1
|
Haroun R, Wood JN, Sikandar S. Mechanisms of cancer pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1030899. [PMID: 36688083 PMCID: PMC9845956 DOI: 10.3389/fpain.2022.1030899] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/14/2022] [Indexed: 01/05/2023]
Abstract
Personalised and targeted interventions have revolutionised cancer treatment and dramatically improved survival rates in recent decades. Nonetheless, effective pain management remains a problem for patients diagnosed with cancer, who continue to suffer from the painful side effects of cancer itself, as well as treatments for the disease. This problem of cancer pain will continue to grow with an ageing population and the rapid advent of more effective therapeutics to treat the disease. Current pain management guidelines from the World Health Organisation are generalised for different pain severities, but fail to address the heterogeneity of mechanisms in patients with varying cancer types, stages of disease and treatment plans. Pain is the most common complaint leading to emergency unit visits by patients with cancer and over one-third of patients that have been diagnosed with cancer will experience under-treated pain. This review summarises preclinical models of cancer pain states, with a particular focus on cancer-induced bone pain and chemotherapy-associated pain. We provide an overview of how preclinical models can recapitulate aspects of pain and sensory dysfunction that is observed in patients with persistent cancer-induced bone pain or neuropathic pain following chemotherapy. Peripheral and central nervous system mechanisms of cancer pain are discussed, along with key cellular and molecular mediators that have been highlighted in animal models of cancer pain. These include interactions between neuronal cells, cancer cells and non-neuronal cells in the tumour microenvironment. Therapeutic targets beyond opioid-based management are reviewed for the treatment of cancer pain.
Collapse
Affiliation(s)
- Rayan Haroun
- Division of Medicine, Wolfson Institute of Biomedical Research, University College London, London, UnitedKingdom
| | - John N Wood
- Division of Medicine, Wolfson Institute of Biomedical Research, University College London, London, UnitedKingdom
| | - Shafaq Sikandar
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Correspondence: Shafaq Sikandar
| |
Collapse
|
2
|
Wang C, Zheng Y, Zheng Y, Wu C, Wang X, Huang M, Wu X, Zhong W, Xu K. Enzymatic Synthesis of Peptide Nanofibers for Self-Delivery of Indomethacin and Tyroservatide in Cancer Therapy. ACS Biomater Sci Eng 2022; 8:3010-3021. [PMID: 35679601 DOI: 10.1021/acsbiomaterials.2c00574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) have drawn considerable attention in the field of cancer treatment, yet these drugs display limited potency and selectivity against cancer cells. To address these problems, we designed a peptide-based self-delivery system [Indomethacin-Phe-Phe-Tyr (H2PO3)-Ser-Val, IDM-FFpYSV] that combines an NSAID molecule (indomethacin, or IDM) and a segment of anticancer tripeptide (tyroservatide, or YSV). IDM-FFpYSV is capable of self-assembling in an aqueous solution to afford nanofibrillar hydrogels under the catalysis of alkaline phosphatases (ALPs), which are overexpressed on the plasma membrane of cancer cells. The IDM-FFpYSV + ALP hydrogel displays a continuous release profile of peptide drugs, whereas a solution mixture of pure drugs (IDM-OH + pYSV + ALP) shows burst release of drug moieties. The treatment of IDM-FFpYSV selectively inhibits the proliferation of HeLa cells in vitro, with precise regulations of intracellular targeting proteins (COX-2 and AC-H3). The enhanced potency and selectivity of IDM-FFpYSV are found to be attributed to enhanced cellular uptake of peptide drugs, which involves a caveolae-mediated endocytosis pathway. Furthermore, intravenous administration of the IDM-FFpYSV formulation significantly inhibits the tumor growth in a HeLa-xenografted mouse model, whereas treatment of solution mixtures of pure drugs (IDM-OH + pYSV) fails to do so. Taken together, the study provides a viable strategy to augment anticancer efficacies of self-delivery system through molecular integration of multiple anticancer elements with an enzyme-instructed self-assembly process.
Collapse
Affiliation(s)
- Chunlu Wang
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China
| | - Yaoyao Zheng
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China
| | - Yaxin Zheng
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China
| | - Can Wu
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Xiujie Wang
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China
| | - Menghua Huang
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China
| | - Xiaoxing Wu
- State Key Laboratory of Natural Medicines and Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Wenying Zhong
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China.,Key Laboratory of Biomedical Functional Materials, China Pharmaceutical University, Nanjing 210009, China.,Key Laboratory of Drug Quality Control and Pharmacovigilance, China Pharmaceutical University, Nanjing 210009, China
| | - Keming Xu
- Department of Chemistry, China Pharmaceutical University, Nanjing 210009, China.,Key Laboratory of Biomedical Functional Materials, China Pharmaceutical University, Nanjing 210009, China
| |
Collapse
|
3
|
Ravuri HG, Satake N, Balmanno A, Skinner J, Kempster S, Mills PC. Pharmacokinetic Evaluation of a Novel Transdermal Ketoprofen Formulation in Healthy Dogs. Pharmaceutics 2022; 14:pharmaceutics14030646. [PMID: 35336020 PMCID: PMC8953954 DOI: 10.3390/pharmaceutics14030646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023] Open
Abstract
Dogs undergo various surgical procedures such as castration, ovariohysterectomy, and other orthopedic procedures, which are known to cause inflammation and pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are very effective analgesics for alleviating postoperative pain in veterinary medicine. Ketoprofen is currently approved in Australia and the United States for treating different painful conditions in dogs. This study evaluated the pharmacokinetic parameters of ketoprofen after intravenous (IV) and transdermal (TD) administration in healthy dogs. A novel transdermal ketoprofen (TDK) formulation containing 20% ketoprofen, dissolved in a combination of 45:45% isopropanol and Transcutol, along with 10% eucalyptus oil, was developed and evaluated for in vitro dermal permeation using Franz diffusion cells. A crossover study was then conducted to determine the pharmacokinetic parameters of the formulation in six dogs following IV ketoprofen (1 mg/kg) and TDK (10 mg/kg) administration. A liquid chromatography–mass spectrometry (LC-M/MS) method was used to measure plasma concentrations of ketoprofen over time, and a non-compartmental analysis determined the pharmacokinetic parameters. The mean terminal elimination half-life (T½ h), AUC0-t (µg·h/mL), and mean residence time (MRT, h) between IV and TDK groups were 4.69 ± 1.33 and 25.77 ± 22.15 h, 15.75 ± 7.72 and 8.13 ± 4.28 µg·h/mL, and 4.86 ± 1.81 and 41.63 ± 32.33 h, respectively. The calculated bioavailability (F%) was ~7%, with a lag time of 30 min to achieve effective plasma concentrations after the application of TDK.
Collapse
Affiliation(s)
- Halley Gora Ravuri
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Nana Satake
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Alexandra Balmanno
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Jazmine Skinner
- School of Agriculture and Environment, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Samantha Kempster
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Paul C Mills
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| |
Collapse
|
4
|
Enzinger AC, Ghosh K, Keating NL, Cutler DM, Landrum MB, Wright AA. Reply to W. E. Rosa et al and T. N. Townsend et al. J Clin Oncol 2021; 40:312-314. [PMID: 34878818 DOI: 10.1200/jco.21.02383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea C Enzinger
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kaushik Ghosh
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nancy L Keating
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David M Cutler
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mary Beth Landrum
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Alexi A Wright
- Andrea C. Enzinger, MD, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Kaushik Ghosh, PhD, The New England Bureau of Economic Research, Cambridge, MA; Nancy L. Keating, MD, MPH, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA; David M. Cutler, PhD, The New England Bureau of Economic Research, Cambridge, MA, The Department of Healthcare Policy, Harvard Medical School, Boston, MA, The Department of Economics, Harvard University, Boston, MA, The Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA; Mary Beth Landrum, PhD, The Department of Healthcare Policy, Harvard Medical School, Boston, MA; and Alexi A. Wright, MD, MPH, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
The Extract of Corydalis yanhusuo Prevents Morphine Tolerance and Dependence. Pharmaceuticals (Basel) 2021; 14:ph14101034. [PMID: 34681258 PMCID: PMC8540887 DOI: 10.3390/ph14101034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022] Open
Abstract
The opioid epidemic was triggered by an overprescription of opioid analgesics. In the treatment of chronic pain, repeated opioid administrations are required which ultimately lead to tolerance, physical dependence, and addiction. A possible way to overcome this conundrum consists of a co-medication that maintains the analgesic benefits of opioids while preventing their adverse liabilities. YHS, the extract of the plant Corydalis yanhusuo, has been used as analgesic in traditional Chinese medicine for centuries. More recently, it has been shown to promote analgesia in animal models of acute, inflammatory, and neuropathic pain. It acts, at least in part, by inhibiting the dopamine D2 receptor, suggesting that it may be advantageous to manage addiction. We first show that, in animals, YHS can increase the efficacy of morphine antinociceptive and, as such, decrease the need of the opioid. We then show that YHS, when coadministered with morphine, inhibits morphine tolerance, dependence, and addiction. Finally, we show that, in animals treated for several days with morphine, YHS can reverse morphine dependence and addiction. Together, these data indicate that YHS may be useful as a co-medication in morphine therapies to limit adverse morphine effects. Because YHS is readily available and safe, it may have an immediate positive impact to curb the opioid epidemic.
Collapse
|
6
|
Fan Y, Ji X, Zhang L, Zhang X. The Analgesic Effects of Static Magnetic Fields. Bioelectromagnetics 2021; 42:115-127. [PMID: 33508148 DOI: 10.1002/bem.22323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/17/2020] [Accepted: 01/02/2021] [Indexed: 11/09/2022]
Abstract
Pain is one of the most common reasons why people seek medical care, which is related to most disease states. Magnetic fields (MFs) can be applied locally to specific parts of human bodies with high penetration and temporal control, which have a long-debated history in folk therapy. The purpose of this review is to collect and analyze experimental data about the analgesic effects of static magnetic fields (SMFs) so that we can have a scientific understanding regarding this topic. We collected 28 studies (25 English and 3 Chinese papers) with proper sham controls that investigated the effects of SMFs on pain relief in humans or mice. We found that 64% of the human studies and all mice studies in the literature showed positive analgesic effects of SMFs, which are related to factors including SMF intensity, treatment time, and pain types. Higher intensity and/or longer treatment time, as well as some specific pain types, may have better pain relief effects. Initial mechanistic studies indicated that membrane receptors, such as capsaicin receptor VR1/TRPV1, opioid receptors, and P2X3 receptors, might be involved. By describing experimental evidence and analysis, we found that SMFs actually hold considerable promise for managing some specific types of pain if proper SMF parameters are used. More studies comprehensively evaluating the parameters of SMF and its corresponding analgesic effects on different pain types, as well as the underlying molecular mechanisms, will be necessary to further validate its therapeutic potential in pain management in the future. Bioelectromagnetics. 00:00-00, 2021. © 2021 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Yixiang Fan
- High Magnetic Field Laboratory, Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
- Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
| | - Xinmiao Ji
- High Magnetic Field Laboratory, Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Lei Zhang
- High Magnetic Field Laboratory, Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Xin Zhang
- High Magnetic Field Laboratory, Key Laboratory of High Magnetic Field and Ion Beam Physical Biology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
- Science Island Branch of Graduate School, University of Science and Technology of China, Hefei, China
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, China
- International Magnetobiology Frontier Research Center (iMFRC), Science Island, Hefei, China
| |
Collapse
|
7
|
Armando RG, Gómez DLM, Gomez DE. New drugs are not enough‑drug repositioning in oncology: An update. Int J Oncol 2020; 56:651-684. [PMID: 32124955 PMCID: PMC7010222 DOI: 10.3892/ijo.2020.4966] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Abstract
Drug repositioning refers to the concept of discovering novel clinical benefits of drugs that are already known for use treating other diseases. The advantages of this are that several important drug characteristics are already established (including efficacy, pharmacokinetics, pharmacodynamics and toxicity), making the process of research for a putative drug quicker and less costly. Drug repositioning in oncology has received extensive focus. The present review summarizes the most prominent examples of drug repositioning for the treatment of cancer, taking into consideration their primary use, proposed anticancer mechanisms and current development status.
Collapse
Affiliation(s)
- Romina Gabriela Armando
- Laboratory of Molecular Oncology, Science and Technology Department, National University of Quilmes, Bernal B1876, Argentina
| | - Diego Luis Mengual Gómez
- Laboratory of Molecular Oncology, Science and Technology Department, National University of Quilmes, Bernal B1876, Argentina
| | - Daniel Eduardo Gomez
- Laboratory of Molecular Oncology, Science and Technology Department, National University of Quilmes, Bernal B1876, Argentina
| |
Collapse
|
8
|
|
9
|
Weggel LA, Pandya AA. Acute Administration of Desformylflustrabromine Relieves Chemically Induced Pain in CD-1 Mice. Molecules 2019; 24:molecules24050944. [PMID: 30866543 PMCID: PMC6432607 DOI: 10.3390/molecules24050944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 01/28/2023] Open
Abstract
Neuronal nicotinic acetylcholine receptors are cell membrane-bound ion channels that are widely distributed in the central nervous system. The α4β2 subtype of neuronal nicotinic acetylcholine receptor plays an important role in modulating the signaling pathways for pain. Previous studies have shown that agonists, partial agonists, and positive allosteric modulators for the α4β2 receptors are effective in relieving pain. Desformylflustrabromine is a compound that acts as an allosteric modulator of α4β2 receptors. The aim of this study was to assess the effects of desformylflustrabromine on chemically induced pain. For this purpose, the formalin-induced pain test and the acetic acid-induced writhing response test were carried out in CD-1 mice. Both tests represent chemical assays for nociception. The results show that desformylflustrabromine is effective in producing an analgesic effect in both tests used for assessing nociception. These results suggest that desformylflustrabromine has the potential to become a clinically used drug for pain relief.
Collapse
Affiliation(s)
- Loni A Weggel
- Department of Biosciences, College of Rural and Community Development, 101D Harper Building, 810 Draanjik Drive, University of Alaska Fairbanks, Fairbanks, AK 99709-3419, USA.
| | - Anshul A Pandya
- Department of Biosciences, College of Rural and Community Development, 101D Harper Building, 810 Draanjik Drive, University of Alaska Fairbanks, Fairbanks, AK 99709-3419, USA.
| |
Collapse
|
10
|
McDermott JD, Eguchi M, Stokes WA, Amini A, Hararah M, Ding D, Valentine A, Bradley CJ, Karam SD. Short- and Long-term Opioid Use in Patients with Oral and Oropharynx Cancer. Otolaryngol Head Neck Surg 2019; 160:409-419. [PMID: 30396321 PMCID: PMC6886698 DOI: 10.1177/0194599818808513] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment. STUDY DESIGN Retrospective population-based study. SETTING Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2008 to 2011. SUBJECTS AND METHODS In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors. RESULTS Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11-5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18-0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05-4.71 and OR, 3.84; 95% CI, 1.44-10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45-5.91 and OR, 3.56; 95% CI, 1.95-6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17-0.62 and OR, 0.26; 95% CI, 0.10-0.67). CONCLUSION Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.
Collapse
Affiliation(s)
- Jessica D. McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Megan Eguchi
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A. Stokes
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Mohammad Hararah
- Department of Otolaryngology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Ding Ding
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Allison Valentine
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cathy J. Bradley
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
11
|
Lakshman TR, Deb J, Ghosh I, Sarkar S, Paine TK. Combining anti-inflammatory and anti-proliferative activities in ternary metal-NSAID complexes of a polypyridylamine ligand. Inorganica Chim Acta 2019. [DOI: 10.1016/j.ica.2018.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
12
|
Scarborough B, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin 2018; 68:182-196. [PMID: 29603142 PMCID: PMC5980731 DOI: 10.3322/caac.21453] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182-196. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Bethann Scarborough
- Brookdale Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Cardinale B. Smith
- Brookdale Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, NY, NY
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY, NY
| |
Collapse
|
13
|
Abstract
Pain is a significant morbidity resulting from head and neck cancer. Pain may also be the result of the treatments directed against head and neck cancer. An experienced practitioner may manage this pain by understanding the multifactorial mechanisms of pain and the various pharmacotherapies available. Pain should be managed with multiple medications in a multimodal approach, and nonpharmacologic therapies should be considered as well.
Collapse
Affiliation(s)
- Jakun W Ing
- University of California Los Angeles, Comprehensive Pain Center, 1245 16th Street, Suite 225, Santa Monica, CA 90404, USA.
| |
Collapse
|
14
|
Combined application of diclofenac and celecoxib with an opioid yields superior efficacy in metastatic bone cancer pain: a randomized controlled trial. Int J Clin Oncol 2017; 22:980-985. [DOI: 10.1007/s10147-017-1133-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/30/2017] [Indexed: 11/26/2022]
|
15
|
Di Pompo G, Lemma S, Canti L, Rucci N, Ponzetti M, Errani C, Donati DM, Russell S, Gillies R, Chano T, Baldini N, Avnet S. Intratumoral acidosis fosters cancer-induced bone pain through the activation of the mesenchymal tumor-associated stroma in bone metastasis from breast carcinoma. Oncotarget 2017; 8:54478-54496. [PMID: 28903357 PMCID: PMC5589596 DOI: 10.18632/oncotarget.17091] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/19/2017] [Indexed: 12/31/2022] Open
Abstract
Cancer-induced bone pain (CIBP) is common in patients with bone metastases (BM), significantly impairing quality of life. The current treatments for CIBP are limited since they are often ineffective. Local acidosis derived from glycolytic carcinoma and tumor-induced osteolysis is only barely explored cause of pain. We found that breast carcinoma cells that prefer bone as a metastatic site have very high extracellular proton efflux and expression of pumps/ion transporters associated with acid-base balance (MCT4, CA9, and V-ATPase). Further, the impairment of intratumoral acidification via V-ATPase targeting in xenografts with BM significantly reduced CIBP, as measured by incapacitance test. We hypothesize that in addition to the direct acid-induced stimulation of nociceptors in the bone, a novel mechanism mediated by the acid-induced and tumor-associated mesenchymal stroma might ultimately lead to nociceptor sensitization and hyperalgesia. Consistent with this, short-term exposure of cancer-associated fibroblasts, mesenchymal stem cells, and osteoblasts to pH 6.8 promotes the expression of inflammatory and nociceptive mediators (NGF, BDNF, IL6, IL8, IL1b and CCL5). This is also consistent with a significant correlation between breakthrough pain, measured by pain questionnaire, and combined high serum levels of BDNF and IL6 in patients with BM, and also by immunofluorescence staining showing IL8 expression that was more in mesenchymal stromal cells rather than in tumors cells, and close to LAMP-2 positive acidifying carcinoma cells in BM tissue sections. In summary, intratumoral acidification in BM might promote CIBP also by activating the tumor-associated stroma, offering a new target for palliative treatments in advanced cancer.
Collapse
Affiliation(s)
- Gemma Di Pompo
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvia Lemma
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Canti
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nadia Rucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Ponzetti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Costantino Errani
- Orthopaedic Oncology Surgical Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- Orthopaedic Oncology Surgical Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Shonagh Russell
- Department of Imaging Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Robert Gillies
- Department of Imaging Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Tokuhiro Chano
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Nicola Baldini
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sofia Avnet
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
16
|
Abstract
Pain is a common and highly distressing symptom in pediatric patients with advanced malignancies. Prompt recognition, assessment, and treatment of pain are necessary, especially at the end of life. Opioid medications remain the mainstay of treatment of malignant pain in children at the end of life and the amount of opioids required for adequate pain control in patients is highly variable. Nonpharmacological approaches including behavioral and physical approaches in addition to non-opioid pain medications should be used when possible to augment pain control. Identification and treatment of any underlying pathology is important and use of adjuvant medications based on pathophysiology and source of pain should be considered. In cases where adequate pain control is not achieved through these multiple modalities, an interdisciplinary approach including potential interventional techniques and alternative treatments is required. This multimodal approach to pain management is best provided by interdisciplinary teams, as these teams can best address the complex causes of pain and associated distress that occurs in patients and within families.
Collapse
|
17
|
Shibata H, Kato S, Sekine I, Abe K, Araki N, Iguchi H, Izumi T, Inaba Y, Osaka I, Kato S, Kawai A, Kinuya S, Kodaira M, Kobayashi E, Kobayashi T, Sato J, Shinohara N, Takahashi S, Takamatsu Y, Takayama K, Takayama K, Tateishi U, Nagakura H, Hosaka M, Morioka H, Moriya T, Yuasa T, Yurikusa T, Yomiya K, Yoshida M. Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese Orthopedic Association, Japanese Urological Association, and Japanese Society for Radiation Oncology. ESMO Open 2016; 1:e000037. [PMID: 27843593 PMCID: PMC5070259 DOI: 10.1136/esmoopen-2016-000037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 01/14/2023] Open
Abstract
Diagnosis and treatment of bone metastasis requires various types of measures, specialists and caregivers. To provide better diagnosis and treatment, a multidisciplinary team approach is required. The members of this multidisciplinary team include doctors of primary cancers, radiologists, pathologists, orthopaedists, radiotherapists, clinical oncologists, palliative caregivers, rehabilitation doctors, dentists, nurses, pharmacists, physical therapists, occupational therapists, medical social workers, etc. Medical evidence was extracted from published articles describing meta-analyses or randomised controlled trials concerning patients with bone metastases mainly from 2003 to 2013, and a guideline was developed according to the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Multidisciplinary team meetings are helpful in diagnosis and treatment. Clinical benefits such as physical or psychological palliation obtained using the multidisciplinary team approaches are apparent. We established a guideline describing each specialty field, to improve understanding of the different fields among the specialists, who can further provide appropriate treatment, and to improve patients’ outcomes.
Collapse
Affiliation(s)
- H Shibata
- Department of Clinical Oncology , Akita University Graduate School of Medicine , Akita , Japan
| | - S Kato
- Department of Clinical Oncology , Juntendo University , Tokyo , Japan
| | - I Sekine
- Department of Clinical Oncology , University of Tsukuba , Tsukuba , Japan
| | - K Abe
- Department of Rehabilitation , Chiba Prefectural University of Health Sciences , Chiba , Japan
| | - N Araki
- Department of Orthopedic Surgery , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - H Iguchi
- Department of Gastroenterology , National Hospital Organization Shikoku Cancer Center , Matsuyama , Japan
| | - T Izumi
- Division of Hematology , Tochigi Cancer Center , Utsunomiya , Japan
| | - Y Inaba
- Department of Diagnostic and Interventional Radiology , Aichi Cancer Center Hospital , Nagoya , Japan
| | - I Osaka
- Division of Palliative Medicine , Shizuoka Cancer Center , Sunto-gun , Japan
| | - S Kato
- Department for Cancer Chemotherapy , Iwate Prefectural Central Hospital , Morioka , Japan
| | - A Kawai
- Division of Musculoskeletal Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - S Kinuya
- Department of Nuclear Medicine , Kanazawa University Hospital , Kanazawa , Japan
| | - M Kodaira
- Department of Breast and Medical Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - E Kobayashi
- Division of Musculoskeletal Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - T Kobayashi
- Department of Diagnostic and Interventional Radiology , Ishikawa Prefectural Central Hospital , Kanazawa , Japan
| | - J Sato
- Department of Clinical Pharmaceutics , School of Pharmacy, Iwate Medical University , Morioka , Japan
| | - N Shinohara
- Department of Renal and Genitourinary Surgery , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - S Takahashi
- Department of Medical Oncology , Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo , Japan
| | - Y Takamatsu
- Division of Medical Oncology , Hematology and Infectious Diseases, Fukuoka University Hospital , Fukuoka , Japan
| | - K Takayama
- Seirei Christopher University , Hamamatsu , Japan
| | - K Takayama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - U Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine , Tokyo Medical and Dental University , Tokyo , Japan
| | - H Nagakura
- Department of Radiology , KKR Sapporo Medical Center , Sapporo , Japan
| | - M Hosaka
- Department of Orthopaedic Surgery , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - H Morioka
- Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan
| | - T Moriya
- Department of Pathology 2 , Kawasaki Medical School , Kurashiki , Japan
| | - T Yuasa
- Department of Urology , Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo , Japan
| | - T Yurikusa
- Division of Dentistry and Oral Surgery , Shizuoka Cancer Center , Sunto-gun , Japan
| | - K Yomiya
- Department of Palliative Care , Saitama Cancer Center , Kitaadachi-gun , Japan
| | - M Yoshida
- Department of Hemodialysis and Surgery , Chemotherapy Research Institute, International University of Health and Welfare , Ichikawa , Japan
| |
Collapse
|
18
|
Remeniuk B, Sukhtankar D, Okun A, Navratilova E, Xie JY, King T, Porreca F. Behavioral and neurochemical analysis of ongoing bone cancer pain in rats. Pain 2015; 156:1864-1873. [PMID: 25955964 PMCID: PMC4578982 DOI: 10.1097/j.pain.0000000000000218] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 01/05/2023]
Abstract
Cancer-induced bone pain is described as dull, aching ongoing pain. Ongoing bone cancer pain was characterized after intratibial injection of breast cancer cells in rats. Cancer produced time-dependent bone remodeling and tactile hypersensitivity but no spontaneous flinching. Conditioned place preference (CPP) and enhanced dopamine (DA) release in the nucleus accumbens (NAc) shell was observed after peripheral nerve block (PNB) selectively in tumor-bearing rats revealing nociceptive-driven ongoing pain. Oral diclofenac reversed tumor-induced tactile hypersensitivity but did not block PNB-induced CPP or NAc DA release. Tumor-induced tactile hypersensitivity, and PNB-induced CPP and NAc DA release, was blocked by prior subcutaneous implantation of a morphine pellet. In sham rats, morphine produced a modest but sustained increase in NAc DA release. In contrast, morphine produced a transient 5-fold higher NAc DA release in tumor bearing rats compared with sham morphine rats. The possibility that this increased NAc DA release reflected the reward of pain relief was tested by irreversible blockade of rostral anterior cingulate cortex (rACC) μ-opioid receptors (MORs). The rACC MOR blockade prevented the morphine-induced transient increased NAc DA release in tumor bearing rats but did not affect morphine-induced effects in sham-operated animals. Consistent with clinical experience, ongoing cancer pain was controlled by morphine but not by a dose of diclofenac that reversed evoked hypersensitivity. Additionally, the intrinsic reward of morphine can be dissociated from the reward of relief of cancer pain by blockade of rACC MOR. This approach allows mechanistic and therapeutic assessment of ongoing cancer pain with likely translation relevance.
Collapse
Affiliation(s)
- Bethany Remeniuk
- Department of Cancer Biology, Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Devki Sukhtankar
- Department of Cancer Biology, Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Alec Okun
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer Y. Xie
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Tamara King
- Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, USA
| | - Frank Porreca
- Department of Cancer Biology, Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
19
|
Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm 2015; 37:767-75. [PMID: 25854310 PMCID: PMC4594093 DOI: 10.1007/s11096-015-0094-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 03/04/2015] [Indexed: 11/03/2022]
Abstract
Background In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration. Objective To describe doses and routes of administration of the most frequently used drugs at admission and at day of death. Setting Palliative care centre in the Netherlands. Method In this retrospective cohort study, prescription data of deceased patients were extracted from the electronic medical records. Main outcome measure Doses, frequency and route of administration of prescribed drugs Results All regular medication prescriptions of 208 patients, 89 % of whom had advanced cancer, were reviewed. The three most prescribed drugs were morphine, midazolam and haloperidol, to 21, 11 and 23 % of patients at admission, respectively. At the day of death these percentages had increased to 87, 58 and 50 %, respectively. Doses of these three drugs at the day of death were statistically significantly higher than at admission. The oral route of administration was used in 89 % of patients at admission versus subcutaneous in 94 % at the day of death. Conclusions Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.
Collapse
|
20
|
Majumdar S, Das A, Kundu R, Mukherjee D, Hazra B, Mitra T. Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery. Perspect Clin Res 2014; 5:172-7. [PMID: 25276627 PMCID: PMC4170535 DOI: 10.4103/2229-3485.140557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Paracetamol; a cyclooxygenase inhibitor; acts through the central nervous system as well as serotoninergic system as a nonopioid analgesic. A prospective, double-blinded, and randomized-controlled study was carried out to compare the efficacy of preoperative 1g intravenous (iv) paracetamol with placebo in providing postoperative analgesia in head-neck cancer surgery. Materials and Methods: From 2008 February to 2009 December, 80 patients for palliative head-neck cancer surgery were randomly divided into (F) and (P) Group receiving ivplacebo and iv paracetamol, respectively, 5 min before induction. Everybody received fentanyl before induction and IM diclofenac for pain relief at8 hourly for 24 h after surgery. Visual analogue scale (VAS) and amount of fentanyl were measured for postoperative pain assessment (24 h). Results and Statistical analysis: The mean VAS score in 1st, 2nd postoperative hour, and fentanyl requirement was less and the need for rescue analgesic was delayed in ivparacetamol group which were all statistically significant. Paracetamol group had a shorter surgical intensive care unit (SICU) and hospital stay which was also statistically significant. Conclusion: The study demonstrates the effectiveness of ivparacetamol as preemptive analgesic in the postoperative pain control after head-neck cancer surgery and earlier discharge from hospital.
Collapse
Affiliation(s)
- Saikat Majumdar
- Department of Anaesthesiology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
| | - Anjan Das
- Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Ratul Kundu
- Department of Anaesthesiology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Dipankar Mukherjee
- Department of Anaesthesiology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
| | - Bimal Hazra
- Department of Anaesthesiology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
| | - Tapobrata Mitra
- Department of Anaesthesiology, Bangur Institute of Neurology, Kolkata, West Bengal, India
| |
Collapse
|
21
|
Prommer E. Levorphanol: revisiting an underutilized analgesic. Palliat Care 2014; 8:7-10. [PMID: 25278763 PMCID: PMC4168847 DOI: 10.4137/pcrt.s13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022] Open
Abstract
Levorphanol (levo-3-hydroxy-N-methylmorphinan) is a step 3 opioid first developed in the 1940s as an alternative to morphine. Levorphanol belongs to the morphinan opioid series. Levorphanol has greater potency than morphine and is a potent N-methyl-d aspartate (NMDA) antagonist. Levorphanol interferes with the uptake of norepinephrine and serotonin, which makes it potentially useful for neuropathic pain. Glucuronidation changes Levorphanol to Levorphanol-3-glucuronide with excretion by the kidney. Levorphanol has a long half-life and may accumulate with repeated dosing. Levorphanol can be administered orally, intravenously, and subcutaneously. This article provides an update regarding the pharmacodynamics, pharmacology, and clinical efficacy of this often overlooked step 3 opioid.
Collapse
Affiliation(s)
- Eric Prommer
- Director of Palliative Care, Division of Hematology/Oncology, Associate Professor, Mayo Clinic College of Medicine, Mayo Clinic Hospital, Scottsdale, Arizona, USA
| |
Collapse
|
22
|
Gulati A, Joshi J, Baqai A. An overview of treatment strategies for cancer pain with a focus on interventional strategies and techniques. Pain Manag 2014; 2:569-80. [PMID: 24645889 DOI: 10.2217/pmt.12.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY As the incidence of cancer increases, considerations for pain treatments become more important and varied. While traditional views on pain therapy are successful in treating the majority of cancer-related pain, a continuum has developed to include interventional strategies in addition to pharmacologic management. Further improvements in understanding anatomy in the context of imaging and pathophysiology of cancer-pain syndromes direct our current interventional pain management options. We discuss the current interventional treatment options regularly used in the cancer-pain population.
Collapse
Affiliation(s)
- Amitabh Gulati
- Department of Anesthesiology & Critical Care, Board Certified in Anesthesiology & Pain Management, Memorial Sloan Kettering Cancer Center, M308, New York, NY, 10065, USA.
| | | | | |
Collapse
|
23
|
Beutlhauser T, Oeltjenbruns J, Schäfer M. Durchbruchschmerzen und kurz wirksame Opioide. Anaesthesist 2013; 62:431-9. [DOI: 10.1007/s00101-013-2193-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, Mohr DC, Berendsen MA, Jacobsen PB. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 2012; 30:539-47. [PMID: 22253460 PMCID: PMC6815997 DOI: 10.1200/jco.2011.37.0437] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 11/08/2011] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Pain is one of the most common, burdensome, and feared symptoms experienced by patients with cancer. American Pain Society standards for pain management in cancer recommend both pharmacologic and psychosocial approaches. To obtain a current, stable, and comprehensive estimate of the effect of psychosocial interventions on pain-an important clinical topic-we conducted a meta-analysis of randomized controlled studies among adult patients with cancer published between 1966 and 2010. METHODS Three pairs of raters independently reviewed 1,681 abstracts, with a systematic process for reconciling disagreement, yielding 42 papers, of which 37 had sufficient data for meta-analysis. Studies were assessed for quality using a modified seven-item Physiotherapy Evidence Database (PEDro) coding scheme. Pain severity and interference were primary outcome measures. RESULTS Study participants (N = 4,199) were primarily women (66%) and white (72%). The weighted averaged effect size across studies for pain severity (38 comparisons) was 0.34 (95% CI, 0.23 to 0.46; P < .001), and the effect size for pain interference (four comparisons) was 0.40 (95% CI, 0.21 to 0.60; P < .001). Studies that monitored whether treatment was delivered as intended had larger effects than those that did not (P = .04). CONCLUSION Psychosocial interventions had medium-size effects on both pain severity and interference. These robust findings support the systematic implementation of quality-controlled psychosocial interventions as part of a multimodal approach to the management of pain in patients with cancer.
Collapse
Affiliation(s)
- Sherri Sheinfeld Gorin
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul Krebs
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Hoda Badr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elizabeth Amy Janke
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Heather S.L. Jim
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Bonnie Spring
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David C. Mohr
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mark A. Berendsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paul B. Jacobsen
- Sherri Sheinfeld Gorin, Herbert Irving Comprehensive Cancer Center, Columbia University; Paul Krebs, New York University School of Medicine; Hoda Badr, Mount Sinai School of Medicine, New York, NY; Elizabeth Amy Janke, University of the Sciences, Philadelphia, PA; Heather S.L. Jim and Paul B. Jacobsen, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Bonnie Spring and Mark A. Berendsen, Northwestern University; and David C. Mohr, Northwestern University, Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
25
|
Dunbar SA, Karamian I, Zhang J. Ketorolac prevents recurrent withdrawal induced hyperalgesia but does not inhibit tolerance to spinal morphine in the rat. Eur J Pain 2012; 11:1-6. [PMID: 16448827 DOI: 10.1016/j.ejpain.2005.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 11/29/2005] [Accepted: 12/13/2005] [Indexed: 10/25/2022]
Abstract
Chronic use of opioid is associated with pro-nociceptive phenomena such as hyperalgesia or tolerance. The interaction between opioid and non-steroidal anti-inflammatory drugs (NSAIDs) with respect to opioid-associated hyperalgesia and tolerance remains largely unknown. This study examines the effect of subcutaneous or intrathecal administration of ketorolac, an NSAID, on recurrent withdrawal induced hyperalgesia and tolerance to spinal morphine in rats. Animals were infused with morphine intrathecally, and daily subcutaneous naloxone was used for recurrent withdrawal purpose. We observed that escape latencies on hot box were decreased in animals subjected to withdrawal, and this decrease was reversed by subcutaneous ketorolac pretreatment. In addition, we observed that recurrent withdrawal did not significantly affect the magnitude of spinal morphine tolerance. Compared to controls, all morphine infused animals showed similar changes in their dose responses to spinal morphine, effective dose 50 values and tolerance ratios; and these changes were not affected by the ketorolac given subcutaneously. The effect of ketorolac on tolerance was further examined by directly delivering ketorolac to the spinal cord, and again we observed similar changes in the daily latency, percentage of area under the curve and percentage of maximal possible effects among groups infused with morphine, regardless of intrathecal ketorolac treatment. Together, our results demonstrate that recurrent withdrawal is associated with hyperalgesia but this has no effect on the tolerance development; ketorolac protects against recurrent withdrawal induced hyperalgesia without significantly altering spinal morphine tolerance.
Collapse
MESH Headings
- Analgesics, Opioid/adverse effects
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Drug Interactions/physiology
- Drug Tolerance/physiology
- Hyperalgesia/chemically induced
- Hyperalgesia/drug therapy
- Hyperalgesia/physiopathology
- Injections, Spinal
- Ketorolac/pharmacology
- Ketorolac/therapeutic use
- Male
- Morphine/adverse effects
- Morphine Dependence/metabolism
- Morphine Dependence/physiopathology
- Naloxone/adverse effects
- Narcotic Antagonists/adverse effects
- Pain Measurement/drug effects
- Pain, Intractable/chemically induced
- Pain, Intractable/drug therapy
- Pain, Intractable/physiopathology
- Rats
- Rats, Sprague-Dawley
- Spinal Cord/drug effects
- Spinal Cord/metabolism
- Spinal Cord/physiopathology
- Substance Withdrawal Syndrome/drug therapy
- Substance Withdrawal Syndrome/physiopathology
- Substance Withdrawal Syndrome/prevention & control
Collapse
Affiliation(s)
- Stuart A Dunbar
- Department of Anesthesiology, Pain Management Center, Baystate Medical Center, Tufts University, 3400 Main Street, Springfield, MA 01199, USA.
| | | | | |
Collapse
|
26
|
Caraceni A, Martini C, Zecca E, Fagnoni E. Cancer pain management and palliative care. HANDBOOK OF CLINICAL NEUROLOGY 2012; 104:391-415. [PMID: 22230457 DOI: 10.1016/b978-0-444-52138-5.00027-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Augusto Caraceni
- Palliative Care Department, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy.
| | | | | | | |
Collapse
|
27
|
Eisenberg E, McNicol ED, Carr DB. Efficacy of mu-opioid agonists in the treatment of evoked neuropathic pain: Systematic review of randomized controlled trials. Eur J Pain 2012; 10:667-76. [PMID: 16337151 DOI: 10.1016/j.ejpain.2005.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 10/21/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Several reviews of randomized controlled trials (RCTs) have shown the efficacy of mu-opioids in reducing spontaneous neuropathic pain (NP). However, relatively little is known about their specific efficacy for evoked pain, which is a significant problem for many patients with NP. The present systematic review assesses the efficacy of opioid agonists for the treatment of evoked NP based upon published RCTs. We searched articles in any language using the MEDLINE database (1966 to December 2004), the Cochrane Central Register of Controlled Trials (4th quarter, 2004) and the reference lists of retrieved papers, employing search terms for RCTs, opioids and NP. Only RCTs in which opioid agonists were given to treat NP of any etiology, and evoked pain was assessed were included. Data were extracted by two independent investigators. Nine articles met inclusion criteria and were classified as short-term (less than 24h; n=7) or intermediate-term trials (4 weeks; n=2). Although the scarcity of retrieved data precluded formal meta-analysis of short-term trials, we found that the intensity of dynamic mechanical allodynia was significantly attenuated by opioids relative to placebo in all studies. In contrast, no consistent effects on the magnitude of static allodynia, the threshold for mechanical allodynia or the threshold or magnitude of heat allodynia were found. The threshold and magnitude of cold-induced allodynia generally responded positively to opioid treatments in patients with peripheral pain syndromes, but not central pain syndromes. Evoked pain was studied in only two intermediate-term trials, in both of which oxycodone was significantly superior to placebo. The results of the two trials were combinable for a meta-analysis that showed an overall 24 points difference in endpoint pain intensities between patients given opioids and those treated with placebo (95% CI -33 to -15; p<0.00001). IN CONCLUSION short-term studies show that opioids can reduce the intensity of dynamic mechanical allodynia and perhaps of cold allodynia in peripheral NP. Insufficient evidence precludes drawing conclusions regarding the effect of opioids on other forms of evoked NP. A meta-analysis of intermediate-term studies demonstrates the efficacy of opioids over placebo for evoked NP. These findings are clinically relevant because dynamic mechanical allodynia and cold allodynia are the most prevalent types of evoked pain in NP.
Collapse
Affiliation(s)
- Elon Eisenberg
- Pain Relief Unit, Rambam Medical Center, Haifa Pain Research Group, the Technion-Israel Institute of Technology, P.O. Box 9602, Haifa 31096, Israel.
| | | | | |
Collapse
|
28
|
Varrassi G, Marinangeli F, Piroli A, Paladini A, Coaccioli S. Challenges in managing cancer pain. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2010.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Bolaños-Díaz R, Regalado-Rafael R. Economic evaluation of ibuprofen/codeine combination versus ibuprofen alone for acute pain treatment in Peru. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2011.00065.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Eisenberg E, Shifrin A. Reassessing the Need for Step 2 of the WHO Analgesic Ladder. J Pain Palliat Care Pharmacother 2011. [DOI: 10.3109/15360288.2011.600429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Sima L, Fang WX, Wu XM, Li F. Efficacy of oxycodone/paracetamol for patients with bone-cancer pain: a multicenter, randomized, double-blinded, placebo-controlled trial. J Clin Pharm Ther 2011; 37:27-31. [PMID: 21208247 DOI: 10.1111/j.1365-2710.2010.01239.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Bone-cancer pain is a common and refractory cancer pain. Opioids, on their own, do not control this type of pain well enough, and co-analgesics are necessary. METHODS Patients with bone metastasis-related pain at Numeric Rating Scale ≥4 were enrolled to this randomized placebo-controlled trial. They had also received morphine or transdermal fentanyl patches for at least 1 week. During the 3-day efficacy phase, patients received placebo or 1-3 tablets of oxycodone/paracetamol (5/325 mg), four times daily for 3 days. All patients kept a daily pain diary. The primary endpoint was the Pain Intensity Difference (PID). Secondary endpoints were cases of breakthrough pain and rescue morphine consumption. Additional analyses included the Short Form-6 Dimensions (SF-6D) quality-of-life scale and a general impression (GI) of patient satisfaction with treatment at the end of the phase. RESULTS AND DISCUSSION Of the 246 patients in the intent-to-treat set, 89·4% completed the 3-day efficacy phase. PIDs were 0·9 and 0·3 in the oxycodone/paracetamol and placebo groups respectively, on day 1 (P < 0·001), and 1·5 and 0·3 respectively on day 3 (P < 0·001). Thirty-eight patients in the treatment group, and 58 in the placebo group, suffered breakthrough pain on day 3 (P < 0·001). The SF-6D score decreased to 21·2 ± 2·5 in the oxycodone/paracetamol group at the end of the phase (P = 0·001). In the oxycodone/paracetamol group, 67% rated GI as good, very good, or excellent. WHAT IS NEW AND CONCLUSION Patients with bone-cancer pain, already on opioids, obtain clinically important, additional pain-control, with regular oxycodone/paracetamol dosing.
Collapse
Affiliation(s)
- L Sima
- National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China.
| | | | | | | |
Collapse
|
32
|
Yang CJ, Wang XW, Li X, Wu GC, Wang YQ, Mao-Ying QL. A rat model of bone inflammation-induced pain by intra-tibial complete Freund's adjuvant injection. Neurosci Lett 2010; 490:175-9. [PMID: 21182894 DOI: 10.1016/j.neulet.2010.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/10/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022]
Abstract
In prior studies, models of inflammatory pain were produced through injecting complete Freund's adjuvant (CFA) or capsaicin directly into either the deep somatic tissue or the animal's hind paw. In contrast, bone cancer-induced pain (BCIP) was simulated through injecting tumor cells into the cavity of the femur or the tibia. It has been reported that, due to differences in afferent innervation, the same stimulus to various tissue types might result in differing patterns of pain response. Hence, the aim of this study is to establish a rat model of bone inflammation-induced pain (BIIP) by injecting CFA into the tibial cavity, the same site involved in the BCIP model. The differences in body weight, bone histology, mechanical allodynia, thermal hyperalgesia, and the pain relieving effects of Celebrex on this model of BIIP were evaluated. The results showed that there was evidence of significant inflammation seen in the bone marrow two days after intra-tibial CFA injection, including nuclear condensation and fragmentation, massive neutrophilic granulocytes, and prominent fibrinous exudates. Fourteen days after injection, marked fibrosis of the bone was detected by histological staining. After unilateral CFA injection, behavioral studies showed mechanical allodynia to von Frey hair stimulation, but no thermal hyperalgesia was observed. Celebrex showed significant anti-allodynic effects on the BIIP model. The results demonstrated that CFA is an effective agent for inducing bone inflammation and subsequent pain-related behavior in rat models, and, thus, provides a practical and valuable contrast for BCIP research.
Collapse
Affiliation(s)
- Chang-Jiang Yang
- Department of Integrative Medicine and Neurobiology, Shanghai Medical College, Institute of Acupuncture Research, State Key Laboratory of Medical Neurobiology, Fudan University, 138 Yi-Xue-Yuan Road, Shanghai 200032, China
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
In the last decades, studies validating the WHO analgesic ladder have been shown to have methodological limitations and different problems are unresolved due to a lack of controlled studies on this subject. These problems include a better definition of the role of NSAIDs, the prolonged use of NSAIDs in cancer pain, and the utility of step 2. Moreover, the indications for using different strong opioids and alternate routes of administration to improve pain relief in difficult pain situations are not well established. The proportion of patients who do not benefit from these treatments remain unclear, and how the opioid response may be improved with the use of adjuvants is also uncertain. This review will offer an update on these problems and the existing therapeutic opportunities.
Collapse
Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit, Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| |
Collapse
|
34
|
Characterization of cancer-induced bone pain: an exploratory study. Support Care Cancer 2010; 19:1393-401. [PMID: 20680354 DOI: 10.1007/s00520-010-0961-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Cancer-induced bone pain (CIBP) is the commonest cause of pain in patients with cancer. Its association with increased morbidity combined with limitations of currently available therapies makes it a clinical challenge. Clinical characterization of this complex pain syndrome is essential in underpinning clinical management and informing future research. The aim of this exploratory study was to characterise CIBP using self-rating scales. PATIENTS AND METHODS A cross-sectional survey of patients with CIBP was carried out in a regional oncology centre. Patients described their pain over the preceding 24 h using the McGill Pain Questionnaire, Brief Pain Inventory (BPI), and a breakthrough pain questionnaire. Multiple linear regression analyses were conducted. RESULTS Fifty-five patients were recruited. Annoying, gnawing, aching, and nagging were the most commonly used words to describe CIBP. From the BPI, median average pain was 4/10 and worst pain was 7/10 on a 0-10 Numerical Rating Scale. The worst pain score correlated more strongly with BPI interference score (p=0.001). Forty-one patients had breakthrough pain. Patients with breakthrough pain had higher total BPI interference scores than those with no breakthrough pain; median (IQR); 35.0 (2.5-44.7) vs. 18.5 (5.5-26.7), p<0.01. Of the patients, 20/41 (48%) had breakthrough pain of rapid onset (less than 5 min) and short duration (less than 15 min). CONCLUSION In CIBP, worst pain most accurately reflects the characteristics of pain flares and functional impairment. Breakthrough pain is often unpredictable, sudden onset and short duration. Further characterization studies of CIBP in the broader cancer population are needed.
Collapse
|
35
|
Gardner-Nix J, Mercadante S. The Role of OROS®Hydromorphone in the Management of Cancer Pain. Pain Pract 2010; 10:72-7. [DOI: 10.1111/j.1533-2500.2009.00313.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
|
37
|
Improvement in Sensory Pain Rating After Palliative Systemic Radionuclide Therapy in Patients With Advanced Prostate Cancer. Am J Ther 2009; 16:127-32. [DOI: 10.1097/mjt.0b013e31816ddb5d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Abstract
Pain ranges in prevalence from 14-100% among cancer patients and occurs in 50-70% of those in active treatment. Cancer pain may result from direct invasion of tumor into nerves, bones, soft tissue, ligaments, and fascia, and may induce visceral pain through distension and obstruction. Cancer pain is multifaceted. Clinicians may describe cancer pain as acute, chronic, nociceptive (somatic), visceral, or neuropathic. Despite implementation of the WHO guidelines, reports of undertreatment of cancer pain persist in various clinical settings and in spite of decades of work to reduce unnecessary discomfort. Substantial obstacles to adequate pain relief with opioids include specific concerns of patients themselves, their family members, physicians, nurses, and the healthcare system. The WHO analgesic ladder serves as the mainstay of treatment for the relief of cancer pain in concert with tumoricidal, surgical, interventional, radiotherapeutic, psychological, and rehabilitative modalities. This multidimensional approach offers the greatest potential for maximizing analgesia and minimizing adverse effects. Primary therapies are directed at the source of the cancer pain and may enhance a patient's function, longevity, and comfort. Adjuvant therapies include nonopioids that confer analgesic effects in certain medical conditions but primarily treat conditions that do not involve pain. Nonopioid medications (over-the-counter agents) are useful in the management of mild to moderate pain, and their continuation through step 3 of the WHO ladder is an option after weighing a drug's risks and benefits in individual patients. Symptomatic treatment of severe cancer pain should begin with an opioid, regardless of the mechanism of the pain. They are very effective analgesics, titrate easily, and offer a favorable risk/benefit ratio. Cancer pain remains inadequately controlled despite the diagnostic and therapeutic means of ensuring that patients feel comfortable during their illness. Therefore, all practitioners need to make control of cancer pain a professional duty, even if they can only use the most basic and least expensive analgesic medications, such as morphine, codeine, and acetaminophen, to reduce human suffering.
Collapse
Affiliation(s)
- Paul J Christo
- Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | |
Collapse
|
39
|
Abstract
This article concentrates on recent evidence about opioid analgesics for persistent noncancer pain. Evidence confirms that opioids are drugs with a definite risk of adverse events. Therefore, before prescribing opioids, careful consideration must be given to be certain that the intended benefit of a particular opioid merits its use despite the potential side effects and to determine if the co-prescription of other pharmacologic agents could reduce the risk of adverse events. Strong opioids should be reserved for patients who fail to respond to other lower-risk options and only after proper consideration is given to the long-term consequences of strong opioid use. Problems associated with opioids dictate that more efficacious and safer drugs need to be found.
Collapse
Affiliation(s)
- Gary McCleane
- Rampark Pain Centre, 2 Rampark Dromore Road, Lurgan BT66 7JH, Northern Ireland, UK.
| | | |
Collapse
|
40
|
Eisenberg E. International Perspectives on Pain and Palliative Care. J Pain Palliat Care Pharmacother 2008. [DOI: 10.1080/15360280802536417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
41
|
Clark GT, Ram S. Orofacial pain and neurosensory disorders and dysfunction in cancer patients. Dent Clin North Am 2008; 52:183-x. [PMID: 18154870 DOI: 10.1016/j.cden.2007.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Orofacial pain and altered nerve sensation may be the initial sign of oropharyngeal or nasopharyngeal cancer. This article focuses on the most common orofacial pain conditions and neurosensory alterations that affect cancer patients, such as neuropathic pain, muscle spasm or contractures, mucositis, and increased or decreased sensory discrimination in the affected area. The various pharmacotherapeutic modalities for cancer pain management ranging from non steroidal anti-inflammatory drugs (NSAIDs) for mild pain to opioids for severe pain are discussed in detail.
Collapse
Affiliation(s)
- Glenn T Clark
- Orofacial Pain and Oral Medicine Center, Division of Diagnostic Sciences, School of Dentistry, University of Southern California, 925 West 34th Street, Room B-14, Los Angeles, CA 90089, USA.
| | | |
Collapse
|
42
|
Management of Cancer Pain. Oncology 2007. [DOI: 10.1007/0-387-31056-8_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Thomas J. Optimizing Opioid Management in Palliative Care. J Palliat Med 2007; 10 Suppl 1:S1-18; quiz S19-23. [DOI: 10.1089/jpm.2007.9828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Jay Thomas
- San Diego Hospice and Palliative Care, Department of Medicine, University of California–San Diego, San Diego, California
| |
Collapse
|
44
|
Abstract
Hundreds of thousands of Americans are affected every year by skeletal complications of oncologic disease. Recent developments in medical oncology, radiation oncology and radiology, particularly with respect to the use of bisphosphonate medication and radiofrequency techniques, have served to greatly lessen the morbidity associated with metastatic skeletal disease. Similarly, there has been significant advancement in the field of orthopaedic oncology in the areas of internal fixation, endoprosthetic implant design, and minimally invasive kyphoplasty technology. Given the palliative intent of intervention in this patient population, the goal of treatment of skeletal metastases must be optimization of limb function and ultimately, quality of life.
Collapse
Affiliation(s)
- Pamela M Aubert
- UCSF Comprehensive Cancer Center, Orthopaedic Oncology Service, 1600 Divisadero Street, San Francisco, CA 94115-1939, USA
| | | |
Collapse
|
45
|
Kontinen VK, Kalso E. Of mice and men: What can we predict from the effects of morphine in a mouse model of bone cancer? Pain 2007; 132:5-7. [PMID: 17854996 DOI: 10.1016/j.pain.2007.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 08/20/2007] [Indexed: 11/27/2022]
|
46
|
Omoti AE, Omoti CE. Pharmacological strategies for the management of cancer pain in developing countries. Pharm Pract (Granada) 2007; 5:99-104. [PMID: 25247009 PMCID: PMC4154742 DOI: 10.4321/s1886-36552007000300001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given 'by the ladder,' 'by the clock' and 'by the appropriate route' using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed.
Collapse
Affiliation(s)
- Afekhide E Omoti
- Department of Ophthalmology, University of Benin Teaching Hospital , Benin City, Nigeria
| | - Caroline E Omoti
- Department of Haematology, University of Benin Teaching Hospital , Benin City, Nigeria
| |
Collapse
|
47
|
Epstein JB, Elad S, Eliav E, Jurevic R, Benoliel R. Orofacial pain in cancer: part II--clinical perspectives and management. J Dent Res 2007; 86:506-18. [PMID: 17525349 DOI: 10.1177/154405910708600605] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cancer-associated pain is extremely common and is associated with significant physical and psychological suffering. Unfortunately, pain associated with cancer or its treatment is frequently under-treated, probably due to several factors, including phobia of opioids, under-reporting by patients, and under-diagnosis by healthcare workers. The most common etiology of cancer pain is local tumor invasion (primary or metastatic), involving inflammatory and neuropathic mechanisms; these have been reviewed in Part I. As malignant disease advances, pain usually becomes more frequent and more intense. Additional expressions of orofacial cancer pain include distant tumor effects, involving paraneoplastic mechanisms. Pain secondary to cancer therapy varies with the treatment modalities used: Chemo-radiotherapy protocols are typically associated with painful mucositis and neurotoxicity. Surgical therapies often result in nerve and tissue damage, leading, in the long term, to myofascial and neuropathic pain syndromes. In the present article, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. As a presenting symptom of orofacial cancer, pain is often of low intensity and diagnostically unreliable. Diagnosis, treatment, and prevention of pain in cancer require knowledge of the presenting characteristics, factors, and mechanisms involved.
Collapse
Affiliation(s)
- J B Epstein
- Department of Oral Medicine and Diagnostic Sciences, MC-838, College of Dentistry, 801 S. Paulina St., Chicago, IL 60612, USA.
| | | | | | | | | |
Collapse
|
48
|
Abstract
Opioids are extensively used in the management of all types of pain and their use is underpinned by extensive trial evidence and an abundance of practical experience. We are still amassing insight into how they achieve their pain-relieving effects, however, and this understanding becomes more complex as time progresses and shows that opioids are medications with complex and diverse central and peripheral nervous system effects. Despite the 200 years that have passed since the chemical isolation of morphine, every year brings new understanding of the mode of action, propensity to cause side effects, and appropriate clinical use of opioids. This article concentrates on this "new" evidence as disclosed by recent publications.
Collapse
Affiliation(s)
- Gary McCleane
- Rampark Pain Centre, 2 Rampark Dromore Road, Lurgaqn BT66 7JH, Northern Ireland, UK.
| | | |
Collapse
|
49
|
Pan H, Zhang Z, Zhang Y, Xu N, Lu L, Dou C, Guo Y, Wu S, Yue J, Wu D, Dai Y. Efficacy and Tolerability of Oxycodone Hydrochloride Controlled-Release Tablets in Moderate to Severe Cancer Pain. Clin Drug Investig 2007; 27:259-67. [PMID: 17358098 DOI: 10.2165/00044011-200727040-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Oxycodone is a semisynthetic opioid analgesic drug classed as a strong opioid. The controlled-release oxycodone tablet formulation (OCRT) was approved in China in 2004 for management of moderate to severe cancer pain. Few data about the efficacy of OCRT and clinical outcomes in Chinese patients taking this drug are available. The purpose of this study was to evaluate the efficacy and tolerability of this drug for relief of moderate to severe cancer pain in Chinese patients. METHODS This was a prospective, open-label, multicentre clinical trial carried out in ten hospitals in Zhejiang Province, China. Patients with cancer pain with a score > or =4 (numerical rating scale) were enrolled. They received oral OCRT at an initial dosage of 5mg every 12 hours for patients scoring 4-6 and 10mg every 12 hours for patients scoring > or =7. Doses were then titrated on an individual basis. Onset of analgesic action, pain score and quality-of-life (QOL) scores - including items measuring family understanding and support, sleep, mental state, appetite, fatigue, and activities of daily life - were evaluated. Adverse effects were also documented. RESULTS 216 patients (126 males and 90 females) aged 22-84 years were enrolled. The total mean OCRT dosage was 445.2 +/- 361.6mg (range 130-2320mg). The daily dosages of the vast majority of cases (89%) were between 10mg and 30mg. Onset of analgesic action occurred within 1 hour in 198 cases (91.7%) following administration of OCRT. 82.4% of cases were titrated to a steady dosage level within 2 days following administration of the first dose of medication. Pain score decreased significantly (p < 0.01) from 7.1 +/- 1.2 at baseline to 2.3 +/- 1.2 one week after starting medication and 1.8 +/- 0.9 four weeks after starting medication. Scores on all six QOL items increased significantly (p < 0.01) compared with baseline but showed varying rates of improvement. Adverse events included constipation, nausea, vomiting, drowsiness and dysuria. These were noted most frequently in the first week (25.5% of patients) and lessened over time. No severe adverse events were noted. CONCLUSION We conclude that OCRT is well tolerated and effective in controlling moderate to severe cancer pain in Chinese patients.
Collapse
Affiliation(s)
- Hongming Pan
- Medical Oncology Department, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Cancer pain assessment and management are integral to palliative medicine. This paper reviews recent publications in the period 1999-2004 in the broad categories of epidemiology, pain assessment, nonpharmacologic approaches to cancer pain (radiation therapy, anesthetic blocks, palliative surgery and chemotherapy, complementary and alternative medicine), and in nociceptive pain, neuropathic pain, visceral pain, and bone pain.
Collapse
Affiliation(s)
- Victor T Chang
- VA New Jersey Health Care System, PDIA Faculty Scholar, East Orange, New Jersey 07018, USA.
| | | | | | | |
Collapse
|