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Jin X, Cheng J, Zhang Q, Ji H, Zhu C, Yang Y, Zhou Y, Yu G, Wang C, Tang Z. Aconitine - A promising candidate for treating cold and mechanical allodynia in cancer induced bone pain. Biomed Pharmacother 2023; 161:114284. [PMID: 36868017 DOI: 10.1016/j.biopha.2023.114284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND AND AIMS Patients suffering from cancer induced bone pain (CIBP) have a poor quality of life that is exacerbated by the lack of effective therapeutic drugs. Monkshood is a flowering plant that has been used in traditional Chinese medicine where it has been used to relieve cold pain. Aconitine is the active component of monkshood, but the molecular mechanism for how this compound reduces pain is unclear. METHODS AND RESULTS In this study, we employed molecular and behavioral experiments to explore the analgesic effect of aconitine. We observed aconitine alleviated cold hyperalgesia and AITC (allyl-isothiocyanate, TRPA1 agonist) induced pain. Interestingly, we found aconitine directly inhibits TRPA1 activity in calcium imaging studies. More importantly, we found aconitine alleviated cold and mechanical allodynia in CIBP mice. Both the activity and expression of TRPA1 in L4 and L5 DRG (Dorsal Root Ganglion) neurons were reduced with the treatment of aconitine in the CIBP model. Moreover, we observed aconiti radix (AR) and aconiti kusnezoffii radix (AKR), both components of monkshood that contain aconitine, alleviated cold hyperalgesia and AITC induced pain. Furthermore, both AR and AKR alleviated CIBP induced cold allodynia and mechanical allodynia. CONCLUSIONS Taken together, aconitine alleviates both cold and mechanical allodynia in cancer induced bone pain via the regulation of TRPA1. This research on the analgesic effect of aconitine in cancer induced bone pain highlights a component of a traditional Chinese medicine may have clinical applications for pain.
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Affiliation(s)
- Xiang Jin
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Jiafei Cheng
- Jiangsu Province Hospital of Chinese Medicine (Affiliated Hospital of Nanjing University of Chinese Medicine), Nanjing 210023, China.
| | - Qing Zhang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Haiwang Ji
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Chan Zhu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Yan Yang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Yuan Zhou
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Guang Yu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Changming Wang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
| | - Zongxiang Tang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing 210023, Jiangsu, China.
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Klafke N, Bossert J, Kröger B, Neuberger P, Heyder U, Layer M, Winkler M, Idler C, Kaschdailewitsch E, Heine R, John H, Zielke T, Schmeling B, Joy S, Mertens I, Babadag-Savas B, Kohler S, Mahler C, Witt CM, Steinmann D, Voiss P, Stolz R. Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Med Sci (Basel) 2023; 11:medsci11010015. [PMID: 36810482 PMCID: PMC9944490 DOI: 10.3390/medsci11010015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 01/31/2023] Open
Abstract
Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Birgit Kröger
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Petra Neuberger
- National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ute Heyder
- Women’s Clinic, Community Hospital Karlsruhe, 76133 Karlsruhe, Germany
| | - Monika Layer
- Center for Integrative Medicine, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Marcela Winkler
- Department of Naturopathy and Integrative Medicine, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Christel Idler
- Department of Naturopathy and Integrative Medicine, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Elke Kaschdailewitsch
- Center for Integrative Oncology, Die Filderklinik, 70794 Filderstadt-Bonlanden, Germany
| | - Rolf Heine
- Anthroposophic Nursing Network in Germany, Academy for Nursing Professions at the Filderklinik, Die Filderklinik, 70794 Filderstadt-Bonlanden, Germany
| | - Heike John
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Tatjana Zielke
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Beeke Schmeling
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Sosamma Joy
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Isabel Mertens
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Burcu Babadag-Savas
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Sara Kohler
- Department of Health, Zurich University of Applied Sciences, 8401 Winterthur, Switzerland
| | - Cornelia Mahler
- Department of Nursing Science, Institute of Health Sciences, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Claudia M. Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zürich and University of Zürich, 8091 Zürich, Switzerland
| | - Diana Steinmann
- Clinic for Radiation Therapy and Special Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Petra Voiss
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45136 Essen, Germany
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, 72076 Tübingen, Germany
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Baillie J, Anagnostou D, Sivell S, Van Godwin J, Byrne A, Nelson A. Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients', carers' and health professionals' experiences and further research questions. BMC Palliat Care 2018; 17:60. [PMID: 29656713 PMCID: PMC5901670 DOI: 10.1186/s12904-018-0314-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients’ symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives’ distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives. The Palliative and end-of-life care Priority Setting Partnership (PeolcPSP) undertook a UK-wide free-text survey to establish research priorities within palliative and end-of-life care and disseminated its results in 2015. Much of the data were related more broadly to personal perceptions and experiences rather than specific research questions. The aim of this article is to report on a supplementary analysis exploring the experiences and questions of PeolcPSP survey respondents regarding symptoms, hydration and nutrition. Methods The PeolcPSP data (n = 1403) were coded by a team of qualitative researchers in a supplementary analysis. There were 190 responses that related to symptoms, nutrition and hydration. The data were analysed thematically using Braun and Clarke’s approach. Results Five themes were identified: pain, breathlessness, agitation, nutrition and hydration. The majority of responses related to symptoms that were sub-optimally managed, in particular pain. Nutrition and hydration were of significant concern, particularly for carers. Overall, respondents consistently asked about the most effective, evidence-based methods for managing symptoms and suggested areas where further research is necessary. Conclusions This study highlights the perceptions and experiences of patients, families and professionals within palliative care, highlighting the need for improved care, communication and further research to establish which treatments are most effective within a palliative care population. This is essential to reduce harm and distress for patients and families. Electronic supplementary material The online version of this article (10.1186/s12904-018-0314-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Despina Anagnostou
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jordan Van Godwin
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Erol O, Unsar S, Yacan L, Pelin M, Kurt S, Erdogan B. Pain experiences of patients with advanced cancer: A qualitative descriptive study. Eur J Oncol Nurs 2018; 33:28-34. [DOI: 10.1016/j.ejon.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 01/09/2023]
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5
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Pain Management for Sarcoma Patients. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Milazzo-Kiedaisch CA, Itano J, Dutta PR. Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing Radiation Therapy to the Head and Neck. Clin J Oncol Nurs 2016; 20:623-628. [PMID: 27857262 PMCID: PMC5621478 DOI: 10.1188/16.cjon.623-628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Oral mucositis (OM) is a painful and debilitating side effect that affects 80%-100% of patients undergoing radiation therapy for head and neck cancer. This dose-limiting side effect may potentially lead to pain, dehydration, malnutrition, infection, and treatment breaks. Treatment breaks can lead to decreased disease control and suboptimal patient outcomes. No primary prevention exists for OM, and management is focused on pain control. Compelling evidence exists that OM pain has somatic and neuropathic components. OBJECTIVES This article reviews the existing literature on the use of gabapentin (Neurontin®) as a co-analgesic in treating the neuropathic pain in OM. METHODS A literature search was performed using CINAHL® and PubMed with the search terms gabapentin and oral mucositis. The selected articles were briefly screened for relevance, and three were included in this review. FINDINGS No systematic reviews exist on the role of gabapentin for neuropathic pain in radiation-induced OM. Two retrospective studies concluded that gabapentin reduced escalation of opioid doses and unplanned treatment breaks. One retrospective study demonstrated favorable swallowing outcomes. Pain and OM are nursing-sensitive outcomes that can be significantly affected by evidence-based nursing interventions.
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7
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Chi NC, Demiris G. Family Caregivers' Pain Management in End-of-Life Care: A Systematic Review. Am J Hosp Palliat Care 2016; 34:470-485. [PMID: 26975303 DOI: 10.1177/1049909116637359] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Pain management was the most identified burden faced by family caregivers in end-of-life caregiving. OBJECTIVES To synthesize current scientific evidence on family caregivers' experience of pain management in end-of-life care. METHODS A systematic review was conducted using CINAHL, Embase, PubMed, and Cochrane Library electronic databases. Data were extracted from each included paper and organized into tables to synthesize the findings. RESULTS Fourteen research papers focusing on family caregivers' experience of pain management and strategies in end-of-life care were included. Nine were observational studies, 3 were case studies, and 2 were experimental studies. These studies mainly focused on exploring family caregivers' engagement in pain management and communication with the hospice care team about pain control; family caregivers' knowledge, skills, and self-efficacy in pain management; and family caregivers' concerns and experience of pain management. CONCLUSION This review identified themes similar to previous reviews on family caregivers of patients with cancer or in palliative care: inadequate knowledge and assessment skills in pain management, misunderstanding of pain medications, and poor communication with the care team. Future research should design educational programs and material for family caregivers to improve their pain management knowledge and skills, communication, and engagement in care. The scientific knowledge on this topic is scarce, and level of evidence is low; it is therefore imperative to have more exploratory studies to expand the quality and quantity of evidence and increase our understanding of family caregivers' needs and barriers to pain management based on larger and more diverse patient and caregiver samples.
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Affiliation(s)
- Nai-Ching Chi
- 1 School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- 1 School of Nursing, University of Washington, Seattle, WA, USA.,2 School of Medicine, University of Washington, Seattle, WA, USA
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8
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Borglin G, Bohman D. An online learning module improves specialist palliative care nurses' pain assessments and patient-reported pain. Evid Based Nurs 2015; 18:122. [PMID: 25740499 DOI: 10.1136/eb-2014-102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Gunilla Borglin
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Doris Bohman
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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9
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Sanderson C, Quinn SJ, Agar M, Chye R, Clark K, Doogue M, Fazekas B, Lee J, Lovell MR, Rowett D, Spruyt O, Currow DC. Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain. BMJ Support Palliat Care 2015; 5:273-80. [PMID: 25324335 PMCID: PMC4552911 DOI: 10.1136/bmjspcare-2014-000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/31/2014] [Accepted: 09/09/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to non-malignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. DESIGN Multisite, prospective, consecutive cohort. POPULATION 127 patients, 114 of whom had cancer, who started gabapentin for neuropathic pain as part of routine clinical care. SETTINGS 42 centres from seven countries. Data were collected at three time points-at baseline, at day 7 (and at any time; immediate and short-term harms) and at day 21 (clinical benefits). RESULTS At day 21, the average dose of gabapentin for those still using it (n=68) was 653 mg/24 h (range 0-1800 mg) and 54 (42%) reported benefits, of whom 7 (6%) experienced complete pain resolution. Harms were reported in 39/127 (30%) patients at day 7, the most frequent of which were cognitive disturbance, somnolence, nausea and dizziness. Ten patients had their medication ceased due to harms. The presence of significant comorbidities, higher dose and increasing age increased the likelihood of harm. CONCLUSIONS Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days.
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Affiliation(s)
- Christine Sanderson
- Department of Palliative Medicine, Calvary Health Care, Sydney, New South Wales, Australia
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Stephen J Quinn
- Flinders Clinical Effectiveness, Flinders University, Adelaide, South Australia, Australia
| | - Meera Agar
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
- Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia
| | - Richard Chye
- Sacred Heart Palliative Care Services, Darlinghurst, New South Wales, Australia
| | - Katherine Clark
- Department of Palliative Care, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Matthew Doogue
- Christchurch & Canterbury District Health Board, University of Otago, Christchurch, New Zealand
| | - Belinda Fazekas
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Jessica Lee
- Department of Palliative Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Melanie R Lovell
- Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia
| | - Debra Rowett
- Drug and Therapeutics Information Service, Repatriation General Hospital, Adelaide, Australia
| | - Odette Spruyt
- Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
- Flinders Clinical Effectiveness, Flinders University, Adelaide, South Australia, Australia
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Piderman KM, Kung S, Jenkins SM, Euerle TT, Yoder TJ, Kwete GM, Lapid MI. Respecting the Spiritual Side of Advanced Cancer Care: a Systematic Review. Curr Oncol Rep 2015; 17:6. [DOI: 10.1007/s11912-014-0429-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Phillips JL, Heneka N, Hickman L, Lam L, Shaw T. Impact of a novel online learning module on specialist palliative care nurses' pain assessment competencies and patients' reports of pain: Results from a quasi-experimental pilot study. Palliat Med 2014; 28:521-529. [PMID: 24685649 DOI: 10.1177/0269216314527780] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain. AIM To test the impact of an online pain assessment learning module on specialist palliative care nurses' pain assessment competencies, and to determine whether this education impacted positively on palliative care patients' reported pain ratings. DESIGN A quasi-experimental pain assessment education pilot study utilising 'Qstream©', an online methodology to deliver 11 case-based pain assessment learning scenarios, developed by an interdisciplinary expert panel and delivered to participants' work emails over a 28-day period in mid-2012. The 'Self-Perceived Pain Assessment Competencies' survey and chart audit data, including patient-reported pain intensity ratings, were collected pre-intervention (T1) and post-intervention (T2) and analysed using inferential statistics to determine key outcomes. SETTING/PARTICIPANTS Nurses working at two Australian inpatient specialist palliative care services in 2012. RESULTS The results reported conform to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines. Participants who completed the education intervention ( n = 34) increased their pain assessment knowledge, assessment tool knowledge and confidence to undertake a pain assessment ( p < 0.001). Participants were more likely to document pain intensity scores in patients' medical records than non-participants (95% confidence interval = 7.3%-22.7%, p = 0.021). There was also a significant reduction in the mean patient-reported pain ratings between the admission and audit date at post-test of 1.5 (95% confidence interval = 0.7-2.3) units in pain score. CONCLUSION This pilot confers confidence of the education interventions capacity to improve specialist palliative care nurses' pain assessment practices and to reduce patient-rated pain intensity scores.
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Affiliation(s)
- Jane L Phillips
- 1 School of Nursing, Sydney, The University of Notre Dame, Australia, Sydney, NSW, Australia.,2 Cunningham Centre for Palliative Care, Sydney, NSW, Australia
| | - Nicole Heneka
- 2 Cunningham Centre for Palliative Care, Sydney, NSW, Australia
| | - Louise Hickman
- 3 Faculty of Health, University of Technology, Sydney, Sydney, NSW, Australia
| | - Lawrence Lam
- 4 Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong SAR, China.,5 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- 6 Workforce Education and Development Group (WEDG), Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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12
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Wieder R, DeLaRosa N, Bryan M, Hill AM, Amadio WJ. Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain. PAIN MEDICINE (MALDEN, MASS.) 2014; 15:42-51. [PMID: 24106748 PMCID: PMC3947034 DOI: 10.1111/pme.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. MATERIALS AND METHODS We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations. RESULTS There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. CONCLUSION Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients.
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Affiliation(s)
- Robert Wieder
- Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, NJ
- Direct correspondence to: Robert Wieder, MD, PhD, 205 South Orange Avenue, Cancer Center H-1216, Newark, NJ 07103, Tel: 973-972-4871, Fax: 973-972-2668,
| | - Nila DeLaRosa
- New York University Langone Medical Center, New York, NY
| | - Margarette Bryan
- Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, NJ
| | - Ann Marie Hill
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
| | - William J. Amadio
- Department of Information Systems and Supply Chain Management, Rider University, Lawrenceville, NJ
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13
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Choi M, Kim HS, Chung SK, Ahn MJ, Yoo JY, Park OS, Woo SR, Kim SS, Kim SA, Oh EG. Evidence-based practice for pain management for cancer patients in an acute care setting. Int J Nurs Pract 2013; 20:60-9. [DOI: 10.1111/ijn.12122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mona Choi
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Hee Sun Kim
- Department of Nursing; Woosuk University; Jeonbuk Korea
| | - Su Kyoung Chung
- Department of Nursing; College of Health and Welfare; Woosong University; Daejeon Korea
| | | | - Jae Yong Yoo
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Ok Sun Park
- Yonsei University Health System; Seoul Korea
| | - So Rah Woo
- Division of Nursing; Yonsei University Health System; Seoul Korea
| | - So Sun Kim
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Sun Ah Kim
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
| | - Eui Geum Oh
- Nursing Policy Research Institute; Yonsei University College of Nursing; Seoul Korea
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14
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Zhu J, Davis RB, Stuver SO, Berry DL, Block S, Weeks JC, Weingart SN. A longitudinal study of pain variability and its correlates in ambulatory patients with advanced stage cancer. Cancer 2012; 118:6278-6286. [DOI: 10.1002/cncr.27673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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15
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Halawi R, Aldin ES, Baydoun A, Dbouk H, Nahleh Z, Nasser Z, Tfayli A. Physical symptom profile for adult cancer inpatients at a Lebanese cancer unit. Eur J Intern Med 2012; 23:e185-9. [PMID: 23009863 DOI: 10.1016/j.ejim.2012.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 08/29/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hospital-based palliative care programs in Lebanon are nonexistent in a structured form. One of obstacles is the lack of knowledge about symptom prevalence and burden of cancer patients in Lebanon. METHODS This is a cross-sectional observational study where 100 adult cancer patients admitted to the American University of Beirut Medical Center inpatient unit completed a survey to assess 20 physical symptoms according the National Cancer Institute's Common Terminology Criteria for Adverse Events 4.0 (NCI-CTCAE 4.0) guidelines. RESULTS Hematologic, gastrointestinal, breast, and lung cancers were the most common. Mean age was 51.5 years; 51% were female. 74% of patients with solid tumors had metastatic disease. Treatment approaches were palliative chemotherapy, followed by curative chemotherapy and best supportive care. The most common symptoms were fatigue, appetite loss, nausea, and pain; most distressing were nausea, pain, and fatigue. Nausea and vomiting were more prevalent among females than males. Females reported more severe vomiting than males, but males had more intense pain. Overall symptom burden difference was statistically significant across age groups, with the 51-60 year group having the most symptoms, but not among different genders. Difference was significant among different treatment intents, with the best supportive care group having most symptoms. CONCLUSION Fatigue should be better addressed as a legitimate symptom. Subgroup differences must be considered when managing gastrointestinal symptoms. Pain should be more effectively managed, and vulnerable subgroups such as the 51-60 year age group and those on best supportive care should receive special consideration.
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Affiliation(s)
- Racha Halawi
- Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El-Solh 1107-2020, Beirut, Lebanon
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Aziz NM, Miller JL, Curtis JR. Palliative and end-of-life care research: embracing new opportunities. Nurs Outlook 2012; 60:384-90. [PMID: 23141198 PMCID: PMC3499046 DOI: 10.1016/j.outlook.2012.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/09/2012] [Accepted: 08/16/2012] [Indexed: 12/25/2022]
Abstract
The past two decades have witnessed dramatic advances in palliative and end-of-life care research with increased understanding of the burden of life-limiting diseases on patients, families, clinicians, and our healthcare system; and researchers have documented palliative care interventions that improve patient and family outcomes and reduce the costs of care (Detering, Hancock, Reade, & Silvester, 2010). These advances have led to a new era of palliative and end-of-life care research and practice with widespread recognition of its accomplishments and successes. Consequently, we now have an important opportunity to reassess our recent successes and challenges and to identify the goals and benchmarks that will ensure ongoing robust advances in this now-recognized and critical scientific area. High-quality palliative and end-of-life care will be best informed by methodologically strong research efforts that generate a body of evidence with the capacity to support and direct care and effect changes in practice. It is in this context that the National Institute of Nursing Research conceptualized and led a Summit titled The Science of Compassion: Future Directions in End-of-Life and Palliative Care Research in August, 2011. In this summary article, we present brief overviews of the six articles chosen for this Special Issue of Nursing Outlook, examine their key conclusions, articulate gaps and needs, and discuss next steps in palliative and end-of-life care research through the lens of these six topics.
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Affiliation(s)
- Noreen M Aziz
- National Institute of Nursing Research, National Institutes of Health, Office of Extramural Programs, Division of Extramural Activities, Bethesda, MD 20892, USA.
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Wilkie DJ, Ezenwa MO. Pain and symptom management in palliative care and at end of life. Nurs Outlook 2012; 60:357-64. [PMID: 22985972 PMCID: PMC3505611 DOI: 10.1016/j.outlook.2012.08.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 12/25/2022]
Abstract
The purpose of this review is to provide a literature update of the research published since 2004 on pain and symptom management in palliative care and at end of life. Findings suggest that pain and symptoms are inadequately assessed and managed, even at the end of life. Although not pervasive, there is evidence of racial/ethnic disparities in symptom management in palliative care and at end of life. There is a need for a broader conceptualization and measurement of pain and symptom management as multidimensional experiences. There is insufficient evidence about mechanisms underlying pain at end of life. Although there are advances in the knowledge of pain as a multidimensional experience and the many symptoms that occur sometimes with pain, gaps remain. One approach to addressing the gaps will involve assessment and management of pain and symptoms as multidimensional experiences in people receiving palliative care and at end of life.
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Affiliation(s)
- Diana J. Wilkie
- Professor and Harriet H. Werley Endowed Chair for Nursing Research Director, Center of Excellence for End-of-Life Transition Research Voic312.413.5469; Fax: 312.996.1819
| | - Miriam O. Ezenwa
- Assistant Professor, Sickle Cell Scholar, and Mayday Fellow Voic312.996.5071; Fax: 312.996.1819
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18
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Weingart SN, Cleary A, Stuver SO, Lynch M, Brandoff D, Schaefer KG, Zhu J, Berry DL, Block S, Weeks JC. Assessing the quality of pain care in ambulatory patients with advanced stage cancer. J Pain Symptom Manage 2012; 43:1072-81. [PMID: 22651950 DOI: 10.1016/j.jpainsymman.2011.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/19/2011] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
Abstract
CONTEXT Pain is common among patients with advanced cancer despite the dissemination of clinical pain care guidelines. OBJECTIVES We sought to assess the quality of pain care among patients with advanced disease. METHODS We reviewed the records of 85 adult ambulatory patients with advanced breast, lung, and gastrointestinal cancer treated in 2004-2006. Patients' screening pain intensity scores were at least 7 of 10. Nurse reviewers completed medical record reviews of care rendered at the index visit and over the subsequent 30 days based on the 2004 National Comprehensive Cancer Network pain guideline. An expert panel then rated the quality of the evaluation, treatment, and overall pain care. We used a multivariable model to analyze guideline compliance and resolution of severe pain. RESULTS Among advanced cancer patients with severe pain, clinicians adjusted pain medications only half the time and made few timely referrals for pain-related consultations. By 30 days after the index visit, 34% of patients continued to report severe pain. The expert panel judged the overall quality of pain care as "fair" or "poor" in about two-thirds of cases because more timely and effective intervention could have reduced the severity and duration of pain. Resolution of severe pain was associated with adjustment of pain medications at the index visit (adjusted odds ratio 3.8, 95% CI 1.3-10.6). CONCLUSION There is room for improvement in the pain care of patients with advanced cancer. Additional research is needed to understand the reasons for poor performance.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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Vadalouca A, Raptis E, Moka E, Zis P, Sykioti P, Siafaka I. Pharmacological treatment of neuropathic cancer pain: a comprehensive review of the current literature. Pain Pract 2011; 12:219-51. [PMID: 21797961 DOI: 10.1111/j.1533-2500.2011.00485.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuropathic cancer pain (NCP), commonly encountered in clinical practice, may be cancer-related, namely resulting from nervous system tumor invasion, surgical nerve damage during tumor removal, radiation-induced nerve damage and chemotherapy-related neuropathy, or may be of benign origin, unrelated to cancer. A neuropathic component is evident in about 1/3 of cancer pain cases. Although from a pathophysiological perspective NCP may differ from chronic neuropathic pain (NP), such as noncancer-related pain, clinical practice, and limited publications have shown that these two pain entities may share some treatment modalities. For example, co-analgesics have been well integrated into cancer pain-management strategies and are often used as First-Line options for the treatment of NCP. These drugs, including antidepressants and anticonvulsants, are recommended by evidence-based guidelines, whereas, others such as lidocaine patch 5%, are supported by randomized, controlled, clinical data and are included in guidelines for restricted conditions treatment. The vast majority of these drugs have already been proven useful in the management of benign NP syndromes. Treatment decisions for patients with NP can be difficult. The intrinsic difficulties in performing randomized controlled trials in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign NP for the management of malignant NP, despite the lack of relevant high quality data. Interest in NCP mechanisms and pharmacotherapy has increased, resulting in significant mechanism-based treatment advances for the future. In this comprehensive review, we present the latest knowledge regarding NCP pharmacological management.
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Affiliation(s)
- Athina Vadalouca
- 1st Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Greece.
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