Oncologic Pain Research Articles

운동형태가 유방암 환자의 유방암 발병위험인자 및 종양 표지자에 미치는 영향

The link between tumor marker CA15-3 and exercise needs to be continued, but domestic research is still small. Therefore, this research was intended to analyze the effects on breast cancer risk factors (E₂, IGF-1, IGFBP-3) and tumor marker (CA15-3) by conducting aerobic and resistance movements for 10 weeks, and to present a form of exercise that is useful for preventing breast cancer and preventing recurrence. Among women aged 30 to 60 years old, those who were not exercising regularly were those who did not have any acute or chronic oncological pain that could affect their studies, within six months or more of the time of the end of the post-surgical radiation therapy. These aerobic exercise group of 15 resistance exercise group, 15, 15 separate and entirely random control group. The exercises were divided into aerobic and resistance exercises, and the same exercise intensity (50~70%HRR) was set up three times a week and the exercise time was 70 minutes a week for 10 weeks. As a result of this study, E2, IGF-1 and IGFBP-3 had interaction effects of group and timing. E₂ and IGFBP-3 were significantly lower than comparison groups in the aerobic and resistance movement groups after exercise compared to before. IGF-1 was significantly lower in resistance after exercise than before than in aerobic exercise groups and comparison groups. CA15-3 had interaction effects of group and timing. It was significantly lower than the comparison groups in the aerobic and resistance movement groups after the exercise compared to before. The results of this study showed positive improvement in estradiol, IGFBP-3 and CA15-3 by regularly conducting aerobic and resistance movements. IGF-1 showed that the resistance movement was more effective than aerobic exercise.

New opioid analgesic tapentadol in the treatment of neuropathic pain in oncology

Famous and familiar analgesics are being replaced by new drugs with improved properties. How to calculate their dose, in which category of patients to use, for what type of pain, with what dose to start therapy and with what adjuvants to combine? Many questions arise when a new opioid is being used. To answer these difficult questions, we decided to share our experience with the new analgesic tapentadol, describing real clinical cases from our practice.

Association of the quality of psychosocial support and quality of life in patients with chronic oncological pain.

e23113 Background: Most studies report that tumor related pain occurs between 46% and 92%. The prevalence of pain by clinical stage is 15% in initial stages, 30% in middle stages, 74% in metastatic cancer and, 87% in terminal disease. In the face of chronic diseases such as cancer, patient's relationships with their social networks are affected; among them the interpersonal relationships between the patient and his networks and these towards the patient. With this, the patient’s quality of life is affected. Most of the recent studies on health-related quality of life come from pharmaceutical groups, so it is necessary for other groups to be vigorously involved in the study of the effect of medical interventions on the quality of life, as well as on the impact on health and on the social support of patients with chronic diseases. Methods: In order to obtain the data, validated questionnaires were used as instruments to evaluate the 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. The instruments were applied to 207 patients of the Oncology Service of the University Center Against Cancer of the University Hospital “Dr. Jose Eleuterio Gonzalez” in Nuevo Leon, Mexico, during a session of 25 to 30 minutes. Results: Data were collected from 207 patients with chronic oncological pain. The satisfaction index with psychosocial support had a high linear correlation ( r = .640) with the quality of life index. On the other hand, the number of caregivers was not correlated with this last index. Fatigue was the symptom most frequently associated with a decrease in the quality of life index. In addition, pain correlated with all variables except the cognitive index. Conclusions: Satisfaction with the perceived social support is a factor associated with the quality of life in patients with chronic oncological 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 oncological pain affect quality of life, identity and social functionality and roles, which in turn impact on the quality of life perceived by patients.

Associated factors with the knowledge of nurses of a high complexity oncology centre in Brazil, on the management of cancer pain

Pain is one of the most prevalent symptoms in cancer patients and may be directly related to cancer or to the procedures needed for its diagnosis and treatment. It is estimated that about 40% of cancer patients receive inadequate treatment for painful conditions. Among the barriers to adequate pain management are inadequate knowledge and the dysfunctional beliefs of healthcare professionals. Therefore, the present study aims to assess the knowledge of oncology nurses on the management of pain, as well as the factors associated with it. It is a cross-sectional study with 126 nurses working at a High Complexity Oncology Centre in Brazil. Knowledge about the management of cancer pain was evaluated through the instrument ‘Nurses’ Knowledge on Cancer Pain Management—World Health Organization—developed by Ramos (1994). In the analysis of the association between knowledge about pain management and the independent variables, Poisson regression was used with robust variance, and values of p ≤ 0.05 were considered statistically significant. Adequate knowledge prevalence was 54.1% confidence intervals (CI 5.40%–62.80%). These nurses differed in relation to those with inadequate knowledge regarding the source of knowledge about pain, the ethical aspects in the treatment of the patient with oncologic pain, and non-pharmacological methods (coeliac plexus neuroleptic block) for pain control. Also, the factors associated with adequate knowledge were longer professional experience time ([10–19 years (ratio prevalence (RP) = 1.72, 95% CI: 1.05–2.81), 20–29 years (RP = 2.56, 95% CI: 1.63–4.02), 30–39 years (RP = 3.45, 95% CI: 2.25–5.29]), and not believing that the use of opioids causes harm to patients corresponded with a greater chance prevalence ratio (PR = 1.20, 95% CI: 1.12–1.20) of having adequate knowledge. The findings of the study point to the need for continuing education, updated education, and reflection, especially for nurses with less professional experience.

Oncologia integrata in radioterapia: evidenze scientifiche e gestione degli effetti collaterali

Success of radiotherapy in eradicating a tumour depends principally on the total radiation given, but the tolerance of healthy tissues surrounding the tumour limits its dose. The clinical manifestations of either acute or late radiation toxicity can be quite severe. Complementary and integrative medicines have recently attracted the interest of researchers and medical practitioners since several trials showed some evidence about the benefi ts of using herbal medicine and acupuncture for cancer-related fatigue, nausea and vomiting, diarrhea, oncological pain, radiodermitis, mucositis, anxiety, and depression. There is also very good evidence for the effi cacy of sport/physical activity and nutrition in oncology, where a regular diet of vegetables is recommended. Physical activity is recommended also during chemo/radiotherapy for the reduction of treatment side effects. Dietary modifi cation such as caloric restriction has been shown to decrease tumour initiation and progression, and could be used during radiotherapy as a novel therapeutic intervention to enhance the cytotoxic effect on the tumour and reduce the cytotoxic effects on healthy tissue.

Lactate and cancer: spinal metastases and potential therapeutic targets (part 2)

Metastatic spine disease is a heterogeneous clinical condition commonly requiring surgical intervention. Despite this heterogeneity, all cases share the common theme of altered tumor metabolism, characterized by aerobic glycolysis and high lactate production. Here we review the existing literature on lactate metabolism as it pertains to tumor progression, metastasis, and the formation of painful bone lesions. We included articles from the English literature addressing the role of lactate metabolism in the following: (I) primary tumor aggressiveness, (II) local tissue invasion, (III) metastasis formation, and (IV) generation of oncologic pain. We also report current investigations into restoring normal lactate metabolism as a means of impeding tumor growth and the formation of bony metastases. Both in vivo and in vitro experiments suggest that high lactate levels may be necessary for tumor cell growth, as small molecules inhibitors of lactate dehydrogenase (LDH5/LDHA) decrease both the rate of tumor growth and formation of metastases. Additionally, in vitro evidence strongly implicates lactate in tumor cell migration by driving the amoeboid movements of these cells. Acidification of the local bony tissue by excess lactate production activates CGRP+ neurons in the bone marrow and periosteum to generate oncologic bone pain. High lactate may also increase expression of acid sensing receptors in these neurons to generate the neuropathic pain seen in some patients with metastatic disease. Lastly, investigation into lactate-directed therapeutics is still early in development. Initial preclinical trials looking at LDH5/LDHA inhibitors as well as inhibitors of lactate transporters (MCT1) have demonstrated promise, but clinical work has been restricted to a single phase I trial. Lactate appears to play a crucial role in the pathogenesis of metastatic spine disease. Efforts are ongoing to identify small molecules inhibitors of targets in the lactogenic pathway capable of preventing the formation of osseous metastatic disease.

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.

A HYPNOSIS-BASED GROUP INTERVENTION TO IMPROVE QUALITY OF LIFE IN CHILDREN WITH CANCER AND THEIR PARENTS

Many children with cancer and their parents suffer from distress, fatigue, and relational difficulties. Hypnosis is often used to decrease children’s procedure-related pain and distress in pediatric oncology and to improve the well-being of adults with cancer. This article describes a pilot study assessing the acceptability and feasibility of a group intervention combining self-care and hypnosis for children with cancer and their parents, and a quasi-experimental protocol aimed at assessing the efficacy of this intervention to improve quality of life, distress, fatigue, and coping. The pilot study showed that the intervention was feasible and perceived positively. Future research is needed to test the efficacy of group interventions combining self-care and hypnosis to improve quality of life for children with cancer and their families.

2C Using a Pain Tracking App in an Adult Oncology Pain Clinic

2C Using a Pain Tracking App in an Adult Oncology Pain Clinic

The efficacy of the ganglion impar block in perineal and pelvic cancer pain.

Visceral pain conducted by sympathetic fibers with pelvic and perineal origin can be treated using ganglion impar (GIB) or Walters' block in a simple and effective manner. This article aims to evaluate the effectiveness, security, and performance difficulty of GIB in patients with pelvic and perineal oncological pain. A retrospective study between January 2016 and August 2017. Patients with poorly controlled pelvic oncological pain and patients experimenting opioid side effects in which GIB was performed ambulatory were included. Prognostic GIB was performed, under echographic and fluoroscopic control, with local anesthetic and corticoid. The neurolytic block was performed under fluoroscopic guidance. The technique was performed by the same anesthetist with pain management competence. For statistical analysis, Microsoft Excel 2013® and IBM SPSS Statistics version 22.0 were used. Fifteen patients were included. One patient was excluded. A statistical significant basal pain score reduction was observed ((median of the verbal numerical scale (VNS) 7 (p25 = 7; p75 = 8)) compared with 72h median VNS 4 ((p25 = 3; p75 = 5.3) p= 0.001, and 3months (median VNS 4 (p25 = 3, p75 = 7)) p= 0.003 after the procedure. Regarding morphine consumption, a statistically significant reduction was observed 3months after GIB performance (p = 0.012). GIB is a safe and easy-to-perform technique achieving satisfactory and statistically significant results, regarding pain control improvement and opioid consumption reduction in patients which meet selection criteria. Prospective, randomized studies with more patients are needed for further conclusions.

Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm.

Neuropathic pain in pediatric oncology can be caused by distinct lesions or disease processes affecting the somatosensory system, including chemotherapy-related neuronal injury, solid tumor-related involvement of neural structures, post-surgical neuropathic pain-including phantom limb pain and pain after limb-sparing surgery-and the complex circumstances of neuropathic pain at the end of life. Treatment algorithms reflect the general treatment principles applied for adult neuropathic pain, but the dose regimens applied in children are modest and rarely escalated to the maximum doses to optimize analgesic efficacy. Pharmacological management of neuropathic pain should be based on a stepwise intervention strategy, as combinations of medications are the most effective approach. Gabapentinoids and tricyclic antidepressants are recommended as first-line therapy. Methadone, ketamine, and lidocaine may be useful adjuvants in selected patients. Prospective studies extended over a substantial length of time are recommended because of the nature of neuropathic pain as persistent, chronic pain and based on the need for sufficient time to escalate medication dose regimens to full analgesic efficacy.

P-Cymene attenuates cancer pain via inhibitory pathways and modulation of calcium currents

BackgroundOncological pain is one of the most prevalent and difficult-to-treat symptoms in patients with cancer. p-Cymene (PC) is a monoterpene found in more than 100 different plant species, endowed with various pharmacological properties—particularly antinociceptive. Hypothesis/PurposePC has antinociceptive effect in a model of oncologic pain due to the activation of the descending inhibitory pathway of pain. Study DesignA pre-clinical, longitudinal, blind and randomized study. MethodsMale Swiss mice were induced with S180 cells in the right hind paw, then treated daily with PC (12.5, 25 and 50 mg/kg, s.c.) and screened for mechanical hyperalgesia, spontaneous nociception, nociception induced by non-noxious palpation, tumor growth, changes in the neuromuscular function and existence of bone degradation in the tumor area. The effect of PC on Ca2+ currents (electrophysiological records), histological and neurochemical changes (immunofluorescence for Fos) were also evaluated. ResultsPC reduced (p < 0.05) the mechanical hyperalgesia, the spontaneous (p < 0.001) and non-noxious palpation (p < 0.001) nociceptions, not changing the tumor development, neuromuscular function or histopathological aspects of the paw affected. PC reduced Fos expression in the spinal cord (p < 0.001) and increased this expression in the PAG (p < 0.05) and in the NRM (p < 0.01). PC decreased the density of calcium channel currents (p < 0.05). ConclusionThese results suggest the antinociceptive effect of PC on oncologic pain, probably acting in both ascending and descending pain pathways, and modulating the calcium channel currents in order to exert its effects.

Tapentadol in the Management of Pain in Cancer Patients

Addressing cancer pain requires real analysis and reflection. Successful management of pain through medical therapy requires a balance between effective analgesia and good tolerability, which is often difficult to achieve with conventional opioids. Treatment with tapentadol for oncologic pain results in successful pain relief, good tolerability and improvement in overall quality of life. This indicates that it is also a therapeutic option in pain of oncological origin. The combination of two mechanisms of action, which interact synergistically to produce analgesia, is a promising approach to generate effective analgesics. Tapentadol combines the agonistic activity of the μ opioid receptor (MOR) with the inhibition of noradrenaline reuptake (NRI) and thus provides highly effective analgesia comparable to strong opioids, but with favorable tolerability.

Prescriptions of Strong Opioid Analgesics in Primary Care (Pharmacy Care)

Objective: Pain is a part of every human life and typically, example is a chronic pain in tumour diseases. In therapy of the chronic cancer pain, opioid analgesics have irreplaceable role. Methods: This retrospective analysis was conducted from January 2015 to March 2015 using the prescriptions of strong opioid analgesics accepted by pharmacy VITAE. Prescriptions of strong analgesics were written in the Oncology Institute in Kosice to adult patients. Opioid prescriptions for all patients in analyses had cancer medical diagnosis. Characterization of patients, diagnosis of cancer type, characterization of prescribed opioids analgesics – generic name and rug forms of prescribed medicament were analyzed in retrospective analyses of the prescriptions. Results: In total, there were 332 prescriptions (100 % of cancer) of strong opioids for 151 (54% male; 46% female) patients treated in the East-Slovak Oncology Institute in Kosice, Slovakia, during the study period. The youngest patient - woman was 27 and the oldest patient - woman was 88. The most frequent cancer diagnosis were the carcinoma of respiratory and thorax organs (male) and the carcinoma of breast (female). The number of package of strong opioids was 543 (fentanyl (44%), buprenorphine (26%), oxycodone (12%), tapentanol (10%), morphine (7%) and hydromorphone (1%)). Conclusions: Our analysis demonstrated, that despite the fact that morphine is still considered as a gold standard in the oncologic pain therapy, other opioids are more frequently prescribed as fentanyl, buprenorphine, oxycodone or new molecule tapentadol. All substances were prescribed for intense pain emerged from different type of advanced tumour diseases.

The antinociceptive effect of resveratrol in bone cancer pain is inhibited by the Silent Information Regulator 1 inhibitor selisistat

To study the antinociceptive effect of single and repeated doses of resveratrol in a bone cancer pain model, and whether this effect is prevented by the Silent Information Regulator 1 (SIRT1) inhibitor selisistat. The femoral intercondylar bone of BALB/c mice was injected with 1000000 BJ3Z cancer cells. Bone resorption and tumour mass growth (measured by invivo X-ray and fluorescence imaging), as well as mechanical nociceptive thresholds (von Frey device) and dynamic functionality (rotarod machine), were evaluated during the following 4weeks. Acute resveratrol (100mg/kg i.p.) and/or selisistat (10mg/kg s.c.) were administered on day 14. Chronic resveratrol (100mg/kg i.p., daily) and/or selisistat (0.5μg/h s.c., Alzet pump) were administered between days 14 and 20. Tumour growth gradually incremented until day 31, while mechanical hyperalgesia started on day 3 after cancer cell injection. Acute resveratrol increased the mechanical threshold of pain (peaking at 1.5h), while the dynamic functionality decreased. Chronic resveratrol produced a sustained antinociceptive effect on mechanical hyperalgesia and improved the loss of dynamic functionality induced by the bone cancer tumour. Selisistat prevented all the effects of resveratrol. Acute and chronic resveratrol induces antinociceptive effect in the model of metastatic osseous oncological pain, an effect that would be mediated by SIRT1 molecular signalling.

A cross-sectional, comparative, syndromic description of oncological mixed pain in Medical Oncology units in Spain.

The reason cancer pain remains prevalent and hard to classify may be partially explained by the failure to identify neuropathic mechanisms. The objective of this research was to identify the syndromes of cancer pain that may be particularly hard to manage due to their mixed pathophysiology. A series of 384 patients who had cancer of any type, at any stage, and suffered from chronic pain (symptom onset > 3months) were assessed during a routine return visit in Spain. Medical oncologists indicated the presence and pathophysiology of 33 predefined pain syndromes on a per-patient basis. This information was then measured against clinical, psychosocial, and health care-related data to determine which syndromes pose particular challenges. The mean (standard deviation) age of patients was 61.6 (12.6)years, 49.7% were women. Most (82%) had advanced metastatic disease, 68.7% were on second-line or palliative therapies. The worst syndrome was nociceptive, pure neuropathic, and mixed in 34.6, 26.9, and 38.6% of patients, respectively. Any syndrome could be of mixed pathophysiology. Only 10 syndromes were common (≥ 5% of patients). Syndromes related to malignant bone pain and involvement of chest wall structures were the most frequent. Certain syndromes (including tumor-related bone pain, chemotherapy-induced peripheral neuropathies, paraneoplastic pain syndromes, and malignant neuralgias or injury to cranial nerves) can be particularly challenging when they have a mixed pathophysiology, because the neuropathic component is rarely or unevenly considered. Virtually all cancer pain syndromes can present mixed pathophysiology. Certain syndromes can include neuropathic components that are frequently overlooked.

Multicenter survey on emergency nurses’ perception of Numerical Rating Scale reliability at triage time in adult Emergency Department patients

Since pain perception is highly subjective and culturally mediated, its objective evaluation remains difficult. Nevertheless, pain measurement should ideally be a part of the assessment of patients in order to plan adequate pain relief. Several scales have been proposed for pain measurement, being the numerical rating scale (NRS) the most widely used, often at triage time. NRS have demonstrated acceptable reliability and validity, in post-operative medicine and in oncologic pain, but data in the Emergency Departments (EDs) are poor. The aim of this study is to evaluate the Emergency Nurses’ (ENs) perception about the reliability of NRS in the triage process. A questionnaire based on 11 items was designed and subsequently administered to a large number of ENs in several EDs in Northern and Central Italy. 301 questionnaires were filled out and returned. The majority declares using NRS scale to measure pain (item 2, mode = 4, mean = 3.8), and attributing priority code based on NRS value (item 3, mode = 4, mean = 3.4). In general, triage nurses believe that NRS is only indicative and that their judgement matters (item 4, mode = 4, mean = 3.2). The vast majority of triage nurses do believe that the patients will indicate a fake higher NRS value with the aim to get a more urgent code (item 5, mode = 5, mean = 4), while only a small minority expects that patients would underestimate their NRS for fear of penalizing more urgent patients. Very few believe that such scale underestimates the patients’ condition, while the majority is ambivalent about whether such scale overestimates it. In conclusion, NRS confirms to be a potentially valuable tool for pain evaluation at triage time, but many nurses express some doubts on its reliability, and will attribute the triage code mainly basing on their own judgement.

An Integrated Review of Cannabis and Cannabinoids in Adult Oncologic Pain Management

ObjectiveThe objective of this paper is to review the available literature regarding the use of cannabis and cannabinoids in adult oncologic pain management. Design and Data SourcesA integrative review was conducted on March 1, 2018 using PubMed, MEDLINE, CINAHL, Embase, and Scopus. A snowball method was used to extract studies included in systematic reviews that were not included in the primary literature search. Review MethodArticles reviewed address the use of cannabinoids or cannabis for pain management in oncology patients, either as stand- alone or adjuvant therapy. ResultsThe final number of articles included is nine articles. Of the nine studies reviewed, eight reviewed the effect of the cannabinoid THC on cancer pain, and one study reviewed the use of medicinally available whole plant cannabis. The following study types were included: multiple multi-center, randomized, placebo- controlled trials and two prospective observational survey studies. Results and ConclusionsOf the eight studies that reviewed the effect of the cannabinoid THC, five found THC to be more effective than placebo, one found THC to be more effective than placebo in American patients but ineffective in patients from other countries, and two found THC to be no more effective than placebo. The study that reviewed the effect of the whole plant cannabis found that there was a significant decrease in pain among those patients smoking cannabis. Nursing Practice ImplicationsThe lack of evidence in this field of research suggests a need to change policy surrounding cannabis research.

Psychotherapy of phantom pain in oncology

Psychotherapy of phantom pain in oncology

Psychotherapy of Phantom Pain in Oncology

Amputation or removal of any part is usually associated with a feeling that the missing part is still present and causes disorders of different types of sensitivity, but mainly excruciating pain sensations. The phantom pain is a false sensation, an illusion of the presence of the missing part of the body. As clinical experience shows, even with the complex application of modern antineuropathic agents, opioid and non-opioid analgesics, regional blocks, the treatment of phantom pain in many cases does not give positive results [1,2].