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Mezaache S, Cutarella C, Frauger E, Micallef J. Transmucosal fentanyl-related opioid use disorder in a cancer survivor. Therapie 2024:S0040-5957(24)00031-3. [PMID: 38494374 DOI: 10.1016/j.therap.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Salim Mezaache
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France.
| | | | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, centre d'évaluation et d'information sur la pharmacodépendance-addictovigilance (CEIP-A) PACA-Corse, AP-HM Timone, AMU, INS, Inserm UMR1106, 13000 Marseille, France
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Varrassi G, Coluzzi F, Guardamagna VA, Puntillo F, Sotgiu G, Vellucci R. Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group. Pain Ther 2021; 10:605-617. [PMID: 33730338 PMCID: PMC8119556 DOI: 10.1007/s40122-021-00248-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00248-x.
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Affiliation(s)
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Anesthesiology, Intensive Care, and Pain Medicine Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Filomena Puntillo
- Department of Interdisciplinary Medicine (DIM), University of Bari; Anesthesia, Intensive Care and Pain Unit, Policlinico Hospital, 70124, Bari, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Renato Vellucci
- University of Florence, Pain and Palliative Care Clinic, Careggi Hospital, 50139, Florence, Italy
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Wirz S, Schenk M, Hofbauer H, Wartenberg HC, Cascella M, Kieselbach K. [Use of rapid-onset fentanyl preparations beyond indication : A random questionnaire survey among congress participants and pain physicians]. Schmerz 2020; 35:114-123. [PMID: 32975670 DOI: 10.1007/s00482-020-00503-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/18/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite publicised advice and warnings, there are only scant data on the non-indicated prescription of rapid-onset preparations of fentanyl (ROF) in non-cancer pain (NCP). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. OBJECTIVE Initiated by the Working Group Cancer Pain and supported by the German Pain Society, a random sample survey was conducted to assess the non-indicated use of ROF. METHODS The survey addressed attendees of pain conferences who were given the option to fill in the questionnaires outside the conference or online. Primary endpoints of the structured questionnaire were quantitative and qualitative items with regard to the prescription of ROF, while secondary endpoints were opioid-induced side effects. RESULTS Obtaining a response rate of 44% (132/300) and an additional 51 online questionnaires revealed that 165 (90%) respondents had knowledge of non-indicated prescriptions or were involved in these. Of these, 65% were clinicians and 17% worked in an outpatient capacity. In all, 22% were trained pain or palliative physicians. Approximately 1205 patients were assessed indirectly. The main causes for dispensing ROF included NCP entities such as back pain (44%), neuropathic pain (33%), head or facial pain (12%), and dyspnea (5%) in cancer pain or lack of break-through pain or basic medication (44%). Sedation (32%), nausea/vomiting (31%), constipation (16%) and insufficient analgesia (31%) were the mostly commonly reported adverse effects. CONCLUSION Despite the non-ambiguous indication for ROF, physicians often demonstrate inappropriate prescription behaviour. Iatrogenic misuse of ROF should be minimized. The rates of adverse effects of ROF seems to be in line with other opioids.
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Affiliation(s)
- Stefan Wirz
- Abteilung für Anästhesie, Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, CURA Krankenhaus, Betriebsstätte der GFO-Kliniken Bonn, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.
| | - Michael Schenk
- Zentrum für Integrative Medizin, Franziskus-Krankenhaus Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland
| | - Hannes Hofbauer
- Sektion Schmerztherapie, Klinik für Anästhesiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Hans-Christian Wartenberg
- Afdeling Anesthesiologie H1-115, Academisch Medisch Centrum, Universiteit van Amsterdam, Meibergdreef 9, NL-1105 AZ, Amsterdam, Niederlande
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, Via Mariano Semmola 52, 80131, Napoli, Italien
| | - Kristin Kieselbach
- Interdisziplinäres Schmerzzentrum ISZ, Universitätsklinikum Freiburg, Breisacherstr. 117, 79106, Freiburg, Deutschland
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Castañeda AM, Lee CS, Kim YC, Lee D, Moon JY. Addressing Opioid-Related Chemical Coping in Long-Term Opioid Therapy for Chronic Noncancer Pain: A Multicenter, Observational, Cross-Sectional Study. J Clin Med 2018; 7:E354. [PMID: 30322212 PMCID: PMC6210168 DOI: 10.3390/jcm7100354] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022] Open
Abstract
Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC. The sample had high pain catastrophizing (≥30 points; 66%), moderate-severe insomnia (≥15 points; 63%), low resilience (68 points), and high suicidal ideation (67%). OrCC patients had greater pain interference (85.18% vs. 58.28%, p = 0.017) and lower satisfaction with the LtOT (56.4% vs. 78.3%, p = 0.002). In multivariable analysis, alcohol abuse (OR = 6.84, p = 0.001), prescription drugs abuse (OR = 19.32, p = 0.016), functional pain (OR = 12.96, p < 0.001), head and neck pain (OR = 2.48, p = 0.039), MEDD (morphine equivalent daily dose) ≥ 200 mg/day (OR = 3.48, p = 0.006), and ongoing litigation (OR = 2.33, p = 0.047) were significant predictors of OrCC. In conclusion, the break-out of OrCC in CNCP in South Korea was comparable to those in countries with high opioid consumption, such as the United States, regardless of the country's opioid consumption rate.
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Affiliation(s)
- Anyela Marcela Castañeda
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 101Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Chang-Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 101Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Yong-Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 101Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Dasom Lee
- Department of Psychiatry, Seoul National University Hospital College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 101Daehak-ro, Jongno-gu, Seoul 03080, Korea.
- Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
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Gómez-del Valle MC, Zertuche-Maldonado T, Bruera E. Compensación química y adicción a opioides: evidencia, valoración de riesgo y manejo en pacientes con cuidados paliativos. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.medipa.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Canal-Sotelo J, Trujillano-Cabello J, Larkin P, Arraràs-Torrelles N, González-Rubió R, Rocaspana-Garcia M, Barallat-Gimeno E. Prevalence and characteristics of breakthrough cancer pain in an outpatient clinic in a Catalan teaching hospital: incorporation of the Edmonton Classification System for Cancer pain into the diagnostic algorithm. BMC Palliat Care 2018; 17:81. [PMID: 29807537 PMCID: PMC5971419 DOI: 10.1186/s12904-018-0336-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breakthrough cancer pain (BTcP) is defined according to its principal characteristics: high intensity, short time interval between onset and peak intensity, short duration, potential recurrence over 24 h and non-responsiveness to standard analgesic regimes. The Edmonton Classification System for Cancer Pain (ECS-CP) is a classification tool that evaluates different dimensions of pain. The aim of this study was to measure prevalence and the main characteristics of BTcP in a sample of advanced cancer patients and to explore the complexity observed when ECS-CP is incorporated into BTcP diagnostics algorithm. METHODS Descriptive prevalence study (Retrospective chart review). Davies' algorithm was used to identify BTcP and ECS-CP was used to recognize appropriate dimensions of pain. The study was conducted in a sample of advanced cancer patients attending hospital outpatient clinic in Lleida, Spain. 277 patients were included from 01/01/2014 to 31/12/2015. No direct contact was made with participants. The following information was extracted from the palliative care outpatient clinic database: age, gender, civil status, cognitive impairment status, functional performance status and variables related to tumour. Only BTcP cases were included. RESULTS Prevalence of BTcP was 39.34% (63.9% men). Mean of age was 68.2 years. Main diagnosis was lung cancer (n = 154; 31.6%). Metastases were diagnosed in 83% of the sample. 138 patients (49.8%) were diagnosed with 1 type of BTcP and 139 (50.2%) were diagnosed with more than one type of BTcP. In total, 488 different types of BTcP were recorded (mean 1.75 ± 0, 9), 244 of these types (50%) presented a component of neuropathic pain. Addictive behaviour, measured through CAGE test, was present in 29.2% (N = 81) of the patients and psychological distress was present in 40.8% (n = 113). CONCLUSIONS Prevalence of BTcP (39.34%) is similar to the one reflected in the existing literature. Study results indicate that the routine use of ECS-CP in a clinical setting allows us to detect more than one type of BTcP as well as additional complexity associated with pain (neuropathic, addictive behavior and psychological distress).
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Affiliation(s)
- Jaume Canal-Sotelo
- Hospital Universitari Arnau de Vilanova, UFISS GSS, Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | | | - Philip Larkin
- University College Dublin, School of Nursing and Midwifery and health Systems Health Sciences, Belfield, Dublin, Ireland
| | | | | | - Mariona Rocaspana-Garcia
- Faculty of Nursing and Phisiotherapy, Universitat de Lleida, Montserrat Roig 2, 25198 Lleida, Spain
| | - Eva Barallat-Gimeno
- Faculty of Nursing and Phisiotherapy, Universitat de Lleida, Montserrat Roig 2, 25198 Lleida, Spain
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Eiden C, Mathieu O, Donnadieu-Rigole H, Marrot C, Peyrière H. High opioids tolerance due to transmucosal fentanyl abuse. Eur J Clin Pharmacol 2017; 73:1195-1196. [DOI: 10.1007/s00228-017-2272-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
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Porta-Sales J, Pérez C, Escobar Y, Martínez V. Diagnosis and management of breakthrough cancer pain: Have all the questions been resolved? A Delphi-based consensus assessment (DOIRON). Clin Transl Oncol 2015; 18:945-54. [PMID: 26693731 DOI: 10.1007/s12094-015-1468-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To ascertain the level of agreement and achieve a consensus among cancer pain specialists in Spain with regard to the optimal definition, diagnosis, and management of breakthrough cancer pain (BTcP). DESIGN Two-round Delphi methodology survey (February-May 2013) using seven-point Likert scales (ranging from 1 "strongly disagree" to 7 "strongly agree") was carried out. Mean scores >5 or <3 indicated, respectively, agreement or disagreement. Scores from 3 to 5 indicated no consensus. RESULTS A total of 126 experienced specialists were surveyed. Response rates were 68 % in round 1 and 90 % in round 2. Agreement (mean Likert score) was strongest for the proposed BTcP definition (6.6), the use of oral (6.1), and intranasal (6.0) transmucosal fentanyl, the need for early assessment after BTcP treatment initiation, and the need to improve staff knowledge of BTcP. Broad agreement was also reached regarding the need to systematically screen all cancer patients for BTcP (5.9). Most respondents (82 %) considered strong opioids to be appropriate treatment. In contrast, no consensus was reached regarding strong opioid treatment for baseline pain as a prerequisite for BTcP diagnosis. CONCLUSIONS Consensus was strong for most treatment, and diagnostic aspects were evaluated in the study. However, several important issues remain unresolved, particularly whether the diagnostic criteria must include strong opioids for background pain. Nurses' awareness and understanding of BTcP was considered insufficient, and more training is needed in this area. Overall, agreement among specialists was good, but more work is needed to better define the optimal diagnostic features and treatments for this condition.
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Affiliation(s)
- J Porta-Sales
- Palliative Care Service, Institut Català d'Oncologia (ICO), Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: End of Life Care, Institut Català d'Oncologia, Barcelona, Spain
| | - C Pérez
- Pain Clinic, Hospital Universitario de la Princesa, C/Diego de León 62, 28002, Madrid, Spain
| | - Y Escobar
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Gene network analysis shows immune-signaling and ERK1/2 as novel genetic markers for multiple addiction phenotypes: alcohol, smoking and opioid addiction. BMC SYSTEMS BIOLOGY 2015; 9:25. [PMID: 26044620 PMCID: PMC4456775 DOI: 10.1186/s12918-015-0167-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 05/12/2015] [Indexed: 01/09/2023]
Abstract
Background Addictions to alcohol and tobacco, known risk factors for cancer, are complex heritable disorders. Addictive behaviors have a bidirectional relationship with pain. We hypothesize that the associations between alcohol, smoking, and opioid addiction observed in cancer patients have a genetic basis. Therefore, using bioinformatics tools, we explored the underlying genetic basis and identified new candidate genes and common biological pathways for smoking, alcohol, and opioid addiction. Results Literature search showed 56 genes associated with alcohol, smoking and opioid addiction. Using Core Analysis function in Ingenuity Pathway Analysis software, we found that ERK1/2 was strongly interconnected across all three addiction networks. Genes involved in immune signaling pathways were shown across all three networks. Connect function from IPA My Pathway toolbox showed that DRD2 is the gene common to both the list of genetic variations associated with all three addiction phenotypes and the components of the brain neuronal signaling network involved in substance addiction. The top canonical pathways associated with the 56 genes were: 1) calcium signaling, 2) GPCR signaling, 3) cAMP-mediated signaling, 4) GABA receptor signaling, and 5) G-alpha i signaling. Conlusions Cancer patients are often prescribed opioids for cancer pain thus increasing their risk for opioid abuse and addiction. Our findings provide candidate genes and biological pathways underlying addiction phenotypes, which may be future targets for treatment of addiction. Further study of the variations of the candidate genes could allow physicians to make more informed decisions when treating cancer pain with opioid analgesics. Electronic supplementary material The online version of this article (doi:10.1186/s12918-015-0167-x) contains supplementary material, which is available to authorized users.
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