Chronic Pain In Cancer Patients Research Articles

Intravenous methadone in the management of acute postoperative pain in a chronic cancer pain patient: A case report and review of the literature

Key Clinical MessageThe current landscape of literature highlights that there is insufficient well‐powered and robust evidence to support the integration of intravenous methadone into current guidelines and frameworks in supporting the pain management of cancer patient with complex pain syndromes. However, there is preliminary evidence, both from the literature as well as this case study that highlights intravenous methadone may be efficaciously and safety used for the management of postoperative pain in cancer patients with chronic pain undergoing operative management. Further research is required to fully elucidate key considerations of integrating this medication into clinical practice including consideration into dosing, opioid conversion, tolerance, and safety.AbstractMethadone is a broad‐spectrum analgesic with long duration of effect. Its multimodal mechanism of action, such as through effects on mu‐opioid receptor and presynaptic N‐methyl‐D‐aspartate receptors, has led to its current use in the management of opioid dependence in the community and in palliative care. These properties however make methadone appealing in the management of postoperative pain, particularly for patients with complex analgesic requirements. We report on an interesting case whereby intravenous methadone was effectively used for postoperative analgesia in a 56‐year‐old female with complex chronic pain secondary to a mucinous pelvic neoplasm of unclear primary who underwent palliative resection. Further, we review the literature surrounding usage of methadone in this setting to understand current challenges and barriers to implementation of methadone as an analgesia option for chronic pain patients following surgery. To do this, a case report and literature review was conducted in accordance to the CARE case report guidelines. The patient provided written consent for the de‐identification and use of their medical information and data for the generation and publication of this case report. Our case report and literature review demonstrate there remains significant heterogeneity, unfamiliarity, and scarce use of intravenous methadone in the perioperative and postoperative space in the management of patients with complex pain regimens such as chronic cancer pain patients. Despite this, our case report and literature review highlight as a broad analgesic, intravenous methadone warrants consideration following more rigorous research and development of safe use guidelines into its use for this purpose.

Cannabidiol: main mechanisms of action and therapeutic targets

Introduction: Over the past few years, multiple publications have proven many beneficial properties associated with CBD. Currently, its use in the treatment of inflammatory and autoimmune diseases is suggested. Also, very often the use of CBD in the treatment of anxiety disorders, schizophrenia and depression, as well as Parkinson's disease and Alzheimer's disease is the subject of scientific research. CBD could be also used in treatment of the chronic pain in cancer patients or in people with diabetic complications. So far, it has been proven that CBD has anti-inflammatory, anticonvulsant, antioxidant, anti-arthritic, procognitive, cardio- and neuroprotective effects. The potential of cannabidiol in the prevention and treatment of many diseases is seen in its complex and multidirectional mechanisms of action. CBD has low affinity for cannabinoid receptors and acts as an inverse agonist of type 2 cannabinoid receptors (CB2-R). Additionally, CBD exerts its effects through many other molecular targets. Aim of the study: The aim of this review is to present mechanisms of action of cannabidiol and its possible therapeutic targets. Materials and methods: The literature available in the PubMed and Google Scholar data bases was reviewed, using the following keywords: "cannabidiol", "CBD", "CBD's mechanism of action", "CBD therapeutic targets", "endocannabinoid system". Conclusions: Cannabidiol is a promising candidate in the treatment of many common diseases. Furthermore, research is needed to confirm its beneficial effects and turn it into an effective drug that supports therapy with other drugs.

Therapy of chronic pain in cancer patients: Tafalgin use experience. Case report

Background. Chronic pain is the most common and severe condition associated with cancer, causing peripheral and central nervous system disorders Inadequate pain control can be destructive and negatively affect patients' quality of life and daily activity. Therefore, developing new drugs for complete pain control during antitumor therapy and palliative care is an urgent problem in modern oncology. One of these directions is the search for selective molecules that interact with 1-opioid receptors without many side effects of opioids.
 Aim. To evaluate the effectiveness of a new selective 1-opioid analgesic, Tafalgin, in treating chronic pain in a patient with pancreatic cancer.
 Materials and methods. Tafalgin was used to control chronic pain in a 60-year-old patient with stage IV pancreatic cancer, pT2 N0M1, with liver metastases, state after 10 cycles of polychemotherapy, and distal subtotal resection of the pancreas with splenectomy, progression in October 2022, liver metastases; state after 4 cycles of polychemotherapy, severe chronic pain.
 Results. The initial pain severity was evaluated using a visual analog scale: 7 points at rest and 9 points on exertion. The patient developed pain during FOLFIRINOX polychemotherapy, for which he received tramadol at a daily dose of 400 mg in combination with paracetamol, with an effect for 1.5 months. The pain severity increased with breakthrough pain. The patient was prescribed long-acting morphine at 60 mg/day, with good effect. However, the patient experienced nausea and vomiting. The morphine dose was reduced to 20 mg, thus resolving side effects and decreasing the effectiveness. Tafalgin was administered at a dose of 4 mg TID. The pain severity decreased to 11.2 points. No adverse events were reported. The patient has been receiving the drug for 52 days. His sleep and appetite have improved, physical activity has increased, and no weight loss has been reported.
 Conclusion. When switching a patient to Tafalgin, continuous adequate pain control is maintained, not inferior to morphine. Tafalgin is associated with a favorable safety profile.

Regression of chronic pain syndrome refractory to opioid pharmacotherapy in a patient after implantation of a spinal cord neurostimulator: case report

BACKGROUND: Pain in cancer patients, often poorly treated, cause severe distress for patients and their caregivers, and significantly reduces quality of life. Modern guides for the medical treatment of chronic pain in cancer patients are not effective in all cases, especially when chronic neuropathic pain syndrome occurs. In this regard, there is a need for a multidisciplinary personalized approach to the tactics of chronic pain management in favor of surgical methods at earlier stages of this condition. Nowadays neuromodulation is widely used for the treatment of neuropathic chronic pain syndrome in patients with various pathologies, whereas it is not used routinely in cancer patients.
 CLINICAL CASE DESCRIPTION: We introduce a case report of successfully applied neuromodulation in patient with severe chronic pain syndrome due to rectal cancer. Epidural spinal cord stimulation at Th10Th12 levels allowed to stop the systemic use of opioids and achieve long-term remission. Spinal cord stimulation has shown itself to be very promising and significantly improved patients quality of life.
 CONCLUSIONS: Our case report evidently shows that current chronic pain management guides and treatment recommendations needs a revision and neuromodulation usage in category of cancer patients should be considered.

Prevalence of Depressive Symptoms among Adult Chronic Cancer Pain Patients of the Philippine General Hospital - Pain Clinic

Objective. Chronic cancer pain and depressive symptoms are interrelated in clinical settings. As local data is lacking, this study aimed to determine the prevalence of depressive symptoms among chronic cancer pain patients seen at the Philippine General Hospital - Pain Clinic (PGH-PC).Methods. In this retrospective, descriptive, cross-sectional study, data were collected from the charts of chroniccancer pain patients seen at the PGH-PC. The Pain Clinic Self-Report Questionnaire (SRQ) tool was used to assess depressive symptoms. Clinico-demographic data were obtained and analyzed using descriptive statistics.Results. Of the 129 patients included in the study, 61 had depressive symptoms corresponding to a prevalence of 47.29% (38.72 - 56.01 95% CI). Overall, a more significant number of patients included in the study were female, belonged to age 41-50, were married, attained secondary education, and were unemployed. Demographically, there were no statistically significant differences between chronic cancer pain patients who exhibited depressive symptoms and those who did not. The cancer type showed a statistically significant difference among those cancer patients with or without depressive symptoms (p = 0.016). Breast and gynecologic malignancies comprised more than half of the patients studied. Neither the cancer stage nor the pain scores had a statistically significant difference among those cancer patients with or without symptoms of depression.Conclusion. Almost 1 in every two chronic cancer pain patients studied had depressive symptoms. Routine screening of patients for depressive symptoms could identify patients and may initiate interventions in this vulnerable population

Chronic pain in cancer patients

Background. Pain is a complex clinical sign that is highly variable in both intensity and perception by patients. Often, a combination of symptoms and signs can indicate a pain syndrome specific to oncology. Virtually all patients with malignant diseases experience recurrent episodes of acute pain, which may accompany previous surgery, invasive procedures, or complications such as pathologic fractures or disease progression. Chronic pain is a huge economic burden on society, both in terms of health care and lost productivity.Effective treatment of chronic pain results in significant improvements in general and psychological wellbeing and functioning of cancer patients and reduces the burden of chronic pain on health services.The purpose is to clarify the problems of the prevalence of chronic pain in cancer patients, the complexity and variability of the pathophysiological mechanisms of the development of pain syndrome, to consider modern approaches to the management of patients with chronic pain.Materials and methods. Modern foreign guidelines for the management of cancer patients with pain syndrome, written in English, data from metaanalyses, reviews and clinical studies were used.Conclusions. Data from a 2016 crosssectional study to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain indicated that patients with chronic pain are at increased risk of developing depressive disorder of varying severity. About onethird of the study sample had major depression, and the overall prevalence of depression among individuals with chronic pain was higher than 50% [3].Up to 75% of all cancer patients with chronic pain have nociceptive (somatic or visceral) or neuropathic syndromes, which are a direct consequence of the development and progression of the neoplasm. Other causes include anticancer drugs and disorders unrelated to the disease or its treatment.Several systems are used to classify the pain syndrome, in particular — ECS-CP, IASP, ACTTION-APS.Today, in the management of cancer patients with chronic pain, the WHO threestep analgesic ladder is used: the first two steps are paracetamol and NSAIDs, mild opioids (control of mild and moderate pain), the third is opioids. The selection of opioids, their dosage and titration features should take into account the individual characteristics of the patient in order to avoid overdose and addiction.In addition to the abovementioned drugs, studies are being conducted to determine the effectiveness and feasibility of using medical cannabis as an alternative means, the use of which will improve the general condition of patients by relieving pain, and preventing the development of opioid addiction.Interventional techniques (neurolytic blockades, neuraxial infusions, trigger point injections, spinal cord stimulation, intrathecal drug administration, and vertebral augmentation) are also used to control chronic pain. The application of physical and psychosocial methods in the comprehensive management of such patients is studied.

Kynurenic acid as chronic pain biomarker for future cancer pain management

The prevalence of chronic pain ranges from 30-50% in patients with cancer undergoing active therapy. Kynurenic acid, xanthurenic acid, and quinolinic acid are significant biomarkers for assessing pain objectively. This study aims to investigate the scientific evidence of the effect of serum kynurenic acid levels on the severity and duration of chronic cancer pain. It is a cross-sectional study with 80 subjects consisting of 19 male and 61 female patients in the palliative outpatient clinic of Dr Soetomo Hospital. The pain assessment was performed using the NRS, and the biochemical analysis of serum kynurenic acid was assessed using the ELISA method. Of the total of 80 subjects, 26 patients had pelvic organ cancer (33.7%), 24 patients had respiratory organ cancer (30.1%), 17 patients had breast cancer (21.7%), 9 patients had abdominal organ cancer (9.6%), 3 patients had malignant melanoma (3.6%), and 1 patient had sternal bone cancer (1.2%). Kynurenic acid significantly correlated with the severity of pain (p = 0.043), with (r) of -0.218. However, kynurenic acid showed no significant correlation with the duration of pain (p = 0.052). Kynurenic acid affected the severity of pain but did not affect the duration of pain in chronic cancer pain patients.

Persistent opioid use in patients with multiple myeloma post-ASCT.

Bone pain is a common presenting symptom of multiple myeloma (MM) and is frequently treated with opioids in addition to myeloma directed therapy. With improved response and survival with modern myeloma therapy, it is important to re-examine the role of opioids in managing symptomatic myeloma. We performed a retrospective analysis of patients with myeloma at Rutgers Cancer Institute of New Jersey (RCINJ) who received an ASCT between January 1, 2012, and December 30, 2017, and who had subsequent follow-up (a total of 138 patients). We sought information specifically from the visits after induction therapy but prior to ASCT, at 100days and 1-year post-ASCT follow-up visits. We compared opioid users and non-users in relation to treatment response, co-morbid conditions, and symptoms. We also examined amounts, duration, and odds of continued opioid use. At the time of the first analysis (before transplant), 34.8% of patients were using opioids and opioid use was more frequent in younger patients and, as expected, in patients with bone lesions. At 1year, 31.9% of patients were still using opioids and continued opioid use was not correlated with disease response. Of the patients using opioids at the time of transplant, 58% either maintained their opioid dose or increased it at 1-year post-transplant. This retrospective analysis shows that despite a small decrease in opioid use over time, opioid use remains frequent in MM patients and is correlated with younger age and bone involvement but not with response to therapy. Over half the patients using opioids at the time of transplant continued or increased opioid use over the following year. With increasing survival in myeloma patients, further attention is required to distinguish cancer pain from chronic pain in cancer patients.

Comparative analysis of the effects of opioids in angiogenesis

BackgroundAngiogenesis, the formation of blood vessel from pre-existing ones, plays an important role in many pathophysiological diseases, such as cancer. Opioids are often used in clinic for the management of chronic pain in cancer patients at terminal phases. Here, we investigated and compared the effects and mechanisms of four opioids on angiogenesis.MethodsWe performed angiogenesis assays on human umbilical vein endothelial cells (HUVEC) that represent an in vitro model to assess the toxicity of drugs to endothelium.ResultsMorphine and oxycodone at 0.1 μM to 100 μM dose-dependently increased endothelial cell tube formation and proliferation. We observed the same in endothelial cells exposed to fentanyl at 0.1 μM to 10 μM but there was a gradual loss of stimulation by fentanyl at 100 μM and 1000 μM. Morphine and fentanyl reduced endothelial cell apoptosis-induced by serum withdrawal whereas oxycodone did not display anti-apoptotic effect, via decreasing Bax level. Oxycodone at the same concentrations was less potent than morphine and fentanyl. Different from other three opioids, codeine at all tested concentrations did not affect endothelial cell tube formation, proliferation and survival. Mechanism studies demonstrated that opioids acted on endothelial cells via μ-opioid receptor-independent pathway. Although we observed the increased phosphorylation of mitogen-activated protein kinase (MAPK) in cells exposed to morphine, fentanyl and oxycodone, the rescue studies demonstrated that the stimulatory effects of morphine but not fentanyl nor oxycodone were reversed by a specific MAPK inhibitor.ConclusionOur work demonstrates the differential effects and mechanisms of opioids on angiogenesis.

Targeting the mu-Opioid Receptor for Cancer Treatment.

Opioids are still the most effective and widely used treatments for acute and chronic pain in cancer patients. This review focuses on the impact of opioids and mu-opioid receptors (MOR) on tumor progression and providing new ideas for targeting the MOR in cancer treatment. Studies estimated that opioids facilitate tumor progression and are related to the worse prognosis in cancer patients. As the primary receptor of opioids, MOR is involved in the regulation of malignant transformation of tumors and participating in proliferation, invasion, metastasis, and angiogenesis. MOR may be a new molecular marker of malignant tumors and thus become a new target for cancer therapy, which may be beneficial to the outcomes of cancer patients.

Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

ObjectiveTo assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain.DesignSystematic review.Data sourcesCENTRAL, EMBASE and MEDLINE.Main outcomes and measuresOpioid dose reduction, pain...

Opioid Use Disorders among Patients on Long-Term Morphine for Management of Chronic Cancer Pain: A Pilot Study from a Tertiary Palliative Care Facility.

Objectives:Long-term opioid use can be associated with misuse and addiction. In the backdrop of increasing burden of cancer patients in India, it is important to assess the rate of opioid use disorders among those with chronic cancer pain. The objectives were to measure the rate of opioid use disorder in chronic cancer pain patients being managed with morphine and to assess its association with demographic and clinical characteristics.Materials and Methods:A cross-sectional study was conducted on chronic cancer pain patients who were prescribed morphine for ≥12 months, dosage of ≥60 mg/day. They were assessed using MINI version 7.0.0, WHO-ASSIST Hindi questionnaire, Addiction Behavior Checklist, and DSM-5 for opioid use disorder.Results:Forty patients who were treated with morphine for a total of 1479 months participated. The average morphine consumption was 159.50 ± 327.90 mg/day. Six (15%) showed possible inappropriate opioid analgesic use and none of the patients had opioid use disorder.Conclusion:This study reports the absence of opioid use disorder due to vigilant use of morphine in chronic cancer patients.

Efficacy of Alpha Lipoic Acid Supplementation In Chemotherapy-Induced Peripheral Neuropathy

A B S T R A C TBackground. Chemotherapy-induced peripheral neuropathy is a side effect ofseveral chemotherapy drugs and a significant cause of chronic pain in cancerpatients, which affects patients' long-term quality of life. The neurotoxicchemotherapy agents most reported to cause neuropathic pains are platinum andtaxane. This study aimed to determine the efficacy of alpha-lipoic acidsupplementation in chemotherapy patients. Methods. This study used arandomized, double-blind clinical trial in the oncology haematology clinic in theDepartment of Internal Medicine at Mohammad Hoesin General Hospital Palembangfrom November 2018 to July 2019. Samples were taken from patients who met theinclusion criteria and signed informed consent forms to join the study. This studyused SPSS version 22.0 for Windows to analyze the data.Results. This researchstudied 30 subjects who were divided into alpha lipoic acid groups and placebogroups with 15 samples each. The alpha-lipoic acid group showed a significantdecline in the Toronto Clinical Scoring System (TCSS) after treatment (p = 0.000)compared to the placebo group (p = 0.164). Conclusions. Treatment with a 600 mgsingle dose each day of alpha-lipoic acid for 12 weeks effectively improved patientscondition significantly.

Spinal cord stimulation in the management of neuropathic pain in cancer patients: case report

Introduction: Neuropathic pain is present in up to 40 % of all cancer patients. A considerable number of patients fail to achieve enough pain relief with conventional treatment, which is why therapeutic alternatives such as spinal cord stimulation should be considered.
 Case description and results: This is the case of a female patient with chronic neuropathic pain secondary to a partial femoral nerve injury sustained during resection and lymph node dissection surgery with curative intent for a large stage II cell squamous cell carcinoma T2N0M0, localized in the right popliteal fossa. The patient presented with difficult to manage chronic neuropathic pain, despite receiving multiple oral analgesics and nerve blocks. A medullary neurostimulator was implanted that relieved the patient’s pain intensity in up to 80%, in addition to improved function and quality of life.
 Conclusions: spinal cord stimulation is considered an effective neuromodulatory intervention which has shown satisfactory results in the treatment of various types of refractory chronic pain in cancer patients, including neuropathic pain.

APLIKASI BRIEF PAIN INVENTORY (BPI) INDONESIAN VERSION UNTUK MENGKAJI NYERI KRONIS PADA PASIEN KANKER

For cancer patients the pain will have an impact on quality of life, is complex and greatly affects daily activities. Pain management is currently felt to be not enough to relieve complaints. One major obstacle to improvement is narrow assessment, as well as an assessment focus that does not consider the multidimensional nature of pain. The Center for Symptom Evaluation in Cancer Care has developed a specific pain assessment for cancer patients, the Brief Pain Inventory (BPI). The purpose of this study is to prove and see the suitability of the Indonesian version of BPI as a study of pain in cancer patients at RSCM Jakarta. Research respondents were 20 cancer patients with pain and observed using the Brief Pain Inventory (BPI) instrument. Based on the results of the Cronbach’s alpha test from BPI it is known as 0.723. These results show that BPI is appropriate and consistent in assessing cancer pain, especially chronic pain, and has a good correlation based on the Spearman correlation with ECOG values (r = -0.75, p = 0.0001). The sensitivity test is known to be 95.7%, specificity 100 %, PPV 100%, NPV 65.67%, LR (-) 0.05, with diagnostic accuracy of 95.73%. BPI is a more multidimensional assessment as a description of biological, psychological, social and cultural conditions of cancer patients who experience pain, so that BPI is suitable for use in the scope of oncology nursing in assessing chronic pain in cancer patients.

Violence and chronic pain in cancer patients in northeastern Mexico.

e24113 Background: Chronic cancer pain generates fear and anguish in cancer patients. It is suffered by 64% of patients with metastatic or terminal disease, 59% of patients in early and intermediate stages, and 33% of patients cured from cancer. They require a psychosocial support network. This network has been proposed as an essential tool to reduce the negative impact of the symptoms and psychosocial implications of cancer on the quality of life of patients. Patients with dysfunctional family networks can add to the pain of suffering cancer when they suffered or suffer violence. Cancer and pain test all personal resources and the patient's support network where family functioning is capital for quality of life. Methods: Descriptive, comparative and correlational study. A sample was taken for convenience with the prior consent of the patients who attend the outpatient clinic of the Pain Clinic of the Oncology Service, of the University Center Against Cancer of the University Hospital “Dr. José Eleuterio González” in Nuevo León. The questionnaires were applied during a session of 25 to 30 minutes. It was requested to answer the scales to assess the level of intra-family functioning, intra-family violence, quality of life, measuring psychosocial and health variables; as well as for the detection of the type and quality of psychosocial support perceived by the subjects. Results: A total of 207 research subjects were included in the study, the average age was 49 years of age (minimum 12, maximum 81 years of age), 23% men and 77% women. Marital status: married 52%, home-based 63%; monthly income less than $120 USD (n = 75, 37%). The quality of life index and chronic cancer pain had a high linear correlation with the variables of family violence, psychosocial support, family functioning, somatic symptoms, among other variables studied. Fatigue was the symptom most frequently associated with the decrease in the quality of life index. Conclusions: The satisfaction of perceived social support is a factor associated with the quality of life in patients with chronic cancer pain, however, the number of caregivers is not. There was no relationship between the size of the network and satisfaction with it. Also, the symptoms associated with chronic cancer pain affect the quality of life, identity, social functionality and roles, which in turn impact the quality of life perceived by the patient. This study supports our comprehensive intervention programs and new protocols to promote the quality of life of cancer patients.

Successful use of buprenorphine-naloxone medication-assisted program to treat concurrent pain and opioid addiction after cancer therapy.

Cancer pain is often treated with opioids, a therapeutic regimen that can become a challenge in patients with an opioid use disorder (OUD). While use of the buprenorphine-naloxone combination is an effective medication-assisted treatment (MAT) for OUD, its use in pain patients with OUD has been controversial due to concerns that co-administration of buprenorphine can reduce or block analge-sia and precipitate opioid withdrawal in those patients requiring full opioid agonists. Data on its use in cancer pain patients are lack-ing. In this case series, the authors explore the frequency of buprenorphine-naloxone use and its outcomes in patients in a Compre-hensive Care Center (CCC) Pain Registry. OUD was deduced from an International Classification of Diseases (ICD-10) diagnostic code for opioid-related disorders recorded in the electronic medical records. Of 2,320 chronic cancer pain patients, 125 patients had ICD-10 code for opioid-related disorders, and 43 had a diagnosis of opioid abuse of whom 11 received buprenorphine-naloxone combina-tions. Eight patients on 18 (6-24) mg per day of buprenorphine-naloxone remained in therapy for 4 (2-7) years without opioid abuse relapse. This assessment was based on clinician's notes, the Prescription Monitoring Program, random urine drug screening, and the absence of Urgent Care Center visits for opioid withdrawal or overdose. When short-term opioids were administered for acute pain, these patients were able to taper down and stop them quickly without an opioid abuse relapse. Buprenorphine-naloxone was effec-tive as the sole analgesic in selected patients. Given its success at the CCC, buprenorphine-naloxone should be made available and strongly considered as a treatment for patients suffering from OUD during and following cancer treatment and when cancer pain re-duces or resolves.

PROBLEM OF CHRONIC PAIN IN ONCOLOGY AND APPROACHES TO ITS RELIEF

This article reviews modern ideas about the pathogenesis of chronic pain in cancer patients and describes main approaches to its relief. Special attention is focused on factors important for the development of a patient-specific approach to the pathophysiology and management of chronic pain syndrome. These factors include genetics, gender, age, early anamnesis, patients’ immunological and endocrine status, as well as those shedding light on the pathogenetic aspects of chronic pain thus facilitating the choice of an optimal therapeutic approach. The review identifies limitations of pharmacotherapy as the major method of chronic pain management and justifies the need for alternative approaches. The latter include monitoring of the circadian rhythms of pain and various nonspecific effects, such as physical factors, psychological methods or reflex therapy. The experience and possibilities of non–pharmacological methods in the complex pathogenetic therapy of chronic pain are analysed, along with preventive measures permitting the development of chronic pain to be avoided. The pathological disorganizing and stressful role of chronic pain is considered with regard to the theory of functional systems. The pathogenetic significance of chronic pain in carcinogenesis and cancer progression is illustrated by examples from scientific literature. The authors emphasize the necessity of effective pain prevention, including invasive methods, in order to ensure an acceptable quality of life for cancer patients at any stage of the malignant process.

Elimination of pain syndrome in patients with advanced pancreatic head cancer

Pain syndrome, along with mechanical jaundice, is one of the most evident clinical manifestations of pancreatic cancer and is often a sign of tumor neglecting. Existing treatment options for chronic pain in cancer patients are diverse and include the various ways of impact on the different links of pathological pain: medicinal, endoscopic, surgical. With this pathology, drug therapy using analgesics, weak and strong opioids, is usually not effective enough. In such cases, preference is given to chemical neurolysis — denervation of the autonomic structures of the retroperitoneal space, carried out under the guidance of ultrasound or computed tomography. Conducting percutaneous neurolysis of the celiac plexus with the use of alcohol or phenol is prescribed upon insufficient effectiveness of pharmacotherapy. Surgical methods of anesthesia are used extremely rarely, as they considerably worsen the patient’s condition, without significantly affecting the quality of life or the prognosis. Thoracoscopic splanchnicectomy is considered a modern and effective method of endoscopic treatment of pain in unresectable pancreatic cancer, the conduction of which can significantly decrease the intensity of pain, reduce the number of narcotic analgesics and improve the quality of life of cancer patients. This minimally invasive intervention is the basis for the subsequent lifelong systemic drug therapy.

Сегидрин как препарат сопроводительной терапии для повышения качества жизни и уменьшения хронического болевого синдрома у онкологических пациентов паллиативного профиля

Сегидрин как препарат сопроводительной терапии для повышения качества жизни и уменьшения хронического болевого синдрома у онкологических пациентов паллиативного профиля