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Alinejadfard M, Rajai Firouzabadi S, Mohammadi I, Oraee S, Golsorkh H, Mahdavi S. Efficacy and safety of hydromorphone for cancer pain: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:283. [PMID: 39123132 PMCID: PMC11312680 DOI: 10.1186/s12871-024-02638-y] [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: 05/23/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Cancer pain significantly impacts individuals' quality of life, with opioids being employed as the primary means for pain relief. Nevertheless, concerns persist regarding the adverse reactions and effectiveness of opioids such as morphine. Hydromorphone, recognized as a potent opioid, is a viable alternative for managing cancer-related pain. The goal of this systematic review and meta-analysis was to determine the effectiveness and safety characteristics of hydromorphone in comparison to other opioids, as well as different methods of administering this medication within the scope of cancer pain treatment. METHODS The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched on December 25th, 2023. Following the PRISMA guidelines, a systematic investigation of databases was carried out, and suitable studies were chosen according to predetermined criteria (PICO framework). The meta-analyses were performed using a random-effects model. RESULTS This review included 18 RCTs with 2271 patients who compared hydromorphone with morphine, oxycodone, or fentanyl, as well as other types of hydromorphone. Hydromorphone demonstrated efficacy similar to that of morphine and oxycodone in reducing cancer pain intensity, decreasing additional analgesic consumption, and improving quality of life. However, morphine showed slight superiority over hydromorphone in reducing breakthrough pain. Adverse events were comparable between hydromorphone and morphine or oxycodone. Patient-controlled and clinician-controlled hydromorphone administration routes yielded similar outcomes. CONCLUSIONS The outcomes of this study substantiate the efficacy of hydromorphone in the management of cancer-related pain, demonstrating similar levels of effectiveness and safety as morphine and oxycodone. These findings are consistent with prior comprehensive analyses, suggesting that hydromorphone is a feasible choice for alleviating cancer-associated pain. Additional investigations are warranted to determine its efficacy in distinct patient cohorts and for different modes of administration. TRIAL REGISTRATION Prospero registration ID: CRD42024517513. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails .
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Affiliation(s)
| | | | - Ida Mohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar Street, Tehran, Iran
| | - Soroush Oraee
- School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar Street, Tehran, Iran
| | - Hossein Golsorkh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar Street, Tehran, Iran
| | - Sajjad Mahdavi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar Street, Tehran, Iran
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2
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Sakellakis M, Reet J, Kladas M, Hoge G, Chalkias A, Radulovic M. Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis. Oncol Rev 2024; 18:1439415. [PMID: 39156014 PMCID: PMC11327047 DOI: 10.3389/or.2024.1439415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
Elevated resting heart rate is frequently observed in cancer patients, and is associated with increased mortality. Although specific chemotherapeutic agents can induce cardiotoxicity, the presence of sinus tachycardia in chemotherapy-naive patients suggests other factors likely contribute to this clinical presentation. Despite its prevalence, cancer-associated resting sinus tachycardia has not been fully recognized and comprehensively described as a separate clinical entity. Secondary effects of cancer, especially structural cardiac changes, secretory factors (inflammatory cytokines), and thromboembolic disease can cause resting tachycardia. Alternatively, rapid heart rate may reflect compensatory mechanisms responding to increased metabolic demands, raised cardiac output states, and even pain. Hence, cancer-associated tachycardia presents a clinical dilemma; acute life-threatening conditions (such as sepsis, pulmonary embolism, etc.) must be ruled out, but cancer itself can explain resting sinus tachycardia and more conservative management can avoid unnecessary testing, cost and patient stress. Furthermore, identification and management of cardiac conditions associated with cancer may improve survival and the quality of life of cancer patients.
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Affiliation(s)
- Minas Sakellakis
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jashan Reet
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Michail Kladas
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Gregory Hoge
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Miroslav Radulovic
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
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3
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Zhang J, Wu W, Ren Y, Yuan Y, Jia L. Electroacupuncture for the treatment of cancer pain: a systematic review and meta-analysis of randomized clinical trials. FRONTIERS IN PAIN RESEARCH 2023; 4:1186506. [PMID: 37255718 PMCID: PMC10225685 DOI: 10.3389/fpain.2023.1186506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objective This paper aims to review the current evidence on electroacupuncture as an effective and safe therapy for cancer pain management. Methods Five databases were searched from their inception through November 11, 2022. Only the randomized controlled trials that meet the eligibility criteria were finally included in the study. Literature screening and data extraction were performed independently by two reviewers, and RevMan 5.3 used for meta-analysis. Results A total of 17 RCTs met our inclusion criteria. We used 8 indicators to estimate the meta-analysis results, most of which proved statistically significant, including VAS scores, NRS scores, and KPS scores. To be specific, VAS scores (MD = -1.41, 95% CI: -2.42 to -0.41, P = 0.006) and NRS scores (MD = -1.19, 95% CI: -1.72 to -0.66, P < 0.0001) were significantly lower in the treatment group compared to the control group. The treatment group's KPS scores (MD = 5.48, 95% CI: 3.27 to 7.69, P < 0.00001) were higher than those of the control group. Also, in the treatment group, the number of burst pain (MD = -2.66, 95% CI: -3.32 to -1.99, P < 0.00001) and side effect rates (RR = 0.51, 95% CI: 0.39 to 0.67, P < 0.00001) greatly reduced, while the response rate (RR = 1.17, 95% CI: 1.09 to 1.26, P < 0.0001) significantly increased compared to the control group. Conclusion This study demonstrates the advantages of electroacupuncture in the treatment of cancer pain. Meanwhile, rigorous RCTs should be designed and conducted in the future to further demonstrate the exact efficacy of electroacupuncture. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022376148.
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Affiliation(s)
- Junning Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weizhen Wu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuehan Ren
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Liqun Jia
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
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4
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Shah D, Lokapur M, Kumar N, Shah H. A review of chronic pain with depression and/or anxiety comorbidities in the Indian population. INDIAN JOURNAL OF PAIN 2023. [DOI: 10.4103/ijpn.ijpn_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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5
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Liu Y, May BH, Hyde AJ, He Y, Guo X, Zhang AL, Lu C, Xue CC, Zhang H. Topical Traditional Chinese Medicines for Cancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Integr Cancer Ther 2023; 22:15347354231210870. [PMID: 37962002 PMCID: PMC10647965 DOI: 10.1177/15347354231210870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Safe and effective management of cancer-related pain is a worldwide challenge. In the search for treatment options, natural products used in Chinese herbal medicines (CHMs) have received attention in clinical studies for their effects on cancer-related pain. The objective of this systematic review is to evaluate the clinical evidence for topically applied CHMs as adjunctive treatments for cancer pain management. METHODS Nine biomedical databases and 4 clinical trial registries were searched for randomized-controlled trials (RCTs) that reported measures of pain and/or quality of life. Risk of bias was assessed using the Cochrane tool. Meta-analysis employed mean difference (MD) with 95% confidence intervals (random effects). RESULTS Twenty (20) RCTs (1636 participants) met the inclusion criteria. Meta-analyses were grouped based on the comparisons and outcome measures. For pain intensity, there was a greater reduction in the topical CHM group versus placebo (MD -0.72 [-1.04, -0.40]), no difference when compared to tramadol (MD -0.15 [-0.38, 0.08]), and a greater reduction when topical CHMs were combined with conventional analgesic medications (MD -0.67 [-0.93, -0.40]). Analgesic onset time was reduced in the CHM group compared to tramadol (MD -26.02 [-27.57, -24.47] minutes), and for CHMs combined with conventional medications (MD -19.17 [-21.83, -16.52] minutes). When CHMs were combined with analgesic medications, improvements were found for duration of analgesia (MD 1.65 [0.78, 2.51] hours), analgesic maintenance dose (MD -31.72 [-50.43, -13.01] milligrams/day), and quality of life. CONCLUSION Addition of topical CHMs to conventional analgesic medications was associated with improved outcomes for pain intensity, some other pain-related outcomes, and measures of quality of life. Limitations included methodological issues in some studies and considerable heterogeneity in some pooled results.
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Affiliation(s)
- Yihong Liu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Brian H. May
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Anna J. Hyde
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yihan He
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Chuanjian Lu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Haibo Zhang
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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6
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Repetti CSF, Rueda JR, Porto CD, Franco RP, Girio RJS, Manhoso FFR, da Costa IB. Palliative care for cancer patients in veterinary medicine. VET MED-CZECH 2023; 68:2-10. [PMID: 38384994 PMCID: PMC10878255 DOI: 10.17221/76/2022-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/15/2022] [Indexed: 02/23/2024] Open
Abstract
Neoplasms account for approximately half of the deaths of dogs over ten years of age. This finding, associated with the fact that canine cancer patients will often suffer from the consequences of the systemic spread of the tumour and paraneoplastic syndromes, shows the importance of understanding palliative care by veterinarians and owners. In view of this, this review aims to address palliative care that can be used in veterinary medicine to promote the patient's well-being and quality of life.
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Affiliation(s)
| | | | - Camila Dias Porto
- Department of Veterinary Science, University of Marília, Marília/SP, Brazil
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7
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Yang M, Baser RE, Li SQ, Hou YN, Chong K, Zhang YL, Hoque I, Bao T, Mao JJ. Tibetan Herbal Pain-Relieving Plaster for Chronic Musculoskeletal Pain Among Cancer Survivors: Study Protocol of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2022; 13:878371. [PMID: 35600872 PMCID: PMC9114465 DOI: 10.3389/fphar.2022.878371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic pain is common and debilitating in cancer survivors. Tibetan herbal pain-relieving plaster is used as an external analgesic to treat musculoskeletal pain in China; however, its safety and efficacy have not been evaluated via clinical trials in cancer survivors. We designed this Phase II randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT04916249) to assess the efficacy and safety of the pain-relieving plaster for temporary pain relief among cancer survivors with chronic musculoskeletal pain. Under ethical approval from the Institutional Review Board at the Memorial Sloan Kettering Cancer Center, we will enroll eligible cancer survivors who have a clinical diagnosis of moderate to severe chronic musculoskeletal pain in this study. We use a central randomization system to allocate the eligible participants to either the treatment or the control group in a 1:1 ratio, with stratification by baseline opioid use. We will instruct the participants to apply the herbal patch (Tibetree Pain-Relieving Plaster, Tibet Cheezheng Tibetan Medicine Co. Ltd., Tibet, China) or placebo patch daily at the focal area with worst pain for 14 consecutive days. Study physician, participant, outcome assessor, and biostatistician are blinded to the group allocation. The primary outcome is pain severity measured by the Brief Pain Inventory on Days 2–7. Secondary outcomes include changes in insomnia, anxiety, depression, fatigue, pressure pain threshold, pain medication use, and global impression of change. We will also monitor the adverse events throughout the study period. Statistical analysis will follow the intention-to-treat principle and linear mixed modeling will be used. With rigorous design and implementation, this randomized, placebo-controlled trial will provide the initial evidence on the efficacy and safety of the pain-relieving plaster for pain relief among cancer survivors with chronic musculoskeletal pain.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY, United States
| | - Susan Q. Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yen-Nien Hou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Kamyar Chong
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Yi Lily Zhang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Irfan Hoque
- Investigational Drug Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering, New York, NY, United States
- *Correspondence: Jun J. Mao,
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8
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Sheldon BL, Bao J, Khazen O, Pilitsis JG. Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:699993. [PMID: 35295456 PMCID: PMC8915692 DOI: 10.3389/fpain.2021.699993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.
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Affiliation(s)
- Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Jonathan Bao
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States.,Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
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9
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Forte AJ, Guliyeva G, McLeod H, Dabrh AMA, Salinas M, Avila FR, Perlman A. The Impact of Optimism on Cancer-Related and Postsurgical Cancer Pain: A Systematic Review. J Pain Symptom Manage 2022; 63:e203-e211. [PMID: 34563629 DOI: 10.1016/j.jpainsymman.2021.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The impact of psychological factors on pain levels continues to be of interest throughout a cancer patient's journey. The relationship between pain and optimism has been described previously in patients with various diseases. OBJECTIVES We further investigated the effect of optimism on pain levels felt by patients diagnosed and living with cancer before and after surgery. MATERIALS AND METHODS The search strategy for relevant articles from inception through June 2020 included five databases. The main outcome of interest was the effect of optimism on cancer-related pain. RESULTS We identified 482 studies. After the full-text screening, seven articles meeting the inclusion criteria were included. Seven studies were analyzed and are included in the data table. Of the seven included articles, four articles described the association of optimism with cancer pain; four articles studied the relationship between optimism and chronic postsurgical pain (CPSP), and one article investigated optimism's relationship with acute postsurgical pain (APSP). All articles observed a negative correlation between optimism and pain levels. CONCLUSION Despite the differences in the pathophysiology of pain types investigated, and which stage of the patient's journey pain was experienced, all studies reported a negative association with the level of optimism and pain described by patients. Therefore, promoting and supporting psychological coping techniques, including optimism for cancer patients may decrease patients' suffering, increase their quality of life at different cancer stages, and reduce opioid use.
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Affiliation(s)
- Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
| | - Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Heidi McLeod
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Abd Moain Abu Dabrh
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA; Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Manisha Salinas
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA; Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam Perlman
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Ardani DM, Surarso B, Purnami N, Perdana RF. Changes in Plasma Beta-Endorphin Levels in Stage III–IV Nasopharyngeal Carcinoma Patients Post World Health Organization 3-Step Analgesic Ladder Therapy. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1740108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Nasopharyngeal carcinoma (NPC) is the most common malignancy in the field of otorhinolaryngology, and chronic pain is identical with this malignancy. Pain therapy according to World Health Organization (WHO) recommendations is WHO 3-step analgesic ladder. Pain is subjective and related to the function of beta-endorphin hormone.
Objective Analyzing the relationship between the degree of pain and plasma endorphin levels in stage III–IV NPC patients before and after the administration of WHO 3-step analgesic ladder.
Materials and Methods The study design used pretest and posttest without control design. Participants were given WHO 3-step analgesic ladder therapy for 3 days. The participants then rated the pain scale using the visual analog scale (VAS) and plasma beta-endorphin levels in venous blood. The statistical test used the dependent t-test, Wilcoxon test, and Spearman test with p < 0.05, confidence interval: 95%.
Results There were 14 stage-III NPC patients with moderate pain (78.57%) and 31 stage-IV NPC participants had moderate pain (83.87%; p = 0.071). The VAS value in the moderate pain group before and after therapy was 82.22 and 66.67%, respectively (p < 0.001). The values of plasma beta-endorphin levels before and after therapy were 74.89 ± 69.12 and 72.49 ± 75.53 pg/mL, respectively (p = 0.647). Plasma beta-endorphin levels were −19.20 ± 37.72 pg/mL (mild pain), −4.76 ± 35.30 pg/mL (moderate pain), and −21.67 ± 6.27 pg/mL (severe pain; p = 0.717).
Conclusion Pain levels in advanced NPC patients have decreased after the therapy, but plasma beta-endorphin levels have no significant difference.
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Affiliation(s)
- Diar Mia Ardani
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bakti Surarso
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nyilo Purnami
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Rizka Fathoni Perdana
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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11
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Chen KJ, Tai YT, Chang EH, Kuo LN, Kuo CN. Effectiveness of collaboration between oncology pharmacists and anaesthesiologists for inpatient cancer pain management: A pilot study in Taiwan. J Int Med Res 2021; 49:3000605211055415. [PMID: 34772313 PMCID: PMC8593302 DOI: 10.1177/03000605211055415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the collaboration between oncology pharmacists and anaesthesiologists for improving pain control management in cancer patients. METHODS This retrospective case-control pilot study enrolled inpatients with active cancer and a pain score of >3 at least once per day for 3 consecutive days. The study group was selected from June 2018 to January 2019. Patients with the same inclusion criteria were selected between November 2017 and May 2018 to serve as the comparison group. The primary outcome was the percentage of patients that experienced pain relief within 7 days from initial pain attack. RESULTS A total of 71 and 77 patients were enrolled in the study and comparison groups. More patients in the study group experienced pain relief within 7 days from the index date (78.9% [56 of 71 patients] versus 72.7% [56 of 77 patients], respectively). The service increased the rate of intervention from attending physicians within 4 days from index date and quality of opioid management. CONCLUSION The collaboration between oncology pharmacists and anaesthesiologists for cancer pain management may be associated with an increase in the rate of pain relief in cancer patients with poor pain control.
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Affiliation(s)
- Kuan-Ju Chen
- Department of Pharmacy, 38032Taipei Medical University, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei
| | - Yu-Ting Tai
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Elizabeth H Chang
- Department of Pharmacy, 38032Taipei Medical University, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Na Kuo
- Department of Pharmacy, 38032Taipei Medical University, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei
| | - Chun-Nan Kuo
- Department of Pharmacy, 38032Taipei Medical University, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei
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12
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Cancer Pain Syndromes. Cancer Treat Res 2021; 182:17-25. [PMID: 34542873 DOI: 10.1007/978-3-030-81526-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pain from cancer can present in a multitude of ways. In this chapter, we will identify the types of cancer pain and their etiologies. Following this, we will explore how cancer pain can present as somatic pain, visceral pain, and neuropathic pain. We will explore the aspects of the history and physical examination that point to specific diagnoses of pain and how to appropriately treat each diagnosis appropriately. Finally, we will touch upon a phenomenon known as opioid neurotoxicity.
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13
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Chen C, Li SQ, Bao T, Zhang L, Seluzicki C, Mao JJ. A Systematic Review of CheeZheng Pain Relieving Plaster for Musculoskeletal Pain: Implications for Oncology Research and Practice. Integr Cancer Ther 2021; 19:1534735420918933. [PMID: 32880472 PMCID: PMC7485161 DOI: 10.1177/1534735420918933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is a common and debilitating condition for cancer patients. Existing therapies for these pain conditions have substantial limitations. To identify an integrative approach to pain management, we conducted a systematic review to evaluate the safety and efficacy of a Tibetan herbal-based topical agent, CheeZheng Pain Relieving Plaster (PRP), for the treatment of osteoarthritis (OA) pain. METHODS We extracted citations from PubMed and Chinese databases (CNKI, WanFang Data, and CQVIP). We included randomized clinical trials evaluating the effectiveness and safety of CheeZheng PRP compared to conventional OA pain treatments. RESULTS Twenty-two randomized clinical trials (n = 2556 participants) compared CheeZheng PRP against nonsteroidal anti-inflammatory drugs (11), glucosamine (2), intraarticular corticosteroid (2), hyaluronic acid injections (6), and acetaminophen (1). Ten studies found a statistically greater effectiveness (assessed by ≥30% reduction in symptom severity) of CheeZheng PRP in improving OA pain (measured by the Visual Analogue Scale), stiffness, and function compared to control. Ten studies reported that 4.8% of participants experienced application site skin irritation that resolved after discontinuing the plaster. Randomization was not sufficiently described in most studies, and no placebo-controlled trials were identified. CONCLUSIONS There is promising evidence for the safety and clinical effectiveness of CheeZheng PRP to treat OA; however, lack of placebo control and unclear descriptions of randomization increase the potential risk for bias. Future randomized, placebo-controlled trials are needed to establish the safety and efficacy of CheeZheng PRP for pain management in oncology settings.
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Affiliation(s)
- Connie Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Lo Bianco G, Papa A, Schatman ME, Tinnirello A, Terranova G, Leoni MLG, Shapiro H, Mercadante S. Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques. J Clin Med 2021; 10:2303. [PMID: 34070601 PMCID: PMC8198659 DOI: 10.3390/jcm10112303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. RESULTS Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95124 Catania, Italy;
- Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
| | - Alfonso Papa
- Pain Department, AO “Ospedali dei Colli”, Monaldi Hospital, 80131 Naples, Italy;
| | - Michael E. Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA;
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Andrea Tinnirello
- Anesthesiology and Pain Management Unit, Azienda Socio Sanitaria Territoriale della Franciacorta, 25032 Chiari, Italy
| | - Gaetano Terranova
- Anaesthesia and Intensive Care Department, Asst Gaetano Pini, 20122 Milano, Italy;
| | | | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Sebastiano Mercadante
- Pain Relief and Supportive Care, Private Hospital La Maddalena, 90100 Palermo, Italy;
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15
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de Almeida AS, Bernardes LDB, Trevisan G. TRP channels in cancer pain. Eur J Pharmacol 2021; 904:174185. [PMID: 34015320 DOI: 10.1016/j.ejphar.2021.174185] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 01/06/2023]
Abstract
Chronic pain is a common symptom experienced during cancer progression. Additionally, some patients experience bone pain caused by cancer metastasis, which further complicates the prognosis. Cancer pain is often treated using opioid-based pharmacotherapy, but these drugs possess several adverse effects. Accordingly, new mechanisms for cancer pain management are being explored, including transient receptor potential channels (TRPs). TRP ion channels are expressed in several tissues and play a key role in pain detection, especially TRP vanilloid 1 (TRPV1) and TRP ankyrin 1 (TRPA1). In the present review, we describe the role of TRPV1 and TRPA1 involved in cancer pain mechanisms. Several studies have revealed that the administration of TRPV1 or TRPA1 agonists/antagonists and TRPV1 or TRPA1 knockdown reduced sensitivity to nociception in cancer pain models. TRPV1 was also found to be involved in various models of cancer-induced bone pain (CIBP), with TRPV1 expression reportedly enhanced in some models. These studies have demonstrated the TRPV1 or TRPA1 association with cancer pain in models induced by tumour cell inoculation into the bone cavity, hind paw, mammary fat pad, and sciatic nerve in mice or rats. To date, only resiniferatoxin, a TRPV1 agonist, has been evaluated in clinical trials for cancer pain and showed preliminary positive results. Thus, TRP channels are potential targets for managing cancer-related pain syndromes.
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Affiliation(s)
- Amanda Spring de Almeida
- Programa de Pós-Graduação Em Farmacologia, Universidade Federal de Santa Maria (UFSM), 97105-900, Santa Maria, RS, Brazil
| | - Laura de Barros Bernardes
- Programa de Pós-Graduação Em Farmacologia, Universidade Federal de Santa Maria (UFSM), 97105-900, Santa Maria, RS, Brazil
| | - Gabriela Trevisan
- Programa de Pós-Graduação Em Farmacologia, Universidade Federal de Santa Maria (UFSM), 97105-900, Santa Maria, RS, Brazil.
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16
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Park SK, Park JA, Yang SY, Shin JY, Koh H. The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data. Curr Med Res Opin 2020; 36:1825-1833. [PMID: 32965131 DOI: 10.1080/03007995.2020.1826917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients. METHODS We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors. RESULTS After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06-3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43-2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61-3.34). CONCLUSIONS From the payer's perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.
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Affiliation(s)
- Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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17
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Sousa AM, Grigio TR, Ashmawi HA, Ribeiro Júnior U. Cancer pain treatment during the COVID-19 pandemic: institutional recommendations. Clinics (Sao Paulo) 2020; 75:e2208. [PMID: 32844957 PMCID: PMC7426599 DOI: 10.6061/clinics/2020/e2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Angela Maria Sousa
- Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Thiago Ramos Grigio
- Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hazem Adel Ashmawi
- Anestesiologia Experimental LIM-08, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ulysses Ribeiro Júnior
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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18
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Remy C, Borniard J, Perez J. Analysis of Unscheduled Telephone Calls Received by a Specialized Cancer Pain Nurse. Pain Manag Nurs 2019; 21:255-258. [PMID: 31473170 DOI: 10.1016/j.pmn.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/10/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND A key to successful symptom management in patients with cancer is to adapt the treatment to patient needs and complexities in an individual and dynamic manner. Rapid access to a clinician via telephone consultation supports treatment compliance, safety, and effectiveness and reduces the number of patients unnecessarily consulting emergency departments. AIMS To define the role of a cancer pain nurse in the management of unscheduled phone calls to the clinic. DESIGN The study is a retrospective analysis of unscheduled phone calls received at an outpatient cancer pain clinic. Details collected included caller identification, reasons for the call, and interventions provided. Actions taken after analysis of the nature of calls are discussed. SETTINGS Retrospective chart analysis. PARTICIPANTS/SUBJECTS Medical charts of patients seen at the cancer pain clinic. METHODS During three consecutive months, 102 unscheduled telephone calls fulfilling research criteria were analyzed. Seventy-four percent were initiated by patients or carers. In 46% and 45% of the calls, respectively, the reason for the call was to report a symptom or concern about the treatment. RESULTS Pain was the most common reported symptom (59.6%) followed by side effects (23.4%). The most frequent inquiry about medications concerned renewal of prescriptions (47.8%). The most common intervention was related to patients' treatments (74.5%), and it included an element of teaching in 51.3% of calls. In one third of cases, a prescription was changed after the call. The nurse was able to provide the intervention without involving a doctor in 87.3% of calls. Several changes were initiated after the analysis to decrease unnecessary calls to the nurse. CONCLUSIONS A telephone call service available for patients and other clinicians is an efficient way to enhance continuity of care for ambulatory patients. Continued efforts to make such a service cost effective must be implemented.
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Affiliation(s)
- Christelle Remy
- Cancer Pain Clinic, McGill University Health Centre, Cedars Cancer Centre, Montreal, Quebec, Canada
| | - Joyce Borniard
- Cancer Pain Clinic, McGill University Health Centre, Cedars Cancer Centre, Montreal, Quebec, Canada
| | - Jordi Perez
- Cancer Pain Clinic, McGill University Health Centre, Cedars Cancer Centre, Montreal, Quebec, Canada.
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19
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Doyle KE, El Nakib SK, Rajagopal M, Babu S, Joshi G, Kumarasamy V, Kumari DP, Chaudhuri P, Mohanthy S, Jatua D, Lohman D, Amon JJ, Palat G. Predictors and Prevalence of Pain and Its Management in Four Regional Cancer Hospitals in India. J Glob Oncol 2018; 4:1-9. [PMID: 30241192 PMCID: PMC6180789 DOI: 10.1200/jgo.2016.006783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE More than 1 million new occurrences of cancer are diagnosed in India annually. Among patients with cancer, pain is a common and persistent symptom of the disease and its treatment. However, few studies to date have evaluated the prevalence of pain and the adequacy of pain management in Indian hospitals. This cross-sectional study aimed to assess the prevalence and sociodemographic patterns of cancer pain and pain management among a sample of inpatients and newly registered outpatients at four large regional cancer centers in India. METHODS A sample of 1,600 patients with cancer who were current inpatients or newly registered outpatients were recruited and administered a questionnaire that was based on the Brief Pain Inventory. The survey tool included questions on demographics, medical history, and extent of clinical pain experienced. In addition, a pain management index score was created to link the severity of cancer pain with medication prescribed to treat it. RESULTS A total of 88% of patients reported pain in the past 7 days, and approximately 60% reported that their worst pain was severe. Several demographic and medical characteristics of the study population predicted severe pain, including the following: lower educational level, outpatient status, and debt incurred as a result of illness. A total of 67% of patients were inadequately treated with analgesics. Inadequate pain management was associated with both treatment hospital and patient type, and patients who reported debt as a result of their illness were more likely to have inadequate pain management. CONCLUSION A majority of Indian patients with cancer experience significant pain and receive inadequate pain management. Improvement of pain management for Indian patients with cancer is needed urgently.
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Affiliation(s)
- Katherine E. Doyle
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Shatha K. El Nakib
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - M.R. Rajagopal
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Sunil Babu
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Geeta Joshi
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Vidya Kumarasamy
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - D. Priya Kumari
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Prabir Chaudhuri
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Sumita Mohanthy
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Debasish Jatua
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Diederik Lohman
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Joseph J. Amon
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Gayatri Palat
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
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20
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Mehta N, O'Connell K, Giambrone GP, Baqai A, Diwan S. Efficacy of methylnaltrexone for the treatment of opiod-induced constipation: a meta-analysis and systematic review. Postgrad Med 2016; 128:282-9. [PMID: 26839023 DOI: 10.1080/00325481.2016.1149017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Constipation is a common adverse effect in patients requiring long-term opioid therapy for pain control. Methylnaltrexone, a quaternary peripheral mu-opioid receptor antagonist, is an effective treatment of opioid induced constipation (OIC) without affecting centrally mediated analgesia. Our objective was to conduct a review and meta-analysis to evaluate the efficacy of methylnaltrexone for treatment of OIC, as well as to provide a clinical discussion regarding newly developed alternatives and provide the current treatment algorithm utilized at our institution. METHODS We performed a systematic review and meta-analysis of randomized control trials using Cochrane Collaboration Databases and MEDLINE from 2007-present. Literature related to methylnaltrexone, opioids, opioid receptors, opioid antagonists, opioid-induced constipation were reviewed. A meta-analysis was completed with the primary outcome of rescue-free bowel movement (RFBM) within four hours of administration. All pooled analyses were based on random-effects models. RESULTS 1239 patients were analyzed; 599 received methylnaltrexone and 640 received placebo. With a 95% CI calculated, the true risk difference is between 0.267 and 0.385, demonstrating a statistically significant difference in RFBM between treatment and placebo groups (p < 0.0001). Both the 0.15 mg/kg, 0.30 mg/kg doses every other day, and 12 mg/day dose were found to have increased risk of RFBM compared to placebo. CONCLUSION Results support the use of methylnaltrexone. Furthermore, the use of methylnaltrexone to induce laxation may decrease use of health care resources, increase work productivity, and improve cost utilization. New treatments have been made available; however, controlled clinical studies are needed to demonstrate long-term efficacy, safety and cost-effectiveness. Possible limitations of this study include the relatively small number of randomized, placebo-controlled trials investigating the efficacy of methylnaltrexone versus placebo. There is also the possibility of publication bias, which may lead to overestimating the efficacy of methylnaltrexone in treating OIC.
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Affiliation(s)
- Neel Mehta
- a Department of Anesthesiology , Weill Cornell Medical College , New York , USA
| | - Kelli O'Connell
- a Department of Anesthesiology , Weill Cornell Medical College , New York , USA
| | - Gregory P Giambrone
- a Department of Anesthesiology , Weill Cornell Medical College , New York , USA
| | - Aisha Baqai
- b Department of Anesthesiology , Memorial Sloan Kettering Cancer Center , New York , USA
| | - Sudhir Diwan
- c Department of Pain Medicine , Lennox Hill Hospital , New York , USA
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21
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Kumar RV, Bhasker S. Health-care related supportive-care factors may be responsible for poorer survival of cancer patients in developing countries. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Lim SN, Han HS, Lee KH, Lee SC, Kim J, Yun J, Park S, Park M, Choe Y, Ryoo HM, Lee K, Cho D, Zang DY, Choi J. A satisfaction survey on cancer pain management using a self-reporting pain assessment tool. J Palliat Med 2015; 18:225-31. [PMID: 25650504 DOI: 10.1089/jpm.2014.0021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain is one of the most common and distressing symptoms in patients with cancer, with a high prevalence of 90%. Appropriate pain assessment is very important in managing cancer pain. OBJECTIVE The aims of this study were to (1) evaluate patient satisfaction with pain control therapy using a self-reporting pain assessment tool, (2) explore the usefulness of a self-reporting assessment tool for patients and physicians, and (3) evaluate patient perception of pain management and opioid analgesics. METHODS We enrolled a total of 587 South Korean adult cancer patients hospitalized for five days or more. Pain assessment using a self-reporting pain assessment tool was performed by patients themselves from Day 1 to Day 5. The average pain intensity on a numeric rating scale (NRS) and the frequency of breakthrough pain between Day 1 and Day 5 were recorded with a self-reporting pain assessment tool. We evaluated patient satisfaction with pain control and the usefulness of a self-reporting pain assessment tool for patients and physicians on Day 5. RESULTS Among the 587 enrolled patients, 551, excluding 36 patients who violated inclusion criteria, were analyzed. The pain satisfaction rate was 79.5%, and only 6.2% of assessed patients had a negative pain management index (PMI). However, symmetry analysis for pain intensity between patient and physician showed low agreement (kappa=0.21). The patients with dissatisfaction for cancer pain control expressed negative attitudes toward using opioid analgesics and misconceptions regarding pain management. The satisfaction for using a self-reporting pain assessment tool was 79.2% in patients and 86.4% in physicians, respectively. CONCLUSION The use of a self-reporting pain assessment tool as a communication instrument provides an effective foundation for evaluating pain intensity in cancer pain management. A more individualized approach to patient education about pain management may improve patient outcome.
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Affiliation(s)
- Sung-Nam Lim
- 1 Department of Internal Medicine, Haeundae-Paik Hospital, College of Medicine Inje University , Busan, South Korea
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23
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Goksu SS, Bozcuk H, Uysal M, Ulukal E, Ay S, Karasu G, Soydas T, Coskun HS, Ozdogan M, Savas B. Determinants of opioid efficiency in cancer pain: a comprehensive multivariate analysis from a tertiary cancer centre. Asian Pac J Cancer Prev 2014; 15:9301-5. [PMID: 25422216 DOI: 10.7314/apjcp.2014.15.21.9301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency. MATERIALS AND METHODS A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis. RESULTS In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (β=-0.31, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (β=-0.34, T=-3.07, P= 0.003). CONCLUSIONS The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.
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Affiliation(s)
- Sema Sezgin Goksu
- Kayseri State Hospital of Research and Education, Department of Medical Oncology, Kayseri, Turkey E-mail :
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24
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Lux EA, Janecki M, Maritz MA. Clinical evaluation of the first oxycodone once daily prolonged release tablet in moderate to severe chronic pain: a randomized, double-blind, multicenter, cross-over, non-inferiority study to investigate efficacy and safety in comparison with an established oxycodone twice daily prolonged release tablet. Curr Med Res Opin 2014; 30:2365-75. [PMID: 25050592 DOI: 10.1185/03007995.2014.946126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The first oxycodone once daily (OOD) has been developed and after successful pharmacokinetic characterization, therapeutic efficacy and safety were compared to an established oxycodone twice daily (OTD: Oxygesic/OxyContin, Mundipharma). DESIGN AND METHODS A randomized, double-blind, multicenter, cross-over, non-inferiority study was conducted in patients (n = 68) with chronic malignant or non-malignant pain. The new OOD was compared to OTD at identical total daily doses (TDD: 40-120 mg/day) employing intensive, five times daily current pain (0-100 mm visual analog scale, VAS) and twice daily 12 h recalled pain assessments as well as safety parameters such as nausea and sedation (VAS) over 5 days for each treatment (after a 5 day run-in phase). RESULTS There was no significant difference in analgesic potency detected between the two treatments based on 95% CI for difference in the daily mean current pain (-2.09 mm VAS) over 5 days, determined as -5.09 to 0.91 mm VAS. A difference ≤12 mm VAS indicated non-inferiority of OOD, i.e. lack of clinically relevant difference in analgesia. Intake of rescue medication had no effect on study results as evaluated by ANCOVA. The difference in adverse events (AEs) between the two treatments did not reach significance, as 19.1% and 23.5% of patients experienced treatment-related AEs while on OOD and OTD, respectively. Advantages for OOD regarding consistency of analgesia (i.e. use of rescue medication, current and recalled pain) and sedation did not reach statistical significance in this limited study population. CONCLUSION Despite the small number of patients and short study duration, the results support the conclusion that new OOD is (at least) equivalent to established OTD regarding safety and efficacy.
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Affiliation(s)
- Eberhard Albert Lux
- Klinik für Schmerz- und Palliativmedizin, Klinikum St.-Marienhospital GmbH , Lünen , Germany
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25
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Zhao Z, Fan H, Higgins T, Qi J, Haines D, Trivett A, Oppenheim JJ, Wei H, Li J, Lin H, Howard OMZ. Fufang Kushen injection inhibits sarcoma growth and tumor-induced hyperalgesia via TRPV1 signaling pathways. Cancer Lett 2014; 355:232-41. [PMID: 25242356 DOI: 10.1016/j.canlet.2014.08.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 12/22/2022]
Abstract
Cancer pain is a deleterious consequence of tumor growth and related inflammation. Opioids and anti-inflammatory drugs provide first line treatment for cancer pain, but both are limited by side effects. Fufang Kushen injection (FKI) is GMP produced, traditional Chinese medicine used alone or with chemotherapy to reduce cancer-associated pain. FKI limited mouse sarcoma growth both in vivo and in vitro, in part, by reducing the phosphorylation of ERK and AKT kinases and BAD. FKI inhibited TRPV1 mediated capsaicin-induced ERK phosphorylation and reduced tumor-induced proinflammatory cytokine production. Thus, FKI limited cancer pain both directly by blocking TRPV1 signaling and indirectly by reducing tumor growth.
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Affiliation(s)
- Zhizheng Zhao
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA; Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Huiting Fan
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA; Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Tim Higgins
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA
| | - Jia Qi
- Neuronal Networks Section, Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Blvd, Baltimore, MD 21224, USA
| | - Diana Haines
- Leidos Biomedical, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Anna Trivett
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA
| | - Joost J Oppenheim
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA
| | - Hou Wei
- Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Li
- Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongsheng Lin
- Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - O M Zack Howard
- Laboratory of Molecular Immunoregulation, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702, USA.
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Abstract
Pain is a widespread clinical symptom in companion animals with cancer, and its aggressive management should be a priority. Education and skills can be acquired by health care professionals and caregivers to better understand, recognize, and treat cancer-associated pain. The early and rational institution of multimodality analgesic protocols can be highly effective and maximize the chances of improving quality of life in dogs and cats with cancer. This article describes the pathophysiology of pain in companion animals diagnosed with cancer. The foundational causes of cancer-associated pain and treatment strategies for alleviating discomfort in companion animals with cancer are discussed.
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Nechutova H, Dite P, Hermanova M, Novotny I, Martinek A, Klvana P, Kianicka B, Soucek M. Pancreatic pain. Wien Med Wochenschr 2014; 164:63-72. [DOI: 10.1007/s10354-014-0265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/27/2014] [Indexed: 12/16/2022]
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Chen Q, Zhu X, Chen Q, Wang K, Meng Z. Unresectable giant pancreatic neuroendocrine tumor effectively treated by high-intensity focused ultrasound: a case report and review of the literature. Pancreatology 2013; 13:634-8. [PMID: 24280584 DOI: 10.1016/j.pan.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 12/11/2022]
Abstract
Patients with pancreatic neuroendocrine tumors (PNETs) diagnosed at late stage are not suitable candidates for surgery. So far, only a limited number of cases have been documented in literature about the effectiveness of HIFU, which has been more frequently reported to treat pancreatic adenocarcinoma rather than PNET. We report herein that a patient with a pancreatic neuroendocrine unresectable tumor was effectively treated with serial high-intensity focused ultrasound (HIFU) ablation, with no significant side effects detected. Upon evaluation, treatment results included: the tendency of tumor shrinkage, pain relief, decreased tumor marker levels, and obvious improvements in quality of life. Sustained efficacy was observed during a follow-up at 25 months with no tumor progression.
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Affiliation(s)
- Qiwen Chen
- Department of Integrated Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Price MA, Bell ML, Sommeijer DW, Friedlander M, Stockler MR, Defazio A, Webb PM, Butow PN. Physical symptoms, coping styles and quality of life in recurrent ovarian cancer: a prospective population-based study over the last year of life. Gynecol Oncol 2013; 130:162-8. [PMID: 23578538 DOI: 10.1016/j.ygyno.2013.03.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/24/2013] [Accepted: 03/28/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to describe the trajectory of physical symptoms, coping styles and quality of life (QoL) and the relationship between coping and QoL over the last year of life in women with recurrent ovarian cancer. METHODS The patient cohort were women recruited to the Australian Ovarian Cancer Study who subsequently experienced recurrent, invasive ovarian cancer and completed at least one psychosocial assessment (optimism, minimisation, hopelessness/helplessness, QoL) during the last year of life (n=217). RESULTS QoL declined sharply from six months before death. Lack of energy was the most prevalent symptom over three measurement periods (67-92%) and also the most severe. Anorexia (36-55%), abdominal swelling (33-58%), nausea (26-47%) and pain (26-43%) all increased in prevalence and severity towards the end of life. Higher optimism (p=0.009), higher minimisation (p=0.003) and lower helplessness/hopelessness (p=0.03) at baseline were significant predictors of subsequent higher QoL. CONCLUSIONS Progressive deterioration in quality of life may be an indicator of death within about six months and therefore should be an important consideration in decisions about subsequent treatment. Coping styles which independently predicted subsequent changes in QoL could potentially be targeted by interventions to minimise worsening QoL.
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Affiliation(s)
- M A Price
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia.
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30
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Kern KU, Nalamachu S, Brasseur L, Zakrzewska JM. Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain? J Pain Res 2013; 6:261-80. [PMID: 23630431 PMCID: PMC3623573 DOI: 10.2147/jpr.s39957] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components. A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies.
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31
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Biró E. Attitudes of Hungarian adults toward use of opioids in pain management. Orv Hetil 2013; 154:455-63. [DOI: 10.1556/oh.2013.29569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Though the most effective pain medication is already available in Western countries, cancer pain is often undertreated. The primary causes of this phenomenon are the fears of opioids, which haven’t been explored systematically in Hungary. Aims: Exploration of the attitudes toward opioids among healthy Hungarian adults. Methods: The participants (88/143 male/female, 29.47 ± 11.05 years) were asked to complete story of a patient who was suggested to accept opioid therapy. The stories were rated by independent raters on Likert-scales to access the strength of attitudes toward pain medication [1]. Results: Only an average 29.6% of the stories expressed positive attitudes, but varied fears (of addiction: 20.9%, nearing death: 10.5%, the inattention of the doctor: 4.7%), and hopes connected to alternative therapies (4.7%) emerged, too. Conclusions: The compliance of the patient and his/her family members is a very important factor of effective medical treatment, therefore individual attitudes must be considered. Orv. Hetil., 2013, 154, 455–463.
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Affiliation(s)
- Eszter Biró
- ELTE Pszichológiai Intézet Affektív Pszichológia Tanszék Budapest Izabella u. 46. 1064
- Magyar Hospice Alapítvány Budapest
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32
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Malpas P, Johnson M. Response to: 'what should we tell medical students and residents about euthanasia and assisted suicide?'. Aust N Z J Psychiatry 2013; 47:290-1. [PMID: 23463083 DOI: 10.1177/0004867412460106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Malcolm Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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33
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Trotter PB, Norton LA, Loo AS, Munn JI, Voge E, Ah-See KW, Macfarlane TV. Pharmacological and other interventions for head and neck cancer pain: a systematic review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2013; 3:e1. [PMID: 24422019 PMCID: PMC3886097 DOI: 10.5037/jomr.2012.3401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/20/2012] [Indexed: 01/03/2023]
Abstract
Objectives Pain is a common complication in head and neck cancer. The aim of this paper
is to evaluate the evidence from randomised control trials investigating
pharmacological and non-pharmacological methods of pain management in head
and neck cancer. Material and Methods Medline, Embase and the Cochrane library databases were searched. Squamous
cell carcinomas of the head and neck excluding nasopharyngeal and salivary
gland cancers were included. The limits were "human" and
"randomised clinical trials". A quality assessment was carried
out. Results 13 studies were included with a total of 644 participants. The primary
outcome for most of these papers was pain control post-treatment. Levels of
bias varied between the studies. Majority (12 out of the 13 studies)
reported intervention to be superior to the control or standard therapy in
pain management. Only 46% of the studies were carried out on an intention to
treat basis. Two studies reported high dropout rates, with one at 66%. Conclusions There is insufficient evidence from randomised clinical trials to suggest an
optimal pharmacological intervention for head and neck cancer pain
post-treatment. Further high quality randomised clinical trials should be
conducted to develop an optimal management strategy for head and neck cancer
pain.
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Affiliation(s)
- Patrick B Trotter
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Lindsey A Norton
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Ann S Loo
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Jonathan I Munn
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
| | - Elena Voge
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom. ; University of Bremen Bremen Germany
| | - Kim W Ah-See
- Department of Otolaryngology, Aberdeen Royal Infirmary Aberdeen United Kingdom
| | - Tatiana V Macfarlane
- School of Medicine and Dentistry, University of Aberdeen Aberdeen United Kingdom
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Kim EB, Han HS, Chung JH, Park BR, Lim SN, Yim KH, Shin YD, Lee KH, Kim WJ, Kim ST. The effectiveness of a self-reporting bedside pain assessment tool for oncology inpatients. J Palliat Med 2012; 15:1222-33. [PMID: 22974435 DOI: 10.1089/jpm.2012.0183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain is common during cancer treatment, and patient self-reporting of pain is an essential first step for ideal cancer pain management. However, many studies on cancer pain management report that, because pain may be underestimated, it is often inadequately managed. OBJECTIVE The aim of this study was to evaluate the effectiveness of bedside self-assessment of pain intensity for inpatients using a self-reporting pain board. METHODS Fifty consecutive inpatients admitted to the Oncology Department of Chungbuk National University Hospital were included in this observational prospective study from February 2011 to December 2011. The medical staff performed pain assessments by asking patients questions and using verbal rated scales (VRS) over 3 consecutive days. Then, for 3 additional days, patients used a self-reporting pain board attached to the bed, which had movable indicators representing 0-10 on a numeric rating scale (NRS) and the frequency of breakthrough pain. RESULTS Patient reliability over the medical staff's pain assessment increased from 74% to 96% after applying the self-reporting pain board (p=0.004). The gap (mean±standard deviation [SD]) between the NRS reported by patients and the NRS recorded on the medical records decreased from 3.16±2.08 to 1.00±1.02 (p<0.001), and the level of patient satisfaction with pain management increased from 54% to 82% (p=0.002). CONCLUSION This study suggests that the self-reporting bedside pain assessment tool provides a reliable and effective means of assessing pain in oncology inpatients.
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Affiliation(s)
- Eun Bi Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
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