Psychologically-based interventions for adults with chronic neuropathic pain: A scoping review

OBJECTIVE

As psychologically-based interventions have been shown to have clinical utility for adults with chronic pain generally, a similar benefit might be expected in the management of chronic neuropathic pain (NeuP). However, to date this has not been established, with existing systematic reviews on this topic being hampered by the scarcity of Randomised Controlled Trials (RCTs). This review aimed to identify the type of psychologically-based interventions studied for adults with chronic NeuP. It also aimed to assess whether there are enough RCTs to justify undertaking an updated systematic review.

METHODS

Seven databases and two clinical trial registries were searched for NeuP and psychologically-based interventions from database inception to December 2021, and the search was updated in February 2023. The search was broadened by reviewing the reference list of included studies and contacting field experts. Predetermined study characteristics were extracted.

RESULTS

Of 4682 records screened, 33 (less than 1%) articles met the eligibility criteria. Four broad intervention approaches were observed, including cognitive-behavioural approaches (n = 16), mindfulness/meditation (n = 10), trauma focused therapy (n = 4), and hypnosis (n = 3). Thirteen RCTs were identified, and of these, nine retained 20 participants in each arm at post-treatment.

CONCLUSIONS

Cognitive Behavioural Therapy was the most common therapeutic approach identified, whereas mindfulness/meditation was the most frequently used technique. Almost half to two-thirds of the studies reported significant improvements in either pain, disability, or distress, suggesting psychologically-based interventions are potentially beneficial for adults with chronic NeuP. An updated systematic review seems warranted.

Drain outlets in patient rooms as sources for invasive fusariosis: an analysis of patients with haematological disorders

BACKGROUND

Invasive fusariosis (IF) is a frequently fatal disease as there are few antifungals to treat it, making the prevention of IF crucial. However, fusarium infections have not been as thoroughly studied as other common pathogenic fungi such as Aspergillus or Candida.

AIM

To investigate the epidemiology of IF in patients with haematological diseases in Japan and to elucidate the infectious route of fusarium infection.

METHODS

We retrospectively analysed 29 IF cases in patients with haematological diseases from 2009 to 2019 in Japan. To discover the infectious source of IF, we performed an indoor environment survey targeted at indoor air and drain outlets in medical institutions and residences using culture-based and metagenomic methods. Finally, we performed aerosol- and droplet-mediated dispersion studies.

FINDINGS

The epidemiological study showed that the primary pathogen of IF was Fusarium solani species complex (FSSC), and the most common species was Fusarium petroliphilum. Most patients were likely to develop IF during hospitalization. A fusarium culture was positive in 26 of 72 drain samples. Few fusarium were detected from air samples; by contrast, 29 of 108 isolates from the drain outlets were identified as fusarium. Furthermore, similar results were obtained in the metagenomic analysis. Interestingly, species belonging to FSSC were isolated from indoor drain outlets, which was similar to those of the IF patients. In the droplet-mediated dispersion study, eight to 17 colonies of fusarium were isolated.

CONCLUSION

Our study indicates that causative Fusarium spp. could inhabit drain outlets in hospitals or residences, and droplet-mediated fusarium dispersion is a potential cause of IF.

Digital Image Processing to Remove Blur from Linear Tomography of the Lung

We have studied digital image processing methods to reduce blur in linear tomography of the lung performed with the Fuji computed radiography (FCR) system. One-dimensional unsharp (blur) mask filtering in the direction of tomographic movement was found to be effective in reducing blur. The appearance of the processed tomograms varied depending largely on the properties of the unsharp mask filters applied. With regard to the spatial frequency response of the filter, a high mid-frequency response and a low low-frequency response of the tomographic image data was most effective in obtaining high image quality tomograms. When the standard 2-dimensional unsharp mask technique of the FCR system was additionally applied to the one-dimensional unsharp mask processed tomogram, the clarity of the tomogram was further enhanced. These observations may also be helpful when considering image processing to obtain diagnostically informative digital radiography.

Size of Normal Hilar Lymph Nodes Measured in Autopsy Specimens

The normal size of lymph nodes for each region of the hilum was determined by direct measurement of the short and long diameters of each node in the transverse plane of the node and the longitudinal diameter in the vertical plane of the node in 30 adult cadavers. The mean short transverse diameters ranged from 3.2 to 6.4 mm, the mean long transverse diameters ranged from 4.9 to 10.0 mm, and the mean longitudinal diameters ranged from 5.7 to 11.3 mm. The largest mean transverse diameters were found in the anterior upper lobe (AUL) and the inferior interlobar (IIL) regions. We noted a different maximum normal size for lymph nodes in each region of the hilum and determined the standard maximum normal short transverse diameters to be as follows: 12 mm for nodes in the right AUL and IIL regions, 10 mm for nodes in the right superior interlobar region and the left AUL and IIL regions, and 8 mm for nodes in other regions. Both the maximum normal long transverse diameters and the longitudinal diameters showed a wider variation, ranging from 18 to 10 mm and from 20 to 12 mm, respectively.

Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations

BACKGROUND

This review aims to assist cancer clinical researchers in choosing between the two most widely used measures of cancer-specific health-related quality of life: the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Functional Assessment of Cancer Therapy-General (FACT-G).

MATERIALS AND METHODS

Information on QLQ-C30 and FACT-G content, scale structure, accessibility and availability was collated from websites and manuals. A systematic review was undertaken to identify all articles reporting on psychometric properties and information to assist interpretability. Evidence for reliability, validity and responsiveness was rated using a standardised checklist. Instrument properties were compared and contrasted to inform recommendations.

RESULTS

Psychometric evidence does not recommend one questionnaire over the other in general. However, there are important differences between the scale structure, social domains and tone that inform choice for any particular study.

CONCLUSIONS

Where research objectives are concerned with the impact of a specific tumour type, treatment or symptom, choice should be guided by the availability, content, scale structure and psychometric properties of relevant European Organisation for the Research and Treatment of Cancer versus Functional Assessment of Chronic Illness Therapy modules. Because the FACT-G combines symptoms and concerns within each scale, individual items should always be reviewed within the context of specific research objectives. Where these issues are indecisive, researchers are encouraged to use an algorithm at the end of the current article.

Phase I/II study of concurrent chemoradiotherapy for localized nasal NK/T-cell lymphoma: Final results of JCOG0211

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Background: Nasal NK/T-cell lymphoma is rare and its standard therapy has not been established. Tumor cells express P-glycoprotein concerning multi-drug resistance (MDR). Anthracycline-containing chemotherapy is not effective and %2-yr overall survival (OS) of radiotherapy (RT) alone is only 45%. Methods: To explore a more effective treatment for localized nasal NK/T-cell lymphoma, we conducted a phase I/II study of concurrent chemoradiotherapy consisted of 50 Gy of RT and 3 courses of DeVIC [carboplatin (CBDCA), etoposide (ETP), ifosfamide (IFM), dexamethasone (DMS)]. Patients (Pts) with newly-diagnosed, localized (IE & contiguous IIE with cervical node involvement) diseases, 20–69 years of age and PS 0–2 were eligible. The 3-D conformal RT planning was required to cover adequately target volumes (2 cm margin to gross tumor, entire nasal cavities and nasopharynx) and to minimize doses to organs at risk. Primary endpoint of the phase II portion was 2-yr OS and the enrollment of 24 pts to the phase II portion was planned. Based on the results of the phase I portion (ASH 2005, #2685), 2/3-dose of DeVIC (CBDCA 200mg/m2 d1 IV, ETP 67mg/m2 d1–3 IV, IFM 1.0g/m2 d1–3 IV, DMS 40mg/body d1–3 IV; every 3 wks) was applied for the phase II portion. RT quality assurance review confirmed no protocol violation (ASTRO 2008, #2682). Results: From Sep 2003 to Dec 2006, 33 pts were enrolled in the phase I/II study. 27 pts evaluated in the phase II portion showed the following features: age 21–68 yrs (median 56), M:F=17:10, stage IE 18, stage IIE 9, B symptom (+) 10, elevated serum LDH 5, PS2 2. With a median follow-up of 32 months (range, 24–62), %2-yr OS was 78% (95% CI, 57–89). Of 26 pts evaluable for response, 20 achieved CR, 1 PR, 2SD, and 3PD. %CR and %ORR were 77% (95% CI, 56–91) and 81%, respectively. The most common grade 3 non-hematologic toxicities were mucositis due to RT (30%) and infection (30%). Grade 4 hyponatremia and dermatitis due to RT were observed in each 1 pt. No treatment-related death was observed. Conclusions: Concurrent chemoradiotherapy using MDR-non-related agents and ETP is a safe and effective treatment for localized nasal NK/T-cell lymphoma, providing the basis for subsequent studies.

No significant financial relationships to disclose.

Advanced oesophageal carcinoma in an 84-year-old treated with chemoradiotherapy

We present a case of advanced oesophageal cancer with cardiac invasion in an 84-year-old male presenting with dysphagia and general malaise. Histological analysis of an endoscopic biopsy specimen revealed a poorly differentiated squamous cell carcinoma. Computed tomography indicated a thickened oesophageal wall that was compressing the left atrium, suggesting invasion of the heart, and oesophagography revealed a polypoid lesion 9 cm in length. No distant metastases were seen on computed tomography. The patient was given chemotherapy with 10 mg/m2 cisplatin on days 1 and 4 every week for 5 weeks and concurrent radiotherapy at a dose of 2 Gy five times per week (total dose 52 Gy). After 4 weeks, the mass was no longer visible on oesophagography or endoscopic examination. The patient was free of recurrence and metastases for 4.5 years. In conclusion, chemoradiotherapy may be curative in elderly patients with unresectable oesophageal carcinoma.