Pain Management In Cancer Patients Research Articles

Quality Of Life of Cancer Patients Attending a Cancer Hospital, Lumbini Province, Nepal

Background: Quality of life is an important aspect and high priority of the cancer patient care. The objective of the study was to find out the quality of life of cancer patients attending a Cancer hospital, Lumbini Province, Nepal. Methods: An analytical cross sectional study design based on quantitative approach was used in the study. The study was conducted in Sushil Koirala Prakhar Cancer Hospital, Khajura, Banke which was selected purposively considering only one cancer hospital in province five, Nepal. The entire cancer patients receiving at least one cycle of cancer treatment was included in the study using non probability purposive sampling technique. Semi structured interview based questionnaires was used and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 (EORTC QLQ- C30) was used for measuring quality of life. The data was collected by the enumerator by face to face interview. The collected data were analyzed by using descriptive and inferential statistics. Results: The patients with carcinoma (ca) lungs were in highest proportion (24.5%) followed by ca breast. The transform mean and SD score of Global Health/QoL was 35.84 (16.87), functional scale 36.35(15.54), symptoms scale 53.02 (14.61).Occupation was found to be associated with quality of life at statistically significant level in (p= .000) function score. Site of cancer was found to be associated with quality of life at statistically significant levels (p=.0.009) in symptom score. The patients with stage I and II had high global health score and least in stage IV. There was positive correlation of .610** (p=.000) significant at 0.01 level with functional scales and high negative correlation of -.521(p=-.521**) with symptom scales at (p=.000) level of significance. The overall quality of life of cancer patients was poor. The pain management of cancer patients should be taken into consideration.

Adequacy of Pain Treatment in Radiotherapy Departments: Results of a Multicenter Study on 2104 Patients (Arise).

Simple SummaryCancer pain is often inadequately treated, as shown by several clinical studies. This problem has been confirmed in different clinical settings but the reasons for this phenomenon are unclear. Furthermore, little evidence is available on the adequacy of pharmacological pain management in patients undergoing radiotherapy. Moreover, studies investigating possible predictors of inadequate pain management reported contradictory results. Therefore, in this analysis, we evaluated a large population of cancer patients undergoing radiotherapy. We recorded, similarly to previous studies, a 45% rate of patients with inadequate analgesic therapy. Furthermore, evaluating the characteristics of patients with inadequate analgesic treatment, we noted that the subjects with better general conditions or better prognostic factors are those most frequently receiving inadequate drug therapy.Aim: The frequent inadequacy of pain management in cancer patients is well known. Moreover, the quality of analgesic treatment in patients treated with radiotherapy (RT) has only been rarely assessed. In order to study the latter topic, we conducted a multicenter, observational and prospective study based on the Pain Management Index (PMI) in RT Italian departments. Methods: We collected data on age, gender, tumor site and stage, performance status, treatment aim, and pain (type: CP—cancer pain, NCP—non-cancer pain, MP—mixed pain; intensity: NRS: Numeric Rating Scale). Furthermore, we analyzed the impact on PMI on these parameters, and we defined a pain score with values from 0 (NRS: 0, no pain) to 3 (NRS: 7–10: intense pain) and an analgesic score from 0 (pain medication not taken) to 3 (strong opioids). By subtracting the pain score from the analgesic score, we obtained the PMI value, considering cases with values < 0 as inadequate analgesic prescriptions. The Ethics Committees of the participating centers approved the study (ARISE-1 study). Results: Two thousand one hundred four non-selected outpatients with cancer and aged 18 years or older were enrolled in 13 RT departments. RT had curative and palliative intent in 62.4% and 37.6% patients, respectively. Tumor stage was non-metastatic in 57.3% and metastatic in 42.7% of subjects, respectively. Pain affected 1417 patients (CP: 49.5%, NCP: 32.0%; MP: 18.5%). PMI was < 0 in 45.0% of patients with pain. At multivariable analysis, inadequate pain management was significantly correlated with curative RT aim, ECOG performance status = 1 (versus both ECOG-PS3 and ECOG- PS4), breast cancer, non-cancer pain, and Central and South Italy RT Departments (versus Northern Italy).Conclusions: Pain management was less adequate in patients with more favorable clinical condition and stage. Educational and organizational strategies are needed in RT departments to reduce the non-negligible percentage of patients with inadequate analgesic therapy.

Randomized double-blind controlled trial to assess the efficacy of intravenous acetaminophen associated with strong opioids in the treatment of acute pain in adult cancer patients: study protocol

BackgroundCancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient’s quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain.MethodsWe will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated.DiscussionThe randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results.Trial registrationClinicaltrials.gov NCT04779567. Registered on March 3, 2021. Retrospectively registered.

Inferior survival outcomes with concomitant immune checkpoint inhibitors and chronic opioid use.

e14564 Background: Immune checkpoint inhibitors (ICI) are monoclonal antibodies that promote immune recognition of tumor cells to facilitate their elimination. Opioids are a major facet of pain management in cancer patients. Since chronic opioid use results in immunosuppression, the purpose of this study was to evaluate the survival outcomes of cancer patients on concurrent ICI and opioid therapy. Methods: This single-institute retrospective study from an NCI-designated comprehensive cancer center evaluated all patients in the primary or recurrent setting who underwent ICI therapy (anti-PD-1/PD-L1/CTLA-4) from 1 January 2020 to 18 June 2021. Demographic, clinicopathologic, and co-morbidity data were obtained from electronic medical records and the New York State Cancer Registry data. The New York State Prescription Monitoring Program was used to collect data about opioid prescriptions filled by patients from 30 days prior to and 30 days after the end of ICI therapy. Patient characteristics were analyzed with the Mann-Whitney U or chi-square tests. Survival analyses were performed using the Kaplan-Meier and Cox model regression, adjusting for relevant clinical factors. Results: A total of 869 patients were evaluable based on inclusion criteria and data availability. Most patients (77.15% chronic users and 64.62% occasional users) had stage III/IV disease. The most represented services included: gynecology (11.54%), soft tissue/melanoma (14.13%), thoracic (38.75%), urology (11.9%). Comorbidities did not vary between the two groups. Pre-treatment median opioid consumption was higher in the chronic users compared to occasional users (240 oral morphine equivalents (OME) vs 120, p = 0.03). Total opioid prescriptions filled was significantly higher for chronic users compared to occasional users (4275.0 vs 520.1 OME, p &lt; 0.001). Chronic users were more likely to be on an additional anti-neoplastic agent (64% vs 44.07% for occasional users). Occasional users had significantly longer progression free (44.7 vs 16.0 months, p &lt; 0.001) and overall (42.7 vs 16.2 months, p &lt; 0.001) survival. When controlling for age, stage, and concurrent therapy, chronic opioid use retained a significantly negative association with PFS and OS. Conclusions: Patients on ICI therapy in the primary and recurrent setting who chronically use opioids exhibit significantly decreased PFS and OS compared to the occasional user cohort. This study provides evidence that chronic opioid use during ICI therapy results in inferior clinical outcomes.

East Asian Herbal Medicine to Reduce Primary Pain and Adverse Events in Cancer Patients : A Systematic Review and Meta-Analysis With Association Rule Mining to Identify Core Herb Combination.

Objective: Cancer pain is an important factor in cancer management that affects a patient’s quality of life and survival-related outcomes. The aim of this review was to systematically evaluate the efficacy and safety of oral administration of East Asian herbal medicine (EAHM) for primary cancer pain and to explore core herb patterns based on the collected data. Methods: A comprehensive literature search was conducted in 11 electronic databases, namely, PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Korean Studies Information Service System, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, Korea Citation Index, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data, and CiNii for randomized controlled trials from their inception until August 19, 2021. Statistical analysis was performed in R version 4.1.1 and R studio program using the default settings of the meta-package. When heterogeneity in studies was detected, the cause was identified through meta-regression and subgroup analysis. Methodological quality was independently assessed using the revised tool for risk of bias in randomized trials (Rob 2.0). Results: A total of 38 trials with 3,434 cancer pain patients met the selection criteria. Meta-analysis favored EAHM-combined conventional medicine on response rate (risk ratio: 1.06; 95% CI: 1.04 to 1.09, p < 0.0001), continuous pain intensity (standardized mean difference: −1.74; 95% CI: −2.17 to −1.30, p < 0.0001), duration of pain relief (standardized mean difference: 0.96, 95% CI: 0.69 to 1.22, p < 0.0001), performance status (weighted mean difference: 10.71; 95% CI: 4.89 to 16.53, p = 0.0003), and opioid usage (weighted mean difference: −20.66 mg/day; 95% CI: −30.22 to −11.10, p < 0.0001). No significant difference was observed between EAHM and conventional medicine on response rate and other outcomes. Patients treated with EAHM had significantly reduced adverse event (AE) incidence rates. In addition, based on the ingredients of herb data in this meta-analysis, four combinations of herb pairs, which were frequently used together for cancer pain, were derived. Conclusion: EAHM monotherapy can decrease adverse events associated with pain management in cancer patients. Additionally, EAHM-combined conventional medicine therapy may be beneficial for patients with cancer pain in increasing the response rate, relieving pain intensity, improving pain-related performance status, and regulating opioid usage. However, the efficacy and safety of EAHM monotherapy are difficult to conclude due to the lack of methodological quality and quantity of studies. More well-designed, multicenter, double-blind, and placebo-controlled randomized clinical trials are needed in the future. In terms of the core herb combination patterns derived from the present review, four combinations of herb pairs might be promising for cancer pain because they have been often distinctly used for cancer patients in East Asia. Thus, they are considered to be worth a follow-up study to elucidate their actions and effects. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021265804

A Comprehensive Strategy to Pain Management for Cancer Patients in an Inpatient Rehabilitation Facility.

Cancer pain has been shown to have a significant negative impact on health-related quality of life (HRQoL) for people experiencing it. This is also true for patients admitted to inpatient rehabilitation facilities (IRFs). An interdisciplinary approach is often needed to fully address a person's pain to help them attain maximum functional independence and to ensure a safe discharge home. Improving a patient's performance status in an IRF may also be a crucial determinant in their ability to continue receiving treatment for their cancer. However, if a person is determined to no longer be a candidate for aggressive, disease modulating treatment, IRFs can also be utilized to help patients and family's transition to comfort directed care with palliative or hospice services. This article will discuss the interventions of the multidisciplinary inpatient rehabilitation team to address a person's pain.

A new approach for leptomeningeal metastases: chemotherapy administered through lumbar intrathecal port.

Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP. The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline. The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting.

Improving access to timely pain management in an underserved oncology clinic: A palliative care-oncology partnership.

e18672 Background: In the 4 years since inception, the palliative care (PC) clinic at Olive-View UCLA Medical Center (OVMC) cared for less than 6% of pain-positive cancer patients based on guidelines put forth by ASCO. As with other under-resourced safety-net settings, the demand for PC services at OVMC far exceeds the manpower available for optimal pain management in oncology patients. This year long project aims to improve pain management in a busy oncology clinic via enhanced identification and prompt treatment of cancer pain by Oncologists. Methods: At the project start, Oncologists were surveyed to identify key elements to be incorporated into formal didactics on pain management principles, case-based discussions and real-time mentoring. At the weekly oncology clinic, patients were screened for pain using the multi-modal PEG scale: Average Pain intensity (P), interference with Enjoyment of life (E), and interference with General activity (G) over the preceding week. The Oncologist was notified of the PEG score if a patient had an average score ≥4 (0-10 scale) for review and intervention. Patients were screened using the same method at subsequent visits. EHR of patients with PEG scores ≥4 were reviewed to determine whether therapeutic interventions were made by the Oncologist. A comparison of PEG scores to the standard nursing intake pain scores was also conducted. Results: Over a 4-month period, 513 PEG forms were administered, 37% of which resulted in a pain score ≥4. Of the 172 patients who screened positive, 54 patients were screened at follow up visit(s). Comparing the pain-positive cohort, we observed an average decrease in pain by 25.5% (7.1 to 5.3) in patients who received intervention as opposed to 7.4% (5.0 to 4.7) in patients who did not receive intervention by their Oncologist. Further, there was a remarkable divergence between the average PEG score (6.7) and nurse intake pain score (1.4) in this patient cohort. Conclusions: Our findings suggest that improved Oncologist real-time pain assessment and intervention incorporating a validated pain screening tool leads to timely pain management in cancer patients. Implementation of a Palliative Care-Oncology partnership promotes provider awareness and confidence in treating patients with complex pain. A functional pain assessment, using PEG, can more accurately reflect pain compared to the current standard nursing intake process. Particularly in resource challenged settings where access to PC is limited, facilitating timely pain management through training and mentoring of oncologists or other primary providers can be a sustainable model to improve patient access to primary palliative care. Given the early indicators of success we hope to expand this workflow in training other healthcare providers within our County safety net system. Research Sponsor: California Health Care Foundation.

Impact of the VA opioid safety initiative on pain management for cancer patients.

102 Background: Limited research exists on how risk reduction policies in response to the opioid epidemic have impacted pain management among cancer patients. This study investigated the impact of the Veteran’s Health Administration (VHA) Opioid Safety Initiative (OSI) on opioid prescribing patterns and opioid-related toxicity among patients undergoing definitive cancer treatment. Methods: This retrospective cohort study included 42,064 opioid-naïve patients receiving definitive local therapy for prostate, lung, breast, and colorectal cancer at the VHA from 2011-2016. Interrupted time series analysis with segmented regression was used to evaluate the impact of the OSI, which launched October 2013. The primary outcome was the incidence of new opioid prescriptions with diagnosis or treatment. Secondary outcomes included rates of high daily dose opioid (≥ 100 morphine milligram equivalent) and concomitant benzodiazepine prescriptions. Additional long-term outcomes included persistent opioid use, opioid abuse diagnoses, pain-related ED visits, and opioid-related admissions. Results: Prior to OSI implementation, the incidence of opioid prescriptions among new cancer patients increased from 26.7% (95% CI 25.0 – 28.4) in the first quarter (Q1) of 2011 to 50.6% (95% CI 48.3 – 53.0) in Q3 2013. There was a monthly increase in opioid prescription rate pre-OSI followed by a monthly decrease post-OSI (Table). High-dose opioid prescriptions were rare, and the monthly rate was stable before and after the OSI. Monthly incidence of concomitant benzodiazepine prescriptions was stable pre-OSI and decreased post-OSI. Persistent opioid use increased pre-OSI and decreased post-OSI. Pain-related ED visits had an incidence of 0.8% (95% CI 0.4 – 1.0) in Q1 2011, 0.3% (95% CI 0.1 – 0.6) in Q3 2013, and 1.8% (95% CI 0.9 – 2.7) in Q4 2016, with an increasing monthly rate after the OSI. At three years, the cumulative incidence of opioid abuse was 1.2% for both the pre- and post-OSI groups but opioid-related admissions were greater in the pre-OSI cohort than the post-OSI cohort (0.9% vs. 0.5%, p &lt; 0.001). Conclusions: The OSI was associated with a decrease in new, persistent, and certain high-risk opioid prescribing as well as an increase in pain-related ED visits. Further research on patient-centered outcomes is required to optimize opioid prescribing policies for patients with cancer.[Table: see text]

Morphine Reduces Tumor Growth in Glioma Mouse Xenograft through Modulation of IDH1 Activity and Metabolic Reprogramming

Background Isocitrate dehydrogenase 1 (IDH1) is a key extra-mitochondrial enzyme, responsible for converting isocitrate to α-ketoglutarate. In low grade gliomas, IDH1 is often mutated (Arg132His), altering the enzymatic product to the oncometabolite 2-hydroxyglutarate (2HG) and inducing drastic metabolic reprogramming1. 2HG also inhibits DNA demethylases thus causing DNA hypermethylation. Contrary to expectation, IDH1 mutation slows tumor growth and increases susceptibility to antineoplastic agents, improving patient outcome2. We previously found that morphine, a commonly used opiate for pain management in cancer patients, is a mixed partial inhibitor of wild type IDH1. We sought to determine if morphine's effect on IDH1 activity replicates the beneficial changes caused by IDH1 mutation. Methods U87 cells (IDH1 wild type) were treated with clinically relevant concentrations of morphine (0.1-10µM) or equipotent hydromorphone for 7 days. Hydromorphone has no effect on IDH1 activity and served as a negative opiate control. DNA methylation was quantified by ELISA assay. Targeted metabolomics was performed using LC/MS. Mitochondrial function was determined using a Seahorse assay. The in vivo effect of morphine was tested using a mouse xenograft model (intraperitoneal U87 injection), with daily subcutaneous injections of morphine (5mg/kg or 10mg/kg) or hydromorphone (2mg/kg). Tumors at 30 days were measured by weight and histopathology. Cooperative capacity of morphine and the antineoplastic drug temozolomide (TMZ) was determined by measuring in vitro cell viability. Results We observed a dose-dependent increase in both DNA methylation (91%, p<0.05) and 2HG oncometabolite levels (75%, p<0.01) relative to vehicle in morphine samples. Levels of 22 metabolites were uniquely affected by morphine (fig. 1). Pathway enrichment analysis highlighted changes to glutamate metabolism, glycolysis, and the pentose phosphate pathway, all previously implicated in the beneficial IDH1 mutant glioma phenotype. Consistent with metabolic reprogramming, morphine reduced basal and ATP-coupled respiration (15%, p<0.01). Tumors from morphine treated mice were significantly smaller than vehicle (3.7-fold, p<0.01). Histological staining of these tumors revealed increased apoptosis (172%, p<0.01) and reduced proliferation (26%, p<0.01) (fig. 2). Morphine potentiated the effect of TMZ, co-treatment exhibited more cell death after 36 hours (18%, p<0.05) than either drug alone. Conclusion Our research has shown that morphine treatment, through its interaction with IDH1, is able to increase 2HG and DNA methylation. The opiate altered pathways significant in glioma metabolism and energy production. Moreover, it significantly reduced glioma tumor growth and enhanced the chemotherapeutic effect of TMZ, much like the known impact of the IDH1 mutation. We conclude that the interaction between morphine and IDH1 mimics the beneficial IDH1 mutation phenotype. Our research highlights the need for personalized medicine pathways, illustrating that that even the choice of opiate for pain management can potentially alter the course of oncologic disease. Sources 1. Dang, L. et al. Nature (2009) 2. Paldor, I. et al. J. Clin. Neurosci. (2016)

Pain management in cancer patients in the main hospitals in Mozambique.

Pain is the most feared and distressing symptom in palliative care. In advanced stages of cancer, its incidence is 70-80%. In Mozambique there is little published information concerning to the prevalence, intensity, and pain's management in cancer patients. A cross-sectional observational study was conducted between August 2018 and January 2019, in Mozambique's main hospitals, and in the only hospital with an isolated provision of palliative care service. The analyzed data included demographic data, pain intensity and its treatment. The Pain Management Index was used to calculate the adequacy of the analgesia. A total of 294 patients were included. The mean patients' age was 46.1 years old. Concerning to pain, 83.7% of the patients had pain, most of them moderate to severe pain. The prevalence of pain was frequent in women mainly in cervical cancer (84.3%) and in men with Kaposi sarcoma (80%). The main analgesic used for severe pain was paracetamol, and it was used alone in 40.9% of the patients. Morphine was used in 8.1% and adjuvants less than 10%. Pain Management Index was negative for 68.7% of the sample, meaning an inadequate analgesia. Significant differences were found in Pain Management Index levels between hospitals. The prevalence of pain in the main health institutions in Mozambique is high. Paracetamol was the analgesic most used in severe pain. Further studies are needed to understand the main reasons of patients' suffering.

Knowledge of morphine use in the management of pain in cancer patients among physicians in a resource-constraint setting

Introduction: The use of morphine is viewed as an integral part of pain management in cancer patients. The responsibility for pain treatment lies with physicians. Therefore, this study assessed the knowledge of clinical use of morphine in the management of pain in cancer patients among physicians working in Kebbi State, Nigeria. Material and method: A self-administered questionnaire was distributed to all the 110 participants in attendance at the Continuing Medical Education meeting organized by the Nigerian Medical Association, Kebbi State Branch. Data were analyzed using SPSS version 20. Result: A total of 95 physicians participated, including 12 consultants (12.6%), 38 registrars (40.0%), 35 medical officers (36.8%), and 7 house officers (7.4%). Only 30 respondents (31.6%) had ever received professional training on pain management or analgesic use. Overall, only 10 (10.5%) respondents had good knowledge of pain management in cancer patients and morphine use. Conclusion: Physicians knowledge of pain management in cancer patients and clinical use of morphine is poor. There is a need to improve active professional analgesic education programs.

La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30% of cases but under treatment. Relief opioids were prescribed in 43% of cases to relieve pain. Paracetamol was prescribed in 26% of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62% consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Impact of Early Intervention in Pain Management in Cancer Patients: A Randomized Controlled Study in a Tertiary Care Cancer Hospital.

The present study aimed to assess the role of early intervention of nerve blocks in the management of cancer pain. We also aimed to study its effect on the quality of life and the opioid requirement. Sixty patients with cancer having pain, 18 to 75 years were randomised and divided into an intervention group and analgesic titration with opioids group. Patients in the intervention group received nerve block and residual pain managed with opioids. Control group patients were managed with opioids alone. The mean visual analog scale score showed statistically significant improvement in both the groups (8.56±1.07 to 2.5±0.63 in the intervention group, 9.3±0.74 to 3.3±0.75 in the control group at 1 month (P=0.000). This was associated with a decrease in the opioid requirement in the intervention group at 1 week (P=0.014) with only 4 patients receiving morphine at the end of 1 month.The change in the Karnofsky scale was statistically significant from baseline to 1 month in both groups. Interventional pain management has a definitive role in palliative setup for pain management. Pain relief was obtained in both groups, but the quality of pain relief was better in the intervention group with an associated reduction in the opioid requirement.

Correlation of Plasma Kynurenic Acid Level with the Severity of Depression, Pain, And the Need of Opioids for Pain Management in Cancer Patients in Palliative Care Unit in Dr. Soetomo General Hospital Surabaya

Introduction: Most cancer cases in Indonesia are diagnosed at an advanced stage, and the cure rate and life expectancy are not as expected. Depression and pain are the most common problems that arise in cancer patients. Kynurenic acid and quinolinic acid are neuroactive metabolites produced in the kynurenine pathway. Decreased kynurenic acid levels have been reported to be associated with depression, pain, and pathology in cancer. Objective: This study aims to determine the correlation between kynurenic acid levels and the severity of depression, pain level, and opioid need in cancer patients undergoing palliative treatment. Material and Method: This study was an observational analytic study with a retrospective cohort design. The study population was adult patients with malignancy in the palliative care unit of Dr. Soetomo General Hospital Surabaya that received opioid treatment during the study period. The sample of this study was 54 patients. Plasma kynurenic acid levels were measured using the ‘Human Kynurenic acid ELISA kit’ from BT Lab. The severity of depression was measured by the Hamilton Depression Rating Scale (HDRS). Pain level was scored with Pain Numeric Rating Scale (NRS), while the opioid use was collected from the patient’s medical record. Result and Discussion: There was a significant relationship between kynurenic acid levels and the severity of depression (p&lt;0.001), pain level (p&lt;0,001), and opioid need (p=0,007). Simple linear regression analysis showed that the lower the kynurenic acid level, the more severe the depression (p&lt;0.001) and the higher the opioid dose needed (p=0,004). Moderate pain has a lower median kynurenic acid level than mild pain, 12.32 nmol/L, and 16.29 nmol/L, respectively. Patients with a lower level of kynurenic acid require a higher dose of the same type of opioid. Conclusion: The lower level of plasma kynurenic acid is associated with more severe depression, more pain level, and more opioid need for pain management in malignancy patients in the palliative care unit of Dr. Soetomo General Hospital Surabaya.

Attitudes and appropriateness of pain management in cancer patients using pain management index

AbstractObjectivesInadequate management of cancer pain (CP) remains a global medical problem. In this study, the aim was to assess attitudes of cancer patients towards their CP treatment and to evaluate effectiveness of pain management.MethodsA sample of 300 adult cancer patients admitted to a single hospital were face-to-face interviewed in a cross-sectional study design using a structured questionnaire. The short form of the Brief Pain Inventory was used to collect data on pain, and Pain Management Index (PMI) was calculated to assess adequacy of pain management.Key findingsMedian age of patients was 53 years (interquartile range, 43–63). Half of patients (50.5%) believed their pain therapy needs improvement. Almost half patients had severe pain at interview (49.8%). Pain interfered most with patient enjoyment of life with a mean interference score 6.13 ± 2.37. Majority of cancer patients (84.3%) received a non-opioid analgesic while a minority (15.7%) received opioid analgesic in which morphine was the most common drug. The use of non-opioid adjuvants was minimal. Mean PMI for patients was −1.15 ± 0.75 (range −2 to +1), and most patients (80.3%) had inadequate pain treatment. Gender and smoking status of patients were significantly associated with adequacy of pain management (P = 0.009 and P = 0.004, respectively). There were no associations between patient age, educational level or tumour characteristics and adequacy of pain management.ConclusionsCancer patients in this study present with severe pain and the rates of undertreatment are high. There is an urgent need to improve management plans to assure appropriate use of therapeutic modalities for treatment of cancer-related pain.

The role of pregabalin in neuropathic pain management in cancer patients

Despite the wide availability of analgesics for prescription in cancer pain, including both opioid and non-opioid medications, population studies have for many years demonstrated unadvisable pain management. International analyses indicate inadequate use of opioid and adjuvant drugs per capita. At the same time, patients complain about the accompanying pain, not treated effectively, especially in the course of cancer. One of the many causes of cancer pain that is difficult to treat is the co-occurrence of neuropathic pain. The article presents contemporary views on the treatment of neuropathic pain associated with cancer, including the site of application of gabapentinoids in the treatment scheme.

Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

Background Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers. Purpose To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21. Result Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18–45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients' self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association. Conclusion This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

Knowledge and Attitudes of Home Care Nurses in Cyprus in the Management of Cancer Pain

Pain is a common symptom for cancer patients. It is a problem for themselves and their relatives. Nurses are confronted with the treatment of cancer pain in their everyday clinical practice. Efficient management requires accurate and appropriate knowledge, positive attitudes, and competent evaluation skills. The aim is to explore the knowledge and attitudes of Cypriot home care nurses in pain management of cancer patients. Regarding methodology, a quantitative descriptive design was used and the data were collected with the Greek version of the McCaffery and Ferrell Nurses’ Knowledge and Attitudes Survey Regarding Pain questionnaire along with a demographic questionnaire. The sample of the study consisted of home care nurses working in non-profit organizations in Cyprus ( n = 31). For the analysis of data, the SPSSv.21. was used and the statistical significance was set to the p = .05. Results revealed of the total of 35 questions only 13 were answered correctly by the 80% of the participants. Limited knowledge was reported mainly on the duration of action, the effect and dosage of Pethidine, the risk of addiction and the use of non-medication interventions. Significant differences were found to the level of knowledge as regards the age and the experience of nurses. In the case study exercise, it was found that false assessment of pain was related to wrong decisions. Nurses’ attitudes seemed to be positive. In conclusion, the study revealed the knowledge deficits and need for continuous education of home care nurses on the assessment and management of pain for patients with cancer. Empowering nurses with better skills to deal with pain, a most distressing symptom of cancer, will result in a better quality of life for patients. However, the integration of pain management within the national cancer strategies is also very important.

Oral Methadone for Cancer Pain Management at the End of Life: A Forgotten Drug

Background: Opioids are used for pain management in cancer patients. Morphine is considered the best option. For some patients with pain of difficult control management and adverse effects, an opioid rotation should be considered. Oral methadone is an opioid to which patients can be rotated safely and effectively and inexpensive for Mexico and Latin America. Our study describes the 9-year experience of opioid rotation to methadone, the population profile, efficacy of methadone in cancer patients of the palliative care service. Methods: Retrospective study of cancer patients rotated to oral methadone for pain control. Tables of frequencies, median and interquartile ranges were made, as well as overall survival. Results: 311 patients were rotated to methadone, predominantly males (58.5%), median age of 54 years with oncological diagnoses in cervix (10.3%), germinal tumors (8.4%), breast (8.0%), prostate (7.4%) and rectal (5.5%). These patients experienced visceral (17.6%) or other types of pain (68.6%), and a combination of different types of pain, the most prevalent pain was neuropathic (88.7%) and 50% received morphine, 21% buprenorphine or fentanyl 19% previously, with a median dose of 60 mg (30-120). The main reason for rotation was difficult pain control (54%), obtaining an efficacy of 70.0%. Conclusion: In this cohort at advanced disease stage, 54% suffered from difficult pain control, thus rotation became necessary, reducing pain and manageable adverse events, without major changes of the initial and final dose. Should be promoted more widely in the management of pain of difficult control by cancer in first position prescription.