1
|
Drake R, Prael G, Phyo Y, Chang S, Hunt J, Herbert A, Mott C, Hynson J, Phillips M, Cossich M, Mherekumombe M, Kim MS, Chong PH, Abitz M, Bernada M, Avery M, Doogue M, Rowett D, Currow D. Gabapentin for Pain in Pediatric Palliative Care. J Pain Symptom Manage 2024; 67:212-222.e1. [PMID: 38036114 DOI: 10.1016/j.jpainsymman.2023.11.011] [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: 07/11/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Gabapentin is commonly used to treat pain in children receiving pediatric palliative care. This study describes the real-world use of gabapentin and the associated benefits and adverse effects/events (AEs). METHODS A prospective, multicenter cohort of standardized data collection after a clinical decision was made to use gabapentin for managing neuropathic or nociplastic pain in children attended on by a pediatric palliative care service. It was conducted across 11 sites in seven countries including hospital, inpatient, and outpatient services. Clinical outcomes were graded using pain scales validated for age and cognitive ability and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) at baseline, 14 days, 28 days, six weeks and 12 weeks after initiation of gabapentin. Ad-hoc safety reporting continued throughout the study. RESULTS Data were collected from 127 children with a median age of 4.7 years (IQR 0.1-17.9); 61% had a neurological disorder, 21% advanced cancer and the cohort had a high level of disability (Lansky/Karnofsky performance score 37.1). Gabapentin was prescribed at standard pediatric doses. On average, 76% of children had a reduction in pain and 42% experienced a potential AE. The mean pain score decreased from 6.0 (SD 2.6) at baseline to 3.3 (SD 2.4) at 14 days and 1.8 (SD 1.8) after 12-weeks of gabapentin therapy. Ten percent had increased pain at each time point. AEs did not increase when individual changes over time were accounted for except for somnolence (7%). Serious AEs attributable to gabapentin were possible or probable in 3% of children. CONCLUSIONS Gabapentin prescribed at standard doses for advanced cancer and severe neurological injury in children under a pediatric palliative care service was associated with generally improved pain intensity at previously described levels of adverse effects.
Collapse
Affiliation(s)
- Ross Drake
- Starship Children's Health (R.D.), Auckland, New Zealand; University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia.
| | - Grace Prael
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia
| | - Yinyin Phyo
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia
| | - Sungwon Chang
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia
| | - Jane Hunt
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia
| | - Anthony Herbert
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia; Centre for Children's Health Research (A.H.), Queensland University of Technology (QUT), Brisbane, Australia
| | - Christine Mott
- Queensland Children's Hospital (C.M.), Brisbane, Australia
| | - Jenny Hynson
- Royal Children's Hospital Melbourne (J.H.), Melbourne, Australia
| | | | - Mary Cossich
- Women's & Children's Hospital Adelaide (M.C.), Adelaide, Australia
| | | | - Min Sun Kim
- Seoul National University Hospital (M.S.K.), Seoul, South Korea
| | | | - Maja Abitz
- PABU, Copenhagen University Hospital (M.A.), Copenhagen, Denmark
| | | | | | - Matt Doogue
- University of Otago (M.D.), Christchurch, NZ
| | - Debra Rowett
- Drug & Therapeutics Information Service (D.R.), Adelaide, Australia; University of South Australia (D.R.), Adelaide, Australia
| | - David Currow
- University of Technology Sydney (UTS) (R.D., G.P., Y.P., S.C., J.H., A.H., D.C.), Centre for Improving Palliative, Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Sydney, Australia; University of Wollongong (D.C.), Sydney, Australia
| |
Collapse
|
2
|
Lee J, Currow D, Lovell M, Phillips JL, McLachlan A, Ritchie M, Brown L, Fazekas B, Aggarwal R, Seah D, Sheehan C, Chye R, Noble B, McCaffrey N, Aggarwal G, George R, Kow M, Ayoub C, Linton A, Sanderson C, Mittal D, Rao A, Prael G, Urban K, Vandersman P, Agar M. Lidocaine for Neuropathic Cancer Pain (LiCPain): study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e066125. [PMID: 36810169 PMCID: PMC9945039 DOI: 10.1136/bmjopen-2022-066125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Many patients experience unrelieved neuropathic cancer-related pain. Most current analgesic therapies have psychoactive side effects, lack efficacy data for this indication and have potential medication-related harms. The local anaesthetic lidocaine (lignocaine) has the potential to help manage neuropathic cancer-related pain when administered as an extended, continuous subcutaneous infusion. Data support lidocaine as a promising, safe agent in this setting, warranting further evaluation in robust, randomised controlled trials. This protocol describes the design of a pilot study to evaluate this intervention and explains the pharmacokinetic, efficacy and adverse effects evidence informing the design. METHODS AND ANALYSIS A mixed-methods pilot study will determine the feasibility of an international first, definitive phase III trial to evaluate the efficacy and safety of an extended continuous subcutaneous infusion of lidocaine for neuropathic cancer-related pain. This study will comprise: a phase II double-blind randomised controlled parallel-group pilot of subcutaneous infusion of lidocaine hydrochloride 10% w/v (3000 mg/30 mL) or placebo (sodium chloride 0.9%) over 72 hours for neuropathic cancer-related pain, a pharmacokinetic substudy and a qualitative substudy of patients' and carers' experiences. The pilot study will provide important safety data and help inform the methodology of a definitive trial, including testing proposed recruitment strategy, randomisation, outcome measures and patients' acceptability of the methodology, as well as providing a signal of whether this area should be further investigated. ETHICS AND DISSEMINATION Participant safety is paramount and standardised assessments for adverse effects are built into the trial protocol. Findings will be published in a peer-reviewed journal and presented at conferences. This study will be considered suitable to progress to a phase III study if there is a completion rate where the CI includes 80% and excludes 60%. The protocol and Patient Information and Consent Form have been approved by Sydney Local Health District (Concord) Human Research Ethics Committee 2019/ETH07984 and University of Technology Sydney ETH17-1820. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617000747325.
Collapse
Affiliation(s)
- Jessica Lee
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David Currow
- University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Melanie Lovell
- Greenwich Palliative and Supportive Care Services, HammondCare, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, St Leonards, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andrew McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan Ritchie
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Linda Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Rajesh Aggarwal
- Palliative Care, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Davinia Seah
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Caitlin Sheehan
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Richard Chye
- Palliative Care, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Beverly Noble
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, Deakin University School of Health and Social Development, Burwood, Victoria, Australia
| | - Ghauri Aggarwal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Rachel George
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Marian Kow
- Pharmacy, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Chadi Ayoub
- Cardiology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Anthony Linton
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Dipti Mittal
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Angela Rao
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Calvary Health Care, Kogarah, New South Wales, Australia
| | - Grace Prael
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
| | - Katalin Urban
- Palliative Care, Northern New South Wales Local Health Network, Lismore, New South Wales, Australia
| | - Priyanka Vandersman
- Research Centre for Palliative Care Death & Dying, Flinders University, Adelaide, South Australia, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney Faculty of Health, Broadway, New South Wales, Australia
- Palliative Care, Sydney South West Area Health Service, Liverpool, New South Wales, Australia
| |
Collapse
|
3
|
Xia P, Yang T, Wang X, Li X. Combination of pregabalin and transcutaneous electrical nerve stimulation for neuropathic pain in a stroke patient after contralateral C7 nerve transfer: a case report. Int J Neurosci 2020; 131:1248-1253. [PMID: 32576077 DOI: 10.1080/00207454.2020.1786687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Contralateral C7 nerve transfer is a new surgical treatment for stroke patients with unilateral upper extremity paralysis, but neuropathic pain in the nonparalyzed side is the common complication after surgery. We report a stroke patient with neuropathic pain after C7 nerve transfer who received combination treatment of transcutaneous electrical nerve stimulation(TENS) and pregabalin. CASE SUMMARY A 53-year old, 6 months post-stroke patient with right hemiplegia after contralateral C7 nerve transfer was admitted in our department with a significant neuropathic pain in his left upper extremity. The treatment of pregabalin and TENS were used for patient. The visual analogue scale(VAS), medical outcomes study sleep scale(MOS-SS) and hospital anxiety and depression scale(HADS) were assessed after 1 months treatment. After treatment, the pain of his nonparalyzed upper extremity was relieved, the sleeping quality and the anxiety and depression were improved in patient. CONCLUSION This report suggests that the combination of pregabalin and TENS have prominent clinical effects on neuropathic pain of nonparalyzed side in stroke patients after contralateral C7 nerve transfer.
Collapse
Affiliation(s)
- Peng Xia
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ting Yang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoju Wang
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xueping Li
- Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Clark K, Byrne PG, Hunt J, Brown L, Rowett D, Watts G, Lovell M, Currow DC. Pharmacovigilance in Hospice/Palliative Care: De-Prescribing Combination Controlled Release Oxycodone-Naloxone. J Palliat Med 2020; 23:656-661. [PMID: 31904310 DOI: 10.1089/jpm.2019.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Pharmacovigilance studies in hospice/palliative care provide extra information to improve medication safety. Combination controlled release oxycodone-naloxone offers an alternative opioid with less risk of opioid-induced constipation. Objective: To examine why palliative care clinicians chose to cease oxycodone-naloxone and to explore immediate and short-term benefits and harms of this medication change. Design: A consecutive cohort study. Setting: 112 adults from 13 palliative care centers. Measurements: Reasons for ceasing medication and the harms and benefits that followed this 24 and 72 hours later. Symptom burdens were summarised by the National Cancer Institute Common Terminology Criteria for Adverse Events Toxicity Gradings. Results: Combination medication was most commonly ceased because of poor pain control or impaired hepatic function. The last median oral morphine equivalent oxycodone dose before the switch was 45 mg (range 7.5-240 mg) with 76 switched to an alternative long-acting opioid (initial median oral morphine equivalent dose being 45 mg [range 5-210 mg]). Subgroup analysis of those switched because of clinicians' concerns about hepatic dysfunction demonstrated this group were receiving significantly lower opioid doses pre-cessation compared to those switched because of other reasons( p = 0.007). Regardless of why the medication was changed, improvements in pain and constipation scores were seen, the latter associated with an attendant increase in laxatives. Conclusions: This preliminary work suggests that despite theoretical concerns regarding the effect of the naloxone on opioid doses, most people were switched safely to very similar opioid doses with attendant improvements in pain control.
Collapse
Affiliation(s)
- Katherine Clark
- Department of Palliative Care, Northern Sydney Local Health District Cancer and Palliative Care Network, St. Leonards, Australia.,Health Sciences, Northern Clinical School, The University of Sydney, Sydney, Australia.,School of Medicine and Public Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia
| | - Paul G Byrne
- Health Sciences, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Jane Hunt
- School of Medicine and Public Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia
| | - Linda Brown
- School of Medicine and Public Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Gareth Watts
- The University of Newcastle, Newcastle, Australia
| | - Melanie Lovell
- Health Sciences, Northern Clinical School, The University of Sydney, Sydney, Australia.,School of Medicine and Public Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia
| | - David C Currow
- School of Medicine and Public Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia
| |
Collapse
|
5
|
Matsuoka H, Tagami K, Ariyoshi K, Oyamada S, Kizawa Y, Inoue A, Koyama A. Attitude of Japanese palliative care specialists towards adjuvant analgesics cancer-related neuropathic pain refractory to opioid therapy: a nationwide cross-sectional survey. Jpn J Clin Oncol 2019; 49:486-490. [PMID: 30793161 DOI: 10.1093/jjco/hyz002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
Cancer-related neuropathic pain (CNP) requires therapy involving multiple pharmaceuticals, including anticonvulsants and antidepressants; however, strong evidence to support this practice is limited. This study is a cross-sectional questionnaire-based survey. As the standard dose of adjuvant analgesics for CNP refractory to opioid therapy is not clear, the purpose of this study is to clarify the opinions of specialists about the usage of duloxetine and pregabalin for patients with CNP refractory to opioid therapy. Two hundred and eight certified palliative care specialists were surveyed and a total of 87 (42%) responses were analyzed. Twenty-five percent of specialists had considered increasing duloxetine doses up to 60 mg/day and 58% had considered increasing pregabalin doses up to 300 mg/day for CNP refractory to opioid therapy. However, 23% of the specialists succeeded in increasing duloxetine doses up to 60 mg/day and 17% in increasing pregabalin doses up to 300 mg/day, respectively.
Collapse
Affiliation(s)
- Hiromichi Matsuoka
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama City, Osaka, Japan.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Japan
| | | | | | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Japan
| | - Atsuko Koyama
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama City, Osaka, Japan
| |
Collapse
|
6
|
Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients. Support Care Cancer 2018; 27:157-164. [PMID: 29915993 DOI: 10.1007/s00520-018-4309-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/06/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE We assessed the effects of subcutaneous-endovenous fentanyl on dyspnoea in a cohort of advanced cancer patients. METHODS We performed a retrospective study in a cohort of advanced cancer patients with dyspnoea at rest who received subcutaneous or intravenous fentanyl. Patients with no shortness of breath at rest or at minimal exertion, no rescue doses per 24 h, were deemed to be responders to fentanyl. The period of assessment was 6 days from the beginning of fentanyl treatment. RESULTS Seventy-two patients were evaluated: 65% males, 50% ≥ 75 years, Palliative Performance Scale (PPS) median of 30%. Seventy-six percent of the patients were responders to fentanyl. Fentanyl efficacy was not statistically related to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses and PPS. The median fentanyl dose in responders was 25 mcg/h (interquartile range 12-70). It was significantly related to age (37 vs 12 mcg/h, for ≤ 75 vs > 75 years, respectively; p = 0.02). There was not a significant difference between fentanyl doses of responders and non-responder patients. Thirty-six, 23 and 15 patients had sustained improvements in dyspnoea over 48, 72 and 96 h. Fentanyl had no significant toxicity. The length of inclusion in the study and exclusion were related to low performance status (hazard ratio 0.961; 95%CI 0.927-0.996; Cox-regression) but not to fentanyl doses (hazard ratio 0.875; 95%CI 0.620-1.234; Cox-regression). CONCLUSION Our preliminary data suggest that subcutaneous-endovenous fentanyl may be associated with dyspnoea relief in dying patients. Further research is needed to confirm these findings.
Collapse
|