Pharmacological Pain Therapy Research Articles

Pharmacological pain management in cancer patients

Pharmacological pain therapy in cancer patients is based on guideline recommendations, which, however, do not fully coincide in all aspects due to varying weighting of evidence. The present article discusses current issues including the decreasing significance of the World Health Organization (WHO) analgesic ladder, with its distinction between step2 and3 being increasingly questioned. Risks of nonopioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in older populations, are discussed. Paracetamol may potentially reduce the effectiveness of immunotherapies. Aspects of administering analgesics via afeeding tube are considered. Recommendations for the treatment of episodic pain, transitioning between different opioids, and some relevant interactions are also discussed.

Hipnokomunikasi Dalam Aplikasi Pasha (Pain Assessment, Stimulating And Healing Application) Dalam Menurunkan Nyeri Pasien Post Operasi

Postoperative pain is the body’s reaction to tissue damage (ranging from skin incisions to damage from surgery), stretching or tightening of internal organs, and diseases (eg cancer, spinal diseases, etc). There are several pain management options in the PASHA (Pain Assessment, Stimulating and Healing Application) application to reduce the pain scale felt by patients, one of which is hypnocommunication. The purpose of this study was to find out how effective hypnocommunication on reducing pain of postoperative patients. This study used a quasy experimental design with a one-group pre-test and post-test approach by measuring the pain scale using the NRS (Numeric Rating Scales). The sample of this study was 30 postoperative patients in the surgical room who were selected by purposive sampling with several inclusion criteria.. The intervention was carried out using the PASHA application and the patient was listened hypnocommunication therapy for 15 minutes in 2 consecutive days The data were collected through computerization by using an dependent t-test. The results of the study showed that the average respondent’s pain intensity before being given hypnocommunication was 5.167 (moderate pain) and the average repondent’s pain intensity after being given hypnocommunication was 4, 00 (moderate pain). It can be conclude there was a significant effect of providing hypnocommunication based on the PASHA application in reducing postoperative patient pain (p value = 0.001). It is recommended to nurses especially in treating pain of postoperative patients by applying hypnocommunication as a non pharmacological pain therapy

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery.

BackgroundNowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting.ObjectivesThe current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery.MethodsThe current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4.ResultsMedian average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent.ConclusionsEach type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.

Health benefits of an adverse events reporting system for chronic pain patients using long-term opioids.

Safety data from long-term opioid therapy in the real world has been poorly studied in chronic non-cancer pain (CNCP). The aim was to design a pharmacovigilance data recording system and assess whether participation in this recording system improves pain management, enhancing patient's health status. A pharmacovigilance data recording system was conducted during24months. Data were self-reported by patients (pain, adverse events [AEs] and healthcare resources use) and physicians (morphine equivalent daily dose [MEDD] prescribed and suspectedadverse drug reaction [ADRs]). Outcomes from patients with(case) or without (controls) suspected ADRs and cases follow-up were also compared with Spanish Pharmacovigilance System data. A total of 753 patientswere recruited in 897 visits. Fentanyl and tramadol were the most prescribed opioids, 89% with concomitant drugs, pregabalin being the one with the most potential drug interactions. Cases presented significantly higherpain intensity (VAS 67±26 vs 59±30mm, P<0.05), number of AEs (8±6 vs 5±3 AEs/patient, P<0.01), polypharmacy related to pain (65% vs 34%, P<0.01) andMEDD (139±130 vs 106±99mg/d, P<0.01)than controls. Furthermore, cases presented significant higher changes in pharmacological pain therapy due to pain, unplanned emergency visits and hospital admission than controls. Physicians notified 168 suspected ADRs mostly related to neurological or psychiatric events and 8% of them were previously unknown. This data recording system provided important information to achieve a better control of CNCP pharmacological pain therapy, improving patient's health status and reducing costs to the Health System.

Pain therapy in intensive care patients

After intensive care unit (ICU) treatment, the recollection of experienced pain is one of the most burdensome aftermaths. In addition, pain has several negative physiological consequences. The majority of patients report moderate to severe pain while being treated on an ICU, often caused by diagnostic or therapeutic procedures. Pain and its functional consequences during ICU treatment should therefore be systematically recorded and treated. Due to their high analgesic potency, pharmacological pain therapy focuses on opioids; however, gastrointestinal motility disturbance and development of tolerance are disadvantages. When applying non-opioids, such as non-steroidal anti-inflammatory drugs (NSAID) and paracetamol, attention should be paid to their possible organ toxicity. Ketamine and α2-antagonists can complement the analgesic concept. Analogous to its perioperative administration, intravenous lidocaine in intensive care seems acceptable because of a favorable impact on opioid requirements and gastrointestinal motility. When using regional anesthesia the positive therapeutic effect and the possible complications need to be carefully weighed. Non-pharmaceutical procedures, especially transcutaneous electrical nerve stimulation (TENS), have proven successful in postoperative pain management. Even if only limited data from intensive care are available, atherapeutic attempt seems justifiable because of the low risk of complications.

Herausforderungen ambulanter Pflegedienste im Schmerzmanagement von Tumorpatienten

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation.By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted.On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment.Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

Pain Management in geriatric patients

Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life. These facts shows the relevance of a sufficient pain therapy in geriatric patients. Nevertheless, on account of existing comorbidity, polypharmacy as well as of impaired organ function, the pharmacological pain therapy in old patients also poses a potential hazard. Although pain prevalence is higher with geriatric than with younger patients, significantly less analgesics are prescribed in the elderly population. This results from existing uncertainties at the treating doctors as well as the complicated pain capture, in particular with cognitive affected patients. The present article should indicate options of treatment for geriatric pain patients.

Systematic review and meta-analysis of pharmacological therapies for pain associated with postherpetic neuralgia and less common neuropathic conditions

To estimate the relative efficacy of pharmacological therapies for the treatment of postherpetic neuralgia (PHN), multiple sclerosis (MS)-related pain, posttraumatic pain, central poststroke pain (CPSP) and human immunodeficiency virus (HIV)-related neuropathic pain (NeP). This systematic review (through June 2011) identified randomised, controlled trials of treatments for these conditions. Bayesian mixed treatment comparison (MTC) methods were used to determine the relative efficacy and safety among the treatments within each pain condition. Fifty studies were identified: 33 PHN, 2 MS-related pain, 3 CPSP, 3 posttraumatic pain and 9 HIV-related NeP. Data from 28 PHN studies including 21 interventions and 4317 patients were included into the PHN MTC. Of treatments studied in ≥ 50 patients, opioids had the greatest mean pain reduction of -1.70 vs. placebo on an 11-point numeric rating scale. Pregabalin ≥ 300 mg/day was most effective for ≥ 30% and ≥ 50% pain reduction [relative risk (RR) vs. placebo = 2.44 and 2.13, respectively]. Data identified for MS-related pain, CPSP, posttraumatic pain and HIV-related NeP were sparse; only 7 of 17 studies had ≥ 50 patients. Adverse events (AEs) and discontinuations for most treatments were not significantly greater than placebo except in PHN, where 8 of 12 treatments had higher risks of AEs compared with placebo and tricyclic antidepressants and opioids had higher risk of discontinuation compared with placebo. Guideline-recommended treatments for PHN were more effective than placebo on the pain NRS and for ≥ 30% and ≥ 50% pain reduction. Although guidelines exist for the management of less common NeP conditions, little published evidence supports them. These results highlight the need for additional evaluations and more complete reporting of outcomes to help guide physicians' treatment selections.

Adherence to Pharmacological Pain Therapy in Patients with NonMalignant Pain: The Role of Patients' Knowledge of Pain Medication

Nonadherence to pharmacological therapy is a common and underexposed problem in patients with chronic nonmalignant pain. It may lead to treatment failure and increased healthcare costs. In this prospective observational study we analyzed the association between knowledge and adherence in the chronic nonmalignant pain population. We included 96 patients treated with a new pharmacological prescription. During the initial visit (T0), demographic variables, pain intensity, knowledge of the prescription (name, dose, and frequency), self-reported adherence to the prescription, and general knowledge of pharmacological pain therapy (according to the Pain Knowledge Questionnaire, Dutch Language Version (PKQ-DLV) were recorded. During two follow-up visits (T1, T2), apart from demographics, these parameters were measured again. Adherence rates were 42%, 42%, and 46% at T0, T1 and T2, respectively. 53%, 59%, and 48% of patients had knowledge of their current prescription, and mean scores on the PKQ-DLV were 56, 55, and 52 percent of the maximum scores, respectively, at T0, T1 and T2. A multivariate binary logistic regression analysis resulted in a significant contribution of knowledge of the prescription and of age to the prediction of adherence. Knowledge of the analgesic prescription is associated with adherence and significantly contributes to the prediction of adherence to analgesic therapy. An interventional study is needed to determine whether increasing knowledge will improve medication adherence and therapy outcome in patients with chronic nonmalignant pain.

Schmerztherapeutische Möglichkeiten in der Unfallchirurgie

Sufficient acute pain therapy has been scientifically proven to be one of the therapeutic pillars for rapid patient convalescence, a low rate of pain chronification, and a high grade of patient satisfaction. This includes not only systemic pharmacological pain therapy, but also nonpharmaceutical measures, e.g., physical, psychological, locoregional, and adequate patient information. This requires a specific infrastructure, exact clinical control mechanisms, and fundamental knowledge about pain avoidance. The surgeon can responsibly contribute to this. The goal of the following article is to demonstrate and deepen this knowledge and to describe the newest scientific developments.

Systematic review and meta-analysis of pharmacological therapies for pain associated with post-herpetic neuralgia

Systematic review and meta-analysis of pharmacological therapies for pain associated with post-herpetic neuralgia

Polypharmacy and pain treatment

Pain is a frequent symptom in clinical practice. Elderly and chronically ill patients are particularly affected. On account of the high prevalence of polypharmacy among these patients, pharmacological pain therapy becomes a challenge for physicians. Drug side effects and drug-drug interactions have to be taken into account so as to minimize the health risk for these patients. Especially the group of NSAID has a high risk of adverse drug reactions and drug interactions. The gastrointestinal, the cardiovascular, the renal and the coagulation system are particularly affected. Except for the toxic effect on the liver (in a high dose) Paracetamol (acetaminophen) has similar risks, to a minor degree, though. According to current data Metamizol is actually better than its reputation. The risk of potential drug interactions seems to be low. Beside the risk of sedation in combination with other drugs, Tramadol and other opioids such as Pethidin may induce the Serotonin syndrome. In order to avoid dangerous drug interactions and adverse side effects in the case of polypharmacy, it is recommended to prefer individual choices instead of sticking to the pain management as proposed by the WHO.

Acupuntura y dolor: una historia en tres partes: Primera parte: Historia del dolor y de la acupuntura desde la Antigüedad hasta el siglo xix

Background The issue ‘pain’ has preoccupied mankind from the very beginning. Still, this individual phenomenon, which depends on physical, emotional, spiritual, and cultural factors, has yet to be fully understood, but is of vital interest. Acupuncture is one of the oldest and most effective means of pain therapy. In its theory, it provides an interface for body, emotion, mind, and culture. Aim By portraying and analyzing the historical evolution it will be shown that a modern understanding of both pain and acupuncture can lead to an integrative therapeutic approach, and that acupuncture –due to its physiological concepts and its idea of man– can lead to an all-encompassing approach in pain therapy. Methods In-depth study of literature, long-time practical experience in the therapy of acute and chronic pain, intensive study of acupuncture in historical context, as well as practical, own clinical and basic research, and knowledge in medical history as well as sinology, thereby joining the competences of two university institutes. Results The first part analyzes the history from ancient times up to the 19th century. It is found that within the course of history, the interpretation of pain has always been a synthesis of individual sensation and cultural, philosophical concepts in both the Eastern and Western world, and that by the time of the 16th century, both worlds had come to influence each other. In the 18th and 19th centuries, acupuncture experienced is first heyday in Europe, which came to an abrupt ending due to the pharmacological breakthrough discoveries of potent analgesics, both in Europe and in China. Discussion The rationalization of the concepts of pain in the historical course from ancient times until the 19th century, and its dissociation from the individual lead to an increase in reputation of modern pharmacological pain therapy over acupuncture, both in Europe and the East. It may be postulated that still today, the results of this historical process stand in the way of the evolution of a much needed, all-encompassing approach including biological, psychological, and sociological factors. It would be necessary to establish an effective theoretical system integrating scientific findings while at the same time paying tribute to the subjectivity of pain. The following parts trace the development of the understanding of pain, modern pain therapy, and various approaches by acupuncture in the 20th and 21st centuries in order to finally, using a model, show a way out of this dilemma.

Akupunktur und Schmerz – eine Historie in 3 Teilen: Teil 1: Geschichte des Schmerzes und der Akupunktur vom Altertum bis ins lange 19. Jahrhundert

Background The issue ‘pain’ has preoccupied mankind from the very beginning. Still, this individual phenomenon, which depends on physical, emotional, spiritual, and cultural factors, has yet to be fully understood, but is of vital interest. Acupuncture is one of the oldest and most effective means of pain therapy. In its theory, it provides an interface for body, emotion, mind, and culture. Aim By portraying and analyzing the historical evolution it will be shown that a modern understanding of both pain and acupuncture can lead to an integrative therapeutic approach, and that acupuncture – due to its physiological concepts and its idea of man – can lead to an all-encompassing approach in pain therapy. Methods In-depth study of literature, long-time practical experience in the therapy of acute and chronic pain, intensive study of acupuncture in historical context, as well as practical, own clinical and basic research, and knowledge in medical history as well as sinology, thereby joining the competences of two university institutes. Results The first part analyzes the history from ancient times up to the 19 th century. It is found that within the course of history, the interpretation of pain has always been a synthesis of individual sensation and cultural, philosophical concepts in both the Eastern and Western world, and that by the time of the 16 th century, both worlds had come to influence each other. In the 18 th and 19 th centuries, acupuncture experienced its first heyday in Europe, which came to an abrupt ending due to the pharmacological breakthrough discoveries of potent analgesics, both in Europe and in China. Discussion The rationalization of the concepts of pain in the historical course from ancient times until the 19 th century, and its dissociation from the individual lead to an increase in reputation of modern pharmacological pain therapy over acupuncture, both in Europe and the East. It may be postulated that still today, the results of this historical process stand in the way of the evolution of a much needed, all-encompassing approach including biological, psychological, and sociological factors. It would be necessary to establish an effective theoretical system integrating scientific findings while at the same time paying tribute to the subjectivity of pain. The following parts trace the development of the understanding of pain, modern pain therapy, and various approaches by acupuncture in the 20 th and 21 st centuries in order to finally, using a model, show a way out of this dilemma.

958 NON PHARMACOLOGICAL PAIN THERAPY

958 NON PHARMACOLOGICAL PAIN THERAPY

Opioids in cancer and chronic non-cancer pain therapy-indications and controversies.

Indications for strong opioids for cancer-related pain as well as for chronic non-cancer pain are that non-opioid drugs, and other less risky therapies, fail and that the pain is opioid-sensitive. The WHO analgesic ladder principle continues to serve as an excellent educational tool in the efforts by WHO in collaboration with the World Federation of Societies of Anaesthesiologists (WFSA) and The International Association for the Study of Pain (IASP) to increase knowledge of pharmacological pain therapy and increase availability of essential opioid analgesics world-wide. Opioids differ in pharmacodynamics and pharmacokinetics, and patients have different pharmacogenetics and pain mechanisms. Sequential trials of the increasing numbers of available opioid drugs are therefore appropriate when oral morphine fails. Controversies continue concerning diagnosis and handling of opioid-insensitive pain in cancer and chronic non-cancer pain, opioid-induced neurotoxicities, risks of tolerance, addiction, pseudo-addiction, and methods for improving effectiveness and decreasing adverse effects of long-term opioid therapy, treating breakthrough pain with immediate release oral and transmucosal opioids. Consensus guidelines have recently been developed in the Nordic countries concerning the ethical practice of palliative sedation when opioids and other pain-relieving therapies fail in patients soon to die. Guidelines for long-term treatment with strong opioids of chronic non-cancer-related pain are also being developed in the Nordic countries, where very diverging traditions for the usage of such therapy still exist.