Cancer Pain Intensity Research Articles

Distinct Susceptibility to Inoculated Melanoma and Sensitivity to Cancer Pain in Mouse Lines With High and Low Sensitivity to Stress

Approximately 30 years ago, we developed 2 mouse lines with enhanced and decreased opioid system activity using bidirectional selection for high (high analgesia [HA] line) and low (low analgesia [LA] line) swim stress-induced analgesia. These mouse lines differ substantially in pain sensitivity, measured as hind paw withdrawal latency in a hot plate test. Moreover, compared with the LA mice, the HA mice exhibited reduced energy expenditure under stress and different depression-like behavior as well as higher sensitivity to mutagens and the high frequency of spontaneous and carcinogen-induced tumors. In the current study, we observed distinct differences in the growth rate of orthotopically implanted melanoma and the onset of cancer pain. Whereas the HA line was prone to tumors and carcinogenesis was rapid in all specimens, the LA mice either did not develop tumors (70%) or developed tumors that often regressed spontaneously (30%). Animals from both lines developed robust thermal hypersensitivity in the tumor-bearing paw compared with animals that were injected with saline. However, we found that hyperalgesia in tumor-bearing mice persists for a much shorter time in the HA than in LA mice. Naltrexone, given subcutaneously, restored hyperalgesia in the HA mice, whereas it was ineffective in the LA mice. The results suggest that activity of the opioid system may influence carcinogenesis and the intensity of cancer pain and indicates that HA and LA mice are good models for such studies.

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy.

IntroductionPancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage of carcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancer patients with no other alternative but palliative treatment constitute a large group.AimTo assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy.Material and methodsBetween 2001 January and 2010 November in the Department of Thorax, General Surgery and Oncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 cases grade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetic trunk and ganglion excision were performed in 89 patients.ResultsBefore the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial group and 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically (p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3 (41-63; SD 0.75). On the 7th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57 (3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1 (39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty days after the procedure 12 patients did not take any painkillers (13.5%), and in the others a considerable decrease of the taken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life, on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantly in relation to the state on the 7th postoperative day to 70.9 (52-88; SD 1.14).ConclusionsSplanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatic tumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significant decrease of cancer pain intensity and considerably improves the quality of patients’ lives.

A Meta-Analysis of Intervention Studies on Cancer Pain

Purpose: This study was to analyze the characteristics and effect size of intervention studies in reference to cancer pain. Methods: In order to conduct a meta-analysis, a total of 208 studies were retrieved from search engine. And 29 studies published from 2000 to 2010 were selected upon their satisfaction with the inclusion criteria. The data was analyzed by the RevMan 5.0 program of Cochrane library. Results: 1) Intervention studies included 7 studies on reflexology (24.1%), 5 for pain management education (17.2%), 3 studies for each music therapy, spiritual care and hand massage (10.3%, respectively), and 2 studies for each hospice and horticultural therapy (6.7%, respectively). 2) The effect size of the intervention studies were high in hand massage (d=-0.98), reflexology (d=-0.74), spiritual care (d=-0.72), pain management education (d=-0.66), music therapy (d=-0.41), and horticultural therapy (d=-0.32). Conclusion: This study suggest that non-drug therapy can reduce the levels of cancer pain intensity, even though the numbers of intervention studies and randomized controlled trials are very rare.

Psychological Aspects and Approaches to Pain Management in Cancer Survivors.

Psychological distress increases with the intensity of cancer pain. Cancer pain is often under-reported and under-treated for a variety of complex reasons, including a number of beliefs held by patients, families and healthcare professionals. There is evidence that cognitive behavioural techniques that address catastrophising and promote self-efficacy lead to improved pain management. Group format pain management programmes could contribute to the care of cancer survivors with persistent pain.

Assessment and classification of cancer breakthrough pain: A systematic literature review

Temporal variations in cancer pain intensity are highly prevalent, and are often difficult to manage. However, the phenomenon is not well understood: several definitions and approaches to classification and bedside assessment of cancer breakthrough pain (BTP) have been described. The present study is a systematic review of published literature on cancer BTP to answer the following questions: which terms and definitions have been used; are there validated assessment tools; which domains of BTP do the tools delineate, and which items do they contain; how have assessment tools been applied within clinical studies; and are there validated classification systems for BTP. A systematic search of the peer-reviewed literature was performed using five major databases. Of 375 titles and abstracts initially identified, 51 articles were examined in detail. Analysis of these publications indicates a range of overlapping but distinct definitions have been used to characterize BTP; 42 of the included papers presented one or more ways of classifying BTP; and while 10 tools to assess patients’ experience of BTP were identified, only 2 have been partially validated. We conclude that there is no widely accepted definition, classification system or well-validated assessment tool for cancer-related breakthrough pain, but there is strong concurrence on most of its key attributes. With further work in this area, an internationally agreed upon definition and classification system for cancer-related breakthrough pain, and a standard approach on how to measure it, hold the promise to improve patient care and support research in this poor-prognosis cancer pain syndrome.

The Brief Pain Inventory: revealing the effect of cancer pain

The science of pain assessment was born in the 1970s when visual analogue and numbered scales were adapted by psychologists from educational research settings and applied to patients with pain. This period also saw the publication of the well known McGill Pain Questionnaire that examined use of verbal descriptors for both the sensory and affective dimensions of pain. Within a short time, research in pain was progressing quickly, affirming the quote attributed to Lord Kelvin: “when you can measure what you are speaking about, and express it in numbers, you know something about it”. Publication of the Brief Pain Questionnaire in 1983, by Daut and colleagues,1 marked the start of the modern era of cancer-pain measurement and inspired better recognition of the effect of pain on the lives of patients with cancer. The Brief Pain Questionnaire also helped to focus attention on the neglected area of cancer-pain management; WHO did not publish the first guidelines advocating regular administration of opioids to patients with cancer pain until 1986.2 This treatment approach was regarded with scepticism by the medical community at that time, and is a view which sometimes prevails today. The 1983 paper reported on a new questionnaire—tested in more than 1200 patients with cancer who attended the Wisconsin Cancer Center and found to be acceptable, reliable, and valid. Although the Brief Pain Questionnaire incorporated existing numbered scales, it was an important step forward in pain measurement because it introduced two new concepts. The first idea reflected the simple observation that the intensity of cancer pain can vary, and measuring both maximum and average pain within the previous week is important. This understanding helped to identify the concept of cancer breakthrough pain. The second concept recognised that pain interferes with aspects of everyday living such as walking, sleeping, mood, and relations with other people. Measuring this interference is essential to understand the experience of cancer pain and monitor the effectiveness of treatment.

The validity of average 8-h pain intensity assessment in cancer patients

Aim of this study was to validate the use of subjective average pain assessment over an 8-h time period to evaluate cancer pain intensity. A sample of 95 consecutive cancer inpatients were asked to score on 0–10 numerical scales the intensity of their pain at hourly intervals, and then, at the 8th hour, to rate their average pain intensity over the last 8 h. Agreement between the average of the 8 hourly measures (8hA) and the single patient-rated average (PA8h) was examined with the intraclass correlation coefficient (ICC) and the absolute difference (AD) between the two measurements. Associations between AD, gender, age older than 70, somatic pain, visceral pain, neuropathic pain, pain on movement and the presence of pain exacerbations during the 8-h period, were also examined. Average pain intensity scores were very similar with the two measurement schedules: 3.4 for 8hA and 3.7 for PA8h, with a median AD of 0.44 points. Only six patients (6.3%) showed ADs higher than 2 points. Also the ICC (0.85) showed a substantial agreement between the two schedules. Among the examined variables, gender, age over 70 years and presence of pain exacerbations showed a significant association with the agreement level. Overall, our results support the validity of a subjective average pain measurement over 8-h period in cancer patients.

A Survey of Cancer Pain Status in Shanghai

This is a multicenter investigational survey conducted in 76 hospitals in Shanghai between July and August 2004. The objective was to investigate the cancer pain status and physicians’ pain management capabilities in Shanghai. A total of 923 cancer patients involved in the investigation completed a questionnaire which included general condition, self-assessment of pain and questions of pain control knowledge. The study results were analyzed concerning: reason for cancer pain, type and intensity of cancer pain, treatment methods, patients’ understanding of addiction, patients’ request for pain treatment, and patients’ and physicians’ viewpoint on current cancer pain treatment.

Intensity of cancer pain

A new study has highlighted how the under-reporting and ineffective management of cancer-related breakthrough pain is resulting in the needless suffering of many patients, says David Pountney

Cancer Pain Intensity Measurement in Outpatients

Cancer Pain Intensity Measurement in Outpatients

Cancer Pain Intensity Measurement in Outpatients

Pain is frequently encountered in outpatient oncology practice and its management often is inadequate. Effective analgesia often could be provided for these patients through simple practices like pain intensity monitoring, documentation and treatment accordingly. A survey was carried out among cancer patients attending outpatient pain clinic to evaluate scale preferences, comparison of different scales as well as proxy reporting by caregiver, health professionals, for pain management. The aim of the study was to determine preferences in Indian population and to compare our study subjects' preferences to those previously reported in other cultures. A total of 99 patients participated in the study. The majority preferred a visual analogue scale (VAS). The visual analogue scale and verbal descriptive scale (VDS) were found to be equally reliable pain rating tools. Proxy reports were found to equally representative of patient's pain. VAS was the preferred pain assessment tool. In the absence of VAS scale, VDS also could be used. Proxy reports could be relied upon for management of pain.

Validity of a verbally administered numeric rating scale to measure cancer pain intensity.

The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. The NRS has been found to be a simple and valid alternative in some disease states; however, the validity of this scale administered verbally, without visual cues, to oncology patients has not yet been established. The present study examined validity of a verbally administered 0-10 NRS using convergence methods. The correlation between the VAS and the NRS was strong and statistically significant (r = 0.847, p < 0.001), supporting the validity of the verbally administered NRS. Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.

Frequency of pain in patients with cancer.

Although more than 5 million people die of cancer every year throughout the world and although by now finely differentiated morbidity and mortality statistics exist on most forms of cancer, there is still practically no reliable information on the frequency and intensity of cancer pain, detailed by sex, age, form of cancer, and stage.

The language of pain intensity and complexity: new methods of scoring the McGill Pain Questionnaire.

In Part I the McGill Pain Questionnaire was administered to 25 cancer patients, scored and analyzed in the traditional manner. Results indicated that patients with cancer pain appear to be similar in terms of intensity of the pain and the kind of pain which they experience with respect to sensory, affective, and evaluative qualities. Part II presents a new method of administering, scoring, and analyzing responses to the questionnaire, which allows for a more comprehensive interpretation of pain. In Part III the data from Part I are reanalyzed using the new scoring system. As hypothesized, the intensity of cancer pain is higher along the affective dimension than along the sensory. With regard to complexity of the experience of cancer pain, neither the sensory nor the affective dimension is more salient. The new system of scoring and analysis may enable future investigators to specify a unique pain intensity-complexity relationship for each clinical pain syndrome.