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Szylak R, Bhargava D, Pridgeon M, Srinivasaiah R, Vijayendra V, Osman-Farah J. Open Thoracic Cordotomy for Cancer Pain with Intraoperative Neuromonitoring: A Case Series and Critical Review of the Literature. World Neurosurg 2023; 179:e90-e101. [PMID: 37574190 DOI: 10.1016/j.wneu.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Cordotomy is a viable option for patients with intractable cancer pain and limited survival. Open thoracic cordotomy is offered when patients are not candidates for percutaneous cordotomy. After the open procedure, traditionally performed purely based on anatomic landmarks, up to 22% of patients experience postoperative limb weakness. The objective of this study is to report our experience with neurophysiology-guided open cordotomy along with a critical review of the literature. METHODS Between 2019 and 2022, 5 open thoracic cordotomies were performed in our center. Intraoperative neurophysiologic monitoring was used in all cases to guide the lesion and standard single-level laminectomy or hemilaminectomy was performed for exposure. Outcome measures were retrospectively reviewed focusing on pain control and neurologic status. Existing literature on cordotomy was critically reviewed. RESULTS There was satisfactory pain relief with preservation of motor function in all 5 cases. Temperature sensation was preserved in all but 1 patient, who lost it after the previous ipsilateral percutaneous cordotomy (PCC). No procedural complications were experienced. We found that the neurophysiology monitoring lesion was guided anterior compared with what would have been lesioned on an anatomic basis. CONCLUSIONS Open thoracic cordotomy is a safe and effective procedure for intractable cancer-related pain. Technical advancements significantly reduced mortality and major morbidity of PCC. Our series suggests that neurophysiology monitoring alters the location of the lesion and may help better targeting of pain fibers within the spinothalamic tract and preserve other long tracts. The safety profile of open cordotomy with neurophysiology compares favorably with the PCC.
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Affiliation(s)
- Rafal Szylak
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
| | - Deepti Bhargava
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Michael Pridgeon
- Department of Neurophysiology, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Rajesha Srinivasaiah
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Vishwas Vijayendra
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Jibril Osman-Farah
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
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Gomes-Ferraz CA, Rezende G, Fagundes AA, De Carlo MMRDP. Assessment of total pain in people in oncologic palliative care: integrative literature review. Palliat Care Soc Pract 2022; 16:26323524221125244. [PMID: 36172038 PMCID: PMC9511321 DOI: 10.1177/26323524221125244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
The promotion of comfort and quality of life of people with cancer in palliative care requires flawless evaluation and management of pain, understood in its multidimensionality and integrality. The objective of this study was to present an overview of the scientific production referring to evaluation of the pain and total pain of patients with advanced cancer in palliative care. The study involved an integrative literature review, searching the databases PubMed, Embase, Cinahl, Lilacs and Web of Science using the descriptors 'Total Pain', 'Cancer Pain', 'Pain', 'Symptom Assessment', 'Pain Measurement', 'Pain Evaluation', 'Neoplasms', 'Cancer', 'Tumor', 'Palliative Care', 'Hospice Care', and 'Terminal Care'. To select the studies, the authors used the reference manager Mendeley and the application Rayyan™, as well as blind and independent peer review. Twenty-two articles were selected, published between 2002 and 2020 in different countries, and classified into two thematic units: 'Physical, social, emotional, and spiritual factors related to pain in cancer' (N = 13) and 'Importance of the overall evaluation and multidisciplinary team in the management of pain' (N = 9). Advanced cancer is associated with high mortality, a decline in health status, the presence of pain, and complex psychosocial concerns. Pain and symptoms in patients in palliative care should be evaluated as a whole and controlled thorough the work of an interdisciplinary team. The qualitative synthesis of the results demonstrates that most of the evaluated studies have a mixed nature; there are significant methodological differences among them and a low level of evidence in studies relating to the subject of pain evaluation in palliative care.
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Affiliation(s)
- Cristiane Aparecida Gomes-Ferraz
- Curso de Terapia Ocupacional, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14058-190 Ribeirão Preto, SP, BrazilNursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Gabriela Rezende
- Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Amanda Antunes Fagundes
- Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Marysia Mara Rodrigues do Prado De Carlo
- Curso de Terapia Ocupacional, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14058-190 Ribeirão Preto, SP, BrazilRibeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
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Golanov AV, Kostjuchenko VV, Antipina NA, Isagulyan ED, Makashova ES, Abuzarova GR, Astafyeva LI, Savateev AN, Asriyants SV. [Radiosurgical hypophysectomy in cancer pain treatment. Literature review and clinical case]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:102-109. [PMID: 33095538 DOI: 10.17116/neiro202084051102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cancer pain is one of the main problem in modern medicine. According European Society for Medical Oncology data, cancer pain prevalence is 64% among patient with terminal stage of disease and in 46% standard pain therapy was ineffective. Radiosurgical hypophysectomy is one of the important and perspective method in cancer pain treatment. This method could be offered patient with chronic disease. According literature review, endocrinology complications were very rare and occurred 10 months after therapy. Value of analgesic effect was 70-90%. In some trials, procedure was effective not only nociceptive, but also in neuropathic pain. More trials require for determination of indications and mechanism of action. The case of successful relief of resistant pain in patient with pancreatic cancer by means of radiosurgical hypophysectomy is described.
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Affiliation(s)
- A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - E S Makashova
- Burdenko Neurosurgical Center, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
| | - G R Abuzarova
- Gertsen Moscow Research Oncological Institute, National Medical Research Center of Radiology, Obninsk, Russia
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García CA, Santos Garcia JB, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C, Rocío Guillén Núnez MD, Hernández Castro JJ, Kraychete DC, Lara-Solares A, Lech O, Rico Pazos MA, Gallegos MS, Marcondes LP. Undertreatment of pain and low use of opioids in Latin America. Pain Manag 2018; 8:181-196. [PMID: 29774774 DOI: 10.2217/pmt-2017-0043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.
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Affiliation(s)
| | | | | | - Frantz Colimon
- Centro Oncológico de Antioquia, Medellín, Antioquia, Colombia
| | | | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia
| | | | | | - Durval Campos Kraychete
- Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil
| | - Argelia Lara-Solares
- Department of Pain Medicine & Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - Osvandré Lech
- Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil
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Ehrlich O, Walker RK. Pain and social processes for hospice cancer patients: An integrative review. Eur J Oncol Nurs 2016; 25:83-89. [DOI: 10.1016/j.ejon.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 09/25/2016] [Accepted: 10/05/2016] [Indexed: 12/01/2022]
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Carlson CL. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review. J Pain Res 2016; 9:515-34. [PMID: 27524918 PMCID: PMC4965221 DOI: 10.2147/jpr.s97759] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%-100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines - while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity.
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Affiliation(s)
- Cathy L Carlson
- School of Nursing, Northern Illinois University, DeKalb, IL, USA
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Mello BS, Massutti TM, Longaray VK, Trevisan DF, de Fátima Lucena A. Applicability of the Nursing Outcomes Classification (NOC) to the evaluation of cancer patients with acute or chronic pain in palliative care. Appl Nurs Res 2016; 29:12-8. [DOI: 10.1016/j.apnr.2015.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/31/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
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Bhatnagar S, Gupta M. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain. Indian J Palliat Care 2015; 21:137-47. [PMID: 26009665 PMCID: PMC4441173 DOI: 10.4103/0973-1075.156466] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients.
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Affiliation(s)
- Sushma Bhatnagar
- Department of Onco-Anaesthesia, Pain and Palliative Care, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Maynak Gupta
- Department of Anaesthesia, Shri Guru Rai Institute of Medical and Health Sciences, Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India
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