Pain In Cancer Patients Research Articles

Investigation and analysis on knowledge and attitude of Cancer pain management among 232 nursing staff in oncology department

Objective To investigate the current status of knowledge and attitudes of oncology nursing staffs on pain management in cancer patients. Methods A total of 232 oncology nursing staffs from 7 Grade III-A Hospitals in 4 provinces and municipalities were surveyed using General Information Questionnaire and knowledge and attitudes survey regarding pain (KASRP) (2014) questionnaire (Chinese version). Results The results of this survey showed that the average score of knowledge and attitude about pain management of 232 oncology nursing staffs was (21.56±4.01) points, and the average correct rate was 52.59%. There were no significant differences in the scores of different education background, years of nursing work, years of cancer clinical nursing care, and the nature of the hospital they worked in(P>0.05). However, there was a difference in the score of nursing staffs with different professional titles (F=5.885, P=0.003). Besides that, difference also showed in scores of nursing staffs with different experiences in caring cancer pain patients (F=3.216, P=0.024). Conclusion The knowledge and attitude of pain management in oncology nursing staffs are in low level, the command of knowledge is not enough, meanwhile, the pain management ability is insufficient. Therefore, it is necessary to strengthen the training of pain related knowledge of nursing staffs and improve their pain management ability. Key words: Pain management; Knowledge; Attitude; Oncology nursing staff

Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial

BackgroundDespite numerous guidelines, nearly one of two patients with cancer pain remains undertreated, thereby affecting their quality of life. Active patient involvement through Therapeutic Patient Education (TPE) is considered as a relevant strategy to overcoming hurdles in pain management. The aim of the EFFADOL study is to assess the effectiveness of a TPE program in improving cancer pain management.Methods/designThe EFFADOL study is a stepped-wedge randomised controlled trial. A total of 260 cancer patients with unbalanced background pain will be randomised over the institutional level, i.e. stepped-wedge cluster design. Six clusters will be formed, one at the regional level of “Basse-Normandie” for patients receiving the educational approach by health providers already trained to TPE. Then, five additional centers will be gradually included at the national level, making it possible to compare the “conventional” management of pain (before medical staff training to TPE) with the educational approach (after being trained). The main study parameter is pain interference on daily life assessed with the self-administrated and validated Brief Pain Inventory questionnaire. Secondary objectives comprised the evaluation of patients’ adherence to pain education program, the description of pain intensity, pain relief, analgesic adherence and pain emotional impact. Educational dimension of the program will be evaluated through the patients’ acquisition of knowledge and skills about their pain and treatment as well as their self-efficacy to participate actively in pain management. The patient’s feeling of pain changes will be measured. Finally, the satisfaction of participants and educators will be reported. We hypothetise active involvement of patients in TPE will lead to an improved pain management compared to standard care.DiscussionAnalyzing the impact of a TPE program in cancer pain patients will improve their pain management and quality of life. We expect that the dissemination of our project educational approach through the French territory will be accompanied by long term change in clinical practices with mutual benefit to patients and caregiver-educators.Trial registrationNCT03297723, registered: 09/28/2017.Protocol version: Version n°1.1 dated from 2016/09/08.

Relationship between expression of high-mobility group box-1 and inflammatory cytokines in patients with bone cancer pain

Objective: To investigate the change and relationship between serum high-mobility group box-1(HMGB1) and related inflammatory cytokines level in patients suffer with bone metastatic pain. Methods: Collection of the bone cancer pain patients who received analgesic therapy the department of pain in The First Affiliated Hospital of Jiaxing University from November 2016 to August 2016. Serum concentration of HMGB1, the Receptor of Advanced Glycation Endproducts (RAGE), monocyte chemotactic protein-1(MCP-1), tumor necrosis factor -α (TNF-α), interleukin-1β (IL-1β), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming growth factor-β (TGF-β) levels were determined in 15 healthy individuals as healthy donor and 15 patients with bone metastatic pain by enzyme-linked immunosorbent (ELISA) . The healthy individuals and patients with bone metastatic pain were collected before treatment and on 7 d after the treatment. Results: The serum concentration of HMGB1 and RAGE were significantly increased in tumorous group compared with healthy group[(8.8±2.3) vs (1.9±1.1) μg/L,(231±16) vs (46±20) ng/L); t=7.10,12.44, both P<0.05], then decreased after analgesic therapy [(4.77±1.36) μg/L, (129.80±29.32) ng/L, t=7.10, 12.44, both P<0.05]. The serum concentration of proinflammatory cytokines such as MCP-1, TNF-α, and IL-1β were significantly increased in tumorous group when compared with healthy group, and decreased after analgesic therapy (all P<0.05). The expression of anti-inflammatory cytokines such as IL-10, IL-13, and TGF-β were significantly increased in tumorous group when compared with healthy group, and decreased after analgesic therapy (all P<0.05).Compared with healthy group, the levels of MCP-1/IL-10, MCP-1/IL-13, MCP-1/TGF-β, TNF-α/IL-10, TNF-α/IL-13, TNF-α/TGF-β, IL-1β/IL-10, IL-1β/IL-13, IL-1β/TGF-β were significantly increased in tumorous group (all P<0.05). Conclusion: HMGB1 may adjust the proinflammatory-anti-inflammatory system homeostasis to participate in the development of bone metastatic pain.

Managing Cancer Pain in Patients with Opioid and Substance Use Disorders.

To discuss the assessment and management of pain in patients with substance use disorders. Peer-reviewed articles, book chapters, internet sources. Patients should be routinely assessed for SUDs. Pain management should be stratified according to patient risk. An interdisciplinary approach is essential. Oncology nurses should be aware of assessment approaches to screen and monitor patients with SUDs. Oncology nurses are an essential part of the interdisciplinary team when monitoring patients with SUDs.

Tapentadol in the management of cancer pain: current evidence and future perspectives.

Thanks to the progress in early diagnosis and treatment of cancer, the life expectancy of cancer patients has now increased. Patients are, therefore, more likely to experience their individual cancer pain as a chronic pain. As a consequence, long-term treatment of cancer-related pain and oncological therapy-related pain are a major need for all patients and a challenge to all healthcare professionals. Tapentadol is a centrally acting analgesic drug characterized by two synergistic mechanisms of action, since it acts at the µ-opioid receptor (MOR) and inhibits noradrenalin re-uptake (NRI). Therefore, tapentadol has been considered the first of a new class of drugs, MOR-NRI. Tapentadol has been tested in different populations of cancer patients (opioid-naive and -pretreated), such as those with pain of mixed etiology, patients with pain from hematological malignancies and patients experiencing pain conditions due to anticancer treatment. According to available evidence, tapentadol prolonged release was well tolerated and effective in cancer pain patients. In randomized, double-blind and active-controlled trials it proved non-inferior to standard opioids like morphine or oxycodone in the management of moderate-to-severe cancer pain, both in opioid-naive and in opioid-pretreated patients. The good analgesic efficacy may be partly due to the action of tapentadol on neuropathic pain components. Together with the low rate of gastrointestinal adverse effects and the overall favorable safety profile, tapentadol can be considered a good option in cancer pain patients, who can suffer frequently from nausea, vomiting, constipation or other events that further reduce their quality of life.

Oral prolonged-release Oxycodone-Naloxone: analgesic response, safety profile, and factors influencing the response in advanced cancer patients.

Oxycodone-Naloxone (OXN) aims to reduce opioid-related constipation while being successfully analgesic. We evaluated the analgesic response, prevalence, and severity of side effects in 176 cancer patients with moderate to severe pain and treated with OXN. Patients were followed for 28 days and evaluated every seven. Pain intensity, changes of therapy, and adverse drug reactions were recorded at each visit. The primary efficacy endpoint was the proportion of responders (≥30% reduction of pain intensity from baseline to final) and final average pain score ≤4 on a 0-10 scale. Average and worst pain intensity, and breakthrough pain (BTP) prevalence decreased over time and 81.3% of patients were responders. The starting daily dose of OXN was raised from 25.1±13.0 mg to 44.1±29.9 mg, and dose escalation >5%/day was observed in 19.4% of patients; 40.8-46.2% and 11.0-17.0% experienced any and severe grade of constipation during the follow-up visit, respectively. Digestive system tumor, thyroid endocrinopathies, psychological irritability, and BTP increased the risk of analgesic non-response. OXN had strong analgesic effect in moderate to severe cancer pain patients: the safety profile is in line with the common adverse effects of opioids and severe constipation was uncommon. This article is protected by copyright. All rights reserved.

Telephone Follow-up Design and Practice for Advanced Cancer Pain Patients.

To describe the design of a telephone follow-up protocol and to evaluate the feasibility of this protocol for advanced cancer pain patients. A series of nine telephone follow-up calls was implemented with 40 advanced cancer pain patients within 3months after their discharge from the Department of Chemotherapy. Cancer pain information and the pain-related knowledge of the patients were collected by nurses using pain follow-up information sheets and the Patient Pain Questionnaire (PPQ); pain self-efficacy and the quality of life were reported by patients using the Chronic Pain Self-Efficacy Scale (CPSS) Chinese version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) Chinese version. The average score assessed by advanced cancer pain patients of the need for pain care from nurses was 24.28 (SD = 4.90). Twenty-one and eight patients completed all nine telephone follow-up calls and seven self-reported questionnaires, respectively. The pain intensity of patients at the time of follow-up was mild, but there had been breakthrough pain in the previous week. All patients were satisfied with the nurses' pain follow-up practices. There was a highly positive correlation between the time of follow-up and the patients' pain-related knowledge scores (r = 0.963**, p < 0.01). Patients' pain self-efficacy scores and quality of life scores varied across different dimensions. The baseline pain self-efficacy subscales were associated with all dimensions of quality of life (p < 0.05 or p < 0.01). Telephone follow-up can be an effective method of transitional care. For advanced cancer pain patients, it is still necessary to further explore the cost effectiveness of this method, including the appropriate follow-up duration, endpoints, and outcome measures based on government requirements and policies.

Research on intelligent management of pain

Pain affects patients’ quality of life. With the acceleration of modern life and the advent of aging society, the incidence of pain keeps rising, becoming one of the important health issues concerned by the whole world. Invention of an intelligent pain management device is necessary in pain management. Combined with clinical data, the mechanism of the intelligent pain management system in cancer pain patients is provided, and how to improve the treatment effect of cancer pain is discussed in this paper.

The Roles of Chemokine CXCL13 in the Development of Bone Cancer Pain and the Regulation of Morphine Analgesia in Rats

Chemokines are important regulators of immune, inflammatory, and neuronal responses in peripheral and central pain pathway. The aim of this study was to investigate whether chemokine (C-X-C motif) ligand 13 (CXCL13) and its receptor (C-X-C chemokine receptor type 5, CXCR5) involve in the development of bone cancer pain (BCP) and the regulation of morphine analgesia in rats. The change of pain behaviors in BCP rats were measured by testing paw withdrawal threshold (PWT). The levels of CXCL13, CXCR5 and signal pathway proteins (p-p38, p-ERK and p-AKT etc.) in the spinal cord were measured via western blots. The expression of CXCL13 and CXCR5 in spinal cord was increased in BCP rats. The BCP rats showed decrease of PWTs, which was relieved by CXCR5i. Intrathecally injection of murine recombinant CXCL13 (mrCXCL13) decreased the PWTs of BCP rats and opposed morphine-induced analgesia in BCP rats. In BCP rats, the signal pathway proteins (p38, ERK and AKT) in the spinal cord were activated. CXCL13 and morphine had contrary effect on the phosphorylation of these proteins. MrCXCL13 directly increased the levels of p-p38, p-ERK and p-AKT in BCP rats. However, morphine decreased the levels of these proteins in BCP rats. While blocking the activation of p-p38, p-ERK and p-AKT, morphine analgesia was enhanced. These results suggest CXCL13 participated in bone cancer pain and opposed morphine analgesia via p38, ERK and AKT pathways. It may be a target to enhance pain management in cancer pain patients.

Breakthrough Cancer Pain in Patients With Abdominal Visceral Cancer Pain

ObjectiveThe objective of this study was to assess the characteristics of breakthrough cancer pain (BTcP) in patients with abdominal cancer pain, and the eventual factors associated with its presentation. MethodsPatients with abdominal visceral cancer presenting BTcP were included in the analysis. Pain intensity, current analgesic therapy, number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset (≤10 minutes or >10 minutes), duration, interference with daily activities, medications and doses currently used for BTcP, and time to meaningful pain relief were collected. Adverse effects imputable to a BTcP medication were recorded. ResultsFour hundred fourteen patients were included in the study. The mean background pain was 2.7 (SD 1.19) and most patients (97.6%) were receiving opioids. The mean number of BTcP episodes/day was 2.2 (SD 1.51). The mean intensity of BTcP was 7.3 (SD 1.32). BTcP onset was ≤10 minutes and >10 minutes in 271 (65.5%) and 143 patients (35.5%), respectively, and the mean duration was 52.6 minutes (SD 38.1). Interference of BTcP with daily activity was relevant for 340 patients (82%). In 122 patients (29.5%), BTcP was predictable and ingestion of food (n = 63, 51.6%) was the most frequent trigger. In comparison with unpredictable BTcP, postprandial BTcP had a lower intensity (P = 0.039), had a faster onset (P = 0.042), and was associated with the use of oxycodone/naloxone (P = 0.003), and less use of nonsteroidal anti-inflammatory drugs (P = 0.006). ConclusionPatients with abdominal visceral BTcP represent a subgroup with specific features of BTcP, particularly those with predictable BTcP. Ingestion of food was the prominent trigger for BTcP, having a faster onset and a lower intensity. This group of patients more frequently used oxycodone/naloxone or no anti-inflammatory drugs. These findings suggest consequential therapeutic decisions.

Association Between Activation of the Programmed Cell Death-1 (PD-1)/Programmed Death-Ligand 1 (PD-L1) Pathway and Pain in Patients with Cancer.

BackgroundThe aim of this study was to investigate the clinical correlation between sPD-1 (soluble programmed cell death-1) and PD-1 (programmed cell death-1) expression and cancer pain.Material/MethodssPD-1 content in peripheral blood was determined by enzyme-linked immunosorbent assay (ELISA). T cell surface-positive rate was determined by flow cytometry, and the correlation of clinical characteristics of patients with cancer pain was analyzed.ResultsThe positive expression rate of PD-1 in sPD-1 and T cells of patients with cancer pain was higher than that in normal patients. There was a significant correlation between sPD-1 and PD-1 positivity on T cell surface with tumor type, differentiation degree, and VAS scores of patients with cancer pain (P<0.05). Peripheral blood sPD-1 level and PD-1 positivity in patients with liver cancer and melanoma cancer were higher than those in patients with renal cell carcinoma and breast cancer. In addition, peripheral blood sPD-1 level and PD-1 positivity in patients with poorly-differentiated cancer pain were higher than those in patients with intermediately- to well-differentiated cancer. The sPD-1 content was lower and PD-1 positivity rate was higher in cancer pain patients with low VAS scores.ConclusionsThe positive expression rate of sPD-1 and PD-1 in patients with cancer pain is higher than that in normal people. The activation rate of the PD-1/PD-L1 pathway was mediated by sPD-1 and PD-1 positive expression, age, tumor type, and differentiation. There are correlations between clinical characteristics such as degree and pain level as shown by VAS score.

Effects of self-efficacy intervention measures on the psychological state of cancer pain and quality of life of patients with malignant tumor radiotherapy and chemotherapy

Objective To explore the effect of self-efficacy intervention measures on cancer pain, psychological state and quality of life of patients with malignant tumor radiotherapy and chemotherapy. Methods A total of 125 patients with malignant tumor treated in the hospital from April 2015 to April 2017 were selected as the research objects.They were randomly divided into the observation group and the control group.The 62 patients of the control group were given routine nursing measures.The 63 patients of the observation group were given self-efficacy intervention measures on this basis.The self-efficacy level, psychological status and quality of life of cancer pain patients in the two groups before and after the intervention were recorded and compared. Meanwhile, nursing satisfaction was calculated and compared. Results After the intervention, the cancer pain of the two groups was significantly reduced, and the pain relief of the observation group was more obvious, the difference was statistically significant(P<0.05). After the intervention, the self-efficacy scores of the two groups were significantly increased, and the self-efficacy scores of the observation group were significantly increased, and the differences were statistically significant(P<0.05). After intervention, the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores of the two groups were significantly decreased, and the SAS and SDS scores of the observation group decreased more obviously, and the differences were statistically significant(P<0.05). After intervention, the eight dimensions of the SF-36 scale of the two groups were significantly increased, and the eight dimensions of the SF-36 scales of the observation group increased more obviously, and the differences were statistically significant(P<0.05). The nursing satisfaction of the observation group patients with malignant tumor undergoing radiotherapy and chemotherapy 98.41%(62/63) was significantly higher than the control group's 79.03%(49/62), and the difference was statistically significant (χ2=2.943, P<0.05). Conclusions Self-efficacy intervention measures given to patients with malignant tumor radiotherapy and chemotherapy can effectively alleviate cancer pain, improve their self-efficacy, improve their psychological state and improve their quality of life, which is worthy of promotion and application. Key words: Self-efficacy intervention measures; Malignant tumor undergoing radiotherapy and chemotherapy; Cancer pain; Psychological status; Quality of life

Cancer Pain Management: Is It Still Problematic?

Objective: To evaluate the efficacy of pain management during 3-month follow-ups for outpatients with cancer pain. Methods: A retrospective chart review was conducted and included all newly diagnosed cancer pain patients visiting the Siriraj Pain Clinic, Mahidol University, between January 2013 and June 2014. Demographic data, pain intensity at first visit, 1-, 2- and 3-month follow-ups, pharmacological therapy and co-treatments were collected. Good treatment response was defined as more than 30% pain reduction from baseline. Predictive factors associated with pain treatment response were also assessed. Results: Out of 432 new patients, 118 cancer pain patients were included in the study with a mean age of 59.8±13.7 years (range 18-91 years). About half of patients had at least one comorbidity. Over 90% of all cancer patients presented with distance metastasis. Mixed neuropathic/nociceptive pain (53.4%) and nociceptive pain alone (43.2%) were common pain features in cancer pain patients. The mean initial pain intensity described by verbal numerical scales was 7.7±2.1 (range 3-10). The majority of patients (60.2%) received co-treatment. The main pharmacological therapies in all patients were opioids (99.2%) and anticonvulsants (90.7%). At 3-month follow-up, nearly half of patients achieved a good treatment response. However, 44.6% of good responders still had moderate and severe pain. No predictive factors associated with the pain treatment response was found. Conclusion: Approximately half of patients with cancer pain in the pain clinic achieved a good treatment response whereas one-fifth of the patients had an increase in pain severity at their 3-month follow-up.

Pattern of Cancer Pain in Patients Admitted at a Tertiary Care Centre in Northern India- A Prospective Observational Study

Pattern of Cancer Pain in Patients Admitted at a Tertiary Care Centre in Northern India- A Prospective Observational Study

Relief of Cancer Pain in Patients with Pancreatic Cancer

Pancreatic cancer is a dismal disease with a poor prognosis and is one of the most painful malignancies. Therefore, adequate pain control is essential to improving the patient's quality of life. Pain in pancreatic cancer has complex pathophysiologic mechanisms and different characteristics. The choice of pain management modalities should be individualized depending on the pain characteristics using a multidisciplinary approach. The treatment options available include medical treatment, chemotherapy, celiac plexus/ganglion neurolysis, radiotherapy, and endoscopic technique. This review discusses the medical and interventional options, leading to optimal pain management in patients with pancreatic cancer.

Focus on Cancer Pain at Home: A Prospective Study of Quality of Life and Its Influencing Factors on Patients

Background and Aims: The treatment of patients with advanced cancer pain is mainly concentrated in the outpatient department, and most of the time in their family, these patients are easy to be ignored, To study the quality of life and its influencing factors of cancer pain patients at home is of great significance to improve the quality of life of patients. Meanwhile, it provides theoretical and practical basis for medical personnel to develop and implement individualized comprehensive intervention programs. Patients and Methods: According to the inclusion and exclusion criteria, 200 patients with cancer pain at home are selected to treat, and their quality of life conditions are observed before treatment, 1 week after treatment and 1 month after treatment, and their influencing factors are analyzed. Results: The patients’ scores of body function, emotional function, cognitive function and social function exist significant difference before and after treatment (p scores of role function and the overall evaluation scores before and after treatment, two stages after treatment exist significant difference (p p appetite loss score before a month and a week after treatment and treatment exists significant difference (p the scores of constipation symptom before treatment and a month after treatment exist significant difference (p p . One week after treatment, tumor staging and metastasis have impact on overall health evaluation, role function, cognitive function and emotional function (p The location of metastasis and the type of pain affect the role function and emotional function respectively (p . One month after treatment, age, metastasis, metastasis site and pain type have influence on cognitive function, emotional function, overall health evaluation and role function respectively (p The overall health status, body function, role function, emotional function, cognitive function and social function of the patients are lower than those of the Norwegian norm (p and vomiting are higher than those of the Norwegian norm before and after treatment (p There was a significant positive correlation between quality of life and total score of social support (p Conclusion: Cognitive interventions should be individualized. The effectiveness of cancer treatment and the control of cancer recurrence and metastasis have influence on the quality of life of patients with cancer pain at home. Although the patients’ function indexes have been improved after treatment, there exist differences in the improvement after treatment. The symptoms of nausea, vomiting, pain and appetite should be intervened promptly. The management of symptoms such as dyspnea, fatigue, constipation should be focused persistently. Objective support and subjective support were the influencing factors of patients’ quality of life, the construction of social support system should be strengthened, we should help them to overcome negative emotions, return to normal family and social roles, seek help in a positive manner and use support to improve the quality of life.

Relationship of OPRM1 118A/G gene polymorphism and oxycodone analygesic dose in paitents with cancer pain

To investigate the relationship between OPRM1 118A/G gene polymorphism and oxycodone analgesic dose in patients with cancer pain. DNA sequencing was used to detect the genotypies of OPRM1 118 A/G site in 203 patients with moderate and severe cancer pain, and to compare the relationship between the pain degree and the dose of oxycodone at 3 and 30 days after treatment in patients with different genotypes. The fequencies of AA, AG and GG genotypes at the OPRM1 118 A/G site were 34.78%, 52.70%, and 12.52%, respectively. The dosage of oxycodone in GG genotype was significantly higher than that in AA genotype and AG genotype (15.44±10.19 vs. 10.25±4.53, 10.49±5.26; 89.15±27.69 vs. 43.59±12.19, 48.27±18.79) on the 3 and 30 day after treatment, difference was statistically significant (P< 0.05). For cancer pain patients with GG genotype of OPRM1 118A/G site, if they need to achieve the same analgesic effect as patients with AA and AG genotype, the dose of oxycodone should be increased.

Opioid responsiveness of nociceptive versus mixed pain in clinical cancer patients

ObjectiveTo investigate whether clinical cancer patients with mixed nociceptive–neuropathic pain are less responsive to opioids than patients with nociceptive pain. BackgroundPain is common in advanced cancer patients. Pain driven by neuropathic mechanisms is considered to be resistant to opioids. This hypothesis is mainly based on animal studies and single-dose opioid studies in humans but has not been confirmed in clinical practice. MethodsData were prospectively collected from 240 clinical cancer pain patients using opioids. Multiple linear regression was used for assessing the associations between the logarithm of the morphine equivalent dose (MED) at three days after admission (T = 3d) relative to admission (T = 0d) (logRMED) and type of pain (nociceptive versus mixed pain), corrected for gender, age, primary cancer site and use of non-opioid and adjuvant analgesics. As secondary outcome measures, associations between logMED and logPFent (fentanyl plasma level) at T = 3d and type of pain were assessed. ResultsPain intensity between T = 0d and T = 3d was significantly and evenly reduced in patients with nociceptive pain (n = 173) and mixed pain (n = 67). Median (interquartile range) MED was 20 (10–52) and 20 (20–80) mg (T = 0d), 40 (10–67) and 40 (20–100) mg (T = 3d), median PFent (T = 3d) was 1.59 (0.58–3.19) and 1.38 (0.54–4.39) ng/ml, none of them significantly different, in patients with nociceptive and mixed pain, respectively. Neither logRMED, logMED (T = 3d), or logPFent (T = 3d) was significantly associated with type of pain, after correction for confounding factors. ConclusionsWe conclude that, at least in clinical cancer patients, mixed pain is as responsive to opioids as nociceptive pain.

Evaluation of Safety and Efficacy of Radiofrequency Lesioning of Thoracic Dorsal Root Ganglion in Chest Cancer Pain Patients

Background: since cancer-associated pain is a common occurrence in malignancies involving the chest. In these cases, pain is complex and may have visceral, somatic or neuropathic components. It has been noticed that the number of cancer patients with refractory chest pain is increasing with more cancer prevalence, also with the advances in therapy and prolonged life expectancy. The demand for interventional procedures to control pain for these patients also increases. Interventional pain procedures are indicated for refractory pain when analgesic drugs are ineffective or associated with intolerable side effects. In controlling cancer pain it is commonly inadequately managed for these patients leading to suffer form of physical disabilities, psychological disturbance and avoiding treatment. Aim of the work: this study was designed to test both the efficacy and safety of thermo-coagulative ablation of the thoracic dorsal root ganglia for pain control in cancer patients that have refractory chest pain. Methodology: this prospective randomized study was conducted in the National Cancer Institute, Cairo University and Aswan University after board approval from October 2016 to March 2018. Sixty-five patients with Refractory Chronic Chest Cancer Pain were selected randomly and prospectively from the pain clinic of both the National Cancer Institute of Cairo University and Aswan University, after taken an informed written consent from the patient. The complete duration of the follow up lasted 3 months post-interventional with assessments after 1 week, 1 month and 3 months. At each follow up each patient was re-assessed with the following assessments; VAS, ECOG Performance Status. Results: we found that with effective pain relief there was a significant reduction in the mean VAS values; which means that there was functional improvement, in all the postinterventional follow ups. Also, there was an improvement in the functional state of the patients throughout the follow-up post-intervention with regards to the ECOG performance status from the results.Conclusion: we concluded that thermal radiofrequency ablation is considered an alternative for treating refractory chronic chest cancer pain of several types and causes. This is because of its efficacy, safety and ease of use. It also requires a minimal hospital stay or can even be performed on an outpatient basis.

Evaluation of Safety and Efficacy of Radiofrequency Lesioning of Thoracic Dorsal Root Ganglion in Chest Cancer Pain Patients Daily Activities and their Quality of Life

Background: in controlling cancer pain it is commonly inadequately managed for these patients leading to suffer in the form of physical disabilities, psychological disturbance, avoiding treatment. Therefore pain that is caused by cancer may directly affect the patient's quality of life; by having an effect on his/her daily activity, physical state and also psychological and emotional status. Thus, making pain relief and control the patient's right; right for a new life "pain free" or at least tolerable non-disabling pain. Aim of the work: this study aimed to test both the efficacy and safety of thermo-coagulative ablation of the thoracic dorsal root ganglia for pain control in cancer patients that have refractory chest pain And the impact on quality of life for patients. Patients and Methods: our prospective study was done on sixty-five patients selected from pain clinics of both the National Institute of Cancer, Cairo University and Aswan University with refractory chronic chest cancer pain according to the inclusion and exclusion criteria. The complete duration of the follow up lasted 3 months postinterventional; with assessments after 1 week, 1 month and 3 months. At each follow up each patient was reassessed with the following assessments; VAS, ECOG performance status, QOLS, drug consumption, side-effects (complications) and patient satisfaction. Results: we found that with effective pain relief there was a significant reduction in the mean VAS values which means that there was functional improvement, in all the postinterventional follow ups. Also, there was an improvement in the functional state of the patients throughout the follow-up post-intervention with regardsto the ECOG performance statusfrom the results. In addition to the ECOG improvement there was also a significant improvement in the QOL (Quality of Life) results, which was due to the pain relief. Regarding drug consumption, it was recorded that all three drugs; pregabalin, oxycodone and amitryptline, should maximum reduction after 1 month following the intervention, with a slight increase 3 months post-interventional, which matched the degree of pain reduction based on the pain scaling scores. Only 11% of our patients were found with numbness and neuritis, which were the only two complications reported. With regards to our patients, 30.6% certainly would repeat the procedure, 54.8% probably would, and 12.9 % probably would not while, only 1.6% certainly would not repeat it. With25.8% certainly would recommend the same procedure, 56.5% probably would, 14.5% probably would not and only 3.2% certainly would not recommend it. Conclusion: we concluded that thermal radiofrequency ablation is considered an alternative for treating refractory chronic chest cancer pain of several types and causes. This is because of its efficacy, safety and ease of use, patient’s quality of life of was largely affected.