The role of drugs in bone pain

Comparison of femoral nerve block and acupuncture analgesia for acute preoperative pain in elderly patients with femoral neck fracture: a retrospective study

OBJECTIVE

This study was to compare the efficacy of femoral nerve block (FNB) and acupuncture for acute preoperative pain in patients with femoral neck fracture (FNF).

METHODS

From June 2017 to June 2019, 130 patients with FNF were included in this study. Sixty-six patients received FNB treatment (FNB group) and sixty-four patients received acupuncture treatment (Acupuncture group). The clinical information, visual analog scale (VAS) scores, nursing quality scores, sleep quality scores, delirium numbers, and perioperative complications were collected and compared between the 2 groups.

RESULTS

The resting VAS score and the exercise VAS score decreased after FNB or acupuncture in both groups. Thirty minutes after analgesia, the resting VAS scores in the FNB group and the acupuncture group were 27.3±8.0 and 27.9±7.8, respectively (P=0.67); while exercise VAS scores were 60.2±10.4 and 59.5±9.8, respectively (P=0.73). In addition, there was no statistical difference in the VAS score between the two groups on day 1 and day 2 after admission. There was no statistical difference in nursing quality, sleep rhythm disorder, sleep quality, or times of mental disorder between the two groups.

CONCLUSION

FNB analgesia and acupuncture analgesia are safe and effective for the control of acute preoperative pain in senile patients with femoral neck fracture. Both methods have good analgesic effects, which can improve nursing and sleep quality, and reduce the incidence of delirium. As a traditional Chinese medicine method, acupuncture analgesia can effectively manage the acute preoperative pain in senile femoral neck fracture patients.

Non-opioid Analgesics and Emerging Therapies

Pain is a common and debilitating symptom of cancer. Cancer-related pain can occur at any point along the continuum from diagnosis to treatment to survivorship¹. A systematic review published in 2016 estimated the prevalence of cancer pain to be 55% in those undergoing antineoplastic treatment, 66.4% in advanced cancer, and 39.3% in the post-treatment population. Thirty-eight percent of cancer patients in this pooled analysis experienced moderate to severe pain².

A Prospective Study to Compare Analgesia from Femoral Obturator Nerve Block with Fascia Iliaca Compartment Block for Acute Preoperative Pain in Elderly Patients with Hip Fracture

Background

This study aimed to compare femoral obturator nerve block (FONB) with fascia iliaca compartment block (FICB) in the management of acute preoperative pain in elderly patients with hip fracture.

Material/Methods

Patients ≥65 years (n=154) diagnosed with hip fracture who had surgery within 48 hours of hospital admission included two groups who received ultrasound-guided nerve block, the FONB group (n=77), and the FICB group (n=77). The visual analog scale (VAS) score for pain, requirement for analgesic drugs, nursing care requirements after hospitalization, post-operative complications, and rehabilitation were compared between the FONB and FICB patient groups.

Results

The VAS scores after both nerve block procedures were significantly reduced compared with those before both nerve block procedures (P<0.05), but there were no differences on the second day after nerve block. The VAS scores at rest and on exercise in the FONB group were significantly lower than those in the FICB group at 30 min and one day after nerve block (P<0.05). The requirement for postoperative analgesic drugs in the FONB group was significantly lower than that in the FICB group (P=0.048). The incidence of nausea and vertigo in the FICB group were significantly higher than in the FONB group (P=0.031 and P=0.034, respectively). Patients in the FONB group experienced significantly improved quality of postoperative function (P=0.029).

Conclusions

Both FONB and FICB provided pain control for elderly patients with hip fracture. However, compared with FICB, FONB resulted in significantly improved analgesia with a reduced requirement for analgesic drugs.

Analgesic drug use in elderly persons: A population-based study in Southern Italy

INTRODUCTION

Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), weak and strong opioids are commonly used among elderly persons. The aim of this study was to describe the demographic and clinical characteristics of elderly analgesic users and to measure the frequency of analgesic use, including the frequency of potentially inappropriate analgesic use.

METHODS

The Arianna database was used to carry out this study. This database contains prescription data with associated indication of use for 1,076,486 inhabitants registered with their general practitioners (GPs) in the Caserta Local Health Unit (Caserta district, Campania region in Italy). A cohort of persons aged ≥65 years old with >1 year of database history having at least one analgesic drug (NSAIDs, strong or weak opioids) between 2010 and 2014 were identified. The date of the first analgesic prescription in the study period was considered the index date (ID).

RESULTS

From a source population of 1,076,486 persons, 116,486 elderly persons were identified. Of these, 94,820 elderly persons received at least one analgesic drug: 36.6% were incident NSAID users (N = 36,629), while 13.2% were incident weak opioid users (N = 12,485) and 8.1% were incident strong opioid users (N = 7,658). In terms of inappropriate analgesic use, 9.2% (N = 10,763) of all elderly users were prescribed ketorolac/indomethacin inappropriately, since these drugs should not be prescribed to elderly persons. Furthermore, at least half all elderly persons with chronic kidney disease or congestive heart failure were prescribed NSAIDs, while these drugs should be avoided.

CONCLUSION

Analgesics are commonly used inappropriately among elderly persons, suggesting that prescribing practice in the catchment area may yet be improved.

Real-life management of patients with breakthrough cancer pain caused by bone metastases in Spain

Purpose: We aimed to explore the characteristics, and real-life therapeutic management of patients with breakthrough cancer pain (BTcP) caused by bone metastases in Spain, and to evaluate physicians’ opinion of and satisfaction with prescribed BTcP therapy.

Participants and methods: For the purposes of this study, an ad-hoc questionnaire was developed consisting of two domains: a) organizational aspects and care standards; b) clinical and treatment variables of bone metastatic BTcP patients. In addition, physicians’ satisfaction with their prescribed BTcP therapy was assessed. Specialists collected data from up to five patients receiving treatment for BTcP caused by bone metastasis, all patients gave their consent to participate prior to inclusion.

Results: A total of 103 cancer pain specialists (radiation oncologists [38.8%], pain specialists [33.0%], and palliative care (PC) specialists [21.4%]) were polled, and data on 386 BTcP patients with bone metastatic disease were collected. Only 33% of the specialists had implemented specific protocols for BTcP management, and 19.4% had established referral protocols for this group of patients. Half of all participants (50.5%) address quality of life and quality of care in their patients; however, only 27.0% did so from the patient’s perspective, as they should do. Most patients had multiple metastases and were prescribed rapid-onset fentanyl preparations (71.2%), followed by immediate-release morphine (9.3%) for the treatment of BTcP. Rapid-onset fentanyl was prescribed more often in PC units (79.0%) than in pain units (75.9%) and radiation oncology units (61.1%) (p<0.01). Furthermore, most physicians (71.8%) were satisfied with the BTcP therapy prescribed.

Conclusions: Our results demonstrate the need for routine assessment of quality of life in patients with bone BTcP. These findings also underscore the necessity for a multidisciplinary therapeutic strategy for breakthrough pain in clinical practice in Spain.