaviors and nonadherence to prescribed regimen; (2) lack of insurance coverage and costly alternative pain treatment options; and (3) chronicity of cancer-related pain not adequately addressed and often mismanaged. CONCLUSIONS Discussions with cancer survivors unveiled personal accounts of unmanaged pain resulting from limited pain management/opioid education, fear of opioid addiction, negative perceptions/experiences with opioids, lack of insurance coverage for alternative pain therapies, and regulatory policies limiting access to opioids. IMPLICATIONS FOR PRACTICE There is a clear need for improved access to multimodal pain management options and nonopioid alternatives for cancer survivors. Oncology nurses should endeavor to support policies and procedures aimed at opioid education, training, and legislation.
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Affiliation(s)
- Victoria Kate Marshall
- Author Affiliations: Colleges of Nursing (Drs Marshall and Efre) and Public Health (Mss Chavez and Lake and Dr Tyson) and Department of Mental Health Law and Policy, College of Behavioral and Community Science (Dr Rigg), University of South Florida; and Moffitt Cancer Center (Drs Lubrano, Pabbathi, and Rajasekhara), Tampa, Florida
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Barakji J, Korang SK, Feinberg JB, Maagaard M, Mathiesen O, Gluud C, Jakobsen JC. Tramadol for chronic pain in adults: protocol for a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. Syst Rev 2023; 12:145. [PMID: 37608394 PMCID: PMC10463795 DOI: 10.1186/s13643-023-02307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Chronic pain in adults is a frequent clinical symptom with a significant impact on patient well-being. Therefore, sufficient pain management is of utmost importance. While tramadol is a commonly used pain medication, the quality of evidence supporting its use has been questioned considering the observed adverse events. Our objective will be to assess the benefits and harms of tramadol compared with placebo or no intervention for chronic pain. METHODS/DESIGN We will conduct a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis to assess the beneficial and harmful effects of tramadol in any dose, formulation, or duration. We will accept placebo or no intervention as control interventions. We will include adult participants with any type of chronic pain, including cancer-related pain. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and BIOSIS for relevant literature. We will follow the recommendations by Cochrane and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors ('bias') and random errors ('play of chance') will be assessed. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DISCUSSION Although tramadol is often being used to manage chronic pain conditions, the beneficial and harmful effects of this intervention are unknown. The present review will systematically assess the current evidence on the benefits and harms of tramadol versus placebo or no intervention to inform clinical practice and future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019140334.
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Affiliation(s)
- J Barakji
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - S K Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - J B Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Medical Department, Cardiology Section, Holbaek University Hospital, Holbaek, Denmark
| | - M Maagaard
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - O Mathiesen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - C Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - J C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
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40
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Han J, Rolles M, Torabi F, Griffiths R, Bedston S, Akbari A, Burnett B, Lyons J, Greene G, Thomas R, Long T, Arnold C, Huws DW, Lawler M, Lyons RA. The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK. Support Care Cancer 2023; 31:531. [PMID: 37606853 PMCID: PMC10444652 DOI: 10.1007/s00520-023-07944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. METHODS A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. RESULTS We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. CONCLUSIONS We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.
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Affiliation(s)
- Jun Han
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Martin Rolles
- Population Data Science, Swansea University Medical School, Swansea, UK.
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK.
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Bruce Burnett
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Rebecca Thomas
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Tamsin Long
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Cathy Arnold
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Data Services, University of Leeds, Leeds, UK
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Mark Lawler
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
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Mestdagh F, Steyaert A, Lavand'homme P. Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques. Curr Oncol 2023; 30:6838-6858. [PMID: 37504360 PMCID: PMC10378332 DOI: 10.3390/curroncol30070500] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
Pain is frequently reported during cancer disease, and it still remains poorly controlled in 40% of patients. Recent developments in oncology have helped to better control pain. Targeted treatments may cure cancer disease and significantly increase survival. Therefore, a novel population of patients (cancer survivors) has emerged, also enduring chronic pain (27.6% moderate to severe pain). The present review discusses the different options currently available to manage pain in (former) cancer patients in light of progress made in the last decade. Major progress in the field includes the recent development of a chronic cancer pain taxonomy now included in the International Classification of Diseases (ICD-11) and the update of the WHO analgesic ladder. Until recently, cancer pain management has mostly relied on pharmacotherapy, with opioids being considered as the mainstay. The opioids crisis has prompted the reassessment of opioids use in cancer patients and survivors. This review focuses on the current utilization of opioids, the neuropathic pain component often neglected, and the techniques and non-pharmacological strategies available which help to personalize patient treatment. Cancer pain management is now closer to the management of chronic non-cancer pain, i.e., "an integrative and supportive pain care" aiming to improve patient's quality of life.
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Affiliation(s)
- François Mestdagh
- Department of Anesthesiology and Pain Clinic, Cliniques Universitaires Saint Luc, University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - Arnaud Steyaert
- Department of Anesthesiology and Pain Clinic, Cliniques Universitaires Saint Luc, University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - Patricia Lavand'homme
- Department of Anesthesiology and Acute Postoperative & Transitional Pain Service, Cliniques Universitaires Saint Luc, University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium
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Nishigami T, Manfuku M, Lahousse A. Central Sensitization in Cancer Survivors and Its Clinical Implications: State of the Art. J Clin Med 2023; 12:4606. [PMID: 37510721 PMCID: PMC10380903 DOI: 10.3390/jcm12144606] [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: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Although the prevalence of cancer pain is 47% after treatment, cancer pain is often underestimated, and many patients are undertreated. The complexity of cancer pain contributes to the lack of its management. Recently, as the mechanism of cancer pain, it has become clear that central sensitization (CS) influences chronic pain conditions and the transition from acute to chronic pain. In this state-of-the-art review, we summarized the association of CS or central sensitivity syndrome with pain and the treatment for pain targeting CS in cancer survivors. The management of patients with CS should not only focus on tissue damage in either the affected body regions or within the central nervous system; rather, it should aim to target the underlying factors that sustain the CS process. Pain neuroscience education (PNE) is gaining popularity for managing chronic musculoskeletal pain and could be effective for pain and CS in breast cancer survivors. However, there is a study that did not demonstrate significant improvements after PNE, so further research is needed. Precision medicine involves the classification of patients into subgroups based on a multifaceted evaluation of disease and the implementation of treatment tailored to the characteristics of each patient, which may play a central role in the treatment of CS.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
| | - Masahiro Manfuku
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka 596-0076, Japan
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Serra S, Spampinato MD, Riccardi A, Guarino M, Fabbri A, Orsi L, De Iaco F. Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach. J Clin Med 2023; 12:4357. [PMID: 37445392 DOI: 10.3390/jcm12134357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.
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Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy
| | | | | | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, Italy
| | - Andrea Fabbri
- Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, Italy
| | - Luciano Orsi
- Palliative Care Physician and Scientific Director of "Rivista Italiane di Cure Palliative", 26013 Crema, Italy
| | - Fabio De Iaco
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, Italy
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Makhlouf SM, Ahmed S, Mulvey M, Bennett MI. Attitudes, Knowledge, and Perceived Barriers Towards Cancer Pain Management Among Healthcare Professionals in Libya: a National Multicenter Survey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:789-797. [PMID: 35650378 PMCID: PMC10235140 DOI: 10.1007/s13187-022-02185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 05/11/2023]
Abstract
Cancer pain presents in approximately 66% of patients in advanced stages. Although several guidelines and pharmacological options are available for cancer pain management (CPM), assessment and treatment of cancer pain remain inadequate globally, particularly in developing countries. Lack of knowledge and negative attitudes towards CPM among healthcare professionals (HCPs) are important barriers to CPM. This survey aimed to evaluate nurses' and physicians' knowledge, attitudes, and potential barriers regarding CPM in Libya. This cross-sectional survey involved a convenience sample of 152 oncology nurses and physicians working in six oncology settings in Libya. The response rate was 76%. The Barriers Questionnaire II (BQ-II) was used for data collection (higher scores signify greater attitudinal barriers and poorer knowledge). Data analysis was carried out using Statistical Package for Social Sciences (SPSS), version 26 software. An independent t-test (unadjusted estimate) indicated that Libyan nurses showed higher mean barrier scores (mean = 3.8, SD = 0.7) to CPM than physicians (mean = 2.9, SD = 0.8), p < 0.001. The six most common differences in attitudinal barriers between nurses and physicians were "opioid side effects," "poor tolerance," "strong patient endures pain," "distract the physician," "drug addiction," and "opioids impair immune function," p < 0.001. Multiple regression results (adjusted estimate) indicated that nurses had more barrier scores to CPM than physicians (B = - 0.530, p < 0.05), and participants with higher educational levels were associated with lower barrier scores to CPM (B = - 0.641, p < 0.05). Our results suggest that Libyan oncology HCPs hold perceived barriers, lack of knowledge, and negative attitudes towards CPM. Professional education and training in CPM, addressing phobia and myths on opioid usage, and the benefits and complications of using opioids are likely to result in reduced barriers to CPM in Libya.
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Affiliation(s)
- Salim M Makhlouf
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Shenaz Ahmed
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Matthew Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
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Naye F, Légaré F, Paquette JS, Tousignant-Laflamme Y, LeBlanc A, Gaboury I, Poitras ME, Toupin-April K, Li LC, Hoens A, Poirier MD, Décary S. Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol. BMJ Open 2023; 13:e066189. [PMID: 37156591 PMCID: PMC10173373 DOI: 10.1136/bmjopen-2022-066189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION The 2021 Action Plan for Pain from the Canadian Pain Task Force advocates for patient-centred pain care at all levels of healthcare across provinces. Shared decision-making is the crux of patient-centred care. Implementing the action plan will require innovative shared decision-making interventions, specifically following the disruption of chronic pain care during the COVID-19 pandemic. The first step in this endeavour is to assess current decisional needs (ie, decisions most important to them) of Canadians with chronic pain across their care pathways. METHODS AND ANALYSIS DesignGrounded in patient-oriented research approaches, we will perform an online population-based survey across the ten Canadian provinces. We will report methods and data following the CROSS reporting guidelines.SamplingThe Léger Marketing company will administer the online population-based survey to its representative panel of 500 000 Canadians to recruit 1646 adults (age ≥18 years old) with chronic pain according to the definition by the International Association for the Study of Pain (eg, pain ≥12 weeks). ContentBased on the Ottawa Decision Support Framework, the self-administered survey has been codesigned with patients and contain six core domains: (1) healthcare services, consultation and postpandemic needs, (2) difficult decisions experienced, (3) decisional conflict, (4) decisional regret, (5) decisional needs and (6) sociodemographic characteristics. We will use several strategies such as random sampling to improve survey quality. AnalysisWe will perform descriptive statistical analysis. We will identify factors associated with clinically significant decisional conflict and decision regret using multivariate analyses. ETHICS AND DISSEMINATION Ethics was approved by the Research Ethics Board at the Research Centre of the Centre Hospitalier Universitaire de Sherbrooke (project #2022-4645). We will codesign knowledge mobilisation products with research patient partners (eg, graphical summaries and videos). Results will be disseminated via peer-reviewed journals and national and international conferences to inform the development of innovative shared decision-making interventions for Canadians with chronic pain.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - France Légaré
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, Québec, Canada
| | - Jean-Sébastien Paquette
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Department of Family and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec, Quebec, Canada
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences, Department of Family Medecine and Emergency Medicine, Research Centre of the CIUSSS de l'Estrie-CHUS, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Longueuil, Quebec, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Research Centre of the CIUSS du Saguenay-Lac-Saint-Jean, Université de Sherbrooke, Chicoutimi, Quebec, Canada
- Centre de santé et de services sociaux de Chicoutimi, Quebec, Quebec, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Dominique Poirier
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean du Québec, Chicoutimi, Quebec, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Sulistio M, Ling N, Finkelstein T, Tee HJ, Gorelik A, Kissane D, Michael N. The Edmonton Classification System for Cancer Pain in Patients with Bone Metastasis: a descriptive cohort study. Support Care Cancer 2023; 31:305. [PMID: 37106261 PMCID: PMC10140090 DOI: 10.1007/s00520-023-07711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE We describe the prevalence of the Edmonton Classification System for Cancer Pain (ECS-CP) features in patients with bone metastasis and cancer-induced bone pain (CIBP) and the relationship between ECS-CP features, pain intensity, and opioid consumption. METHODS We assessed ECS-CP features and recoded pain mechanisms and opioid use in adult patients with bone metastasis. Validated measures were used to assess pain intensity, incident pain, psychological distress, addictive behavior, and cognition. RESULTS Among 147 eligible patients, 95.2% completed the assessment. Mean participant age was 73.2 years, the majority female (52.1%) with breast cancer occurring most commonly (25.7%). One or more ECS-CP features were present in 96.4% and CIBP in 75.7% of patients. The median average and worst pain scores were 3 and 6, respectively. Neuropathic pain was the most prevalent pain mechanism (45.0%) and was associated with breakthrough pain frequency (p=0.014). Three-quarters had incident pain, which was strongly associated with a higher average and worst pain scores (3.5 and 7, p<0.001 for both), background oral morphine equivalent daily dose (26.7mg, p=0.005), and frequency of daily breakthrough analgesia (1.7 doses/day, p=0.007). Psychological distress (n=90, 64.3%) was associated with a significantly higher average pain score (4, p=0.009) and a slightly higher worst pain score (7, p=0.054). Addictive behaviour and cognitive dysfunction were relatively uncommon (18.6% and 12.9%, respectively). CONCLUSION There is a need to promote standardized assessment and classification of pain syndromes such as CIBP. The ECS-CP may allow us to consider CIBP in a systematic manner and develop personalized pain interventions appropriate to the pain profile. TRIAL REGISTRATION Retrospectively registered in ANZCTR ACTRN12622000853741 (16/06/2022).
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Affiliation(s)
- Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia.
| | - Natalie Ling
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Tara Finkelstein
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hoong Jiun Tee
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
| | - Alexandra Gorelik
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
- Sacred Heart Health Service, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
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Cuthbert C, Twomey R, Bansal M, Rana B, Dhruva T, Livingston V, Daun JT, Culos-Reed SN. The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:254. [PMID: 37039883 PMCID: PMC10088810 DOI: 10.1007/s00520-023-07716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management. METHODS We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool. RESULTS Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g = - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low. CONCLUSION There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.
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Affiliation(s)
- Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Benny Rana
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Tana Dhruva
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
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Fialho MFP, Brum ES, Becker G, Brusco I, Oliveira SM. Kinin B2 and B1 Receptors Activation Sensitize the TRPA1 Channel Contributing to Anastrozole-Induced Pain Symptoms. Pharmaceutics 2023; 15:pharmaceutics15041136. [PMID: 37111622 PMCID: PMC10143169 DOI: 10.3390/pharmaceutics15041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Aromatase inhibitors (AIs) cause symptoms of musculoskeletal pain, and some mechanisms have been proposed to explain them. However, signaling pathways downstream from kinin B2 (B2R) and B1 (B1R) receptor activation and their possible sensitizing of the Transient Receptor Potential Ankyrin 1 (TRPA1) remain unknown. The interaction between the kinin receptor and the TRPA1 channel in male C57BL/6 mice treated with anastrozole (an AI) was evaluated. PLC/PKC and PKA inhibitors were used to evaluate the signaling pathways downstream from B2R and B1R activation and their effect on TRPA1 sensitization. Anastrozole caused mechanical allodynia and muscle strength loss in mice. B2R (Bradykinin), B1R (DABk), or TRPA1 (AITC) agonists induced overt nociceptive behavior and enhanced and prolonged the painful parameters in anastrozole-treated mice. All painful symptoms were reduced by B2R (Icatibant), B1R (DALBk), or TRPA1 (A967079) antagonists. We observed the interaction between B2R, B1R, and the TRPA1 channel in anastrozole-induced musculoskeletal pain, which was dependent on the activation of the PLC/PKC and PKA signaling pathways. TRPA1 seems to be sensitized by mechanisms dependent on the activation of PLC/PKC, and PKA due to kinin receptors stimulation in anastrozole-treated animals. Thus, regulating this signaling pathway could contribute to alleviating AIs-related pain symptoms, patients’ adherence to therapy, and disease control.
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Affiliation(s)
- Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Evelyne Silva Brum
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Gabriela Becker
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Indiara Brusco
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences, Biochemical Toxicology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
- Department of Biochemical and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Camobi, Santa Maria 97105-900, RS, Brazil
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Brusco I, Becker G, Palma TV, Pillat MM, Scussel R, Steiner BT, Sampaio TB, Ardisson-Araújo DMP, de Andrade CM, Oliveira MS, Machado-De-Avila RA, Oliveira SM. Kinin B 1 and B 2 receptors mediate cancer pain associated with both the tumor and oncology therapy using aromatase inhibitors. Sci Rep 2023; 13:4418. [PMID: 36932156 PMCID: PMC10023805 DOI: 10.1038/s41598-023-31535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Pain caused by the tumor or aromatase inhibitors (AIs) is a disabling symptom in breast cancer survivors. Their mechanisms are unclear, but pro-algesic and inflammatory mediators seem to be involved. Kinins are endogenous algogenic mediators associated with various painful conditions via B1 and B2 receptor activation, including chemotherapy-induced pain and breast cancer proliferation. We investigate the involvement of the kinin B1 and B2 receptors in metastatic breast tumor (4T1 breast cancer cells)-caused pain and in aromatase inhibitors (anastrozole or letrozole) therapy-associated pain. A protocol associating the tumor and antineoplastic therapy was also performed. Kinin receptors' role was investigated via pharmacological antagonism, receptors protein expression, and kinin levels. Mechanical and cold allodynia and muscle strength were evaluated. AIs and breast tumor increased kinin receptors expression, and tumor also increased kinin levels. AIs caused mechanical allodynia and reduced the muscle strength of mice. Kinin B1 (DALBk) and B2 (Icatibant) receptor antagonists attenuated these effects and reduced breast tumor-induced mechanical and cold allodynia. AIs or paclitaxel enhanced breast tumor-induced mechanical hypersensitivity, while DALBk and Icatibant prevented this increase. Antagonists did not interfere with paclitaxel's cytotoxic action in vitro. Thus, kinin B1 or B2 receptors can be a potential target for treating the pain caused by metastatic breast tumor and their antineoplastic therapy.
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Affiliation(s)
- Indiara Brusco
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil.
| | - Gabriela Becker
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Tais Vidal Palma
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Micheli Mainardi Pillat
- Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Rahisa Scussel
- Graduate Program in Health Sciences, University of Extreme South Catarinense, Criciuma, SC, Brazil
| | - Bethina Trevisol Steiner
- Graduate Program in Health Sciences, University of Extreme South Catarinense, Criciuma, SC, Brazil
| | - Tuane Bazanella Sampaio
- Graduate Program in Pharmacology, Department of Physiology and Pharmacology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Daniel Mendes Pereira Ardisson-Araújo
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
- Department of Cell Biology, Institute of Biological Sciences, University of Brasilia, Brasilia, DF, Brazil
| | - Cinthia Melazzo de Andrade
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil
| | - Mauro Schneider Oliveira
- Graduate Program in Pharmacology, Department of Physiology and Pharmacology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Biochemistry Toxicology, Department of Biochemistry and Molecular Biology, Federal University of Santa Maria, Av. Roraima 1000, Camobi, Santa Maria, RS, 97105-900, Brazil.
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Noninvasive Brain Stimulation for Cancer Pain Management in Nonbrain Malignancy: A Meta-Analysis. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/5612061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Purpose. Noninvasive brain stimulation (NIBS) has been reported to have analgesic effects on fibromyalgia and chronic neuropathic pain; however, its effects on cancer pain have yet to be determined. The present study aimed to evaluate the effects of NIBS on patients with pain secondary to nonbrain malignancy. Methods. Electronic databases including PubMed, Embase, Cochrane Library, and Web of Science were searched from inception through June 5th, 2022. Parallel, randomized, placebo-controlled studies were included that enrolled adult patients with cancer pain, except for that caused by brain tumors, compared NIBS with placebo stimulation, and reported sufficient data for performing meta-analysis. Results. Four parallel, randomized, sham-controlled studies were included: two of repetitive transcranial magnetic stimulation (rTMS), one of transcranial direct current stimulation (tDCS), and one of cranial electrical stimulation (CES). rTMS significantly improved pain in the subgroup analysis (standardized mean difference (SMD): −1.148, 95% confidence interval (CI): −1.660 to −0.637, (
)), while NIBS was not benefited in reducing pain intensity (SMD: −0.632, 95% CI: −1.356 to 0.092, p = 0.087). Also, NIBS significantly improved depressive symptoms (SMD: −0.665, 95% CI: −1.178 to −0.153, p = 0.011), especially in the form of rTMS (SMD: −0.875, 95% CI: −1.356 to −0.395,
) and tDCS (SMD: −1.082, 95% CI: −1.746 to −0.418, p = 0.001). Conclusion. rTMS significantly improved pain secondary to nonbrain malignancy apart from other forms of NIBS without major adverse events.
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