Oncologic Pain Research Articles

Psychometric properties of the Short-Form McGill Pain Questionnaire (SF-MPQ) in adult Mexican cancer patients with chronic pain.

Pain is a frequent symptom in cancer patients (CP), and its multidimensional assessment is essential for a comprehensive approach and to establish clinical prognoses. The Short-Form McGill Pain Questionnaire (SF-MPQ) is an internationally recognized tool for the multidimensional assessment of pain, both in clinical and research settings. However, no studies have been reported in Latin America that determine its psychometric properties in CP and chronic pain. To determine the psychometric properties of the SF-MPQ in adult Mexican cancer patients with chronic pain. An instrumental design was used with a non-probabilistic convenience sample of 222 cancer patients treated at the pain clinic of a tertiary care hospital. Analyses were conducted to evaluate factorial structure (exploratory and confirmatory factor analysis [CFA]), reliability (internal consistency), measurement invariance, and criterion validity (concurrent and divergent). CFA verified a 9-item structure divided into 2 factors: (1) Affective-Nociceptive and (2) Neuropathic. A global Cronbach's alpha coefficient of .82 and a global McDonald's Omega index of .82 were identified. Configural, metric, and scalar invariance (ΔCFI ≤ .01; ΔRMSEA ≤ .015) were confirmed regarding the sex variable. Finally, the SF-MPQ showed a positive correlation with the Numerical Rating Scale (rho = .436, p< .01) and a negative correlation with the EORTC-QLQ C30 (rho = -.396, p< .01). The Mexican version of the SF-MPQ presented adequate psychometric properties and fit indices, making it a valid and reliable instrument for use in clinical and research settings in Mexico. Its use is recommended for the comprehensive assessment of pain in oncology in Mexico, as it allows for the understanding of pain characteristics beyond intensity, guiding the establishment of clinical prognoses.

Causes and management of acute oncological pain: a narrative review.

Acute pain in cancer is an important but often overlooked feature of many patients' oncological journey. Cancer-related pain is associated commonly with more persistent pain states caused by both the disease and its treatment, but there are numerous causes of acute pain which can develop in patients with cancer. This pain is frequently severe, can be challenging to manage and its suboptimal control can directly impact on oncological outcomes. This narrative review provides an overview of several causes of acute pain in patients with cancer and management approaches. A focused literature review was conducted to encompass the search terms 'acute pain', 'oncology' and 'cancer' in adult and paediatric populations. Acute pain is common in patients with cancer with a number of pain generators identified. Broadly, these are disease- and treatment-related but commonality in pain mechanisms and features are present. Importantly, these pain states do not occur in isolation; a patient may experience multiple acute pain episodes during their oncology journey. As the oncological treatment landscape shifts and increasing numbers of novel treatments are employed, the number of causes of acute pain in patients with cancer rises. This pain is often managed by non-pain specialists and suboptimal control has a variety of deleterious effects. It is important that awareness of acute pain in the oncological population is increased and treatment approaches, which adopt a biopsychosocial structure, are optimised.

Ethical issues in palliative care: nursing and quality of life

BackgroundNurses occupy a pivotal role in the provision of palliative care, acting as frontline providers who address the physical, emotional, social, and spiritual needs of patients. The complexities inherent in palliative care frequently give rise to ethical dilemmas that significantly impact nurses’ decision-making and patient interactions. It is therefore essential to gain an understanding of nurses’ perceptions of ethical issues, quality of life, and adherence to patient rights in order to enhance the care delivered in these settings.AimThis study aims to assess the ethical issues encountered by nurses in palliative care, evaluate their quality of life, and measure their understanding and adherence to patient rights.MethodsA quantitative cross-sectional survey was conducted among a sample of 85 nurses working in palliative care settings, specifically within the Oncology Department and Pain Clinic at a Specialized Hospital in Egypt. A stratified random sampling technique was employed. The data were collected using standardised questionnaires, including the Ethical Issues Scale (EIS), the Nursing Quality of Life Scale (NQOLS), and the Patient Rights Questionnaire (PRQ). The validity and reliability of these instruments were established prior to the commencement of the study. The collected data were subjected to mean and standard deviation (SD) calculations. Statistical analyses, including the calculation of Pearson correlation coefficients, were conducted.ResultsThe study sample comprised a diverse cohort of nurses, with a mean age of 40 years. The ethical issues were evaluated, yielding a mean score of 4.03 (SD = 0.74) on the EIS, with the highest score for “Patient Care” (M = 4.2, SD = 0.7). The overall quality of life mean score was 6.75, with the working dimension exhibiting the highest mean score at 7.1. The PRQ results indicated a high level of awareness regarding patient rights, with a total mean score of 49.5 (SD = 6.8). The results of the correlation analysis indicated a moderate positive correlation between ethical issues and patient rights (r = 0.52, p < 0.01), and ethical issues and quality of life (r = 0.45, p < 0.01). Conversely, a weaker correlation was found between quality of life and patient rights (r = 0.40, p < 0.05).ConclusionsThe findings elucidate the ethical challenges confronted by nurses in palliative care and their ramifications for the quality of life and adherence to patient rights. It is imperative that nurses engaged in palliative care undergo continuous education and training in order to enhance their ethical decision-making abilities and thereby improve the quality of care they provide.RecommendationsIt is imperative that strategies be developed to support nurses in addressing ethical dilemmas, to promote awareness of patient rights, and to enhance their overall quality of life through targeted interventions and resources.Clinical trialNo clinical Trial.

Harnessing Cannabis: Pain Management Strategies for Oncology Patients – A Narrative Review

Cancer-related pain represents a serious challenge in oncological care, often refractory to conventional analgesics and significantly impacting patients' quality of life. In recent years, medical marijuana (cannabis) has emerged as a potential adjunctive or alternative therapy for managing pain in oncological patients. This narrative review critically evaluates the existing literature on the efficacy, safety, and underlying mechanisms of action of medical marijuana in alleviating pain associated with cancer. Drawing upon a synthesis of preclinical and clinical studies, as well as meta-analyses and systematic reviews, this review provides insights into the scientific basis and clinical implications of utilizing medical marijuana in oncological pain management.

Assessing Gender Differences for Non-Predictable Breakthrough Cancer Pain Phenomenon: A Secondary Analysis from IOPS-MS Study.

Breakthrough cancer pain (BTcP) is a temporary exacerbation of pain that "breaks through" a phase of adequate pain control by an opioid-based therapy. The non-predictable BTcP (NP-BTcP) subtype occurs in the absence of any specific activity. Evidence showed that gender differences exist in pain response sensitivity and clinical pain risk. This analysis aimed to signify the gender differences for the NP-BTcP phenomenon. This is a secondary analysis of the Italian Oncologic Pain multiSetting-Multicentric Survey (IOPS-MS), the largest study on BTcP. The subset of NP-BTcP cases for non-gender-specific cancer was considered. Univariable and multivariate analyses were conducted to identify gender differences for the NP-BTcP profile about its intensity, number of episodes per day, and type. A metastatic status-stratified analysis was performed to compare gender with the main clinical variables among the population with NP-BTcP. Males exhibited a higher occurrence of BTcP in the thorax region compared to females (15% vs 11%, respectively, p = 0.03). Males also had a higher onset of BTcP, a higher BTcP therapy dosage (33% vs 28%, p = 0.04, mean: 201 vs 186, p = 0.02) and a lower Karnofsky score (mean: 46.9 vs 49.2, p = 0.03) compared to females. Similar gender differences were found for metastatic patients in the BTcP site (14% vs 8.5%, respectively; p = 0.01), peak onset (33% vs 27%, p = 0.02), BTcP therapy dosage (199 vs 185, p=0.04), and Karnofsky score (mean 47.5 vs 50.4, p = 0.009). Phenotype 2 was more characterized by non-metastatic males (41% vs 23%, p = 0.020) while non-metastatic females presence was predominant among others. In this study, gender differences according to site, onset and dosage of BTcP were found. The phenotype characterization of BTcP needs to be further investigated for a possible useful function in the management of cancer-related pain in non-metastatic patients.

Spinal Metastases of the Vertebrae: Three Main Categories of Pain.

Oncologic back pain, infection, inflammation, and trauma are the only specific etiologies of chronic low back pain (CLBP) in contrast to most patients who have non-specific CLBP. In oncologic patients developing CLBP, it is critically important to perform further investigation to exclude spinal metastases (SM).The incidence of cancer is increasing, with 15.7-30% developing SM. In the case of symptomatic SM, we can distinguish three main categories: tumor pain; mechanical pain due to instability, with or without pathologic fractures; and metastatic epidural spinal cord compression (MESCC) or radicular compression. Treatment of SM-related pain is dependent on these categories and consists of symptomatic treatment, target therapy to the bone, radiotherapy, systemic oncologic treatment, and surgery. The care for SM is a multidisciplinary concern, with rapid evolutions in all specialties involved. It is of primordial importance to incorporate the knowledge of specialists in all participating disciplines, such as oncology, radiotherapy, and spinal surgery, to determine the adequate treatment to preserve ambulatory function and quality of life while limiting the burden of treatment if possible. Awareness of potential SM is the first and most important step in the treatment of SM-related pain. Early diagnosis and timely treatment could prevent further deterioration. In this review, we explore the pathophysiology and symptomatology of SM and the treatment options for SM-related pain: tumor pain; mechanical pain due to instability, with or without pathologic fractures; and MESCC or radicular compression.

Prevalence and characterization of pain in radiation oncology: the PREDORT multicenter cross-sectional study.

Pain in cancer patients has enormous impact on their quality-of-life. Radiation therapy (RT) is a cornerstone in cancer treatment. The objective of the PREDORT study is to estimate the prevalence of pain in patients attending at Radiation Oncology (RO) Services. A prospective, multicenter study was designed for patients treated at the RO Services of reference hospitals. Patients were seen in their initial Nursing consultation, during which key data was collected, including demographic and comorbidities data, medical history, and oncological and pain characteristics. The study has received approval from the Ethics Committee of Navarra, and all patients signed the Informed Consent. Of the 860 participating patients, 306 reported some type of pain, which implies a prevalence of 35.6%. Of them, 213 identified a cause of oncological origin. The proportion of pain was similar among sexes, but the proportion of non-cancer pain was higher among women (p < 0.05). Regarding pain intensity, the magnitude of breakthrough pain in patients with oncological pain is nearly 1 point greater than in patients with non-oncological pain (7.53 vs 6.81; p = 0.064). Cancer pain is more likely to be limiting of normal life than non-cancer pain (59% versus 38%, p < 0.001). Regarding analgesic treatment, only 60/306 patients (19.6%) were receiving strong opioids. There were 68 patients with pain without any treatment (22.2%). The prevalence of pain in cancer patients referred to RO services is 35.6%, with the prevalence of exclusively oncological pain being 24.8%. Understanding and addressing oncological pain is essential to provide comprehensive care to patients.

Optimizing medication guidance support for patients with cancer pain: development and evaluation of a pharmaceutical care system for healthcare professionals.

Effective management of cancer pain critically depends on timely medication administration and adherence to precise medication guidelines. In the context of limited time and a busy healthcare environment, tailoring the optimal medication schedule for each patient with cancer pain presents a significant challenge for physicians and clinical pharmacists. To address this challenge, we conducted a comprehensive analysis of healthcare professionals' needs in guiding cancer pain medication. By developing core features based on key user needs and continuously updating them, we have created the Universal Medication Schedule System (UMSS). We invited 20 physicians and pharmacists specializing in oncology or cancer pain to trial the system and assessed UMSS usage through distributed questionnaires. We identified five key needs of healthcare professionals in cancer pain medication guidance. Based on these needs, we (1) constructed a comprehensive drug information database, including basic information for 1135 drugs, 130,590 drug interaction data entries, and 1409 individual medication timing constraints, and (2) developed a web-based system that provides essential reference information such as drug interactions and dietary restrictions. It can create medication schedules and provide medication education tailored to the patient's daily routine. Participating evaluators unanimously agreed (100%) that the system aids in accurately assessing the risks of polypharmacy and quickly scheduling medication regimens. UMSS, by offering personalized medication schedule support, assists healthcare professionals in better managing patients' medication treatment plans. However, further improvements are needed in the automation of database updates and maintenance, as well as in integrating it with electronic health records.

A Narrative Review of Pain in Pediatric Oncology: The Opioid Option.

Opioid therapy is the mainstay for managing pain in pediatric oncology. This narrative review describes the current literature regarding opioids for pediatric cancer pain. The review explores the multifaceted landscape of opioid utilization in this population, including the role of opioids in certain clinical circumstances, modalities of opioid delivery, unique opioids, outpatient and at-home pain management strategies, and other key concepts such as breakthrough pain. This review highlights the importance of individualized dosing and multimodal approaches to enhance efficacy and minimize adverse effects. Drawing from a wide range of evidence, this review offers insights to optimize pediatric oncology pain management.

Predictive Factors and the Role of Conventionally Fractionated Radiation Therapy for Bone Metastasis from Renal Cell Carcinoma in the Era of Targeted Therapy.

Background and Objectives: Despite rapid advances in targeted therapies for renal cell carcinoma (RCC), bone metastases remain a major problem that significantly increases morbidity and reduces patients' quality of life. Conventional fractionated radiotherapy (CF-RT) is known to be an important local treatment option for bone metastases; however, bone metastases from RCC have traditionally been considered resistant to CF-RT. We aimed to investigate the effectiveness of CF-RT for symptomatic bone metastasis from RCC and identify the predictive factors associated with treatment outcomes in the targeted therapy era. Materials and Methods: Between January 2011 and December 2023, a total of 73 lesions in 50 patients treated with a palliative course of CF-RT for symptomatic bone metastasis from RCC were evaluated, and 62 lesions in 41 patients were included in this study. Forty-five lesions (72.6%) were treated using targeted therapy during CF-RT. The most common radiation dose fractionations were 30 gray (Gy) in 10 fractions (50%) and 39 Gy in 13 fractions (16.1%). Results: Pain relief was experienced in 51 of 62 lesions (82.3%), and the 12-month local control (LC) rate was 61.2%. Notably, 72.6% of the treatment course in this study was combined with targeted therapy. The 12-month LC rate was 74.8% in patients who received targeted therapy and only 10.9% in patients without targeted therapy (p < 0.001). Favorable Eastern Cooperative Oncology Group performance status (p = 0.026) and pain response (p < 0.001) were independent predictors of improved LC. Radiation dose escalation improved the LC in radiosensitive patients. A consistent treatment response was confirmed in patients with multiple treatment courses. Conclusions: CF-RT enhances pain relief and LC when combined with targeted therapy. Patients who responded well to initial treatment generally showed consistent responses to subsequent CF-RT for additional painful bone lesions. CF-RT could therefore be an excellent complementary local treatment modality for targeted therapy.

Validity of central pain processing biomarkers for predicting the occurrence of oncological chronic pain: a study protocol

BackgroundDespite recent improvements in cancer detection and survival rates, managing cancer-related pain remains a significant challenge. Compared to neuropathic and inflammatory pain conditions, cancer pain mechanisms are poorly understood, despite pain being one of the most feared symptoms by cancer patients and significantly impairing their quality of life, daily activities, and social interactions. The objective of this work was to select a panel of biomarkers of central pain processing and modulation and assess their ability to predict chronic pain in patients with cancer using predictive artificial intelligence (AI) algorithms.MethodsWe will perform a prospective longitudinal cohort, multicentric study involving 450 patients with a recent cancer diagnosis. These patients will undergo an in-person assessment at three different time points: pretreatment, 6 months, and 12 months after the first visit. All patients will be assessed through demographic and clinical questionnaires and self-report measures, quantitative sensory testing (QST), and electroencephalography (EEG) evaluations. We will select the variables that best predict the future occurrence of pain using a comprehensive approach that includes clinical, psychosocial, and neurophysiological variables.DiscussionThis study aimed to provide evidence regarding the links between poor pain modulation mechanisms at precancer treatment in patients who will later develop chronic pain and to clarify the role of treatment modality (modulated by age, sex and type of cancer) on pain. As a final output, we expect to develop a predictive tool based on AI that can contribute to the anticipation of the future occurrence of pain and help in therapeutic decision making.

The efficacy of ketamine for pain management in patients with cancer: A systematic review.

e24069 Background: Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as the study of ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. Methods: We conducted a literature review in MEDLINE, EMBASE, and Scopus, spanning from January 1, 1982, to October 20, 2022. Abstracts were screened against inclusion criteria, and eligible studies underwent a thorough full-text review. Data were extracted from the included studies, and a framework analysis approach was employed to summarize the evidence regarding ketamine's use in patients with cancer. The quality of included studies was assessed using the NIH Quality Assessment Tool for controlled intervention studies. Results: A total of 22 studies conducted between 2001 and 2019 were included, all assessed as having good quality. Three studies focusing on intrathecal administration of ketamine following oncological surgery demonstrated a substantial improvement in pain scores and a reduction in postoperative morphine requirements. Two studies exploring intramuscular use concluded that it led to improved pain scores. In contrast, three studies on subcutaneous administration and two studies on topical ketamine did not exhibit a significant impact on reducing pain scores or alleviating chemotherapy-induced peripheral neuropathy. Findings from two studies on oral administration and eight studies on intravenous administration indicated that intravenous ketamine reduced postoperative morphine requirements, while oral ketamine had no discernible effect on lowering pain scores. Conclusions: The use of intrathecal ketamine demonstrates significant improvement in post-op oncological pain and refractory cancer pain, resulting in lowered pain scores and decreased morphine requirements. Further research is essential to ascertain the extent to which incorporating ketamine with opioids in cancer pain treatment can enhance pain outcomes, especially in morphine-tolerant patients.

Promising Effects of Casearins in Tumor-Bearing Mice and Antinociceptive Action against Oncologic Pain: Molecular Docking and In Vivo Findings.

Safer analgesic drugs remain a hard challenge because of cardiovascular and/or gastrointestinal toxicity, mainly. So, this study evaluated in vivo the antiproliferative actions of a fraction with casearins (FC) from Casearia sylvestris leaves against human colorectal carcinomas and antihyperalgesic effects on inflammatory- or opiate-based pain relief and oncologic pain in Sarcoma 180 (S180)-bearing mice. Moreover, docking investigations evaluated the binding among Casearin X and NMDA(N-methyl-D-aspartate)-type glutamate receptors. HCT-116 colorectal carcinoma-xenografted mice were treated with FC for 15 days. Antinociceptive assays included chemically induced algesia and investigated mechanisms by pharmacological blockade. Intraplantar region S180-bearing animals received a single dose of FC and were examined for mechanical allodynia and behavior alterations. AutoDock Vina determined molecular interactions among Cas X and NMDA receptor subunits. FC reduced tumor growth at i.p. (5 and 10 mg/kg) and oral (25 mg/kg/day) doses (31.12-39.27%). FC reduced abdominal pain, as confirmed by formalin and glutamate protocols, whose antinociception activity was blocked by naloxone and L-NAME (neurogenic phase) and naloxone, atropine, and flumazenil (inflammatory phase). Meanwhile, glibenclamide potentiated the FC analgesic effects. FC increased the paw withdrawal threshold without producing changes in exploratory parameters or motor coordination. Cas X generated a more stable complex with active sites of the NMDA receptor GluN2B subunits. FC is a promising antitumor agent against colorectal carcinomas, has peripheral analgesic effects by desensitizing secondary afferent neurons, and inhibits glutamate release from presynaptic neurons and/or their action on cognate receptors. These findings emphasize the use of clerodane diterpenes against cancer-related pain conditions.

Effects of Intravenous Lidocaine as an Analgesic Adjuvant in Oncological Pain

Objectives: To verify that intravenous lidocaine is effective as an adjuvant analgesic in pain for hospitalized cancer patients at the National Institute of Cancerology, Mexico. Methods: Clinical records of patients hospitalized at the National Institute of Cancerology who received intravenous lidocaine infusion as an adjuvant to pain during the 4-year period from November 1, 2019, to October 31, 2023, were reviewed. Patients who met inclusion and exclusion criteria were included. A statistically significant measure was defined as a decrease equal to or greater than 4 points in the NRS value after lidocaine administration.&#x0D; Results: A total of 179 patients were included; 46.4% were men, and 53.6% were women. The most common painful syndrome was somatic (54%). Patients with neuropathic pain received a higher lidocaine dose (mg/kg/hr) of 1.9 ± 0.79. Regarding adverse effects, 1.7% of patients experienced them. It was established that a reduction of 4 points with respect to the previous value on the numeric rating scale (NRS) would be considered statistically significant. A statistically significant association was found between patients under 38 years old and a higher risk of not achieving the objective (p 0.05, CI 0.95–1 OR 0.9). Patients who received lidocaine infusions for less than 4.63 days also had a risk of not reaching the goal (p 0.02, CI 0.7–0.9, OR 0.8).&#x0D; Conclusions: This study demonstrated that the analgesic adjuvant use of intravenous lidocaine infusion is an effective and well-tolerated analgesic intervention for oncology patients.&#x0D; Keywords: lidocaine, Neuropathic Pain, Somatic Pain, Visceral Pain, numeric rating scale.

Effectiveness of Botulinum Toxin for Oncologic Pain

Introduction: The use of botulinum toxin for medical purposes has expanded nowadays through the extensive study of its complex structure and mechanism of action, highlighting its ability to inhibit the release of acetylcholine, and its impact on the chemical signaling cascade involved in different models of pain.&#x0D; Objective: To evaluate the association of the use of botulinum toxin A with the reduction of pain in oncologic patients at Instituto Nacional de Cancerología, México.&#x0D; Methodology: A retrospective, observational, descriptive, and cross-sectional study was performed. Data were obtained from patients attended during the period from January 1, 2022 to September 30, 2023 in whom botulinum toxin was applied as an adjuvant for pain management.&#x0D; Results: Thirty-two patients who met the inclusion criteria were included. After the application of botulinum toxin there was a statistically significant reduction in pain, as measured by the Numeric Pain Rating Scale and Verbal Rating Scale. The degree of satisfaction after the application of botulinum toxin was measured by a Likert-type scale, and 68% satisfaction was found in the patients who underwent the onotoxin treatment.&#x0D; Conclusions: The use of botulinum toxin proved to be an effective and safe therapy, complementary to the multimodal approach for the treatment of different pain patterns in oncologic patients. It can be considered as a pharmacological option for use in this group of patients.&#x0D; Keywords: Oncologic pain, Pain management, Botulinum toxin

Spiritual Care in Patient with Cancer Pain: Literature Review

Spiritual care for cancer pain is an intervention to address the spiritual needs of patients with cancer in managing pain. Despite numerous studies conducted in this area, the diversity of spiritual care interventions for cancer pain remains a challenge. Objective: This literature review aimed to identify spiritual care interventions for cancer patients in managing pain. Method: The database used Scopus, Pubmed, Proquest, Science Direct, and Google Scholar. The keywords used were “spiritual care” OR “spiritual therapies” OR “spiritual healing” OR “faith healing” OR “spiritual intervention” OR “religious intervention” AND “cancer pain” OR “cancer-related pain” OR “neoplasm-related pain” OR “oncology pain. The search was limited to articles published between 2011 and 2021, resulting in the identification of 6642 articles, which only 10 met the inclusion criteria. The selected articles underwent critical appraisal using JBI tools. Results: This literature review showed that the types of spiritual care interventions consist of yoga, psychoreligious intervention, mindfulness, music therapy, and therapeutic touch, and the primary outcomes of spiritual care are pain levels. Conclusions: This literature review showed the interventions were very diverse in all types of cancer. Therefore, a spiritual care intervention study on managing pain with a specific type of cancer is needed.

Хроническая (неонкологическая и онкологическая) боль: рациональный подход к консервативной терапии

INTRODUCTION. Chronic pain represents an important interdisciplinary problem. A distinction should be made between primary and secondary chronic pain, which can be subdivided into oncologic and non-oncologic pain. The diagnosis of chronic pain is based on the use of assessment scales. Therapy of patients suffering from chronic pain should be based on clinical guidelines. The choice of therapy for chronic pain syndrome should be etermined by the intensity of pain and the pathogenetic characterization of pain. Opioid therapy is one of the main ethods of treatment of chronic pain in palliative care of oncologic and non-oncologic patients. CONCLUSION. Tapentadol (Palexia retard) is an effective analgesic in the therapy of chronic pain syndrome of moderate to high intensity in patients suffering from oncologic and non-oncologic pain. KEYWORDS: chronic pain, opioids, Tapentadol

Management of oncological pain in the elderly by the nursing team os a private hospital in the state os São Paulo

Background and objective: Elderly people represent 12% of the world's population, with this number expected to double by 2050. Cancer is the main public health problem in the world and is already among the four main causes of premature death in most countries. In the elderly population, the prevalence of pain is quite high. To guide the use of analgesics in the treatment of pain, the WHO created the “analgesic ladder”, classifying opioids according to their potency. In clinical practice, what often prevails is the individualized knowledge of each nurse, which directs the type of medication prescribed. To evaluate pain symptoms and pain management, using the Pain Management Index, in hospitalized elderly patients. Methodology: Observational, quantitative and retrospective study. The study population will be made up of the number of hospitalized patients in 2021. To collect the information, access to data in medical records was made. To investigate pain management, the Pain Management Index was used, which analyzes analgesic potency in relation to pain intensity. Results: 687 patients were selected, with 1178 pain scores recorded during the studied period. 590 records had their pain reset in the first reassessment, which took an average of 6h39 minutes. Regarding the PMI calculation, most patients did not have their pain controlled. Conclusion: It is necessary to standardize the instrument used in the research, so that it has a theoretical-clinical basis, making the best analgesic choice for the patient, since the majority of them do not have adequate control.

Novel Techniques of Radiotherapy in the Management of Oncologic Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Oncologic pain (OP), in general, increases with disease progression. Moderate or severe intensity OP occurs in around 30% of cancer patients receiving treatment and in 60% to 90% of patients with advanced cancer. Radiotherapy (RT) is an effective non-pharmacological method of treatment of OP. Two new techniques of RT are available for pain control: ablative RT for oligometastatic disease and lattice RT, for voluminous tumors. We will review their efficacy and results, concluding that OP is a complex biologic phenomenon and its successful treatment requires careful assessment of its nature, understanding the different types and patterns. Specific pain management with new radiation techniques can be effective and provide good pain control, allowing the reduction of analgesics use, improving the quality of life.

Palliative and Supportive Care for Patients with End-Stage Hepatocellular Carcinoma: Perspectives of Egyptian Domestic Caregivers.

Palliative care is a holistic, patient-centered approach to improving the quality of life for those with terminal diseases and their families. The main objective of the current study was to evaluate the Egyptian domestic caregivers' knowledge, attitudes, and competencies related to palliative and supportive care. Three hundred and thirty-five family caregivers in total were recruited. A descriptive research design was used. Four tools were used to collect data; structured interview questionnaire to collect demographic questions, palliative care knowledge questionnaire, Palliative Attitude Scale, and Competence Scale. The study was conducted in oncology outpatient and pain clinics located at the Damietta Cancer Institute in Damietta Governorate, Egypt. Nearly two-thirds of the informal family caregivers are aged between 30-40 years old; 54% are female, and 83% are married. Also, sixty-seven point eight of the informal family caregivers were working (part-time). Furthermore, 65 % of them had insufficient knowledge, 68 % had a positive attitude, and 58% of the informal family caregivers had non-competency skills regarding palliative and supportive care. Approximately two-thirds of informal care providers had insufficient total knowledge scores, more than half possessed a positive attitude, and more than half reported non-competency skills regarding palliative care of hepatocellular patients. It is highly advisable to launch extensive health education programs and campaigns aimed at all of the unpaid informal family careers of patients with serious terminal illnesses, including hepatocellular carcinoma, at various governments with greater sample sizes.