Pain Relief Rate Research Articles

Application Value of Evidence-based Nursing in Patients with Multiple Myeloma and Evaluation of Nursing Quality

<i>Objective</i> to explore the application value and quality of evidence-based nursing in patients with multiple myeloma. <i>Methods</i> A total of 92 patients with multiple myeloma from December 2016 to December 2019 were selected as observation objects, and they were divided into control group 46 and observation group 46 according to the order of admission. The control group was given routine nursing care, and the observation group was given evidence-based nursing care. The bone pain relief rate, Pittsburgh Sleep Quality Score (PSQI), anxiety self-rating scale (SAS) score, depression self-rating scale (SDS) score and nursing quality were compared between the two groups. <i>Results</i>: The relief rate of bone pain in the observation group was higher than that in the control group (P <0.05). The quality of sleep, sleep time, sleep time, sleep efficiency, sleep disorders, daytime dysfunction scores and PSQI total scores in the observation group were lower than those in the control group after nursing (P <0.05). P <0.05); SAS and SDS scores in the observation group were lower than those in the control group after nursing (P <0.05). After the implementation of evidence-based nursing, the quality of basic nursing, specialist nursing, critical care, ward management, and health education nursing care of nursing staff was higher than that before implementation (P <0.05). <i>Conclusion</i> Applying evidence-based nursing to patients with multiple myeloma can improve bone pain relief, improve sleep quality, reduce anxiety and depression, and improve the quality of care.

The Effects of Auricular Therapy for Cancer Pain: A Systematic Review and Meta-Analysis.

Objective This study aims to systematically assess the efficacy and safety of auricular therapy for cancer pain. Methods A systematic search was conducted using PubMed, EMBASE, Cochrane library databases, CNKI, VIP, WanFang Data, and CBM for randomized controlled trials (RCTs). Review Manager 5.3 was used for meta-analysis. Results Of the 275 screened studies, nine RCTs involving 783 patients with cancer pain were systematically reviewed. Compared with drug therapy, auricular therapy plus drug therapy has significant advantages both in the effective rate for pain relief (RR = 1.40; 95% CI 1.22, 1.60; P < 0.00001) and adverse effects rate (RR = 0.46; 95% CI 0.37, 0.58; P < 0.00001). And the result revealed that auricular acupuncture had superior pain-relieving effects as compared with sham auricular acupuncture (SMD = -1.45; 95% CI -2.80, -0.09; P=0.04). However, the analysis indicated no difference on the effective rate for pain relief between auricular therapy and drug therapy (RR = 1.24; 95% CI 0.71, 2.16; P=0.46). Conclusion Our meta-analysis indicated that auricular therapy is effective and safe for the treatment of cancer pain, and auricular therapy plus drug therapy is more effective than drug therapy alone, whether in terms of pain relief or adverse reactions. However, the included RCTs had some methodological limitations; future large, rigor, and high-quality RCTs are still needed to confirm the benefits of auricular therapy on cancer pain.

Comparison of different chemoradiotherapy methods for bone metastasis of non-small cell lung cancer

Objective To compare the clinical efficacy and safety of concurrent chemoradiotherapy and sequential chemoradiotherapy for bone metastasis of non-small cell lung cancer(NSCLC). Methods This was a retrospective cohort study, in which 120 patients with bone metastases from NSCLC admitted to our hospital from June 2013 to June 2018 were enrolled.Of these patients, 60 received sequential chemotheradiotherapy and 60 patients received concurrent chemoradiotherapy.Bone pain was measured before treatment, at 1-month, 2-months into treatment, and 1-month after treatment.Short-term efficacy and adverse reactions were compared between the two groups. Results There were no significant differences in pain relief rate at 1-month, 2-months into treatment and 1-month after treatment between the two groups(all P>0.05). Meanwhile, the objective response rate(50.0% vs.36.7%)and disease control rate(90.0% vs.83.3%)were also similar between the two groups(χ2=2.172, 1.154, P=0.141, 0.283). The incidences of toxic and side effects, including neutropenia(90.0% vs.60.0%), leukopenia(96.7% vs.63.3%)and nausea(50.0% vs.23.0%)were significantly higher in the concurrent chemoradiotherapy group than those in the sequential chemotherapy/radiotherapy group(all P 0.05). Conclusions Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy has similar short-term efficacy in pain relief for bone metastasis of NSCLC, but the incidence of side effects is higher. Key words: Carcinoma, non-small cell lung; Neoplasm metastasis; Radiotherapy

Endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound

Objective: To evaluate the clinical efficacy of endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound. Methods: The clinical data of 40 patients with non-thrombotic right iliac vein compression syndromereceiving intravascular ultrasound-assisted balloon dilatation combined with stent implantation from January 2012 to December 2018 were retrospectively analyzed. There were 32 males and 8 females, the average age of whom was 63 (46-81) years old. The patients were classified according to the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) classification: 7 cases as C3, 18 as C4, 10 as C5 and 5 as C6. All patients underwent percutaneous right femoral vein puncture, intravascular ultrasound, and balloon dilatation combined with stentimplantation in the right iliac vein lesion location. Results: The success rate of clinical operations was 100%. There were no serious complications during the perioperative period. All patients were followed up for 4-58 months. During the follow-up period, the relief rate of limb edema was 88.6% (31/35), the pain relief rate was 86.7%(13/15), and the healing rate of ulcers was 100% (6/6). After the stent implantation, the endovascular area of the compression site was significantly enlarged (34.5mm(2)± 11.1mm(2)vs129.8 mm(2)±17.2 mm(2), P<0.001). The follow-up of color Doppler and/or anterograde angiography for deep veins of lower limb with digital subtraction angiography showed that the blood flow in the stentsweres mooth in all patients. Three cases were observed that the intimal hyperplasia led to mild in-stent restenosis, no obvious in stent restenosis (>50%). The abdominal X-ray plain film showed no obvious displacement and fracture of the stents. The venous clinical severity score (VCSS) was statistically significant (13.0±2.4 vs 6.2±2.0, P<0.001). The statistical results of short-form health surver SF-36 showed that the scores of life quality in all dimensions of the affected limb were significantly improved after operation (P=0.000). Conclusion: Intravascular ultrasound-assisted balloon dilatation combined with stent implantation is not only a safe and effective treatment for non-thrombotic right iliac vein compression syndrome, but also has a good mid-term patency rate.

The Effect of Botulinum Toxin Injection into the Common Extensor Tendon in Patients with Chronic Lateral Epicondylitis: A Randomized Trial.

Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.

Application of multimode pain management in the control of cancer pain in Geriatrics Department

Objective To explore the application effect of multimode pain management in cancer pain in Geriatrics Department. Methods Using convenient sampling method, 80 cancer patients hospitalized in Geriatric Department from July 2017 to June 2018 were randomly divided into control group and observation group, with 40 cases in each group. Routine nursing care was given for the control group and multimode pain management was used in the observation group. The pain sensitive index, nursing satisfaction and cancer pain relief rate were compared between the two groups. Results The accuracy rate of pain evaluation, nursing satisfaction rate and cancer pain relief rate of the observation group were 80.0%, 95.0% and 87.5%, respectively, all higher than those of the control group, and the differences were statistically significant (χ2=6.765, 6.275 , 5.000; P<0.05) . Conclusions Multimode pain management can reduce the cancer pain of cancer patients and improve the satisfaction of nursing. Key words: Neoplasm; Pain; Aged; Multimode pain management; Pain sensitive index; Nursing satisfaction; Cancer pain relief rate

Gamma Knife radiosurgery for bilateral trigeminal neuralgia

OBJECTIVEA small subset of patients with trigeminal neuralgia (TN) will experience bilateral symptoms. Treatment in these patients is controversial because the population is heterogeneous and patients may have nonvascular etiologies of their pain. This study reports treatment outcomes in the largest cohort of patients with bilateral TN who have undergone Gamma Knife radiosurgery (GKRS) to date.METHODSA retrospective chart review identified 51 individual nerves in 34 patients with bilateral TN who were treated with GKRS at the authors’ institution between 2001 and 2015, with 12 nerves in 11 patients undergoing repeat GKRS for recurrent or persistent symptoms. Long-term follow-up was obtained by telephone interview. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain scale, with BNI IIIb or better considered a successful treatment.RESULTSThere was sufficient follow-up to determine treatment outcomes for 48 individual nerves in 33 patients. Of these nerves, 42 (88%) achieved at least BNI IIIb pain relief. The median duration of pain relief was 1.9 years, and 1-, 3-, and 5-year pain relief rates were 64%, 44%, and 44%, respectively. No patients experienced bothersome facial numbness, and 1 case of anesthesia dolorosa and 2 cases of corneal dryness were reported. Patients with a history of definite or possible multiple sclerosis were significantly more likely to experience BNI IV–V relapse. There was no statistically significant difference in treatment outcomes between patients in this series versus a large cohort of patients with unilateral TN treated at the authors’ institution. There was sufficient follow-up to determine treatment outcomes for 11 individual nerves in 10 patients treated with repeat GKRS. Ten nerves (91%) improved to at least BNI IIIb after treatment. The median duration of pain relief was 2.8 years, with 1-, 3-, and 5-year rates of pain relief of 79%, 53%, and 53%, respectively. There was no statistically significant difference in outcomes between initial and repeat GKRS. One case of bothersome facial numbness and 1 case of corneal dryness were reported, with no patients developing anesthesia dolorosa with retreatment.CONCLUSIONSGKRS is a safe, well-tolerated treatment for patients with medically refractory bilateral TN. Efficacy of treatment appears similar to that in patients with unilateral TN. GKRS can be safely repeated in this population if necessary.

Gamma Knife Radiosurgery for Multiple Sclerosis-Associated Trigeminal Neuralgia.

Trigeminal neuralgia in the setting of multiple sclerosis (MS-TN) is a challenging condition to manage that is commonly treated with Gamma Knife radiosurgery (GKRS; Elekta AB). However, data regarding the efficacy of this treatment are somewhat limited, particularly for repeat GKRS. To report outcomes of GKRS for MS-TN from a cohort study. Retrospective review of our GKRS database identified 77 cases of unilateral MS-TN (UMSTN) in 74 patients treated with GKRS between 2001 and 2016, with 37 cases undergoing repeat GKRS. Background medical history, treatment outcomes and complications, and dosimetric data were obtained by retrospective chart reviews and telephone interviews. Eighty-two percent of UMSTN cases achieved Barrow Neurological Institute (BNI) IIIb or better pain relief following initial GKRS for a median duration of 1.1 yr. Estimated rates of pain relief at 1, 3, and 5 yr were 51, 39, and 29% respectively. Eighty-eight percent achieved BNI IIIb or better pain relief after repeat GKRS for a median duration of 4.0 yr. Estimated rates of pain relief at 1 and 3 yr were 70 and 54%, respectively. Median doses for initial and repeat GKRS were 85 and 80 Gy to the 100% isodose line, respectively. Those with MS-TN had a shorter duration of BNI IIIb or better pain relief after initial (4.6 vs 1.1 yr), but not repeat GKRS (3.8 vs 4.0 yr) compared to a historical cohort from our institution. GKRS is an effective, well-tolerated treatment for patients with MS-TN. More durable relief is often achieved with repeat GKRS.

Coblation annuloplasty in cervical discogenic pain without radiculopathy.

IntroductionThe nerve fibers innervating the annulus fibrosus are the major origin of degeneration-associated discogenic pain. Coblation is a tissue-dissociating technique in which the nerve fibers in the degenerative disc tissue are ablated. We hypothesized that coblation annuloplasty would be an effective maneuver for cervical discogenic pain without radiculopathy.AimTo observe the therapeutic efficacy of coblation annuloplasty in patients with cervical discogenic pain without radiculopathy.Material and methodsForty patients diagnosed with cervical discogenic pain without radiculopathy were screened for coblation annuloplasty therapy. The patient-rated visual analog scale (VAS) score for pain, significant pain relief rate, and Modified MacNab pain-relieving effect were adopted to evaluate the therapeutic effect within a 1-year follow-up period.ResultsThirty-three patients eventually completed the study. The average pain duration was 4.6 ±1.6 years (range: 0.5–8 years). The mean VAS pain score decreased from preoperative 6.8 ±0.9 to postoperative 2.5 ±1.3 (p < 0.01). For all participants, the immediate pain relief rate was 78.7% (26/33), which continued to postoperative 6 months. One year later, 22 (66.6%) subjects reported that their pain was significantly alleviated. According to the Modified MacNab criteria, 63.6–82.1% considered the effect of surgery for their pain therapy as “excellent” during the 1-year follow-up period. No significant complications such as hemorrhage, paresthesia, or infection were observed.ConclusionsThis study is the first to demonstrate that coblation annuloplasty is an effective intervention providing significant alleviation of neck pain from cervical discogenic injury without radiculopathy.

Cyberknife Radiosurgery for Trigeminal Neuralgia.

IntroductionImage-guided robotic radiosurgery is an emerging minimally-invasive treatment option for trigeminal neuralgia (TN). Our group has treated 560 cases up to date, and report here the clinical outcomes of 387 treatments with three years follow-up. This study represents the largest single-center experience on CyberKnife radiosurgery for the treatment of TN so far reported.MethodsCyberKnife radiosurgery treatment was offered to patients with drug-resistant TN, after the failure of other treatments or refusal of invasive procedures. A second treatment was offered to patients with a poor response after the first treatment or with recurrent pain. Treatment protocol required the non-isocentric delivery of 60 Gy prescribed to the 80% isodose to a 6 mm retrogasserian segment of the affected trigeminal nerve. Retreatments typically received 45 Gy, again prescribed to the 80% isodose. The final plan was developed accordingly to individual anatomy and dose distribution over the trigeminal nerve, gasserian ganglion, and brainstem. Clinical outcomes such as pain control and hypoesthesia/numbness have been evaluated after 6, 12, 24, and 36 months. ResultsOur group has treated 527 patients with Cyberknife radiosurgery at Centro Diagnostico Italiano (CDI), Milan, Italy, during the last decade. A minimum follow-up of six months was available on 496 patients. These patients received 560 treatments: 435 patients (87.7%) had a single treatment, 60 patients (12.1%) had two treatments, and one patient (0.2%) had five treatments (two on the right side, three on the left side). Twenty four patients had multiple sclerosis (4.8%). Four hundred and forty-three patients (84%) received the treatment without previous procedures, while 84 patients (16%) underwent radiosurgery after the failure of other treatments. A neurovascular conflict was identified in 59% of the patients. Three hundred and forty-three patients (receiving a total of 387 treatments) had a minimum of 36 months follow up. Pain relief rate at 6, 12, 18, 24, 30 and 36 months was respectively 92, 87, 87, 82, 78 and 76%. Forty-four patients out of 343 (12.8%) required a second treatment during the observed period. At 36 months post-treatment, 21 patients (6,1%) reported the presence of bothering facial hypoesthesia. Eighteen patients out of 21 (85.7%) developed this complication after a repeated treatment. ConclusionsFrameless image-guided robotic radiosurgery in experienced hands is a safe and effective procedure for the treatment of TN, providing excellent pain control rates in the absence of major neurological complications. Repeated treatments due to recurrent pain are associated with restored pain control but at the price of a higher rate of sensory complications.

Is cholecalciferol a potential disease-modifying anti-rheumatic drug for the management of rheumatoid arthritis?

Vitamin D is a pleiotropic molecule with a well-characterised immunomodulatory activity in vitro; however, its potential clinical application in autoimmune conditions has yet to be clarified. Several authors have investigated the use of vitamin D as a disease-modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA), obtaining divergent conclusions. This systematic review summarises and critically analyses the findings of papers assessing the impact of vitamin D supplementation on pain relief, disease activity, functional status and flare rate. We conclude that the correction of hypovitaminosis D may have a beneficial effect on pain perception; moreover, the achievement of an adequate plasma vitamin D concentration obtained with high-dose regimens might evoke immunomodulatory activities of vitamin D and favourably impact on disease control. Nevertheless, the current evidence is still not strong enough to support the use of cholecalciferol as a DMARD in RA, and further studies are required to clarify this issue.

Clinical study of ultrasound-guided intra-articular injection of autologous platelet rich plasma for the treatment of lumbar facet joint syndrome

Objective To investigate the clinical efficacy of ultrasound-guided intra-articular injection of autologous platelet rich plasma (PRP) for lumbar facet joint. Methods A total of 40 patients with back pain caused by lumbar facet joint syndrome were enrolled in this study according to the inclusion criteria. They were assigned into two groups (n=20) using the method of random number table to receive the treatment of intra-articular injection of autologous PRP (P group) and glucocorticoid combined with local anesthetic treatment (S group). The therapeutic effects at postoperative (immediately, 1 week, 1 month, 3 months, 6 months) were evaluated by using the Visual Analogue Scale (VAS) score, remission rate of pain [(VAS score before operation-VAS score after operation)/VAS score before operation] and the number of patients with pain relief rate (≥50%). In addition, the adverse reactions, such as aggravation of pain, symptoms of local or systemic infection, symptoms related to nerve injury, hemorrhage and fever from the immediately end after injection to one week after treatment of the two groups were also compared. Results The S group has lower VAS score, higher pain relief rate and more numbers of patients with pain relief rate≥50% than that of P group at postoperative (immediately, 1 week, 1 month)(P<0.05). However, the P group has lower VAS score, higher pain relief rate and more numbers of patients with pain relief rate≥50% than that of S group at 3 months and 6 months after operation (P<0.05). Both groups didn′t show the adverse reactions immediately and 1 week after operation. Conclusions The clinical efficacy of ultrasound-guided intra-articular injection of autologous PRP for lumbar facet joint is not better than glucocorticoid combined with local anesthetic injection at the time of end of operation, 1 week and 1 month after the treatment, but is better than the effect at the time points of 3 months and 6 months after the treatment. Key words: Lumbar facet joint syndrome; Platelet rich plasma; Glucocorticoid

Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II

The ACCURATE randomized, controlled trial compared outcomes of dorsal root ganglion (DRG) stimulation versus tonic spinal cord stimulation (SCS) in 152 subjects with chronic lower extremity pain due to complex regional pain syndrome (CRPS) type I or II. This ACCURATE substudy was designed to evaluate whether therapy habituation occurs with DRG stimulation as compared to SCS through 12-months. A modified intention-to-treat analysis was performed to assess percentage pain relief (PPR) and responder rates at follow-up visits (end-of-trial, 1, 3, 6, 9, 12-months postpermanent implant) for all subjects that completed trial stimulation (DRG:N = 73, SCS:N = 72). For both groups, mean PPR was significantly greater at end-of-trial (DRG = 82.2%, SCS =0 77.0%) than all other follow-ups. Following permanent DRG system implantation, none of the time points were significantly different from one another in PPR (range = 69.3–73.9%). For the SCS group, PPR at 9-months (58.3%) and 12-months (57.9%) was significantly less than at 1-month (66.9%). The responder rate also decreased for the SCS group from 1-month (68.1%) to 12-months (61.1%). After stratifying by diagnosis, it was found that only the CRPS-I population had diminishing pain relief with SCS. DRG stimulation resulted in more stable pain relief through 12-months, while tonic SCS demonstrated therapy habituation at 9- and 12-months.Trial Registration: The ACCURATE study was registered at ClinicalTrials.gov with Identifier NCT01923285. PerspectiveThis article reports on an ACCURATE substudy, which found that long-term therapy habituation occurred at 12-months with SCS, but not DRG stimulation, in patients with CRPS. The underlying mechanisms of action for these results remain unclear, although several lines of inquiry are proposed.

The long-term clinical outcomes of microvascular decompression for treatment of trigeminal neuralgia compressed by the vertebra-basilar artery: a case series review

BackgroundMicrovascular decompression (MVD) is a type of neurosurgery used to treat trigeminal neuralgia (TN) caused by the vertebrobasilar contact/compression. The surgery is not risk-free, however; it may cause recurrent facial pain or other side-effects. The objective of this study was to assess the long-term pain relief and the complications of MVD surgery for the vertebrobasilar compression treatment.MethodsTwenty-three patients with TN compressed by the vertebra-basilar artery (VBA) were treated with MVD. Teflon felt was placed between the brain stem and the offending artery to mobilize the artery towards the skull base and the clivus. The Barrow Neurological Institute (BNI) Pain Intensity Scale score was used to assess pre- and post-surgical pains.ResultsOf 23 patients with pre-operative BNI IV to V, 19 patients (83%) were pain-free after surgery. Four patients experienced transient partial pain relief with BNI II–III, and 3 of them (13%) were completely pain-free within 3 months. The success rate was 96%. Three patients (13%) had pain recurrences, and one received a second MVD surgery for pain relief during the period of follow-up. Four patients suffered from TN hypesthesia, and only 2 patients (8.6%) had permanent facial hypesthesia, while one patient (4.3%) developed a gradual hearing loss after surgery.ConclusionsWhile our success rate of immediate pain relief after surgery was comparable with some reports, the percentage of patients who had pain recurrences was lower, and cases who had permanent facial hypesthesia or developed a gradual hearing loss were fewer after MVD surgery. Our rate of transient complications was higher, and the postoperative pain relief seemed unusually delayed. Our study indicates that MVD is an effective, reliable, and safe neurosurgery for treatment of TN compressed by the VBA albeit our small sample size. Failure of treatment and recurrence of the disease as well as complications could be minimized by preventing displacement of the Teflon implant and extraneous Teflon touching the trigeminal nerves.

Risk of Vertebral Fracture and Local Recurrence after Palliative Spine Stereotactic Body Radiotherapy (SBRT)

Bony metastases to the spinal column are a common manifestation of cancer that can lead to significant morbidity. Although stereotactic body radiotherapy (SBRT) has been increasingly employed as an effective treatment for spinal column metastases, the optimal dosimetric parameters to maximize disease control and minimize toxicity remain unclear. Thus, we sought to understand the dosimetric factors associated with pain palliation, local control, and toxicity with spinal column SBRT for bone metastases. Patients from a single institution treated with spine SBRT between 2010 and 2017 for metastatic disease had electronic records retrospectively reviewed. Baseline patient characteristics, treatment parameters including spinal cord dose, and follow-up data were collected. Treatment-related outcomes including freedom from fracture rate (FFFR), myelitis, and freedom from local recurrence (FFLR) were assessed. Statistical analysis of categorical variables was done with Fischer’s exact test and continuous variables with Wilcoxon rank sum, with the threshold for significance of all tests at a p-value <0.05. During the study period 96 patients were treated with SBRT to 137 sites in the cervical, thoracic, and lumbar spine, with a median clinical follow up of 15 months per lesion (IQR: 4-33). There were 79, 19, and 39 treatments with 1, 3, and 5 fractions, with dose ranges of 14-20 Gy, 24-27 Gy, and 30-40 Gy, respectively. Eight lesions were treated post-operatively, 19 lesions were treated with SBRT as re-irradiation, with the rest of the lesions undergoing SBRT as the first treatment of choice. Pain was a presenting symptom at 104 of treated sites, and the median pain score was 3/10 (IQR: 1-7). On post treatment clinical follow up approximately 2-4 weeks after treatment, 89% of patients noted improved pain, with a median decrease in score of 3 points. FFFR at 12 and 24 months was 91% (CI: 86-97) and 86% (CI: 78-94) respectively without significant association with fractionation, dose, SINS score, or pre-existing compression fracture. The median D0.035cc of the true spinal cord for 1, 3, and 5 fraction treatments were 12.9 Gy (IQR:10.4-14.4), 18.5 Gy (IQR: 17.2-20.8), and 25.2 Gy (IQR: 21.8-28.4), with only one case of asymptomatic radiographic myelitis noted. FFLR at 12 and 24 months was 84% (CI: 77-92) and 78% (CI: 69-87) respectively, with no significant association between histology, dose, or fractionation and local recurrence. Spine SBRT demonstrated high rates of pain relief with acceptable toxicity profile over a range of relatively conservative dose-fractionation schema. Treatments typically exceeded TG101 guideline spinal cord “threshold doses,” while respecting maximum point doses, for the spinal cord without evidence of symptomatic myelitis. These results show superior FFFR and FFLR than prior reported studies and supports increasing use of SBRT in a wide range of patients.

Results of a Third or Fourth Radiosurgery for Trigeminal Neuralgia

Stereotactic Radiosurgery SRS is an accepted option for treatment of medically refractory trigeminal neuralgia (TN) with a median duration of pain relief of 5 years. Repeat SRS for recurrent pain has been well described with similar results. Data regarding the use of a third or fourth SRS for recurrent pain are limited. Here we report the largest series to date on the use of a third or fourth SRS for TN. Retrospective review of a single institution SRS database identified 24 cases of unilateral TN in 23 patients who were treated with 3 sessions of SRS from 1999 to 2018. 3 patients underwent a fourth SRS. Background history, treatment outcomes and toxicity, and dosimetric data were obtained by chart review and telephone interview. Pain relief was defined using the Barrow Neurological Institute (BNI) scale. Categorical variables were compared using the chi square or Fisher’s exact test. Duration of at least BNI IIIB pain relief was estimated using the Kaplan-Meier method and compared with the log-rank test. Univariate cox proportional hazards were used to evaluate for predictors of pain relief. 22 of 24 cases had sufficient follow up to determine BNI pain outcomes. 18 of the 22 cases (82%) achieved at least BNI IIIb pain relief. At a median follow up of 1.96 years, the median duration of at least BNI IIIb pain relief after third SRS was 3.90 years, with 1, 3, and 5 year pain relief rates of 59%, 51%, and 38% respectively. New or worsening facial numbness was seen in 9 cases (41%) with 1 (4.5%) being reported as bothersome. 1 case (4.5%) of corneal abrasions requiring surgery and 2 cases (9%) of dry eye without vision loss or corneal abrasions, and 0 cases of anesthesia dolorosa were reported. The median dose at third SRS was 75 Gy (range 75-85). All 3 patients treated with a fourth SRS had at least BNI IIIb pain relief with no relapse at a median follow up of 2.54 years. No cases of severe numbness or toxicity were reported after fourth SRS. No factors predicting initial response to a third SRS were identified. Patients with a successful second SRS were less likely to experience pain relapse after third SRS (HR 0.12, p = .02). Third and fourth SRS had a longer durability of pain relief than first and second SRS (p = .02). No factors predictive of numbness after third SRS were identified. Non-numbness toxicity after third SRS was associated with a higher dose to the pons surface (median 41.6 Gy vs 16.9 Gy, p < .01) and decreased distance from the isocenter to the pons surface (median 2.9 mm vs 4.6 mm, p < .01). A third or fourth SRS is an effective treatment option for recurrent TN and may be more durable than the first or second SRS. Durable relief is more likely in patients with a successful second SRS. Toxicity rates appear to increase with third SRS, and dose to the pons should be limited to decrease this risk. The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

Patient-Reported Outcomes–Secondary Analysis of the SCORE-2 Trial Comparing 4 Gy × 5 to 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression

To compare 4 Gy × 5 (1 week) to 3 Gy × 10 (2 weeks) in relieving pain and distress in patients with metastatic epidural spinal cord compression (MESCC). The randomized SCORE-2 trial compared 4 Gy × 5 (n = 101) to 3 Gy × 10 (n = 102) for MESCC. In this additional analysis, these regimens were compared for their effect in relieving pain and distress. Distress was evaluated with the distress-thermometer (0 = no distress, 10 = extreme distress) and pain on a linear scale (0 = no pain, 10 = worst pain). Relief of distress was defined as decrease of ≥2 points; complete and partial pain relief were defined as achieving a score of 0 points and a decrease ≥2 points, respectively, without increase of analgesic use. This prospective secondary analysis of the SCORE-2 trial aimed to show that 4 Gy × 5 was not inferior to 3 Gy × 10 regarding distress and pain relief. Analyses were performed using the unconditional test of noninferiority for binomial differences based on restricted maximum likelihood estimates (noninferiority margin: -20%). Evaluations were performed before, directly after, and 1, 3, and 6 months after radiation therapy. (ClinicalTrials.gov: NCT02189473). At baseline, median distress scores were 8 (2-10) points in the 4 Gy × 5 group and 8 (2-10) points in the 3 Gy × 10 group. At 1 month, distress relief rates were 58.1% (43/74) and 62.7% (47/75) (difference: -4.6%; 95% confidence interval, -20.0% to +11.1%; P = .025). At baseline, median pain scores were 7 (2-10) and 7 (2-10) points, respectively. At 1 month, complete pain relief rates were 23.5% (16/68) versus 20.0% (14/70) (difference, +3.5%; 95% confidence interval, -10.4% to +17.5%; P < .001), and overall pain relief rates were 52.9% (36/68) versus 57.1% (40/70) (difference, -4.2%; 95% confidence interval, -20.5% to +12.3%; P = .029). Distress and pain relief rates after 4 Gy × 5 were largely comparable to 3 Gy × 10 at all time points. Associated 95% confidence intervals did not point toward any relevant differences. In patients with MESCC and poor to intermediate survival prognoses, 4 Gy × 5 appeared noninferior to 3 Gy × 10 regarding pain and distress relief.

Efficacy and safety of Kanglaite injection combined with radiochemotherapy in the treatment of advanced pancreatic cancer

Kanglaite (KLT) injection, a kind of Chinese medicine, is considered a promising complementary therapeutic option for malignant cancer treatment. This study aimed to systematically investigate the efficacy and safety of the combination of KLT injection and radiochemotherapy for the treatment of advanced pancreatic cancer (PC). Studies were identified by searching Cochrane Library, Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM), Wanfang database and Chinese Scientific Journal Database (VIP) before October 2018. The primary reported outcomes including efficacy, quality of life (QoL), and adverse events were systematically evaluated. Data from 16 trials with 960 patients with advanced PC were included. Compared with radiochemotherapy alone, the combination of KLT injection and radiochemotherapy significantly improved the 1-year overall survival (OS, odds ratio [OR] = 2.58 95% CI: 1.12-5.93 P = .03), overall response (ORR, OR = 2.16 95% CI: 1.58-2.94 P <.00001) and disease control rates (DCR, OR = 2.50 95% CI: 1.84-3.38 P <.00001). The QoL of patients, who received a combination of radiochemotherapy and KLT injection, also improved compared with radiochemotherapy treatment alone as indicated by the increased quality of life improved rate (QIR, OR = 3.68 95%CI: 2.36-5.75 P <.00001), pain relief rate (PRR, OR = 3.70 95% CI: 2.23-6.14 P <.00001) and weight gain rate (WGR, OR = 3.69 95% CI: 2.22-6.13 P <.00001). Adverse events related to radiochemotherapy including gastrointestinal side effects, nephrotoxicity, leukopenia, thrombocytopenia, and myelosuppression were alleviated (P <.05) when KLT was injected to patients with PC. Evidence from the Meta-analysis suggested that the combinational treatment of radiochemotherapy and KLT injection is more effective in advanced PC treatment than radiochemotherapy alone. Additionally, the combination therapy improved QoL of the patients. KLT injection can alleviate the adverse effects associated with the radiochemotherapy.

Morphologic Factors Predict Pain Relief Following Pancreatic Head Resection in Chronic Pancreatitis Description of the Chronic Pancreatitis Pain Relief (CPPR) Score.

This study analyzes the clinicopathologic findings and their impact on outcome of patients so as to identify which patients benefit most from surgical treatment in chronic pancreatitis, especially in regard to pain relief. The predominant symptom of chronic pancreatitis is chronic pain resulting in reduced quality of life. It is well known that the main reason for development of the disease is abuse of alcohol and nicotine, but only little data on factors influencing outcome are available. One thousand one hundred forty-six consecutive patients who underwent surgery for chronic pancreatitis were included. Clinicopathologic data, including morphology of the pancreas in preoperative diagnostics and the histopathologic results, were evaluated. A long-term follow-up including Quality of Life and pain scores was performed. Additionally, we describe the novel Chronic Pancreatitis Pain Relief Score (CPPR-Score) as a tool for prediction of pain relief. Overall the rate of pain relief was 79.8% after surgery. The presence of an inflammatory mass in the pancreatic head larger than 4 cm (P < 0.001), presence of a dilated main pancreatic duct of over 4 mm (P < 0.001), histopathologically detected severe calcifications (P = 0.001) and severe fibrosis (P < 0.001) as well as ethanol induced disease (P < 0.001) found to be strong independent prognostic factors for pain relief. The CPPR-Score (0-5 points) proved to be a very good predictive score for pain-relief (P < 0.001). The rate of pain relief after surgical treatment in chronic pancreatitis is high and the commonly used procedures can be performed with acceptable morbidity and mortality. The Chronic Pancreatitis Pain Relief Score allows identifying patients who will benefit most from surgery.

High Temporal Summation of Pain Predicts Immediate Analgesic Effect of Acupuncture in Chronic Pain Patients-A Prospective Cohort Study.

Objectives: This prospective cohort study explored whether two distinguished sensory parameters predicted acupuncture effects in chronic pain patients; namely high temporal summation of pain (TS) indicating spinal synaptic facilitation as well as a low vibration detection threshold (VDT) indicating a loss of Aβ-fiber function.Methods: Pinprick induced TS and VDT were assessed by standardized, validated methods at the most painful body site and a pain free control site in 100 chronic pain patients receiving six acupuncture sessions as part of an interdisciplinary multimodal pain treatment (IMPT). Immediate change in pain intensity after the first acupuncture session (first treatment on the first day of IMPT) was assessed by the verbal rating scale (VRS, 0–100). After 4 weeks of treatment, patients indicated in a questionnaire whether acupuncture had relieved pain immediately and whether it had contributed to overall pain reduction and well-being after IMPT.Results: Logistic regression analysis revealed an association between high TS at the control site and a reduction in pain intensity of at least 30% (VRS) after the first acupuncture (OR [95%-CI] 4.3 [1.6–11.8]). Questionnaire ratings of immediate pain relief after acupuncture were associated with high TS at the control site (OR [95%-CI] 3.8 [1.4–10.2] any pain relief, OR [95%-CI] 5.5 [1.7–17.1] over 50% pain reduction) and at the pain site (OR [95%-CI] 3.2 [1.2–8.9] any pain relief). Appraisals of the contribution of acupuncture to overall pain reduction and well-being after IMPT were not associated with TS. The VDT was not associated with any outcome.Conclusion: This explorative study provides first-time evidence that high TS, especially at a pain free control site, but not VDT, might predict immediate analgesic response to acupuncture in chronic pain patients. Thus, highly centrally sensitized chronic pain patients might respond particularly well to acupuncture.