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Sample records for adult cancer pain

  1. Management of Total Cancer Pain: A Case of Young Adult

    PubMed Central

    Satija, Aanchal; Singh, Suraj Pal; Kashyap, Komal; Bhatnagar, Sushma

    2014-01-01

    Pain due to cancer is one of the most distressing symptoms experienced by the patients at some or the other time during the course of treatment or disease progression. The multidimensional nature of cancer pain is characterized by various dimensions including physical, social, psychological, and spiritual; which together constitute the term “total pain”. Young cancer patients illustrate their unique psychological and developmental needs. This case report highlights the concept of “total cancer pain” in a young adult and demonstrates his distinctive social, spiritual, and psychological sufferings. The report emphasizes that addressing all these concerns is considerably significant in order to provide optimal pain relief to the patient. In the present scenario, it has been done by a skillful multiprofessional team communicating effectively with both the patient and the carer. PMID:25125874

  2. Cancer-related pain in older adults receiving palliative care: Patient and family caregiver perspectives on the experience of pain

    PubMed Central

    McPherson, Christine J; Hadjistavropoulos, Thomas; Lobchuk, Michelle M; Kilgour, Kelly N

    2013-01-01

    BACKGROUND: Despite an emphasis on pain management in palliative care, pain continues to be a common problem for individuals with advanced cancer. Many of those affected are older due to the disproportionate incidence of cancer in this age group. There remains little understanding of how older patients and their family caregivers perceive patients’ cancer-related pain, despite its significance for pain management in the home setting. OBJECTIVES: To explore and describe the cancer pain perceptions and experiences of older adults with advanced cancer and their family caregivers. METHODS: A qualitative descriptive approach was used to describe and interpret data collected from semistructured interviews with 18 patients (≥65 years of age) with advanced cancer receiving palliative care at home and their family caregivers. RESULTS: The main category ‘Experiencing cancer pain’ incorporated three themes. The theme ‘Feeling cancer pain’ included the sensory aspects of the pain, its origin and meanings attributed to the pain. A second theme, ‘Reacting to cancer pain’, included patients’ and family caregivers’ behavioural, cognitive (ie, attitudes, beliefs and control) and emotional responses to the pain. A third theme, ‘Living with cancer pain’ incorporated individual and social-relational changes that resulted from living with cancer pain. CONCLUSIONS: The findings provide an awareness of cancer pain experienced by older patients and their family caregivers within the wider context of ongoing relationships, increased patient morbidity and other losses common in the aged. PMID:23957019

  3. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  4. [Pain from AIDS (adult)].

    PubMed

    Bouhassira, D

    1997-10-01

    Pain, a major handicapping factor for HIV patients, has been underestimated and insufficiently treated. The pain may have various origins, including the virus itself, antiviral or anticancer treatments, secondary infections or their treatments, or unrelated intercurrent infection. Just as in the general population, three types of pain may be distinguished: nociceptive, neuropathic, and idiopathic. The lesions capable of producing nociceptive pain are numerous in HIV patients. The most common etiologies are oropharyngeal, gastrointestinal, and rheumatic. Neurological complications are among the most frequently encountered in the course of HIV infection, and some may cause typical neuropathic pain. Such pain may be secondary to a central lesion, as in cerebral toxoplasmosis, but usually is related to a peripheral effect. The principal etiologies of peripheral neuropathic pain are HIV neuropathies, postherpetic neuralgia, toxic neuropathies secondary to antiviral treatment, and diabetic neuropathies. Pain management should be part of the treatment of HIV complications. In the absence of a validated protocol for treatment of HIV-related pain, the guidelines for cancer pain management developed by the World Health Organization can be used as a starting point for nociceptive pain. Dosage and administration should be individually adjusted. Treatment of neuropathic pain is based primarily on tricyclic antidepressants and anticonvulsants. Nonpharmaceutical interventions such as transcutaneous electric stimulation, hypnosis, and acupuncture may also be useful. Evaluation and management of psychological factors should be an integral part of treatment, as in all patients with chronic pain. PMID:12348806

  5. Back pain in adults.

    PubMed

    Becker, Jonathan A; Stumbo, Jessica R

    2013-06-01

    This article provides a summary of the many causes of back pain in adults. There is an overview of the history and physical examination with attention paid to red flags that alert the clinician to more worrisome causes of low back pain. An extensive differential diagnosis for back pain in adults is provided along with key historical and physical examination findings. The various therapeutic options are summarized with an emphasis on evidence-based findings. These reviewed treatments include medication, physical therapy, topical treatments, injections, and complementary and alternative medicine. The indications for surgery and specialty referral are also discussed. PMID:23668645

  6. Pain in cancer survivors

    PubMed Central

    Ramirez, Juan D; Farquhar-Smith, Paul

    2014-01-01

    Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients’ quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available. PMID:26516548

  7. Neuropathic pain in cancer.

    PubMed

    Urch, C E; Dickenson, A H

    2008-05-01

    Neuropathic pain in cancer arises following injury to peripheral or central neurons, in a similar manner to such pain arising from a non-cancer injury. Much of our knowledge of neuropathic pain is based on peripheral originating events with little known about central neuropathic pain. This article explores some of the similarities and differences between cancer and non-cancer-related neuropathic pain. The neural pathways, ion channels, receptors and neurotransmitters that potentially can be altered in both neuropathies are the same; however the nature of the injury, the timing, repeated injuries and the co-existence of simultaneous non-neuropathic pain states lead to potential unique constellations of neuroreceptor and neurotransmitter expression in the context of cancer pain. This in turn may lead to different clinical presentation of pain sensations and potentially lead to specific treatment options. PMID:18492553

  8. Pain in Cancer Survivors

    PubMed Central

    Glare, Paul A.; Davies, Pamela S.; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.

    2014-01-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  9. Pain in cancer survivors.

    PubMed

    Glare, Paul A; Davies, Pamela S; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L

    2014-06-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  10. The Neurobiology of Cancer Pain.

    PubMed

    Schmidt, Brian L

    2015-12-01

    Oral cancers are often severely painful and clinically difficult to manage. Few researchers have investigated the neurobiologic factors responsible for cancer pain; however, the study of oral cancer pain might inform us about the fundamental biology of cancer. The purpose of the present report was to summarize the clinical challenges inherent in oral cancer pain management, oral cancer pain mechanisms and mediators, and the convergence of the investigation of carcinogenesis and pain. PMID:26608142

  11. Cancer treatment: dealing with pain

    MedlinePlus

    ... ency/patientinstructions/000827.htm Cancer treatment: dealing with pain To use the sharing features on this page, ... health care provider about your options. What Causes Pain The pain from cancer can have a few ...

  12. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  13. Music in Reducing Anxiety and Pain in Adult Patients Undergoing Bone Marrow Biopsy for Hematologic Cancers or Other Diseases

    ClinicalTrials.gov

    2012-07-12

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Psychosocial Effects of Cancer and Its Treatment

  14. Treatment for Chronic Pain in Patients With Advanced Cancer

    ClinicalTrials.gov

    2010-11-07

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Pain; Precancerous/Nonmalignant Condition; Small Intestine Cancer; Unspecified Adult Solid Tumor, Protocol Specific

  15. Cancer treatment: dealing with pain

    MedlinePlus

    ... You have a right to receive treatment for cancer pain. There are many medicines and other treatments that ... There are three main types of medicines for cancer pain. Your provider will work with you to find ...

  16. The Neurobiology of Cancer Pain

    PubMed Central

    Schmidt, Brian L.

    2014-01-01

    The global burden of cancer pain is enormous and opioids, despite their side effects, remain the primary therapeutic approach. The cause of cancer pain is unknown. Mechanisms driving cancer pain differ from those mechanisms responsible for inflammatory and neuropathic pain. The prevailing hypothesis put forward to explain cancer pain posits that cancers generate and secrete mediators which sensitize and activate primary afferent nociceptors in the cancer microenvironment. Moreover, cancers induce neurochemical reorganization of the spinal cord, which contributes to spontaneous activity and enhanced responsiveness. The purpose of this review, which covers clinical and preclinical studies, is to highlight those peripheral and central mechanisms responsible for cancer pain. The challenges facing neuroscientists and clinicians studying and ultimately treating cancer pain are discussed. PMID:24664352

  17. Dealing with Persistent Pain in Older Adults

    MedlinePlus

    ... Pain Management Related Documents PDF Dealing with Persistent Pain in Later Life Download Join our e-newsletter! Resources Dealing with Persistent Pain in Older Adults Tools and Tips Printer-friendly ...

  18. Intractable pain with breast cancer.

    PubMed Central

    Watson, C. P.; Evans, R. J.

    1982-01-01

    This study examines retrospectively the cause, clinical features, natural history and results of treatment of intractable pain associated with breast cancer in 210 patients. The three chief types of pain were that due to skeletal metastases or brachial plexus neuropathy and pain of psychogenic origin. Onset at the time of cancer diagnosis characterized the psychogenic pain, whereas pain from metastases first occurred after a median latency of 3.7 years. Treatment was custom-tailored to the specific patient and pain problem, with several factors taken into account. The onset of intractable pain due to metastatic disease indicated a short survival (median, 9 months). PMID:6277445

  19. A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures.

    PubMed

    Snow, Alison; Dorfman, David; Warbet, Rachel; Cammarata, Meredith; Eisenman, Stephanie; Zilberfein, Felice; Isola, Luis; Navada, Shyamala

    2012-01-01

    Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study. PMID:22571244

  20. Interventional Treatments of Cancer Pain.

    PubMed

    Sindt, Jill E; Brogan, Shane E

    2016-06-01

    Pain is a significant burden for patients with cancer and is particularly prevalent among those with advanced cancer. Appropriate interventional cancer pain therapies complement conventional pain management by reducing the need for systemic opioid therapy and its associated toxicity; however, these therapies are often underutilized. This article reviews techniques, indications, complications, and outcomes of the most common interventional approaches for the management of cancer-related pain. These approaches include intrathecal drug delivery, vertebral augmentation, neurolysis of the celiac, superior hypogastric and ganglion impar plexus', image-guided tumor ablation, and other less commonly performed but potentially beneficial interventions. PMID:27208713

  1. Post surgical pain treatment - adults

    MedlinePlus

    Postoperative pain relief ... Pain that occurs after surgery is an important concern. Before your surgery, you and your surgeon may have discussed how much pain you should expect and how it will be ...

  2. Management of pain in older adults.

    PubMed

    Cavalieri, Thomas A

    2005-03-01

    The elderly are often untreated or undertreated for pain. Barriers to effective management include challenges to proper assessment of pain; underreporting on the part of patients; atypical manifestations of pain in the elderly; a need for increased appreciation of the pharmacokinetic and pharmacodynamic changes of aging; and misconceptions about tolerance and addiction to opioids. Physicians can effectively manage pain in the elderly by understanding different types of pain (nociceptive and neuropathic), and appropriate use of nonopioid, opioid, and adjuvant medications. Opioids have become more widely accepted for treating older adults who have persistent pain, but their use requires physicians have an understanding of prevention and management of side effects, opioid titration and withdrawal, and careful monitoring. Placebo use is unwarranted and unethical. Nonpharmacologic approaches to pain management are essential and include osteopathic manipulative treatment, cognitive behavioral therapy, exercise, and spiritual interventions. The holistic and interdisciplinary approach of osteopathic medicine offers an approach that can optimize effective pain management in older adults. PMID:18154193

  3. Advances in cancer pain from bone metastasis

    PubMed Central

    Zhu, Xiao-Cui; Zhang, Jia-Li; Ge, Chen-Tao; Yu, Yuan-Yang; Wang, Pan; Yuan, Ti-Fei; Fu, Cai-Yun

    2015-01-01

    With the technological advances in cancer diagnosis and treatment, the survival rates for patients with cancer are prolonged. The issue of figuring out how to improve the life quality of patients with cancer has become increasingly prominent. Pain, especially bone pain, is the most common symptom in malignancy patients, which seriously affects the life quality of patients with cancer. The research of cancer pain has a breakthrough due to the development of the animal models of cancer pain in recent years, such as the animal models of mouse femur, humerus, calcaneus, and rat tibia. The establishment of several kinds of animal models related to cancer pain provides a new platform in vivo to investigate the molecular mechanisms of cancer pain. In this review, we focus on the advances of cancer pain from bone metastasis, the mechanisms involved in cancer pain, and the drug treatment of cancer pain in the animal models. PMID:26316696

  4. Biofield therapies and cancer pain.

    PubMed

    Anderson, Joel G; Taylor, Ann Gill

    2012-02-01

    The public and healthcare professionals have become increasingly aware and accepting of the benefit in physical, psychological, social, and spiritual support for patients with cancer. Patients with cancer often seek nonpharmacologic interventions to complement conventional care and decrease the pain associated with cancer and its treatment. Most often referred to as complementary and alternative medicine (CAM), these supportive therapies consist of a heterogeneous group of modalities used as adjuncts to allopathic health care. Biofield therapies are CAM modalities that involve the direction of healing energy through the hands to facilitate well-being by modifying the energy field of the body. This critical review of studies of biofield therapies emphasizes research using these modalities to decrease pain in patients with cancer. Although the therapies have demonstrated clinical efficacy, additional research is warranted. Oncology nurses should familiarize themselves with biofield therapies so they can offer informed recommendations to patients with cancer experiencing pain. PMID:22297006

  5. Pain in far-advanced cancer.

    PubMed

    Twycross, R G; Fairfield, S

    1982-11-01

    Hundred patients with far-advanced cancer and pain were interviewed within a few days of admission to a special care unit. Eighty had more than one pain; 34 had four or more. A total of 303 anatomically distinct pains were recorded. Ninety-one patients had pain caused by the cancer itself. Twelve had treatment-related pain; and 19 had pain related to chronic disease or debility ('associated pain'). Thirty-nine patients had one or more pains unrelated to cancer or treatment; the most common of these was myofascial pain. In 41 patients only was all the pain caused directly by the cancer. Bone involvement and nerve compression were the most common forms of cancer-related pain; soft tissue and visceral pains also occurred frequently. Fifty-seven patients had pain for more than 4 months. PMID:6218464

  6. Managing chronic pain in adults.

    PubMed

    Barrie, Janette; Loughlin, Diane

    2014-10-21

    The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management. PMID:25315569

  7. Psychosocial aspects of cancer pain.

    PubMed

    Stiefel, F

    1993-05-01

    Pain, and especially cancer pain, is not a pure nociceptive, physical experience, but involves different dimensions of man, such as personality, affect, cognition, behavior and social relations. Cancer pain is best conceptualized as the convergence of multiple activated systems with feedback mechanisms to a complex, multidimensional model. The psychosocial aspects of this multidimensional model will be analyzed with special emphasis on results from recent research. Although most research has been conducted on the role of affect and cognition in cancer pain, data on other factors such as personality, behavior or social aspects exist and will be presented. In the second part of this paper the implications of these results for therapeutic strategies in clinical work will be discussed. Although a considerable body of knowledge exists to support the hypothesis of a multidimensional model of cancer pain, where psychosocial variables play an important role, only a few studies address the issue of to what degree different factors exercise their influence. This may be different from patient to patient and may change over the course of the disease. Whatever importance these single variables in the multidimensional model of cancer pain may have, the patient is best treated when none of these aspects is neglected in the assessment and all are taken care of in the treatment. A multidisciplinary team, with a psychiatrist as one of the team members, is often best prepared to fulfill this task. PMID:8149139

  8. Post surgical pain treatment - adults

    MedlinePlus

    ... of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology . 2012;116:248-73. PMID: 22227789 www.ncbi. ... chap 18. Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend ...

  9. Facts and Figures on Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Health Statistics survey indicated that low back pain was the most common (27%), followed by severe ...

  10. Counseling Adult Clients Experiencing Chronic Pain

    ERIC Educational Resources Information Center

    Burns, Stephanie T.

    2010-01-01

    Chronic pain affects 35% to 57% of the adult population in the United States and results in billions of dollars spent annually in direct health-care costs and lost productivity. Extensive research confirms the considerable role psychological factors play in the experience and expression of chronic pain. The author discusses implications for…

  11. Management of Hip Pain in Young Adults.

    PubMed

    Ward, Derek; Parvizi, Javad

    2016-07-01

    The diagnosis and treatment of hip pain in the young adult remains a challenge. Recently, understanding of a few specific hip conditions has improved; most notably femoroacetabular impingement. The differential diagnosis of hip pain has also expanded significantly, offering new challenges and opportunities. Along with the diagnostic dilemma, optimal treatment strategies for many conditions have yet to be proven and are current areas of important inquiry. This article reviews the current research on hip pain in the young adult and presents an overview of diagnostic and management strategies. PMID:27241373

  12. Cancer pain and current theory for pain control.

    PubMed

    Kahan, Brian

    2014-05-01

    This article discusses current trends in managing cancer pain, with specific regard to opioid transmission, descending pathway inhabitation, and ways to facilitate the endogenous antinociceptive chemicals in the human body. Various techniques for opioid and nonopioid control of potential pain situations of patients with cancer are discussed. The benefits of using pharmacogenetics to assess the appropriate medications are addressed. Finally, specific treatment of abdominal cancer pain using radiofrequency lesioning is discussed. PMID:24787342

  13. Cancer pain management-current status

    PubMed Central

    Thapa, Deepak; Rastogi, V; Ahuja, Vanita

    2011-01-01

    Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain.The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included. PMID:21772673

  14. Episodic pain in patients with advanced cancer.

    PubMed

    Zeppetella, Giovambattista; Ribeiro, Maria D C

    2002-01-01

    Episodic pain is a common problem for patients with advanced cancer and is often difficult to manage successfully. In this article, the daily variations in cancer-related episodic pain in a patient with metastatic lung cancer are described. The definition, etiology, prevalence, and pharmacological management of episodic pain are also reviewed PMID:12141792

  15. Splanchnicectomy for Pancreatic Cancer Pain

    PubMed Central

    Masuda, Toshiro; Kuramoto, Masafumi; Shimada, Shinya; Ikeshima, Satoshi; Yamamoto, Kenichiro; Nakamura, Kenichi; Baba, Hideo

    2014-01-01

    Persistent pain is a serious problem that often contributes to a poor quality of life in pancreatic cancer patients. Medical management by opioid analgesics is often accompanied by side effects and incomplete pain relief. A celiac plexus block is a simple treatment which relieves pain, but the procedure demands a certain degree of proficiency and the duration of the effects obtained can be rather limited. Transhiatal bilateral splanchnicectomy achieves a certain denervation of splanchnic nerves, but it requires a laparotomy. Unilateral thoracoscopic splanchnicectomy is a minimally invasive procedure to cause definite denervation. Bilateral thoracoscopic splanchnicectomy is recommended for unsatisfactory cases or recurrent pain occurring after the initial unilateral splanchnicectomy. It is important to select the most suitable treatment depending on patients' actual medical state and the predicted outcomes. PMID:24868557

  16. Psychiatric aspects of pain in cancer patients.

    PubMed

    Ozkan, Sedat

    2010-01-01

    The goal of this review is to discuss the psychiatric aspects of pain in cancer patients from a biopsychosocial approach. Pain in cancer patients is considered as a complex reaction causing severe suffering and involves many psychological aspects. It has many dimensions such as personality, affect, cognition and social relations. The pain experience may also be influenced by some psychological factors such as anxiety, depression and the meaning of pain. Therefore, a successful management of cancer pain requires a multidisciplinary approach. Since cancer pain is generally treated medically, the psychological impact of pain is often underestimated. However, cancer pain is usually related to high levels of psychological distress. Culture, as an important factor affecting cancer pain, will also be discussed during this review. It is crucial to understand cultural diversity in the treatment of cancer patients with pain. Research shows that a minority patients of various ethnicities have less control of their pain because of the miscommunication problem within the medical setting. By paying attention to patients' cultural diversities, problems such as miscommunication causing inadequate control of pain can be eliminated. In order to manage pain in cancer patients, cognitive-behavioral interventions may be integrated with pharmacotherapy. The main goal of these strategies is to provide a sense of control and better coping skills to deal with cancer. Patients' maladaptive thoughts or behaviors may cause physical and emotional stress. Main behavioral strategies include biofeedback, relaxation training, and hypnosis. Cognitive strategies include guided imagery, distraction, thought monitoring and problem solving. By discussing all of these aspects of cancer pain, the multidimensional characteristic of pain and the relation between cancer pain and psychiatric factors will be clarified. PMID:20590361

  17. Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis

    PubMed Central

    Herbert, Matthew S.; Goodin, Burel R.; Pero, Samuel T.; Schmidt, Jessica K.; Sotolongo, Adriana; Bulls, Hailey W.; Glover, Toni L.; King, Christopher D.; Sibille, Kimberly T.; Cruz-Almeida, Yenisel; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Background Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). Purpose The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. Methods We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Results Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Conclusions Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA. PMID:24352850

  18. Adult Cancers in Adolescents and Young Adults.

    PubMed

    Laurence, Valérie; Marples, Maria; Stark, Daniel P

    2016-01-01

    The pattern of cancer seen in young people changes with increasing age, transitioning from childhood- to adult-type cancer in adolescence and the third decade. The risk factors, presentation and biology of cancer in young adults differ from those in the older adult population. Factors of particular significance in adolescents and young adults (AYAs) include genetic predisposition to adult-type cancer, diagnostic uncertainty, long-term morbidity and considerations of fertility. New systemic therapies are being introduced that can prolong life and even increase the chance of cure, but the impact on AYAs is uncertain, as these patients are often under-represented in clinical trials. Here, we discuss the management of AYAs with 3 of the most common cancers affecting adults, when they emerge in the AYA populations, and therefore are currently met by medical oncologists - breast cancer, colorectal cancer and melanoma. PMID:27595357

  19. Pain Assessment in Noncommunicative Adult Palliative Care Patients.

    PubMed

    McGuire, Deborah B; Kaiser, Karen Snow; Haisfield-Wolfe, Mary Ellen; Iyamu, Florence

    2016-09-01

    Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients. PMID:27497016

  20. Predictors of Pain Management among American Indian Cancer Survivors.

    PubMed

    Hodge, Felicia; Nandy, Karabi; Cadogan, Mary; Itty, Tracy; Warda, Umme; Martinez, Fernando; Quan, Ann

    2016-01-01

    There is little research on cancer symptom management among Indigenous populations. This paper reports on the predictors of cancer pain management among American Indian cancer patients/survivors and their caregivers/family. The intervention was a symptom management toolkit delivered via traditional talking circles vs. standard care (control) at eight randomized reservation and urban clinic sites in the Southwest. Participants (N=184) were American Indian adults diagnosed with cancer and/or caregiver/family members. The primary outcome measure collected via pre-test and post-test questionnaires was the ability to manage cancer pain. Significant differences at post-test were the ability to manage cancer-related pain (p=.02) and a close relationship (p=.0018) that proved significant for intervention participants and was instrumental in fostering their ability to manage pain. The study also showed improvement in the desire and ability to improve cancer pain management among intervention participants. Programs targeting American Indians should use culturally appropriate education to improve management of cancer-related symptoms. PMID:27180700

  1. Clinical and Genetic Factors Related to Cancer-Induced Bone Pain and Bone Pain Relief

    PubMed Central

    Scarpi, Emanuela; Calistri, Daniele; Klepstad, Pål; Kaasa, Stein; Skorpen, Frank; Habberstad, Ragnhild; Nanni, Oriana; Amadori, Dino

    2014-01-01

    Objective. The study objective was to evaluate whether there are clinical or genetic differences between patients with cancer-induced bone pain (CIBP) and patients with non-CIBP, and, in the CIBP group, in those with good versus poor opioid response. Materials and Methods. A total of 2,294 adult patients with cancer who were receiving opioids for moderate or severe pain were included in the European Pharmacogenetic Opioid Study. Pain intensity and pain relief were measured using the Brief Pain Inventory. Linkage disequilibrium of 112 single nucleotide polymorphisms was evaluated in 25 candidate genes, and 43 haplotypes were assessed. Correlations among demographical factors, disease-related factors, genetic factors, CIBP, and pain relief were analyzed by logistic regression models corrected for multiple testing. Patients with bone metastases and bone/soft tissue pain were defined as having prevalent bone pain (CIBP population). This population was compared with patients who had other types of cancer pain (non-CIBP). Results. A total of 577 patients (26.2%) had CIBP, and 1,624 patients (73.8%) had non-CIBP. Patients with CIBP had more breakthrough cancer pain episodes (64.2% vs. 56.4%, p = .001), had significantly higher pain interference in “walking ability in the past 24 hours” (p < .0001), used more adjuvant drugs (84.1% vs. 78.3%, p = .003), and had a higher, albeit nonsignificant, median overall survival (3.8 vs. 2.9 months, p = .716) than patients with non-CIBP. None of the examined haplotypes exceeded p values corrected for multiple testing for the investigated outcomes. Conclusion. Patients with CIBP who were taking opioids had a clinical profile slightly different from that of the non-CIBP group. However, no specific genetic pattern emerged for CIBP versus non-CIBP or for responsive versus nonresponsive patients with CIBP. PMID:25342315

  2. Opioids for the management of breakthrough cancer pain in adults: a systematic review undertaken as part of an EPCRC opioid guidelines project.

    PubMed

    Zeppetella, Giovambattista

    2011-07-01

    The usual management of cancer related breakthrough pain is with supplemental doses of analgesics (commonly opioids) at a dose proportional to the total around-the-clock opioid dose. The aim of this review, undertaken as part of a European Palliative Care Research Collaborative (EPCRC) project, to update the EAPC guidelines on opioid analgesics in cancer pain was to determine the evidence for the utility of opioids in the management of breakthrough pain in patients with cancer. Randomized controlled trials of opioids used as rescue medication were identified using electronic search strategies. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, and patient satisfaction. The date of the final search was 31 July 2009. Eight studies (790 patients) met the inclusion criteria. Most studies investigated rescue medication delivery via the buccal or nasal transmucosal routes. Intravenous morphine has been compared with the transmucosal route and the two found to be effective. The oral route has not been formally tested although found to be an inferior comparator in one study. Most studies showed no meaningful relationship between the effective dose of transmucosal opioid and the around-the-clock scheduled medication or the previous rescue medication, although one study found a fixed proportion of either intravenous morphine or transmucosal fentanyl to be efficacious. PMID:21708858

  3. Mechanisms of cancer-induced bone pain

    PubMed Central

    Lozano-Ondoua, AN; Symons-Liguori, AM; Vanderah, TW

    2013-01-01

    Cancerous cells can originate in a number of different tissues such as prostate, breast and lung, yet often go undetected and are non-painful. Many types of cancers will metastasize toward the bone microenvironment first. Tumor burden within the bone causes excruciating breakthrough pain with properties of continual pain inadequately managed with current analgesics. Part of this failure is due to the poor understanding of the etiology of cancer pain. Animal models of cancer-induced bone pain (CIBP) have revealed that the neurochemistry of cancer has features distinctive from other chronic pain states. For example, preclinical models of metastatic cancer often result in the upregulation of neurotrophins, such as NGF and BDNF that can lead to nociceptive sensitization. Preclinical cancer models demonstrate nociceptive neuronal expression of acid sensing receptors, such as ASIC1 and TRPV1 that respond to a significant increase in an acidic cancer-induced environment within the bone. CIBP is correlated with a significant increase in pro-inflammatory mediators acting peripherally and centrally, contributing to neuronal hypersensitive states. And finally, cancer cells generate high levels of oxidative molecules that are thought to significantly increase extracellular glutamate, thus activating primary afferent neurons. Knowledge of the unique neuro-molecular profile of cancer pain will ultimately lead to the development of novel and superior therapeutics for CIBP. PMID:24076008

  4. The role of a pharmacist in ambulatory cancer pain management.

    PubMed

    Ratka, Anna

    2002-06-01

    Cancer pain is progressive and complex. The multidimensional character of cancer pain requires comprehensive management by a multidisciplinary team of health care professionals. Pharmacotherapy is a cornerstone of cancer pain management. Pharmacists who are engaged in ambulatory cancer pain management can play a pivotal role in the pharmacotherapy of cancer pain by optimizing medication therapy, monitoring outcomes, enhancing adherence through patient education regarding drug use, pain and symptom control, educating other health professionals and students, and conducting research. To fully meet the therapeutic challenges of cancer pain, pharmacists need to improve their knowledge and attitudes about cancer pain and pain medications. PMID:12003689

  5. [Traditional Chinese medicine for cancer pain].

    PubMed

    Wang, Ju-yong; Xu, Ling; Zhang, Rui-xin; Lao, Lixing

    2011-02-01

    Pain is one of the common symptoms of cancer which seriously affects the quality of life of the patients. Cancer pain is mainly treated with the three-step method, biological therapy or nerve block therapy based on antitumor therapy. However, up to 50 percent of patients with cancer-related pain do not receive adequate pain relief, affecting their physical and psychological well-being, and leading to a lower quality of life for the patient after conventional treatment. Clinical observation suggests that traditional Chinese medicine may alleviate cancer-related pain either by oral administration, topical administration, acupuncture or other means with continuing non-addictive and non-drug-resistant qualities. However, scientific evaluation of the efficacy of herbs in the treatment of pain is insufficient; the underlying mechanisms are unclear and, safety and toxicity remain a concern. PMID:21288445

  6. 23. Pain in patients with cancer.

    PubMed

    Vissers, Kris C P; Besse, Kees; Wagemans, Michel; Zuurmond, Wouter; Giezeman, Maurice J M M; Lataster, Arno; Mekhail, Nagy; Burton, Allen W; van Kleef, Maarten; Huygen, Frank

    2011-01-01

    Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program. PMID:21679293

  7. Cancer: Unique to Older Adults

    MedlinePlus

    ... improve significantly with treatment. Changes in Thinking or Memory Some people who are treated for cancer experience “ ... helpful in cancer pain. These include: acupuncture biofeedback hypnosis heat or cold applications massage imagery meditation relaxation ...

  8. Treatment of Cancer Pain by Targeting Cytokines

    PubMed Central

    Vendrell, I.; Macedo, D.; Alho, I.; Dionísio, M. R.; Costa, L.

    2015-01-01

    Inflammation is one of the most important causes of the majority of cancer symptoms, including pain, fatigue, cachexia, and anorexia. Cancer pain affects 17 million people worldwide and can be caused by different mediators which act in primary efferent neurons directly or indirectly. Cytokines can be aberrantly produced by cancer and immune system cells and are of particular relevance in pain. Currently, there are very few strategies to control the release of cytokines that seems to be related to cancer pain. Nevertheless, in some cases, targeted drugs are available and in use for other diseases. In this paper, we aim to review the importance of cytokines in cancer pain and targeted strategies that can have an impact on controlling this symptom. PMID:26538839

  9. Treatment Considerations for Cancer Pain: A Global Perspective.

    PubMed

    Pergolizzi, Joseph V; Gharibo, Christopher; Ho, Kok-Yuen

    2015-11-01

    Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. Reasons for undertreating cancer pain include attitudes of patients, clinicians, and factors associated with healthcare systems. The consequences of not treating cancer pain may include reduced quality of life for patients with cancer (who now live longer than ever), functional decline, and increased psychological stress. Early analgesic intervention for cancer pain may reduce the risk of central sensitization and chronification of pain. To manage pain in oncology patients, clinicians should assess pain during regular follow-up visits using validated pain measurement tools and follow prescribing guidelines, if necessary referring patients with cancer to pain specialists. Many patients with cancer require opioids for pain relief. Pain associated with cancer may also relate to cancer treatments, such as chemotherapy-induced peripheral neuropathy. Many patients with cancer are what might be considered "special populations," in that they may be elderly, frail, comorbid, or have end-stage organ failure. Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes. PMID:25469726

  10. Pharmacotherapy of cancer-related episodic pain.

    PubMed

    Zeppetella, Giovambattista; Ribeiro, Maria D C

    2003-04-01

    Episodic pain is a transient increase in pain intensity over background pain. Episodic pain occurs commonly in cancer patients; it is a heterogeneous phenomenon that is incapacitating, debilitating and can have a significant impact on quality of life. Episodic pain can be difficult to manage; it is often unpredictable, typically of fast onset, of short duration and feels similar to background pain except that it may be more severe. The successful management of episodic pain can only be achieved following a thorough assessment. The subsequent management usually involves both pharmacological and non-pharmacological strategies integrated into the overall care and appropriate for the stage of the patient's disease. Pharmacological management includes the implementation of primary therapies (e.g., chemotherapy for the underlying aetiology of the pain, optimising the scheduled medication (e.g., analgesics and adjuvant analgesics) and specific pharmacological interventions for the episodic pain (e.g., rescue medication). PMID:12667112

  11. Fentanyl sublingual spray for breakthrough pain in cancer patients.

    PubMed

    Zeppetella, Giovambattista

    2013-06-01

    Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. Typically, breakthrough pain has a fast onset and short duration, and a significant impact on patients' quality of life. Normal-release oral opioids are the traditional pharmacological approach for patients who are receiving an around the clock opioid regimen; however, their onset and duration of action may not be suitable for treating many breakthrough pains. Efforts to provide nonparenteral opioid formulations that could provide more rapid, and more effective, relief of breakthrough pain have led to the development of transmucosal opioid formulations including fentanyl sublingual spray (FSLS). This is a formulation of fentanyl available in doses of 100, 200, 400, 600, and 800 μg strengths approved for the management of breakthrough pain in adult cancer patients already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. Published pharmacokinetic, efficacy, tolerability, and safety data suggest that FSLS has a valuable role to play in the symptomatic pharmacological management of breakthrough pain. The effective dose of FSLS is determined by titration according to the needs of the individual patient. PMID:25135032

  12. A multidimensional model for understanding cancer pain.

    PubMed

    Wool, Margaret S; Mor, Vincent

    2005-01-01

    The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment. PMID:16377591

  13. Stereotactic Mesencephalotomy for Cancer - Related Facial Pain

    PubMed Central

    Kim, Deok-ryeong; Lee, Sang-won

    2014-01-01

    Cancer-related facial pain refractory to pharmacologic management or nondestructive means is a major indication for destructive pain surgery. Stereotactic mesencephalotomy can be a valuable procedure in the management of cancer pain involving the upper extremities or the face, with the assistance of magnetic resonance imaging (MRI) and electrophysiologic mapping. A 72-year-old man presented with a 3-year history of intractable left-sided facial pain. When pharmacologic and nondestructive measures failed to provide pain alleviation, he was reexamined and diagnosed with inoperable hard palate cancer with intracranial extension. During the concurrent chemoradiation treatment, his cancer-related facial pain was aggravated and became medically intractable. After careful consideration, MRI-based stereotactic mesencephalotomy was performed at a point 5 mm behind the posterior commissure, 6 mm lateral to and 5 mm below the intercommissural plane using a 2-mm electrode, with the temperature of the electrode raised to 80℃ for 60 seconds. Up until now, the pain has been relatively well-controlled by intermittent intraventricular morphine injection and oral opioids, with the pain level remaining at visual analogue scale 4 or 5. Stereotactic mesencephalotomy with the use of high-resolution MRI and electrophysiologic localization is a valuable procedure in patients with cancer-related facial pain. PMID:25289131

  14. Neuropathic pain in the cancer patient.

    PubMed

    Allen, R R

    1998-11-01

    Cancer presents itself in numerous ways, adding to the complexity of any pain syndrome with which it is associated. Neuropathic pain, unlike many other pain syndromes, is difficult to treat even in the absence of cancer. The combination results in a heterogeneous group of patients with a complex set of symptoms. This makes the assessment of pain, classification of syndromes, and clinical study a challenge. If the disease is nonprogressive, general principles of care are essentially the same as in those without cancer. In patients with progressive disease and more refractory painful conditions, spinal anesthetic and neurosurgical therapies must often be considered. Under such circumstances, caregivers are forced to carefully balance uncertain benefits and risks, often without the luxury of time. More careful observation and controlled trials in these patients help facilitate this challenging process. PMID:9767067

  15. Drug management of pain in cancer patients.

    PubMed Central

    Tuttle, C B

    1985-01-01

    Chronic severe cancer pain is often not well controlled because both patient and physician have a poor understanding of the nature of the pain and of the actions of various potent analgesics. Physicians often fail to tailor analgesic dosages to the needs of the individual and unnecessarily limit the dosage because they have an ill founded fear that the patient will become addicted. The basis of rational management of cancer pain with drugs is an appropriate analgesic given regularly in doses adequate to suppress pain continuously. This review compares the potent analgesics and identifies and discusses those that have a role in treating chronic cancer pain. It emphasizes the value of morphine sulfate and gives information on starting and individualizing dosages and managing side effects. PMID:2856896

  16. Hypnosis: adjunct therapy for cancer pain management.

    PubMed

    Kravits, Kathy

    2013-03-01

    Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers' lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it. PMID:25031986

  17. Hypnosis: Adjunct Therapy for Cancer Pain Management

    PubMed Central

    Kravits, Kathy

    2013-01-01

    Pain is a symptom associated with prolonged recovery from illness and procedures, decreased quality of life, and increased health-care costs. While there have been advances in the management of cancer pain, there is a need for therapeutic strategies that complement pharmaceutical management without significantly contributing to the side-effect profile of these agents. Hypnosis provides a safe and efficacious supplement to pharmaceutical management of cancer pain. One barrier to the regular use of hypnosis is health-care providers’ lack of current knowledge of the efficacy and safety of hypnosis. Advanced practitioners who are well-informed about hypnosis have an opportunity to increase the treatment options for patients who are suffering with cancer pain by suggesting to the health-care team that hypnosis be incorporated into the plan of care. Integration of hypnosis into the standard of care will benefit patients, caregivers, and survivors by reducing pain and the suffering associated with it. PMID:25031986

  18. Assessing the impact of breakthrough cancer pain.

    PubMed

    Burton, Beth; Zeppetella, Giovambattista

    Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger despite relative stable and adequately controlled background pain. Breakthrough pain is a common and distinct component of cancer pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30-60minutes. Despite the self-limiting nature of breakthrough pain, it can place significant physical, psychological, and economic burdens on both patients and their carers. Patients with breakthrough pain are often less satisfied with their analgesic therapy, they have decreased functioning because of their pain, and may also experience social and psychosocial consequences, such as increased levels of anxiety and depression. Successful management of breakthrough pain is best achieved by a thorough assessment which includes determining the severity, pathophysiology, and aetiology of the pain and takes into account both background and breakthrough pains while considering whether the underlying disease, co-morbidities or precipitating events are amenable to interventions. The features of breakthrough pain and the challenges it presents to patients, their carers, and health professionals are illustrated with a case study. PMID:21647006

  19. Ambulatory continuous interscalene blocks for cancer pain.

    PubMed

    Gemayel, Michael C; Chidiac, Joseph E; Chidiac, Elie J

    2015-03-01

    Continuous peripheral nerve blocks are used in the management of pain following surgical procedures. They can also be used in patients with cancer-related pain, to improve sleep quality, reduce opioid requirements and their side effects. We describe two cancer patients in whom interscalene brachial plexus catheters were used on an outpatient basis, allowing them to travel, decrease their opioid use, and improve their ability to perform routine activities. PMID:25562724

  20. Pain Assessment in Hospitalized Older Adults With Dementia and Delirium

    PubMed Central

    Paulson, Christina May; Monroe, Todd; Mion, Lorraine C.

    2015-01-01

    Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization. PMID:24800815

  1. Breakthrough pain in cancer patients.

    PubMed

    Zeppetella, G

    2011-08-01

    Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. A typical episode of breakthrough pain has a fast onset and short duration, yet despite the self-limiting nature of each breakthrough pain, the repeated episodes can have a significant effect on patients' quality of life. Normal-release oral opioids have been the mainstay pharmacological approach for patients who are receiving an around the clock opioid regimen, but the onset and duration of action of oral opioids such as morphine may not be suitable for treating many breakthrough pains. Efforts to provide non-parenteral opioid formulations that could provide more rapid, and more effective, relief of breakthrough pain have led to the development of transmucosal opioid formulations. PMID:21227666

  2. The McGill Pain Questionnaire as a Multidimensional Measure in People with Cancer: An Integrative Review

    PubMed Central

    Ngamkham, Srisuda; Vincent, Catherine; Finnegan, Lorna; Holden, Janean E.; Wang, Zaijie Jim; Wilkie, Diana J.

    2010-01-01

    First published in 1975, the McGill Pain Questionnaire (MPQ) is an often cited pain measure but there have been no systematic reviews of the MPQ in cancer populations. The objective is to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n=29 studies) and pain quality (n=27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain and the effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported that the MPQ was an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective, complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand if those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management. PMID:22341138

  3. The McGill Pain Questionnaire as a multidimensional measure in people with cancer: an integrative review.

    PubMed

    Ngamkham, Srisuda; Vincent, Catherine; Finnegan, Lorna; Holden, Janean E; Wang, Zaijie Jim; Wilkie, Diana J

    2012-03-01

    First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management. PMID:22341138

  4. Therapeutic strategies for cancer pain management.

    PubMed Central

    Miller, T. W.; Spiro, K.; Jay, L. L.

    1990-01-01

    Clinical issues related to treating the oncology pain patient have gained considerable attention in the medical and health care literature. Addressed are management strategies which focus specifically on cognitive-behavioral, psychosocial, and pharmacologic approaches to treating the oncology pain patient. Each strategy possesses unique qualities that can benefit the care and management of the cancer patient and provide a better understanding of the disease entity and the patient's ability to develop coping strategies that may be effective in understanding and confronting pain associated with cancer. PMID:2097904

  5. Topical NSAIDs for acute pain in adults

    PubMed Central

    Massey, Thomas; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Use of topical NSAIDs to treat acute musculoskeletal conditions is widely accepted in some parts of the world, but not in others. Their main attraction is their potential to provide pain relief without associated systemic adverse events. Objectives To review the evidence from randomised, double-blind, controlled trials on the efficacy and safety of topically applied NSAIDs in acute pain. Search methods We searched MEDLINE, EMBASE, The Cochrane Library, and our own in-house database to December 2009. We sought unpublished studies by asking personal contacts and searching on-line clinical trial registers and manufacturers web sites. Selection criteria We included randomised, double-blind, active or placebo (inert carrier)-controlled trials in which treatments were administered to adult patients with acute pain resulting from strains, sprains or sports or overuse-type injuries (twisted ankle, for instance). There had to be at least 10 participants in each treatment arm, with application of treatment at least once daily. Data collection and analysis Two review authors independently assessed trial quality and validity, and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk and numbers needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. Main results Forty-seven studies were included; most compared topical NSAIDs in the form of a gel, spray, or cream with a similar placebo, with 3455 participants in the overall analysis of efficacy. For all topical NSAIDs combined, compared with placebo, the number needed to treat to benefit (NNT) for clinical success, equivalent to 50% pain relief, was 4.5 (3.9 to 5.3) for treatment periods of 6 to 14 days. Topical diclofenac, ibuprofen, ketoprofen, and piroxicam were of similar efficacy, but indomethacin and benzydamine were not significantly better than placebo. Local skin reactions were generally mild and transient, and did not differ from

  6. Toward freedom from cancer pain in Japan.

    PubMed

    Otsuka, Kuniko; Yasuhara, Hajime

    2007-01-01

    Life expectancy in Japan is highest in the world. Cancer is the leading cause of mortality in Japan, accounting for about 30 percent of all deaths. Many Japanese cancer patients experience severe pain although they and their families hope to be pain free at the end of their lives. Toward that end, the consumption of morphine in Japan has increased markedly since 1989. The amount of morphine hydrochloride and morphine sulfate consumed in 2001 was 6.1 times that used in Japan in 1989. However, the amount of morphine consumed in Japan is still less than in other developed nations, and was only one-sixth of the amount used in Australia in 2001. As a result, many Japanese cancer patients experience potentially manageable cancer pain, largely because the amount of the drug used by doctors is insufficient for pain control. An increasing number of Japanese doctors now understand that their patients' quality of life is most important in end-of-life care and how to use the three step analgesic ladder of the World Health Organization (WHO). However, other doctors do not understand these issues sufficiently causing some patients to die without good pain control. Both the general population and some medical professionals misunderstand and have prejudice against the use of morphine. Patients often do not participate in decision making about medical treatment because of remaining paternalism in the relationship between Japanese doctors and patients. Thus, cancer pain management in Japan is not as effective as it can be and not all Japanese cancer patients receive appropriate management for their cancer pain. To improve outcomes for Japanese patients, it is necessary for health professional and social work students and practicing professionals to receive contemporary education including an introduction to palliative care and ethics. PMID:18032354

  7. Motor regulation problems and pain in adults diagnosed with ADHD

    PubMed Central

    2013-01-01

    Background Most children who are diagnosed with attention deficit-hyperactivity disorder (ADHD) have moderate-to-severe motor problems using the Motor Function Neurological Assessment battery (MFNU). The MFNU focuses on specific muscle adjustment problems associated with ADHD, especially motor inhibition problems and high muscle tone. Here we investigated whether adults with ADHD/hyperkinetic disorder (HKD) have similar motor problems. In our clinical experience, adults with ADHD often complain about back, shoulder, hip, and leg pain. We also investigate reported pain in adults with ADHD. Methods Twenty-five adult outpatients diagnosed with ADHD/HKD who were responders to methylphenidate (MPH) were compared to 23 non-ADHD controls on 16 MFNU subtests and using a ‘total score’ (‘TS’) parameter. The MFNU test leader was blinded to group identity. The two groups were also compared using the Pain Drawing and Numerical Pain Rating Scale. Results The adult ADHD group had significantly (p < .001) more motor problems (higher TS) than controls. On the muscle regulation subtests, 36–96% of the ADHD group showed ‘moderate’ to ‘severe’ problems compared to 13–52% of the control group, and 80% of the ADHD group reported widespread pain. Highly significant differences were found between the ADHD and control groups for the variables ‘pain level’ (p < .001) and ‘pain location’ (p < .001). Significant correlations were found between TS and ‘pain location’ and between TS and ‘pain level’. Conclusions These findings suggest that similar to children with ADHD, adults diagnosed with ADHD also have motor inhibition problems and heightened muscle tone. The presence of significantly higher pain levels and more widespread pain in the ADHD group compared to non-ADHD controls might indicate that pain is a long-term secondary effect of heightened muscle tone and restricted movement that can be demonstrated in children and adults by the MFNU

  8. Reducing Cancer Patients' Painful Treatment

    NASA Video Gallery

    A NASA light technology originally developed to aid plant growth experiments in space has proved to reduce the painful side effects resulting from chemotherapy and radiation treatment in bone marro...

  9. Canadian recommendations for the management of breakthrough cancer pain.

    PubMed

    Daeninck, P; Gagnon, B; Gallagher, R; Henderson, J D; Shir, Y; Zimmermann, C; Lapointe, B

    2016-04-01

    Breakthrough cancer pain (btcp) represents an important element in the spectrum of cancer pain management. Because most btcp episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of btcp; however, there are no uniform national recommendations for the management of btcp. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of btcp. Currently, immediate-release oral opioids are the treatment of choice for btcp. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of btcp. Novel transmucosal fentanyl formulations might be more appropriate for some types of btcp, but limited access to such drugs hinders their use. In addition, the recognition of btcp and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of btcp, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of btcp and the alleviation of the suffering and discomfort experienced by adult cancer patients. PMID:27122974

  10. Canadian recommendations for the management of breakthrough cancer pain

    PubMed Central

    Daeninck, P.; Gagnon, B.; Gallagher, R.; Henderson, J.D.; Shir, Y.; Zimmermann, C.; Lapointe, B.

    2016-01-01

    Breakthrough cancer pain (btcp) represents an important element in the spectrum of cancer pain management. Because most btcp episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of btcp; however, there are no uniform national recommendations for the management of btcp. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of btcp. Currently, immediate-release oral opioids are the treatment of choice for btcp. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of btcp. Novel transmucosal fentanyl formulations might be more appropriate for some types of btcp, but limited access to such drugs hinders their use. In addition, the recognition of btcp and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of btcp, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of btcp and the alleviation of the suffering and discomfort experienced by adult cancer patients. PMID:27122974

  11. Adult-Age Inflammatory Pain Experience Enhances Long-Term Pain Vigilance in Rats

    PubMed Central

    Li, Sheng-Guang; Wang, Jin-Yan; Luo, Fei

    2012-01-01

    Background Previous animal studies have illustrated a modulatory effect of neonatal pain experience on subsequent pain-related behaviors. However, the relationship between chronic pain status in adulthood and future pain perception remains unclear. Methodology/Principal Findings In the current study, we investigated the effects of inflammatory pain experience on subsequent formalin-evoked pain behaviors and fear conditioning induced by noxious stimulation in adult rats. Our results demonstrated an increase of the second but not the first phase of formalin-induced pain behaviors in animals with a history of inflammatory pain that have recovered. Similarly, rats with persistent pain experience displayed facilitated acquisition and prolonged retention of pain-related conditioning. These effects of prior pain experience on subsequent behavior were prevented by repeated morphine administration at an early stage of inflammatory pain. Conclusions/Significance These results suggest that chronic pain diseases, if not properly and promptly treated, may have a long-lasting impact on processing and perception of environmental threats. This may increase the susceptibility of patients to subsequent pain-related disorders, even when chronic pain develops in adulthood. These data highlight the importance of treatment of chronic pain at an early stage. PMID:22574223

  12. Pain-QuILT: Clinical Feasibility of a Web-Based Visual Pain Assessment Tool in Adults With Chronic Pain

    PubMed Central

    Kumbhare, Dinesh; Stinson, Jennifer N; Henry, James L

    2014-01-01

    Background Chronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation. Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]). Objective The goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI. Methods Participants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report. Results The sample consisted of 50 adults (54% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use

  13. Early Life Course Pathways of Adult Depression and Chronic Pain

    PubMed Central

    Goosby, Bridget J.

    2013-01-01

    Applying cumulative inequality theory, this study examines the extent to which childhood socioeconomic disadvantage and maternal depression increase the risk of major depression and chronic pain in U.S. working-aged adults. Further, I assess whether low socioeconomic status amplifies the risk of adult depression and/or pain. Using data from the 2003 National Comorbidity Survey Replication (N=4339), I find that socioeconomic disadvantage and maternal depression during youth increases the risk of adult depression and/or chronic pain. The probability of having chronic pain increases in magnitude over the life course for adults whose parents have lower educational attainment relative to those with more highly educated parents. Childhood socioeconomic circumstances are not completely explained by adulthood socioeconomic status indicators. These findings help illustrate the far-reaching influence of childhood context on adult physical and mental health. PMID:23426854

  14. Analgesic Effect of Intrathecal Ginsenosides in a Murine Bone Cancer Pain

    PubMed Central

    Kim, Woong Mo; Lee, Hyung Gon; Choi, Jeong Il; Kim, Yeo Ok; Song, Ji A

    2010-01-01

    Background Bone cancer pain has a disruptive effect on the cancer patient's quality of life. Although ginsenosides have been used as traditional medicine in Eastern Medicine, the effect on bone cancer pain has not been thoroughly studied. The aim of this study was to determine whether ginsenosides may alter the bone cancer pain at the spinal level. Methods NCTC 2472 tumor cells (2.5 × 105) were injected into the femur of adult male C3H/HeJ mice to evoke bone tumor and bone cancer pain. To develop bone tumor, radiologic pictures were obtained. To assess pain, the withdrawal threshold was measured by applying a von Frey filament to the tumor cells inoculation site. The effect of intrathecal ginsenosides was investigated. Effect of ginsenosides (150, 500, 1,000 µg) was examined at 15, 30, 60, 90, 120 min after intrathecal delivery. Results The intrafemoral injection of NCTC 2472 tumor cells induced a radiological bone tumor. The withdrawal threshold with tumor development was significantly decreased compared to the sham animals. Intrathecal ginsenosides effectively increased the withdrawal threshold in the bone cancer site. Conclusions NCTC 2472 tumor cells injection into the mice femur caused bone tumor and bone cancer pain. Intrathecal ginsenosides attenuated the bone cancer-related pain behavior. Therefore, spinal ginsenosides may be an alternative analgesic for treating bone cancer pain. PMID:21217885

  15. Role of adult hippocampal neurogenesis in persistent pain

    PubMed Central

    Apkarian, A. Vania; Mutso, Amelia A.; Centeno, Maria V.; Kan, Lixin; Wu, Melody; Levinstein, Marjorie; Banisadr, Ghazal; Gobeske, Kevin T.; Miller, Richard J.; Radulovic, Jelena; Hen, René; Kessler, John A.

    2016-01-01

    The full role of adult hippocampal neurogenesis (AHN) remains to be determined, yet it is implicated in learning and emotional functions, and is disrupted in negative mood disorders. Recent evidence indicates that AHN is decreased in persistent pain consistent with the idea that chronic pain is a major stressor, associated with negative moods and abnormal memories. Yet, the role of AHN in development of persistent pain has remained unexplored. In this study, we test the influence of AHN in postinjury inflammatory and neuropathic persistent pain-like behaviors by manipulating neurogenesis: pharmacologically through intracerebroventricular infusion of the antimitotic AraC; ablation of AHN by x-irradiation; and using transgenic mice with increased or decreased AHN. Downregulating neurogenesis reversibly diminished or blocked persistent pain; oppositely, upregulating neurogenesis led to prolonged persistent pain. Moreover, we could dissociate negative mood from persistent pain. These results suggest that AHN-mediated hippocampal learning mechanisms are involved in the emergence of persistent pain. PMID:26313405

  16. Hypnosis for pain management in the older adult.

    PubMed

    Cuellar, Norma G

    2005-09-01

    Pain is a physical, emotional and psychologic phenomenon that is often ignored in older adults causing depression and poor quality of life. Older adults report the use of complementary and alternative medicine in some form with 80% of these users reporting improvement in their health conditions. Although physical pain in the older adult is usually managed with pharmacologic interventions, methods that may reduce the use of prescription drugs may decrease adverse effects that can compromise the physiologic state of the older adult. Hypnosis has continued to gain acceptance within mainstream medicine as an appropriate treatment and can be integrated safely with conventional medicine as an effective treatment for a variety of conditions in the older adult. It is an intervention that can be used for relaxation and pain control, especially when conventional pharmacologic regimens have failed. The purpose of this article is to review the concepts related to pain in older adults; the use of complementary and alternative medicine in the older adult; hypnosis and the older adult (i.e., background, definition, benefits, research, mechanism of action, hypnotizability, and the process); and the implications of using hypnosis for pain management in the older adult. PMID:16129381

  17. Controversies in cancer pain. Medical perspectives.

    PubMed

    Foley, K M

    1989-06-01

    The treatment of pain in the patient with cancer has focused attention on a series of controversial issues involving medical, social, and moral factors. The medical factors include a lack of knowledge on the part of health care professionals regarding the rational use of opioid drugs. This is coupled with real limitations in the general understanding of the mechanisms of pain and its treatment using pharmacologic, anesthetic, and neurosurgical approaches. Several pharmacologic controversies, including the choice of drug, route and method of administration, and tolerance development and risk of substance abuse, have emerged with the use of opioids on a chronic basis in the cancer population. The social and moral implications involve the issue of who will pay for high technology pain management approaches for patients either at home or in hospice care and the ethical considerations in managing pain with opioid drugs. Carefully designed studies to assess these factors, coupled with broad educational programs, will improve the care of cancer patients in pain and expand our understanding of these important issues. PMID:2566369

  18. How childhood cancers are different from adult cancers

    MedlinePlus

    Childhood cancers are not the same as adult cancers. The type of cancer, how far it spreads, and how it is treated is often different than adult cancers. Children's bodies and the way they respond to ...

  19. Improving the Management of Pain in Hospitalized Adults

    PubMed Central

    Morrison, R. Sean; Meier, Diane E.; Fischberg, Daniel; Moore, Carlton; Degenholtz, Howard; Litke, Ann; Maroney-Galin, Catherine; Siu, Albert L.

    2011-01-01

    Background Pain is a major quality issue. The objective of this study was to evaluate the effectiveness of a series of interventions on pain management. Methods This controlled clinical trial (April 1, 2002, to February 28, 2003) involved the staggered implementation of 3 interventions into 2 blocks of matched hospital units. The setting was an 1171-bed hospital. A total of 3964 adults were studied. Interventions included education, standardized pain assessment using a 1- or 4-item (enhanced) pain scale, audit and feedback of pain scores to nursing staff, and a computerized decision support system. The main outcome measures were pain assessment and severity and analgesic prescribing. Results Units using enhanced pain scales had significantly higher pain assessment rates than units using 1-item pain scales (64% vs 32%; P<.001), audit and feedback of pain results was associated with increases in pain assessment rates compared with units in which audit and feedback was not used (85% vs 64%; P<.001), and the addition of the computerized decision support system was associated with significant increases in pain assessment only when compared with units without audit and feedback (79% vs 64%; P<.001). The enhanced pain scale was associated with significant increases in prescribing of World Health Organization step 2 or 3 analgesic for patients with moderate or severe pain compared with the 1-item scale (83% vs 66%; P=.01). The interventions did not improve pain scores. Conclusions A clinically meaningful pain assessment instrument combined with either audit and feedback or a computerized decision support system improved pain documentation to more than 80%. The enhanced pain scale was associated with improved analgesic prescribing. Future interventions should be directed toward altering physician behavior related to titration of opioid analgesics. PMID:16682579

  20. Sleep and pain sensitivity in adults.

    PubMed

    Sivertsen, Børge; Lallukka, Tea; Petrie, Keith J; Steingrímsdóttir, Ólöf Anna; Stubhaug, Audun; Nielsen, Christopher Sivert

    2015-08-01

    Sleep problems and pain are major public health concerns, but the nature of the association between the 2 conditions is inadequately studied. The aim of this study was to determine whether a range of sleep measures is associated with experimental increased pain sensitivity. A cross-sectional large population-based study from 2007 to 2008, the Tromsø 6 study, provided data from 10,412 participants (age: mean [SD], 58 [13] years; 54% women). Self-reported sleep measures provided information on sleep duration, sleep onset latency (SOL), and sleep efficiency, as well as frequency and severity of insomnia. The main outcome measure was pain sensitivity tests, including assessment of cold-pressor pain tolerance. We found that all sleep parameters, except sleep duration, were significantly associated with reduced pain tolerance. Both the frequency and severity of insomnia, in addition to SOL and sleep efficiency, were associated with pain sensitivity in a dose-response manner. Adjusting for demographics and psychological distress reduced the strengths of the hazard ratios, but most associations remained significant in the fully adjusted models. There was also a synergistic interaction effect on pain tolerance when combining insomnia and chronic pain. We conclude that sleep problems significantly increase the risk for reduced pain tolerance. Because comorbid sleep problems and pain have been linked to elevated disability, the need to improve sleep among patients with chronic pain, and vice versa, should be an important agenda for future research. PMID:25915149

  1. Adult attachment and reports of pain in experimentally-induced pain.

    PubMed

    Andrews, Nicole Emma; Meredith, Pamela Joy; Strong, Jenny

    2011-05-01

    Attachment theory has been proposed as a framework for understanding the development of chronic pain, with evidence supporting the overrepresentation of insecure attachment styles in chronic pain populations and links between insecure attachment and factors known to impact one's ability to cope with pain. The present study sought to extend two earlier studies exploring the relationships between adult attachment and communication of an acute pain experience, in anticipation of providing insight into individual differences in vulnerability in development of chronic pain. It was hypothesised that: (a) fearful attachment would be associated with perceptions of the pain as less intense, and (b) anxious attachment would be associated with lower pain thresholds. A convenience sample of 82 healthy adults completed self-report measures of attachment, neuroticism, and negative affect prior to taking part in a coldpressor pain inducement task. Results demonstrated that fearful attachment was associated with lower levels of pain intensity throughout the coldpressor task. In addition, dismissing attachment was also associated with less intense pain, as well as increased coldpressor endurance (tolerance) in the presence of a known assessor. These associations were retained after controlling for measures of neuroticism, negative affect, age, and social desirability. The results of this study are consistent with the proposition that fearful and dismissing individuals tend to mask their underlying distress caused by the pain experience, potentially leading to difficulties coping with pain over time. PMID:21095633

  2. Optimal management of breakthrough cancer pain (BCP).

    PubMed

    Escobar, Y; Mañas, A; Juliá, J; Gálvez, R; Zaragozá, F; Margarit, C; López, R; Casas, A; Antón, A; Cruz, J J

    2013-07-01

    Breakthrough cancer pain (BCP) is common in patients with cancer, causing a negative impairment in quality of life. Recent diagnostic criteria allow for differentiation of background chronic pain and BCP, for which proportion of unpredictable episodes is very high. Five characteristics define BCP: rapid onset, high intensity, maximum intensity (minutes), mean duration 30 min, and unpredictable onset. Fentanyl is a synthetic opioid characterized by rapid absorption and start of the analgesic effects. In addition to comparing some of the marked differences between the four pharmaceutical forms of fentanyl marketed in Spain, this paper discusses the data collected in a comprehensive clinical trial program with fentanyl pectin nasal spray (FPNS), a formulation that takes advantage of the intranasal route and the PecSys™ technology. The FPNS formulation achieves analgesic action 5 min after application and significant pain relief at 10 min. FPNS, therefore, has key features to be an optimal treatment for BCP. PMID:23263914

  3. Complementary and Alternative Medicine for Cancer Pain: An Overview of Systematic Reviews

    PubMed Central

    Bao, Yanju; Kong, Xiangying; Yang, Liping; Liu, Rui; Shi, Zhan; Li, Weidong; Hua, Baojin; Hou, Wei

    2014-01-01

    Background and Objective. Now with more and more published systematic reviews of Complementary and Alternative Medicine (CAM) on adult cancer pain, it is necessary to use the methods of overview of systematic review to summarize available evidence, appraise the evidence level, and give suggestions to future research and practice. Methods. A comprehensive search (the Cochrane Library, PubMed, Embase, and ISI Web of Knowledge) was conducted to identify all systematic reviews or meta-analyses of CAM on adult cancer pain. And the evidence levels were evaluated using GRADE approach. Results. 27 systematic reviews were included. Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain. PMID:24817897

  4. Complementary and alternative medicine for cancer pain: an overview of systematic reviews.

    PubMed

    Bao, Yanju; Kong, Xiangying; Yang, Liping; Liu, Rui; Shi, Zhan; Li, Weidong; Hua, Baojin; Hou, Wei

    2014-01-01

    Background and Objective. Now with more and more published systematic reviews of Complementary and Alternative Medicine (CAM) on adult cancer pain, it is necessary to use the methods of overview of systematic review to summarize available evidence, appraise the evidence level, and give suggestions to future research and practice. Methods. A comprehensive search (the Cochrane Library, PubMed, Embase, and ISI Web of Knowledge) was conducted to identify all systematic reviews or meta-analyses of CAM on adult cancer pain. And the evidence levels were evaluated using GRADE approach. Results. 27 systematic reviews were included. Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain. PMID:24817897

  5. Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Pain

    PubMed Central

    Harrington, Shana; Gilchrist, Laura; Sander, Antoinette

    2014-01-01

    Background Pain is one of the most commonly reported impairments after breast cancer treatment affecting anywhere from 16-73% of breast cancer survivors Despite the high reported incidence of pain from cancer and its treatments, the ability to evaluate cancer pain continues to be difficult due to the complexity of the disease and the subjective experience of pain. The Oncology Section Breast Cancer EDGE Task Force was created to evaluate the evidence behind clinical outcome measures of pain in women diagnosed with breast cancer. Methods The authors systematically reviewed the literature for pain outcome measures published in the research involving women diagnosed with breast cancer. The goal was to examine the reported psychometric properties that are reported in the literature in order to determine clinical utility. Results Visual Analog Scale, Numeric Rating Scale, Pressure Pain Threshold, McGill Pain Questionnaire, McGill Pain Questionnaire – Short Form, Brief Pain Inventory and Brief Pain Inventory – Short Form were highly recommended by the Task Force. The Task Force was unable to recommend two measures for use in the breast cancer population at the present time. Conclusions A variety of outcome measures were used to measure pain in women diagnosed with breast cancer. When assessing pain in women with breast cancer, researchers and clinicians need to determine whether a unidimensional or multidimensional tool is most appropriate as well as whether the tool has strong psychometric properties. PMID:25346950

  6. Feldenkrais method empowers adults with chronic back pain.

    PubMed

    Pugh, Judith Dianne; Williams, Anne M

    2014-01-01

    A phenomenological approach was used to explore the experiences of 11 adults attending Awareness Through Movement lessons in the Feldenkrais Method to manage chronic-episodic back pain. Semistructured interviews were analyzed. The results suggest improving self-efficacy through somatic education and awareness potentially offers a way forward given the back pain epidemic. PMID:24722612

  7. A Community Art Therapy Group for Adults with Chronic Pain

    ERIC Educational Resources Information Center

    O'Neill, Aimee; Moss, Hilary

    2015-01-01

    This paper describes a community art therapy group for people living with chronic pain. Nine adults were offered 12 weekly group art therapy sessions that included art therapy activities such as guided imagery focusing on body scans followed by art responses and artistic expressions of the pain experience. This pilot group art therapy program is…

  8. CE: Intrathecal Pumps for Managing Cancer Pain.

    PubMed

    Textor, Laura Hanssen

    2016-05-01

    : It is estimated that more than 1.6 million new cases of cancer were diagnosed in the United States in 2014. Among patients with cancer, moderate to severe pain is prevalent and can be refractory, even with the use of systemic opioids, which may cause adverse effects that are difficult to manage at the doses required to control pain. When delivered intrathecally, however, opioids and adjuvant analgesics may provide greater pain relief at dramatically lower doses and with fewer adverse effects. Although the use of intrathecal drug delivery systems for cancer pain management has increased dramatically over the past several years and is expected to continue growing, patients with intrathecal pumps often report interactions with nurses unfamiliar with the technology. This article provides an overview of intrathecal pump therapy and explains how it prolongs duration of action and improves the efficacy of certain analgesics while reducing their adverse effects. The author discusses the costs involved, the patients most likely to derive benefit, the types of pumps currently used in the United States, the medications that can be delivered intrathecally, the potential risks and complications associated with intrathecal therapy, and the nursing care required by patients who use an intrathecal pump. PMID:27082422

  9. The impact of chronic low back pain on older adults

    PubMed Central

    Rudy, Thomas E.; Weiner, Debra K.; Lieber, Susan J.; Slaboda, Jill; Boston, J. Robert

    2007-01-01

    Chronic low back pain (CLBP) is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. Many older adults remain quite functional despite CLBP, and because age-related comorbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown. We conducted this research to identify the multidimensional factors that distinguish independent community dwelling older adults with CLBP from those that are pain-free. Three hundred twenty cognitively intact participants (162 with ≥ moderate pain for ≥ 3 months, and 158 pain-free) underwent comprehensive assessment of pain severity, medical comorbidity (illnesses, body mass index, medications), severity of degenerative disc and facet disease, lumbar flexion, psychological constructs (self-efficacy, mood, overall mental health), and self-reported as well as performance-based physical function. Significant differences were ascertained for all 22 measures. Discriminant function analysis revealed that eight measures uniquely maximized the separation between the two groups (self-reported function with the Functional Status Index and the SF-36, performance-based function with repetitive trunk rotation and functional reach, mood with the Geriatric Depression Scale, comorbidity with the Cumulative Illness Rating Scale and BMI, and severity of degenerative disc disease). These results should help to guide investigators that perform studies of CLBP in older adults and practitioners that want an easily adaptable battery for use in clinical settings. PMID:17317008

  10. Evaluation of elbow pain in adults.

    PubMed

    Kane, Shawn F; Lynch, James H; Taylor, Jonathan C

    2014-04-15

    The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior. The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities. Lateral and medial epicondylitis are two of the more common diagnoses and often occur as a result of occupational activities. Patients have pain and tenderness over the affected tendinous insertion that are accentuated with specific movements. If lateral and medial epicondylitis treatments are unsuccessful, ulnar neuropathy and radial tunnel syndrome should be considered. Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing. Biceps tendinopathy is a relatively common source of pain in the anterior elbow; history often includes repeated elbow flexion with forearm supination and pronation. Olecranon bursitis is a common cause of posterior elbow pain and swelling. It can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary. Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions. Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain. Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures. PMID:24784124

  11. How childhood cancers are different from adult cancers

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000845.htm How childhood cancers are different from adult cancers To use the sharing features on this page, ... with cancer can be cured. Types of Childhood Cancers Cancer in children is rare, but some types ...

  12. Measurement Properties of the Non-Communicating Adult Pain Checklist (NCAPC): A Pain Scale for Adults with Intellectual and Developmental Disabilities, Scored in a Clinical Setting

    ERIC Educational Resources Information Center

    Lotan, M.; Moe-Nilssen, R.; Ljunggren, A. E.; Strand, L. I.

    2010-01-01

    The 18 items' Non-Communicating Adult Pain Checklist (NCAPC) has been developed from the 27 items Non-Communicating Children Pain Checklist to better capture pain behavior of adults with Intellectual and Developmental Disabilities (IDD). As part of the NCAPC's measurement properties, internal consistency, reliability and sensitivity to pain have…

  13. Fentanyl Buccal Soluble Film: A Review in Breakthrough Cancer Pain.

    PubMed

    Garnock-Jones, Karly P

    2016-05-01

    Fentanyl buccal soluble film (Onsolis(®), Breakyl(®), Painkyl™) comprises two layers: a mucoadhesive layer containing the active drug, and an inactive layer with the aim of preventing the diffusion of fentanyl into the oral cavity. It is approved in several countries worldwide, including the USA and those of the EU, for the management of breakthrough cancer pain in opioid-tolerant, adult patients with cancer. This article reviews the pharmacological properties of fentanyl buccal soluble film and its clinical efficacy and tolerability in these patients. Fentanyl buccal soluble film provides an additional option for transmucosal delivery of fentanyl, with approximately half of the dose undergoing an initial, rapid absorption via the buccal mucosa (accounting for its high bioavailability). In clinical trials, fentanyl buccal soluble film was associated with significant improvements in pain intensity scores versus placebo and was generally well tolerated. The most common adverse events were typical opioid-associated adverse events, such as nausea and vomiting. Fentanyl buccal soluble film is a useful option for the treatment of breakthrough cancer pain in opioid-tolerant patients. PMID:27007271

  14. Usefulness of Cordotomy in Patients With Cancer Who Experience Bilateral Pain: Implications of Increased Pain and New Pain

    PubMed Central

    Higaki, Nobuhiro; Yorozuya, Toshihiro; Tsubota, Shinzo; Fujii, Tomomi; Fukunaga, Tomoe; Moriyama, Mitsuhide; Yoshikawa, Takeki

    2015-01-01

    BACKGROUND: Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain. OBJECTIVE: To assess the usefulness of cordotomy for bilateral pain from the viewpoint of increased pain or new pain caused by a referred pain mechanism. METHODS: Twenty-six patients who underwent percutaneous cordotomy through C1-C2 for severe bilateral cancer pain in the lumbosacral nerve region were enrolled. Pain was dominant on 1 side in 23 patients, and pain was equally severe on both sides in 3 patients. Unilateral cordotomy was performed for the dominant side of pain, and bilateral cordotomy was performed for 13 patients in whom pain on the nondominant side developed or remained severe after cordotomy. RESULTS: After unilateral cordotomy, 19 patients (73.1%) exhibited increased pain, which for 14 patients was as severe as the original dominant pain. After bilateral cordotomy, 7 patients (53.4%) exhibited new pain, which was located cephalad to the region rendered analgesic by cordotomy and was better controlled than the original pain. No pathological organic causes of new pain were found in any patient, and evidence of a referred pain mechanism was found in 3 patients after bilateral cordotomy. CONCLUSION: These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain. PMID:25603110

  15. Clinical Management of Pain in Advanced Lung Cancer

    PubMed Central

    Simmons, Claribel P.L.; MacLeod, Nicholas; Laird, Barry J.A.

    2012-01-01

    Lung cancer is the most common cancer in the world and pain is its most common symptom. Pain can be brought about by several different causes including local effects of the tumor, regional or distant spread of the tumor, or from anti-cancer treatment. Patients with lung cancer experience more symptom distress than patients with other types of cancer. Symptoms such as pain may be associated with worsening of other symptoms and may affect quality of life. Pain management adheres to the principles set out by the World Health Organization’s analgesic ladder along with adjuvant analgesics. As pain can be caused by multiple factors, its treatment requires pharmacological and non-pharmacological measures from a multidisciplinary team linked in with specialist palliative pain management. This review article examines pain management in lung cancer. PMID:23115483

  16. Associations between adult attachment dimensions and attitudes toward pain behaviour

    PubMed Central

    McWilliams, Lachlan A; Murphy, Paul DJ; Bailey, S Jeffrey

    2010-01-01

    BACKGROUND: Despite the important role positive reinforcement of pain behaviour is believed to play in chronic pain, there is a paucity of research regarding factors that influence the provision of such reinforcement. Attachment theory suggests that individuals high in attachment avoidance view the pain behaviour of others in a negative manner and would, therefore, provide little reinforcement of pain behaviour. As an initial step in evaluating this model, relationships between attachment dimensions and attitudes toward pain behaviour were examined. Attachment avoidance was hypothesized to be negatively associated with accepting attitudes toward pain behaviour. METHODS: A sample of undergraduate students (n=160) completed the Relationships Structures Questionnaire, which provides global ratings of adult attachment dimensions (anxiety and avoidance) by assessing attachment across four relationship targets (friend, mother, father and romantic partner). Attitudes regarding the acceptability of pain behaviour were assessed using male and female versions of the Appropriate Pain Behaviour Questionnaire (APBQ). RESULTS: Consistent with the hypothesis, attachment avoidance was negatively correlated with both APBQ-Female and APBQ-Male scores. Multiple regression analyses were used to investigate the relationships between the attachment scales and the APBQ scales while statistically adjusting for sex and testing for interaction effects. The findings revealed complex relationships involving interaction effects that provided further support for the hypothesis. CONCLUSIONS: The findings provided support for the hypothesis that attachment avoidance is associated with less accepting attitudes toward pain behaviour. Additional research regarding the role of attachment and attitudes on responses to pain behaviour is warranted. PMID:21165372

  17. An Epidemiological Study of Neuropathic Pain Symptoms in Canadian Adults

    PubMed Central

    VanDenKerkhof, Elizabeth G.; Mann, Elizabeth G.; Torrance, Nicola; Smith, Blair H.; Johnson, Ana; Gilron, Ian

    2016-01-01

    The reported prevalence of neuropathic pain ranges from 6.9% to 10%; however the only Canadian study reported 17.9%. The objective of this study was to describe the epidemiology of neuropathic pain in Canada. A cross-sectional survey was conducted in a random sample of Canadian adults. The response rate was 21.1% (1504/7134). Likely or possible neuropathic pain was defined using a neuropathic pain-related diagnosis and a positive outcome on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) or the Douleur Neuropathique 4 (DN4) Questions. The prevalence of likely neuropathic pain was 1.9% (S-LANSS) and 3.4% (DN4) and that of possible neuropathic pain was 5.8% (S-LANSS) and 8.1% (DN4). Neuropathic pain was highest in economically disadvantaged males. There is a significant burden of neuropathic pain in Canada. The low response rate and a slightly older and less educated sample than the Canadian population may have led to an overestimate of neuropathic pain. Population prevalence varies by screening tool used, indicating more work is needed to develop reliable measures. Population level screening targeted towards high risk groups should improve the sensitivity and specificity of screening, while clinical examination of those with positive screening results will further refine the estimate of prevalence. PMID:27445636

  18. Quality of Life in Cancer Patients with Pain in Beijing

    PubMed Central

    Yang, Ping; Sun, Li-qiu; Pang, Dong

    2012-01-01

    Objective To investigate the quality of life (QOL) of cancer pain patients in Beijing, and explore the effect of cancer pain control on patients’ QOL. Methods Self-developed demographic questionnaire, numeric rating scale and SF-36 questionnaire were used together among 643 cancer pain patients in 28 Grade 2nd to 3rd general hospitals and 2 Grade 3rd cancer hospitals. Results The SF-36 eight dimensions scores ranged from 31.75 to 57.22 in these cancer pain patients. The t test and Wilcoxon rank sum test were used to compare the QOL between pain controlled (PC) group and pain uncontrolled (PUC) group, and the results showed that patients in PC group had the higher QOL scores in 6 areas of SF-36 (P<0.05). Binary logistic regression results found that pain management satisfaction scores (P<0.001), family average personal monthly income (P=0.029), current receiving chemotherapy (P=0.009) and cancer stage (P<0.001) were the predictors to cancer pain controlled results. Conclusion Cancer patients with pain in Beijing had poor QOL. Pain control will improve the QOL of cancer pain patients. PMID:23359351

  19. Oxycodone controlled release in cancer pain management.

    PubMed

    Biancofiore, Giuseppe

    2006-09-01

    Oral opioids are the treatment of choice for chronic cancer pain. Morphine is the strong opioid of choice for the treatment of moderate to severe cancer pain according to guidelines from the World Health Organization (WHO). This recommendation by the WHO was derived from availability, familiarity to clinicians, established effectiveness, simplicity of administration, and relative inexpensive cost. It was not based on proven therapeutic superiority over other options. Patients who experience inadequate pain relief or intolerable side effects with one opioid may often be successfully treated with another agent or with the same agent administered by a different route. Opioid rotation, or switching to an alternative opioid, helps some patients achieve better pain control with fewer associated adverse effects. Oxycodone is a mu-opioid receptor specific ligand, with clear agonist properties. It is an active potent opioid, which is in part a kappa-receptor agonist. Like morphine and other pure agonists, there is no known ceiling to the analgesic effects of oxycodone. The active metabolites of oxycodone (eg, oxymorphone) could be important in oxycodone-mediated analgesia. The main pharmacokinetic difference between oxycodone and morphine is in oral bioavailability. The bioavailability of oxycodone is >60% and the bioavailability of morphine is 20%. Controlled-release oxycodone is absorbed in a bi-exponential fashion. There is a rapid phase with a mean half-life of 37 min, accounting for 38% of the dose, and a slow phase with a half-life of 6.2 h, which accounts for the residual 62%. Oxycodone elimination is impaired by renal failure because there are both an increased volume of distribution and reduced clearance. A lot of studies prove that the efficacy of controlled-release oxycodone in cancer-pain control is at least the same as morphine, immediate-release oxycodone and hydromorphone. Its toxicity profile seems better than that of morphine. There are actually several

  20. Cancer-related pain management in clinical oncology.

    PubMed

    Cipta, Andre M; Pietras, Christopher J; Weiss, Timothy E; Strouse, Thomas B

    2015-10-01

    Uncontrolled pain is one of the most feared and debilitating symptoms among cancer patients, and many suffer unnecessarily from suboptimal pain control. Cancer-related pain is often multidimensional and can affect all aspects of a patient's life. Hence, achieving adequate pain relief among cancer patients involves a proper assessment of psychosocial, spiritual, and physical pain issues, matched with an individualized treatment plan involving pharmacologic, nonpharmacologic, and procedural therapies when appropriate. Providing effective pain relief can help ease the overall burden of disease among oncology patients while helping them tolerate cancer-directed therapies and achieve the most optimal quality of life throughout all phases of the disease continuum. In this review, the authors will discuss the syndromes, assessment of, and treatment for cancer-related pain in the outpatient setting. PMID:26862909

  1. For Cancer Patients, Pain May Rise as Finances Dwindle

    MedlinePlus

    ... nih.gov/medlineplus/news/fullstory_157508.html For Cancer Patients, Pain May Rise as Finances Dwindle Suffering can escalate ... policy. More Health News on: Cancer--Living with Cancer Pain Stress Recent Health News Related MedlinePlus Health Topics ...

  2. Adult NREM Parasomnia Associated with Lancinating Throat Pain

    PubMed Central

    Bušková, Jitka; Šonka, Karel

    2014-01-01

    We report the case of a 30-year-old woman presenting with dangerous nocturnal NREM episodes with the clinical feature of lancinating throat pain. We hypothesize that the pain may have represented sensory hallucination analogous to commonly recognized visual images associated with NREM parasomnias. This case is also unusual for probable psychological triggers that could play a role in the pathogenesis of the disease, as evidenced by successful psychotherapy. Citation: Bušková J, Šonka K. Adult NREM parasomnia associated with lancinating throat pain. J Clin Sleep Med 2014;10(8):925-926. PMID:25126041

  3. General Information about Adult Primary Liver Cancer

    MedlinePlus

    ... Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  4. Cancer patient supportive care and pain management. Special listing

    SciTech Connect

    Not Available

    1981-04-01

    This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.

  5. Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements.

    PubMed

    Müller-Schwefe, Gerhard; Ahlbeck, Karsten; Aldington, Dominic; Alon, Eli; Coaccioli, Stefano; Coluzzi, Flaminia; Huygen, Frank; Jaksch, Wolfgang; Kalso, Eija; Kocot-Kępska, Magdalena; Kress, Hans-Georg; Mangas, Ana Cristina; Ferri, Cesar Margarit; Morlion, Bart; Nicolaou, Andrew; Hernández, Concepción Pérez; Pergolizzi, Joseph; Schäfer, Michael; Sichère, Patrick

    2014-09-01

    Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms - rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level. PMID:24841174

  6. P2X receptors: New players in cancer pain

    PubMed Central

    Franceschini, Alessia; Adinolfi, Elena

    2014-01-01

    Pain is unfortunately a quite common symptom for cancer patients. Normally pain starts as an episodic experience at early cancer phases to become chronic in later stages. In order to improve the quality of life of oncological patients, anti-cancer treatments are often accompanied by analgesic therapies. The P2X receptor are adenosine triphosphate (ATP) gated ion channels expressed by several cells including neurons, cancer and immune cells. Purinergic signaling through P2X receptors recently emerged as possible common pathway for cancer onset/growth and pain sensitivity. Indeed, tumor microenvironment is rich in extracellular ATP, which has a role in both tumor development and pain sensation. The study of the different mechanisms by which P2X receptors favor cancer progression and relative pain, represents an interesting challenge to design integrated therapeutic strategies for oncological patients. This review summarizes recent findings linking P2X receptors and ATP to cancer growth, progression and related pain. Special attention has been paid to the role of P2X2, P2X3, P2X4 and P2X7 in the genesis of cancer pain and to the function of P2X7 in tumor growth and metastasis. Therapeutic implications of the administration of different P2X receptor blockers to alleviate cancer-associated pain sensations contemporarily reducing tumor progression are also discussed. PMID:25426266

  7. Single dose oral ibuprofen for acute postoperative pain in adults

    PubMed Central

    Derry, Christopher J; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions. Objectives To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less

  8. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain

    PubMed Central

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10–15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  9. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain.

    PubMed

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  10. [Etiology and prevalence of chronic pain in adults: a narrative review].

    PubMed

    Latina, Roberto; Sansoni, Julita; D'Angelo, Daniela; Di Biagio, Ettore; De Marinis, Maria Grazia; Tarsitani, Gianfranco

    2013-01-01

    The chronic nonmalignant pain is an underestimated epidemiologic health problem. It is a disease in its own right. It is one of the major reasons because patients use health service. The magnitude of chronic pain is in terms of human suffering and costs to society. The aim of this review is to identify the diagnosis and the prevalence of nonmalignant chronic pain in the adults. We have done a review of the literature from 1998 to 2012 using the virtual newspaper libraries starting from data bases (Pub-Med, CINAHL, Cochrane). We have made a narrative review of the articles obtained. Excluding topics of headache, pain for pediatric and geriatric groups, cancer pain and disease-specific items. Studies were classified for year, author sample, methods, age groups and definition of pain. We have obtained 7 articles. These epidemiological studies conducted in different part of the world, reported prevalence rates of chronic pain ranging from 16-53%. They shows a high heterogeneity of results concerning diagnosis and methods. Although limited the number of articles, show the high complexity of the phenomenon. PMID:24083495

  11. The pharmacoeconomics of breakthrough cancer pain.

    PubMed

    Kuo, Kuan-Ling; Saokaew, Surasak; Stenehjem, David D

    2013-06-01

    Breakthrough cancer pain (BTP) has a significant impact on patients' activities of daily living, family, and the society; however, the economic ramifications of BTP are largely unknown. This review aims to summarize the available pharmacoeconomics studies of BTP in the context of the availability of several formulations of rapid-onset opioids administered by various routes, which are significantly more expensive than oral opioids. A systematic literature search of PubMed and Tufts registry through August 2012 was conducted using key words including "breakthrough cancer pain" and "cost effectiveness." After exclusion of irrelevant articles, a total of six articles were included. Studies reviewed include two economic survey studies, two quality improvement projects, and two decision-analytic models. These studies demonstrate BTP causes significant financial burden to patients and society through increased hospitalization and health care utilization. Only one study comparing placebo with intranasal fentanyl spray, oral transmucosal fentanyl citrate, and oral transmucosal fentanyl buccal tablet has demonstrated the cost-effectiveness of these rapid-onset opioids for the treatment of BTP. Overall, there is a lack of pharmacoeconomic studies for BTP management with rapid-onset opioids. Further study is warranted assessing the net benefit of rapid-onset opioids to oral opioids to assist decision-making by patients, clinicians, and payers. PMID:23688496

  12. Road map for pain management in pancreatic cancer: A review.

    PubMed

    Lahoud, Marie José; Kourie, Hampig Raphael; Antoun, Joelle; El Osta, Lana; Ghosn, Marwan

    2016-08-15

    Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief. PMID:27574552

  13. Road map for pain management in pancreatic cancer: A review

    PubMed Central

    Lahoud, Marie José; Kourie, Hampig Raphael; Antoun, Joelle; El Osta, Lana; Ghosn, Marwan

    2016-01-01

    Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief. PMID:27574552

  14. Acidosis and Formaldehyde Secretion as a Possible Pathway of Cancer Pain and Options for Improved Cancer Pain Control.

    PubMed

    Hoang, Ba X; Shaw, D Graeme; Han, Bo; Fang, Josephine Y; Nimni, Marcel

    2015-09-01

    The prevalence of cancer pain in patients with cancer is high. The majority of efforts are spent on research in cancer treatment, but only a small fraction focuses on cancer pain. Pain in cancer patients, viewed predominantly as a secondary issue, is considered to be due to the destruction of tissues, compression of the nerves, inflammation, and secretion of biological mediators from the necrotic tumor mass. As a result, opioid drugs have remained as the primary pharmacological therapy for cancer pain for the past hundred years. This report reviews evidence that cancer pain may be produced by the metabolic effects of two byproducts of cancer-high acidity in the cancer microenvironment and the secretion of formaldehyde and its metabolites. We propose the research and development of therapeutic approaches for preemptive, short- and long-term management of cancer pain using available drugs or nutraceutical agents that can suppress or neutralize lactic acid production in combination with formaldehyde scavengers. We believe this approach may not only improve cancer pain control but may also enhance the quality of life for patients. PMID:26368037

  15. Pain assessment and management in critically ill older adults.

    PubMed

    Kirksey, Kenn M; McGlory, Gayle; Sefcik, Elizabeth F

    2015-01-01

    Older adults comprise approximately 50% of patients admitted to critical care units in the United States. This population is particularly susceptible to multiple morbidities that can be exacerbated by confounding factors like age-related safety risks, polypharmacy, poor nutrition, and social isolation. The elderly are particularly vulnerable to health conditions (heart disease, stroke, and diabetes) that put them at greater risk of morbidity and mortality. When an older adult presents to the emergency department with 1 or more of these life-altering diagnoses, an admission to the intensive care unit is often inevitable. Pain is one of the most pervasive manifestations exhibited by intensive care unit patients. There are myriad challenges for critical care nurses in caring for patients experiencing pain-inadequate communication (cognitively impaired or intubated patients), addressing the concerns of family members, or gaps in patients' knowledge. The purpose of this article was to discuss the multidimensional nature of pain and identify concepts innate to pain homeostenosis for elderly patients in the critical care setting. Evidence-based strategies, including an interprofessional team approach and best practice recommendations regarding pharmacological and nonpharmacological pain management, are presented. PMID:26039645

  16. Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome?

    PubMed

    Kashikar-Zuck, Susmita; King, Christopher; Ting, Tracy V; Arnold, Lesley M

    2016-04-01

    While a majority of research has focused on adult fibromyalgia (FM), recent evidence has provided insights into the presence and impact of FM in children and adolescents. Commonly referred as juvenile fibromyalgia (JFM), youths, particularly adolescent girls, present with persistent widespread pain and cardinal symptoms observed in adult FM. A majority of youth with JFM continue to experience symptoms into adulthood, which highlights the importance of early recognition and intervention. Some differences are observed between adult and juvenile-onset FM syndrome with regard to comorbidities (e.g., joint hypermobility is common in JFM). Psychological comorbidities are common but less severe in JFM. Compared to adult FM, approved pharmacological treatments for JFM are lacking, but non-pharmacologic approaches (e.g., cognitive-behavioral therapy and exercise) show promise. A number of conceptual issues still remain including (1) directly comparing similarities and differences in symptoms and (2) identifying shared and unique mechanisms underlying FM in adults and youths. PMID:26984803

  17. The Infusaid Pump in the Management of Intractable Cancer Pain

    PubMed Central

    Bryant, D'Orsay D.; DeWitty, Robert L.; Dennis, Gary C.

    1987-01-01

    At Howard University Hospital, nine terminally ill cancer patients with chronic pain have been treated with continuous intrathecal infusion of morphine delivered by the implantable Infusaid pump. The case of a patient treated at Howard University Hospital with this method of pain management is presented. Following Infusaid pump insertion, the patient lived for 22 months and obtained substantial relief of his cancer pain with no adverse side effects. PMID:3573060

  18. Pain Prevention Using Head and Neck Cancer as a Model

    PubMed Central

    McMenamin, Erin M.; Grant, Marcia

    2015-01-01

    Pain is a common and often debilitating consequence of cancer and its treatment. Efforts to improve pain management for patients diagnosed with cancer have not resulted in widespread patient reports of acceptable management of pain. Patients and providers alike remain opiophobic due to a number of issues, resulting in suboptimal management of pain. Recent literature has revealed that it may be possible to prevent pain related to cancer and its treatment and therefore avoid or decrease the amount of opioids used to treat pain. This may result in better quality of life for patients. Several newer antiepileptic drugs (AEDs) have been found to decrease the perception of pain in a number of patient populations, including those with head and neck cancer. The side-effect profile for the newer AEDs is mild and well tolerated. Future efforts should focus on the use of newer AEDs to prevent pain in other cancer populations, with a focus on ideal dose and scheduling. Once established, recommendations regarding the prevention of pain in patients with cancer can be incorporated into national guidelines. PMID:26413373

  19. Patient Satisfaction with Pain Level in Patients with Cancer.

    PubMed

    Golas, Mary; Park, Chang Gi; Wilkie, Diana J

    2016-06-01

    Interest in satisfaction with pain management as a pain-related outcome variable wavered when investigators found poor correlations with pain intensity when they measured satisfaction with pain management rather than satisfaction with pain level. The aim was to explore the relationship between satisfaction with pain level and pain intensity among patients receiving ongoing outpatient cancer care. In a comparative, secondary data analysis of a cross-sectional sample of 806 cancer patients (57% male, mean age 56 ± 13 years, 77% Caucasian), the authors measured satisfaction with pain level as a single item (yes, no, not sure) and pain intensity as an average of current, least, and worst pain intensity (all 0-10 scales) in the past 24 hours. Of the 806 participants, 447 (56%) subjects were satisfied with their pain level, 291 (36%) were not satisfied and 68 (8%) were not sure. Satisfaction was moderately correlated with API (rho = -0.43, p < .001). Patients satisfied with their pain levels reported statistically lower mean API scores (2.26 ± 1.70) than those who were not satisfied (4.68 ± 2.07) or not sure (4.21 ± 2.2.1), p < .001. With pair wise post hoc comparisons, mean API scores of satisfied patients were significantly lower than those who were not satisfied or not sure. In contrast with other researchers who have not found associations between satisfaction with pain management and pain intensity, the authors demonstrated that when satisfaction is measured specifically, patients with higher pain intensity are not satisfied. The authors recommend that researchers use "satisfaction with pain level" instead of "satisfaction with pain management" as the pain satisfaction outcome. PMID:27283267

  20. Psychological and behavioral approaches to cancer pain management.

    PubMed

    Syrjala, Karen L; Jensen, Mark P; Mendoza, M Elena; Yi, Jean C; Fisher, Hannah M; Keefe, Francis J

    2014-06-01

    This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain. PMID:24799497

  1. Intrathecal Drug Delivery Systems for Cancer Pain: A Health Technology Assessment

    PubMed Central

    2016-01-01

    Background Intrathecal drug delivery systems can be used to manage refractory or persistent cancer pain. We investigated the benefits, harms, cost-effectiveness, and budget impact of these systems compared with current standards of care for adult patients with chronic pain due owing to cancer. Methods We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library databases, National Health Service's Economic Evaluation Database, and Tufts Cost-Effectiveness Analysis Registry from January 1994 to April 2014 for evidence of effectiveness, harms, and cost-effectiveness. We used existing systematic reviews that had employed reliable search and screen methods and searched for studies published after the search date reported in the latest systematic review to identify studies. Two reviewers screened records and assessed study validity. The cost burden of publicly funding intrathecal drug delivery systems for cancer pain was estimated for a 5-year timeframe using a combination of published literature, information from the device manufacturer, administrative data, and expert opinion for the inputs. Results We included one randomized trial that examined effectiveness and harms, and one case series that reported an eligible economic evaluation. We found very low quality evidence that intrathecal drug delivery systems added to comprehensive pain management reduce overall drug toxicity; no significant reduction in pain scores was observed. Weak conclusions from economic evidence suggested that intrathecal drug delivery systems had the potential to be more cost-effective than high-cost oral therapy if administered for 7 months or longer. The cost burden of publicly funding this therapy is estimated to be $100,000 in the first year, increasing to $500,000 by the fifth year. Conclusions Current evidence could not establish the benefit, harm, or cost-effectiveness of intrathecal drug delivery systems compared with current standards of care for managing refractory cancer pain in

  2. Meta-Analysis of Massage Therapy on Cancer Pain.

    PubMed

    Lee, Sook-Hyun; Kim, Jong-Yeop; Yeo, Sujung; Kim, Sung-Hoon; Lim, Sabina

    2015-07-01

    Cancer pain is the most common complaint among patients with cancer. Conventional treatment does not always relieve cancer pain satisfactorily. Therefore, many patients with cancer have turned to complementary therapies to help them with their physical, emotional, and spiritual well-being. Massage therapy is increasingly used for symptom relief in patients with cancer. The current study aimed to investigate by meta-analysis the effects of massage therapy for cancer patients experiencing pain. Nine electronic databases were systematically searched for studies published through August 2013 in English, Chinese, and Korean. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk-of-bias scales. Twelve studies, including 559 participants, were used in the meta-analysis. In 9 high-quality studies based on the PEDro scale (standardized mean difference, -1.24; 95% confidence interval, -1.72 to -0.75), we observed reduction in cancer pain after massage. Massage therapy significantly reduced cancer pain compared with no massage treatment or conventional care (standardized mean difference, -1.25; 95% confidence interval, -1.63 to -0.87). Our results indicate that massage is effective for the relief of cancer pain, especially for surgery-related pain. Among the various types of massage, foot reflexology appeared to be more effective than body or aroma massage. Our meta-analysis indicated a beneficial effect of massage for relief of cancer pain. Further well-designed, large studies with longer follow-up periods are needed to be able to draw firmer conclusions regarding the effectiveness. PMID:25784669

  3. Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.

    PubMed

    Hanssen, Denise J C; Naarding, Paul; Collard, Rose M; Comijs, Hannie C; Oude Voshaar, Richard C

    2014-10-01

    Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain. PMID:25072890

  4. Behavioral characteristics of a mouse model of cancer pain.

    PubMed

    Lee, Bae Hwan; Seong, Jinsil; Kim, Un Jeng; Won, Ran; Kim, Jiyoung

    2005-04-30

    Pain is a major symptom in cancer patients, and most cancer patients with advanced or terminal cancers suffer from chronic pain related to treatment failure and/or tumor progression. In the present study, we examined the development of cancer pain in mice. Murine hepatocarcinoma cells, HCa-1, were inoculated unilaterally into the thigh or the dorsum of the foot of male C3H/HeJ mice. Four weeks after inoculation, behavioral signs were observed for mechanical allodynia, cold allodynia, and hyperalgesia using a von Frey filament, acetone, and radiant heat, respectively. Bone invasion by the tumor commenced from 7 days after inoculation of tumor cells and was evident from 14 days after inoculation. Cold allodynia but neither mechanical allodynia nor hyperalgesia was observed in mice that received an inoculation into the thigh. On the contrary, mechanical allodynia and cold allodynia, but not hyperalgesia, were developed in mice with an inoculation into the foot. Sometimes, mirror-image pain was developed in these animals. These results suggest that carcinoma cells injected into the foot of mice may develop severe chronic pain related to cancer. This animal model of pain would be useful to elucidate the mechanisms of cancer pain in humans. PMID:15861499

  5. Pain Control: Support for People with Cancer

    MedlinePlus

    ... Support for Caregivers Survivorship Questions to Ask About Cancer Research Advanced Cancer Choices for Care Talking about Advanced ... Cancer and Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Advance ...

  6. Enhancing cancer pain control regimens through patient education.

    PubMed

    Rimer, B; Levy, M H; Keintz, M K; Fox, L; Engstrom, P F; MacElwee, N

    1987-12-01

    The problem of cancer-related pain afflicts millions of people annually. The study described here was aimed at improving cancer patients' pain control through a planned patient education program. A randomized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed materials. The sample included 230 cancer patients. One month later, patients in the experimental group were more likely to have taken their pain medicine on the correct schedule and to have taken the correct dosage. The experimental group also was significantly less likely to report stopping the medicine when they felt better. In addition, they were significantly less worried about tolerance and addiction to pain medicines. Forty-four percent of the experimental group compared to 24% of the control group reported no or mild pain at the posttest. PMID:10315745

  7. Intrathecal Drug Delivery (ITDD) systems for cancer pain

    PubMed Central

    Bhatia, Gaurav; Lau, Mary E; Koury, Katharine M; Gulur, Padma

    2014-01-01

    Intrathecal drug delivery is an effective pain management option for patients with chronic and cancer pain. The delivery of drugs into the intrathecal space provides superior analgesia with smaller doses of analgesics to minimize side effects while significantly improving quality of life. This article aims to provide a general overview of the use of intrathecal drug delivery to manage pain, dosing recommendations, potential risks and complications, and growing trends in the field. PMID:24555051

  8. Single dose oral lumiracoxib for postoperative pain in adults

    PubMed Central

    Roy, Yvonne M; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background Lumiracoxib is a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors were developed to avoid COX-1-related gastrointestinal (GI) problems while maintaining the analgesic and anti-inflammatory activity of traditional non-steriodal anti-inflammatory drugs (NSAIDs). Objectives To review the analgesic efficacy, duration of analgesia, and adverse effects of a single oral dose of lumiracoxib for moderate to severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, and EMBASE to February 2010. Selection criteria Single oral dose, randomised, double-blind, placebo-controlled trials of lumiracoxib for relief of established moderate to severe postoperative pain in adults. Data collection and analysis Studies were assessed for methodological quality and the data extracted by two review authors independently. Summed total pain relief over six hours (TOTPAR 6) was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals, the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over six hours. Numbers of participants using rescue medication, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results In this updated review four studies met the inclusion criteria. In total 366 participants were treated with lumiracoxib 400 mg, 51 with lumiracoxib 100 mg, and 212 with placebo. Active comparators were naproxen 500 mg, rofecoxib 50 mg, celecoxib 200 mg, celecoxib 400 mg, and ibuprofen 400 mg. With lumiracoxib 400 mg 50% of participants had at least 50% pain relief over six hours, compared with 8% given placebo; RB 6.9 (95% CI 4.1 to 12), NNT 2.4 (2.1 to 2.8). Median time to onset of analgesia was shorter for lumiracoxib 400 mg (0.6 to 1.5 hours) than

  9. Many Patients with Cancer Need Better Treatments for Pain

    Cancer.gov

    Inadequate pain treatment in patients with cancer remains a significant problem and appears to be more frequent among minorities, according to a new study published online April 16, 2012, in the Journal of Clinical Oncology.

  10. Breast cancer pain management - A review of current & novel therapies

    PubMed Central

    Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

    2014-01-01

    Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

  11. Validity, Sensitivity, and Responsiveness of the 11-Face Faces Pain Scale to Postoperative Pain in Adult Orthopedic Surgery Patients.

    PubMed

    Van Giang, Nguyen; Chiu, Hsiao-Yean; Thai, Duong Hong; Kuo, Shu-Yu; Tsai, Pei-Shan

    2015-10-01

    Pain is common in patients after orthopedic surgery. The 11-face Faces Pain Scale has not been validated for use in adult patients with postoperative pain. To assess the validity of the 11-face Faces Pain Scale and its ability to detect responses to pain medications, and to determine whether the sensitivity of the 11-face Faces Pain Scale for detecting changes in pain intensity over time is associated with gender differences in adult postorthopedic surgery patients. The 11-face Faces Pain Scale was translated into Vietnamese using forward and back translation. Postoperative pain was assessed using an 11-point numerical rating scale and the 11-face Faces Pain Scale on the day of surgery, and before (Time 1) and every 30 minutes after (Times 2-5) the patients had taken pain medications on the first postoperative day. The 11-face Faces Pain Scale highly correlated with the numerical rating scale (r = 0.78, p < .001). When the scores from each follow-up test (Times 2-5) were compared with those from the baseline test (Time 1), the effect sizes were -0.70, -1.05, -1.20, and -1.31, and the standardized response means were -1.17, -1.59, -1.66, and -1.82, respectively. The mean change in pain intensity, but not gender-time interaction effect, over the five time points was significant (F = 182.03, p < .001). Our results support that the 11-face Faces Pain Scale is appropriate for measuring acute postoperative pain in adults. PMID:25962544

  12. Single dose oral diclofenac for acute postoperative pain in adults

    PubMed Central

    Derry, Philip; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), available as a potassium salt (immediate-release) or sodium salt (delayed-release). This review updates an earlier review published in The Cochrane Database of Systematic Reviews (Issue 2, 2004) on ‘Single dose oral diclofenac for postoperative pain’. Objectives To assess single dose oral diclofenac for the treatment of acute postoperative pain. Search methods Cochrane CENTRAL, MEDLINE, EMBASE, Biological Abstracts, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of single dose, oral diclofenac (sodium or potassium) for acute postoperative pain in adults. Data collection and analysis Two review authors independently assessed studies for inclusion and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants with at least 50% pain relief over 4 to 6 hours, using validated equations. Relative benefit (risk) and number needed to treat to benefit (NNT) were calculated. Information on adverse events, time to remedication, and participants needing additional analgesia was also collected. Main results Fifteen studies (eight additional studies) with 1512 participants more than doubled the information available at each dose. Overall 50% to 60% of participants experienced at least 50% pain relief over 4 to 6 hours at any dose with diclofenac, compared to 10 to 20% with placebo, giving NNTs of about 2.5 for doses of 25 mg to 100 mg (similar to earlier review); no dose response was demonstrated. At 50 mg and 100 mg, NNTs for diclofenac potassium (2.1 (1.8 to 2.4) and 1.9 (1.7 to 2.2)) were significantly lower (better) than for diclofenac sodium (6.7 (4.2 to 17) and 4.5 (3.2 to 7.7)). The median time to use of rescue medication was 2 hours for placebo, 4.3 hours for diclofenac 50 mg and 4.9 hours

  13. New Mechanism of Bone Cancer Pain: Tumor Tissue-Derived Endogenous Formaldehyde Induced Bone Cancer Pain via TRPV1 Activation.

    PubMed

    Wan, You

    2016-01-01

    In recent years, our serial investigations focused on the role of cancer cells-derived endogenous formaldehyde in bone cancer pain. We found that cancer cells produced formaldehyde through demethylation process by serine hydroxymethyltransferase (SHMT1 and SHMT2) and lysine-specific histone demethylase 1 (LSD1). When the cancer cells metastasized into bone marrow, the elevated endogenous formaldehyde induced bone cancer pain through activation on the transient receptor potential vanilloid subfamily member 1 (TRPV1) in the peripheral nerve fibers. More interestingly, TRPV1 expressions in the peripheral fibers were upregulated by the local insulin-like growth factor I (IGF-I) produced by the activated osteoblasts. In conclusion, tumor tissue-derived endogenous formaldehyde induced bone cancer pain via TRPV1 activation. PMID:26900062

  14. Characteristics and associations of pain intensity in patients referred to a specialist cancer pain clinic

    PubMed Central

    Pina, Paulo; Sabri, Elham; Lawlor, Peter G

    2015-01-01

    BACKGROUND: Uncontrolled cancer pain (CP) may impair quality of life. Given the multidimensional nature of CP, its poor control is often attributed to poor assessment and classification. OBJECTIVES: To determine the characteristics and associations of pain intensity in a specialist CP clinic. METHODS: Consecutive patients referred to the CP clinic of the Portuguese Cancer Institute (Lisbon, Portugal) had standardized initial assessments and status documentation of the following: Brief Pain Inventory ratings for ‘pain now’ as the outcome variable; initial pain intensity (iPI) on a 0 to 10 scale; pain mechanism (using the Douleur Neuropathique 4 tool to assess neuropathic pain); episodic pain; Eastern Cooperative Oncology Group rating; oral morphine equivalent daily dose (MEDD); Hospital Anxiety Depression Scale and Emotional Thermometer scores; and cancer diagnosis, metastases, treatment and pain duration. Univariable analyses were conducted to test the association of independent variables with iPI. Variables with P<0.1 were entered into a multivariable regression model, using backward elimination and a cut-point of P=0.2 for final model selection. RESULTS: Of 371 participants, 285 (77%) had moderate (4 to 6) or severe (7 to 10) iPI. The initial median MEDD was relatively low (30 mg [range 20 mg to 60 mg]). In the multivariable model, higher income, Eastern Cooperative Oncology Group rating 3 to 4, cancer diagnosis (head and neck, genitourinary and gastrointestinal), adjuvant use and initial MEDD were associated with iPI (P<0.05). The model’s R2 was 18.6, which explained only 19% of iPI variance. CONCLUSIONS: The diversity of factors associated with pain intensity and their limited explanation of its variance underscore the biopsychosocial complexity of CP. Adequacy of CP management warrants further exploration. PMID:26291125

  15. Topical rubefacients for acute and chronic pain in adults

    PubMed Central

    Matthews, Paul; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Rubefacients (containing salicylates or nicotinamides) cause irritation of the skin, and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter remedies. A non-Cochrane review in 2004 found limited evidence for efficacy. Objectives To review current evidence for efficacy and safety of topically applied rubefacients in acute and chronic painful musculoskeletal conditions in adults. Search methods Cochrane CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Selection criteria Randomised, double blind, placebo or active controlled clinical trials of topical rubefacient for musculoskeletal pain in adults, with at least 10 participants per treatment arm, and reporting outcomes at close to 7 (minimum 3, maximum 10) days for acute conditions and 14 (minimum 7) days or longer for chronic conditions. Data collection and analysis Two review authors independently assessed trials for inclusion and quality, and extracted data. Relative benefit or risk and number needed to treat to benefit or harm (NNT or NNH) were calculated with 95% confidence intervals (CI). Acute and chronic conditions were analysed separately. Main results Six placebo and one active controlled studies (560 and 137 participants) in acute pain, and seven placebo and two active controlled studies (489 and 90 participants) in chronic pain were included. All used topical salicylates. The evidence in acute conditions was not robust; using only better quality, valid studies, there was no difference between topical rubefacient and topical control, though overall, including lower quality studies, the NNT for clinical success compared with placebo was 3.2 (95% CI: 2.4 to 4.9). In chronic conditions the NNT was 6.2 (95% CI: 4.0 to 13) compared with topical placebo. Adverse events and withdrawals occurred more often with rubefacients than placebo

  16. Management of breakthrough pain in children with cancer

    PubMed Central

    Friedrichsdorf, Stefan J; Postier, Andrea

    2014-01-01

    Breakthrough pain in children with cancer is an exacerbation of severe pain that occurs over a background of otherwise controlled pain. There are no randomized controlled trials in the management of breakthrough pain in children with cancer, and limited data and considerable experience indicate that breakthrough pain in this pediatric patient group is common, underassessed, and undertreated. An ideal therapeutic agent would be rapid in onset, have a relatively short duration, and would be easy to administer. A less effective pharmacologic strategy would be increasing a patient’s dose of scheduled opioids, because this may increase the risk of oversedation. The most common and effective strategy seems to be multimodal analgesia that includes an immediate-release opioid (eg, morphine, fentanyl, hydromorphone, or diamorphine) administered intravenously by a patient-controlled analgesia pump, ensuring an onset of analgesic action within minutes. Intranasal fentanyl (or hydromorphone) may be an alternative, but no pediatric data have been published yet for commercially available fentanyl transmucosal application systems (ie, sublingual tablets/spray, buccal lozenge/tablet/film, and nasal spray), and these products cannot yet be recommended for use with children with cancer and breakthrough pain. The aim of this paper was to emphasize the dearth of available information on treatment of breakthrough pain in pediatric cancer patients, to describe the treatment protocols we currently recommend based on clinical experience, and to suggest future research on this very important and under-researched topic. PMID:24639603

  17. Predictors of Pain among Head and Neck Cancer Patients

    PubMed Central

    Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A.; Duffy, Sonia A.

    2014-01-01

    Objective Pain is a strong contributor to cancer patients’ quality of life. The objective of this study was to determine predictors of pain 1 year after the diagnosis of head and neck cancer. Design Prospective, multi-site cohort study. Setting Three academically-affiliated medical centers. Patients Previously untreated patients with carcinoma of the upper aerodigestive tract (n=374). Main Outcome Measures Participants were surveyed pre-treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the SF-36 bodily pain score 1 year after diagnosis. Results The mean SF-36 bodily pain score at 1 year was 65, compared to 61 at diagnosis (p=.004), compared to 75 among population norms (lower scores indicate worse pain). Variables independently associated with pain included pre-treatment pain score (p<0.001), less education (p=0.02), neck dissection (p=0.001), feeding tube (p=0.05), xerostomia (p<0.001), depressive symptoms (p<0.001), taking more pain medication (p<0.001), less physical activity (p=.02), and poor sleep quality (p=0.006). Current smoking and problem drinking were marginally significant (p=0.07 and 0.08, respectively). Conclusions Aggressive pain management may be indicated for head and neck cancer patients who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco and alcohol abuse may also reduce pain and improve quality of life among head and neck cancer patients. PMID:23165353

  18. Carbamazepine for acute and chronic pain in adults

    PubMed Central

    Wiffen, Philip J; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Carbamazepine is used to treat chronic neuropathic pain. Objectives Evaluation of analgesic efficacy and adverse effects of carbamazepine for acute and chronic pain management (except headaches). Search methods Randomised controlled trials (RCTs) of carbamazepine in acute, chronic or cancer pain were identified, searching MEDLINE, EMBASE, SIGLE and Cochrane CENTRAL to June 2010, reference lists of retrieved papers, and reviews. Selection criteria RCTs reporting the analgesic effects of carbamazepine. Data collection and analysis Two authors independently extracted results and scored for quality. Numbers needed to treat to benefit (NNT) or harm (NNH) with 95% confidence intervals (CI) were calculated from dichotomous data for effectiveness, adverse effects and adverse event withdrawal. Issues of study quality, size, duration, and outcomes were examined. Main results Fifteen included studies (12 cross-over design; three parallel-group) with 629 participants. Carbamazepine was less effective than prednisolone in preventing postherpetic neuralgia following acute herpes zoster (1 study, 40 participants). No studies examined acute postoperative pain. Fourteen studies investigated chronic neuropathic pain: two lasted eight weeks, others were four weeks or less (mean 3 weeks, median 2 weeks). Five had low reporting quality. Ten involved fewer than 50 participants; mean and median maximum treatment group sizes were 34 and 29. Outcome reporting was inconsistent. Most placebo controlled studies indicated that carbamazepine was better than placebo. Five studies with 298 participants provided dichotomous results; 70% improved with carbamazepine and 12% with placebo. Carbamazepine at any dose, using any definition of improvement was significantly better than placebo (70% versus 12% improved; 5 studies, 298 participants); relative benefit 6.1 (3.9 to 9.7), NNT 1.7 (1.5 to 2.0). Four studies (188 participants) reporting outcomes equivalent to 50% pain reduction or more

  19. Dynamic cancer pain management outcomes: the relationship between pain severity, pain relief, functional interference, satisfaction and global quality of life over time.

    PubMed

    Hwang, Shirley S; Chang, Victor T; Kasimis, Basil

    2002-03-01

    To examine the relationship between different cancer pain management outcomes over time, 74 patients with the worst cancer related pain rated as four or greater on an 11-point numeric scale were followed weekly with the Brief Pain Inventory (BPI), and the satisfaction questionnaire and global visual analogue scale quality of life (VASQOL) for 3 weeks. Univariate and multivariate regression analyses were performed at weekly time points. The analyses indicated that pain outcomes can be categorized into separate QOL and satisfaction paths linked by the worst pain severity. In the QOL path, the worst pain severity predicted a pain interference score, which consistently predicted VASQOL. For the satisfaction path, independent predictors were pain relief at Week 1, and worst pain severity and changes in worst pain severity at Week 2. No variables predicted satisfaction at Week 3. The data suggest that satisfaction and quality of life may be independent outcomes of pain management. The timing of assessment may itself be important. PMID:11888717

  20. A Practical Approach to Improving Pain Control in Cancer Patients

    PubMed Central

    Brigden, Malcolm L.; Barnett, Jeffrey B.

    1987-01-01

    Despite a wealth of recent articles, many patients with cancer pain continue to suffer needlessly. The satisfactory treatment of cancer pain requires a variety of practical management strategies. Practicing physicians need a wider understanding of both the basic principles of analgesic therapy and the pharmacologic features of analgesics. Certain analgesics are best not used in cancer care. The use of pharmacologic adjuncts may lessen overall narcotic requirements and side effects. The appropriate use of alternative therapies can dramatically improve the quality of patients' overall survival. PMID:2884781

  1. Buprenorphine for cancer pain: is it ready for prime time?

    PubMed

    Prommer, Eric

    2015-12-01

    Buprenorphine (BUP) is a semisynthetic derivative of the opium alkaloid thebaine found in the poppy Papaver somniferum. Its chemical structure contains the morphine structure but differs by having a cyclopropylmethyl group. Buprenorphine is a potent µ opioid agonist. Buprenorphine undergoes extensive first-pass metabolism in the liver and gut. The development of a transdermal BUP formulation in 2001 led to its evaluation in cancer pain. This article provides the practitioner with an update on the current role of BUP in cancer care. It highlights data suggesting effectiveness in various types of cancer pain. The article reviews pharmacology, routes of administration, adverse effects, drug interactions, and cost considerations. PMID:25163678

  2. A Biopsychosocial-Spiritual Model of Chronic Pain in Adults with Sickle Cell Disease

    PubMed Central

    Taylor, Lou Ella V.; Stotts, Nancy A.; Humphreys, Janice; Treadwell, Marsha J.; Miaskowski, Christine

    2011-01-01

    Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biological, psychological, sociological, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model; biopsychosocial model for SCD pain; Health Belief Model) are published. The biopsychosocial (BPS) multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, this dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A BPS-Spiritual model is proposed for adults with chronic pain from SCD since it embraces the whole person. This model includes the biological, psychological, sociological, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel’s model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biological, psychological, sociological, spiritual). The paper concludes with a discussion of implications for the use of this model in research. PMID:24315252

  3. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    PubMed

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner. PMID:24882026

  4. Pain in Breast Cancer Treatment: Aggravating Factors and Coping Mechanisms

    PubMed Central

    Guerreiro Godoy, Maria de Fatima; Pereira de Godoy, Livia Maria; Barufi, Stelamarys; de Godoy, José Maria Pereira

    2014-01-01

    The objective of this study was to evaluate pain in women with breast cancer-related lymphedema and the characteristics of aggravating factors and coping mechanisms. The study was conducted in the Clinica Godoy, São Jose do Rio Preto, with a group of 46 women who had undergone surgery for the treatment of breast cancer. The following variables were evaluated: type and length of surgery; number of radiotherapy and chemotherapy sessions; continued feeling of the removed breast (phantom limb), infection, intensity of pain, and factors that improve and worsen the pain. The percentage of events was used for statistical analysis. About half the participants (52.1%) performed modified radical surgery, with 91.3% removing only one breast; 82.6% of the participants did not perform breast reconstruction surgery. Insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain; it was mild in 28.8% of the cases (scale 1–5), moderate in 34.8% (scale 6–9), and severe in 4.3%. The main mechanisms used to cope with pain were painkillers in 41.30% of participants, rest in 21.73%, religious ceremonies in 17.39%, and chatting with friends in 8.69%. In conclusion, many mastectomized patients with lymphedema complain of pain, but pain is often underrecognized and undertreated. PMID:25349741

  5. Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia.

    PubMed

    Ford, Brianne; Snow, A Lynn; Herr, Keela; Tripp-Reimer, Toni

    2015-10-01

    Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (χ(2) = 19.167, p < .001). No significant differences were noted across ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample. PMID:25962546

  6. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

    PubMed Central

    Toms, Laurence; McQuay, Henry J; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on ‘Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain’. The last version of this review concluded that paracetamol is an effective analgesic for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way. Objectives To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain. Search methods We searched The Cochrane Library, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Area under the “pain relief versus time” curve was used to derive the proportion of participants with paracetamol or placebo experiencing at least 50% pain relief over four to six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated, with 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use, were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected. Main results Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at

  7. Repressive coping style: relationships with depression, pain, and pain coping strategies in lung cancer outpatients.

    PubMed

    Prasertsri, Nusara; Holden, Janean; Keefe, Francis J; Wilkie, Diana J

    2011-02-01

    Researchers have shown that coping style is related to pain and adjustment in people with chronic illness. This study was the first to examine how coping style related to pain, pain coping strategies, and depression in lung cancer outpatients. We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4±10.43 years, 88% Caucasian). As in prior studies, we classified patients into four coping style groups based on Marlowe-Crowne Social Desirability Scale and trait anxiety scores. The coping style groups were low-anxious (n=25); high-anxious (n=31); defensive high-anxious (n=21); and repressive (n=30). Compared to other coping style groups, the repressive group reported statistically significant lower mean scores for pain quality, pain catastrophizing, and depression. Assessing coping style by measuring personal characteristics such as social desirability and trait anxiety may help clinicians to identify vulnerable individuals with lung cancer who may be candidates for early and timely intervention efforts to enhance adjustment to pain. PMID:20557973

  8. Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential

    PubMed Central

    Running, Alice

    2015-01-01

    Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75–90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose. PMID:26170887

  9. Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential.

    PubMed

    Running, Alice

    2015-01-01

    Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75-90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose. PMID:26170887

  10. A feminist critique of research on cancer pain.

    PubMed

    Im, E O; Chee, W

    2001-11-01

    A number of studies on cancer pain have been conducted but the researchers rarely considered gender and ethnic differences in cancer pain. In this article, nursing research on cancer pain is critiqued from a feminist perspective, and directions for future nursing research are proposed. A total of 82 nursing articles published in the United States were retrieved through MEDLINE and MELVYL data retrieval systems, and analyzed and critiqued in terms of four basic elements of research from a feminist perspective (bias as resources, dependability, credibility and adequacy, and intersubjectivity). In this article, the critique is presented with four themes that may provide reasons why nursing research on cancer pain rarely incorporated gender and ethnic differences: absence of participants' own views and experiences, androcentrism and ethnocentrism, lack of consideration on contextual factors, and distant relationships between researchers and research participants. To overcome the limitations, six critical elements including gender and ethnic sensitivity, avoidance of distorted views, respectfor participants' own views and interests, trust and openness, empowerment, and multiple methods are suggested to be incorporated in future nursing research on cancer pain. PMID:11675798

  11. Single dose oral analgesics for acute postoperative pain in adults

    PubMed Central

    Moore, R Andrew; Derry, Sheena; McQuay, Henry J; Wiffen, Philip J

    2014-01-01

    Background Thirty-five Cochrane Reviews of randomised trials testing the analgesic efficacy of individual drug interventions in acute postoperative pain have been published. This overview brings together the results of all those reviews and assesses the reliability of available data. Objectives To summarise data from all Cochrane Reviews that have assessed the effects of pharmaceutical interventions for acute pain in adults with at least moderate pain following surgery, who have been given a single dose of oral analgesic taken alone. Methods We identified systematic reviews in The Cochrane Library through a simple search strategy. All reviews were overseen by a single Review Group, had a standard title, and had as their primary outcome numbers of participants with at least 50% pain relief over four to six hours compared with placebo. For individual reviews we extracted the number needed to treat (NNT) for this outcome for each drug/dose combination, and also the percentage of participants achieving at least 50% maximum pain relief, the mean of mean or median time to remedication, the percentage of participants remedicating by 6, 8, 12, or 24 hours, and results for participants experiencing at least one adverse event. Main results The overview included 35 separate Cochrane Reviews with 38 analyses of single dose oral analgesics tested in acute postoperative pain models, with results from about 45,000 participants studied in approximately 350 individual studies. The individual reviews included only high-quality trials of standardised design and outcome reporting. The reviews used standardised methods and reporting for both efficacy and harm. Event rates with placebo were consistent in larger data sets. No statistical comparison was undertaken. There were reviews but no trial data were available for acemetacin, meloxicam, nabumetone, nefopam, sulindac, tenoxicam, and tiaprofenic acid. Inadequate amounts of data were available for dexibuprofen, dextropropoxyphene 130

  12. Validation of Malay Brief Pain Inventory Questionnaire to Measure Cancer Pain

    PubMed Central

    Aisyaturridha, A; Naing, L; Nizar, AJ

    2005-01-01

    Purpose: This study was conducted to translate and validate the Brief Pain Inventory (BPI) questionnaire in the Malay language. The psychometric properties in terms of construct and concurrent validity of the Malay version of BPI were evaluated. The internal consistency and test-retest stability were also evaluated. Methodology: The original version of BPI was translated into a Malay version by the standard procedure and piloted among 35 cancer patients with pain. A total of 113 (95.0%) agreed to participate in this study out of 119 eligible patients with an age ranging from 18 to 76 years. They were interviewed between August and November 2004 for the main study to evaluate the psychometric properties of Malay version of BPI. Results: The pain intensity items demonstrated high loading with a factor whereas the pain interference items were loaded on the other factor in factor analysis. Two factors explained 62% of the variance. With Karnofsky Performance Scale (KPS), pain intensity scale had a moderate negative (Pearson’s) correlation (r=−0.520, p<0.001) and pain interference scale had a good negative correlation (r=−0.732, p<0.001), showing an appropriate concurrent validity. The coefficient alpha of both scales demonstrated a good internal consistency of the items. The intraclass correlation coefficient for the test-retest stability was 0.61 for the pain intensity scale and 0.88 for the pain interference scale. Conclusion: Overall, the Malay version of the BPI is a reliable and valid instrument for cancer pain assessment and it is comparable with the original version of the BPI in terms of structure and psychometric properties.

  13. Quercetin Reduces Ehrlich Tumor-Induced Cancer Pain in Mice

    PubMed Central

    Calixto-Campos, Cassia; Corrêa, Mab P.; Carvalho, Thacyana T.; Zarpelon, Ana C.; Hohmann, Miriam S. N.; Rossaneis, Ana C.; Coelho-Silva, Leticia; Pavanelli, Wander R.; Pinge-Filho, Phileno; Crespigio, Jefferson; Bernardy, Catia C. F.; Casagrande, Rubia; Verri, Waldiceu A.

    2015-01-01

    Cancer pain directly affects the patient's quality of life. We have previously demonstrated that the subcutaneous administration of the mammary adenocarcinoma known as Ehrlich tumor induces pain in mice. Several studies have shown that the flavonoid quercetin presents important biological effects, including anti-inflammatory, antioxidant, analgesic, and antitumor activity. Therefore, the analgesic effect and mechanisms of quercetin were evaluated in Ehrlich tumor-induced cancer pain in mice. Intraperitoneal (i.p.) treatments with quercetin reduced Ehrlich tumor-induced mechanical and thermal hyperalgesia, but not paw thickness or histological alterations, indicating an analgesic effect without affecting tumor growth. Regarding the analgesic mechanisms of quercetin, it inhibited the production of hyperalgesic cytokines IL-1β and TNFα and decreased neutrophil recruitment (myeloperoxidase activity) and oxidative stress. Naloxone (opioid receptor antagonist) inhibited quercetin analgesia without interfering with neutrophil recruitment, cytokine production, and oxidative stress. Importantly, cotreatment with morphine and quercetin at doses that were ineffective as single treatment reduced the nociceptive responses. Concluding, quercetin reduces the Ehrlich tumor-induced cancer pain by reducing the production of hyperalgesic cytokines, neutrophil recruitment, and oxidative stress as well as by activating an opioid-dependent analgesic pathway and potentiation of morphine analgesia. Thus, quercetin treatment seems a suitable therapeutic approach for cancer pain that merits further investigation. PMID:26351625

  14. Pain Characteristics Associated With the Onset of Disability in Older Adults: The MOBILIZE Boston Study

    PubMed Central

    Eggermont, Laura H.P.; Leveille, Suzanne G.; Shi, Ling; Kiely, Dan K.; Shmerling, Robert H.; Jones, Rich N.; Guralnik, Jack M.; Bean, Jonathan F.

    2014-01-01

    Background/Objectives To determine the effects of chronic pain on the development of disability and decline in physical performance over time among older adults. Design Longitudinal cohort study with 18 months follow-up. Setting Urban/suburban communities Participants 634 community-dwelling older adults aged >64 years. Measurements Chronic pain assessment consisted of musculoskeletal pain locations, and pain severity and pain interference by subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADL, IADL). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models. Results Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18-months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite) and 39% (widespread pain, p-value for trend <0.001). Similar graded effects were found for other disability measures. Elders with multisite or widespread pain had at least a three-fold increased risk for onset of mobility difficulty compared to their peers without pain after adjusting for disability risk factors (multisite pain: RR=2.95, 95%CI, 1.58–5.50; widespread pain: RR=3.57, 95%CI, 1.71–7.48). Widespread pain contributed to decline in mobility performance (1 point decline in SPPB, RR=1.47, 95%CI, 1.08–2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and (I)ADL disability. Weaker and less consistent associations were observed with pain severity. Conclusion Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantial increased risk for developing disability over time and for

  15. A characterization of pain in racially and ethnically diverse older adults: a review of the literature.

    PubMed

    Lavin, Robert; Park, Juyoung

    2014-04-01

    This article presents a critical review of the influence of interracial and ethnic variation on pain prevalence, intensity, interference/function/disability, and treatment in older adults. A search of scientific databases published from 1900 to 2011, using key words associated with pain, geriatrics, and race/ethnicity, identified 180 articles, of which 27 empirical studies met the inclusion criteria. Of the retained articles, 17 reported that race/ethnicity was a statistically significant factor at p < .05. Minority older adults reported a higher prevalence of pain and higher pain intensity, and variable responses regarding function/disability compared with responses by non-Hispanic White older adults. Minority older adults were less likely to receive prescription pharmacologic treatments and surgery, and they were more likely to use complementary and alternative medicine treatments. There are interracial/ethnic differences in pain assessment and treatment interventions among older adults. PMID:24717736

  16. Percentage of Adults Who Receive Colorectal Cancer Screening as Appropriate

    MedlinePlus

    ... Appropriate Percentage of Adults Who Receive Colorectal Cancer Screening as Appropriate Colorectal cancer is the second leading ... Percentage of Adults Who Receive Recommended Colorectal Cancer Screening by Age Group 78pm-ubty Download these data » ...

  17. Pain assessment in the critically ill adult: Recent evidence and new trends.

    PubMed

    Gélinas, Céline

    2016-06-01

    Pain assessment in the critically ill adult remains a daily clinical challenge. Position statements and practice guidelines exist to guide the ICU care team in the pain assessment process. The patient's self-report of pain remains the gold standard measure for pain and should be obtained as often as possible. When self-report is impossible to obtain, observational pain scales including the Behavioural Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) have been recommended for clinical use in the critically ill adult. However, their adaptation and validation in brain-injured and burn ICU patients is required. Family caregivers may help in the identification of pain-related behaviours and should be more involved in the ICU pain assessment process. Fluctuations in vital signs should only be considered as cues for further assessment of pain with appropriate tools, and may better represent adverse events of severe pain. Other physiologic measures of pain should be explored in the ICU, and pupillometry appears as a promising technique to further study. Implementation of systematic pain assessment approaches using tools adapted to the patient's ability to communicate and condition has shown positive effects on ICU pain practices and patient outcomes, but randomised control trials are needed to confirm these conclusions. PMID:27067745

  18. Opioid endocrinopathy: A clinical problem in patients with cancer pain

    PubMed Central

    MERDIN, ALPARSLAN; MERDIN, FATMA AVCI; GÜNDÜZ, ŞEYDA; BOZCUK, HAKAN; COŞKUN, HASAN ŞENOL

    2016-01-01

    Opioids are commonly used in cancer pain management. The present study aimed to investigate the occurrence of endocrine dysfunction in patients with cancer pain treated with opioids. The study included 20 patients with cancer-associated pain. All data were obtained from malignant tumors diagnosed and followed up at the Oncology Clinic of Akdeniz University Hospital (Akdeniz, Turkey) between May 2009 and December 2013. Serum samples were collected to determine the levels of hypophyseal, gonadal and thyroid hormones. The inclusion criteria for the study were as follows: Chronic cancer pain, daily treatment with a morphine equivalent daily dose (MEDD) of ≥25 mg/dl for ≥1 month, and a visual analog score of <2. All independent predictors were evaluated using logistic regression analysis. The results did not demonstrate any significant association between MEDD and gender, or the levels of adrenocorticotropic hormone, cortisol, prolactin, thyroid-stimulating hormone, free thyroxine, follicle-stimulating hormone and luteinizing hormone. However, the levels of testosterone (P=0.040) and of free testosterone (P=0.041) were significantly affected by the MEDD. Conversely, prolactin levels were demonstrated to significantly increase with MEDD (P=0.083). The results also indicated that the required opioid analgesic dose and MEDD were significantly affected by age (P≤0.001). Opioid therapy in patients with cancer may inhibit gonadal function and cause hyperprolactinemia. PMID:27168810

  19. Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

    PubMed Central

    Kern, Kai-Uwe; Nalamachu, Srinivas; Brasseur, Louis; Zakrzewska, Joanna M

    2013-01-01

    An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components. A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies. PMID:23630431

  20. Fentanyl buccal tablet for breakthrough cancer pain: why titrate?

    PubMed

    Kleeberg, Ulrich R; Filbet, Marilène; Zeppetella, Giovambattista

    2011-01-01

    Breakthrough cancer pain is a significant problem for many patients with cancer because of the fast onset and often unpredictable nature of the pain episodes. The rapid onset opioids therefore have a central role to play in the management of breakthrough cancer pain. The rapid onset opioid fentanyl buccal tablet provides a fast analgesic effect and is easy to administer. However, titration of the medication is essential in order to optimize the management of pain. This is because individual patient characteristics, comorbidities, and other treatments may influence the absorption, pharmacokinetics, and pharmacodynamics of drugs. It is therefore important to individualize treatment by determining the effective dose for each patient, which is the dose that provides adequate analgesia and minimizes undesirable adverse effects. Data from clinical studies of fentanyl buccal tablet show that patients' effective doses ranged from 100 to 800 µg per episode, highlighting the need for the titration process. Following successful dose titration, treatment with fentanyl buccal tablet can achieve significant pain relief as early as 10 minutes after administration, resulting in a high level of patient satisfaction. PMID:20807349

  1. The Effect of Sleep Continuity on Pain in Adults with Sickle Cell Disease

    PubMed Central

    Moscou-Jackson, Gyasi; Finan, Patrick H.; Campbell, Claudia M.; Smyth, Joshua M.; Haythornthwaite, Jennifer A.

    2015-01-01

    This analysis examined the influence of quantifiable parameters of daily sleep continuity, primarily sleep duration and sleep fragmentation, on daily pain in adults with Sickle Cell Disease (SCD). Seventy-five adults with SCD completed baseline psychosocial measures and daily morning (sleep) and evening (pain) diaries over a three-month period. Mixed-effect modeling was used to examine daily between- and within-subjects effects of sleep continuity parameters on pain, as well as the synergistic effect of sleep fragmentation and sleep duration on pain. Results revealed nights of shorter sleep duration and time in bed, increased fragmentation, and less efficient sleep (relative to one’s own mean) were followed by days of greater pain severity. Further, the analgesic benefit of longer sleep duration was attenuated when sleep fragmentation was elevated. These results suggest that both the separate and combined effects of sleep duration and fragmentation should be considered in evaluating pain in adults with SCD. PMID:25842346

  2. Reliability of the Non-Communicating Adult Pain Checklist (NCAPC), Assessed by Different Groups of Health Workers

    ERIC Educational Resources Information Center

    Lotan, M.; Moe-Nilssen, R.; Ljunggren, A. E.; Strand, L. I.

    2009-01-01

    Evaluating pain in adults with intellectual and developmental disability (IDD) is a challenge. The Non-Communicating Adults Pain Checklist (NCAPC) was recently developed from the Non-Communicating Children's Pain Checklist (NCCPC) and examined in a group of adults with IDD (N = 228) and found to hold satisfactory construct validity, internal…

  3. Concept analysis of coping with arthritic pain by South Korean older adults: development of a hybrid model.

    PubMed

    Seomun, Gyeong-Ae; Chang, Sung Ok; Lee, Pyoung Sook; Lee, Sook Ja; Shin, Hyun Jeong

    2006-03-01

    This study was conducted to clarify and conceptualize the phenomenon of coping with arthritic pain by older adults. The Hybrid Model of concept development was applied to develop a conceptual structure of coping with arthritic pain by older adults. A refined definition of coping with arthritic pain by older adults emerged that identified the attributes and structure of the concept. This study reveals the characteristics of the ways that older adults cope with arthritic pain, such as how they experience themselves, how pain affects their daily life, and how they perceive the meaning of coping with arthritic pain. These characteristics indicate the complexity of the concept regarding the coping of older adults with arthritic pain. This area needs to be clarified when nursing staff assess coping with pain and plan pain management for older adults. PMID:16451424

  4. Perceptions of Pharmacy Students Concerning Cancer Pain and Its Treatment.

    ERIC Educational Resources Information Center

    Holdsworth, Mark T.; Raisch, Dennis W.

    1993-01-01

    A survey of 62 third- and 105 fourth-year pharmacy students found a number of misperceptions concerning cancer pain and its management that may translate into inadequate provision of care to future patients. Research on educational strategies to address these misperceptions is recommended. (Author/MSE)

  5. [Care-related pain in patients with cancer].

    PubMed

    Arbiol, Évelyne; Brasy, Sonia; Morlière, Lise

    2015-04-01

    The pathway of a patient suffering from cancer can stretch over years, marked by multiple examinations, treatments and procedures. These can all result in induced pain which can be prevented thanks to the knowledge and skills of the caregivers along with pharmacological and non-pharmacological treatments. PMID:26145418

  6. Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain.

    PubMed

    Slater, Helen; Paananen, Markus; Smith, Anne J; OʼSullivan, Peter; Briggs, Andrew M; Hickey, Martha; Mountain, Jenny; Karppinen, Jaro; Beales, Darren

    2015-12-01

    This study investigated the association between menstrual pain severity and psychophysical measures of cold and pressure pain sensitivity. A cross-sectional design was used with young women (n = 432) from the Western Australian Pregnancy Cohort (Raine) Study. Menstrual pain severity and oral contraception use was obtained from questionnaires at 20 and 22-year follow-ups. A visual analog scale (VAS; range from 0 [none] to 10 [unbearable]) was used to measure menstrual pain severity at both 20 and 22 years over the 3-year period, with 3 groups created: (1) no pain or mild pain (VAS 0-3), (2) at least moderate pain at a minimum of 1 of the 2 time points (hereafter named "mixed)", and (3) severe pain (VAS 8-10). Cold pain sensitivity (dorsal wrist) and pressure pain sensitivity (lumbar spine, upper trapezius, dorsal wrist, and tibialis anterior) were assessed using standardised quantitative sensory testing protocols. Confounding variables included number of musculoskeletal pain sites, oral contraceptive use, smoking, physical activity, body mass index, psychological distress, and sleep. Severe menstrual pain and mixed menstrual pain were positively associated with heightened cold pain sensitivity (distant from menstrual pain referral site) and pressure pain sensitivity (local to menstrual pain referral site). These associations remained significant after adjusting for potential confounding variables including multisite musculoskeletal pain. Our findings suggest peripheral and central neurophysiological mechanisms contributing to heightened pain sensitivity in young women with moderate and severe menstrual pain. These data highlight the need for innovative management approaches to attenuate the negative impact of severe menstrual pain in young women. PMID:26262827

  7. The assessment of pain in advanced cancer.

    PubMed Central

    Twycross, R G

    1978-01-01

    This is one of a group of papers read at the London Medical Group conference of "Pain: a necessity?",' which was held in Charing Cross Hospital Medical School, London in February 1978. Dr Twycross argues that complete assessment implies the ability not only to make a diagnosis but also to initiate appropriate treatment. Describing the site, severity and quality of the pain is only the first step. A doctor needs to: 1) Be aware of the range of diagnostic possibilities 2) Appreciate the influences of non-physical factors such as mood and morale 3) Be aware of the range of treatemnt options 4) Establish realistic objectives with the patient 5) Reassess at appropriate intervals to review treatment, monitor side-effects, and develop and maintain a good working relationship with the patient. PMID:691013

  8. Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

    PubMed

    Novy, Diane M; Engle, Mitchell P; Lai, Emily A; Cook, Christina; Martin, Emily C; Trahan, Lisa; Yu, Jun; Koyyalagunta, Dhanalakshmi

    2016-07-01

    The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain. PMID:27454270

  9. Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study

    PubMed Central

    Hicks, Gregory E.; Shardell, Michelle; Miller, Ram R.; Bandinelli, Stefania; Guralnik, Jack; Cherubini, Antonio; Lauretani, Fulvio; Ferrucci, Luigi

    2009-01-01

    OBJECTIVES To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex. DESIGN Population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING Community. PARTICIPANTS Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli. MEASUREMENTS Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L. RESULTS The mean age ± standard deviation was 75.1 ± 7.3 for women and 73.9 ± 6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio = 1.96, 95% confidence interval = 1.01–3.59) but not in men. CONCLUSION Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency. PMID:18331295

  10. Comorbidity in older adults with cancer.

    PubMed

    Williams, Grant R; Mackenzie, Amy; Magnuson, Allison; Olin, Rebecca; Chapman, Andrew; Mohile, Supriya; Allore, Heather; Somerfield, Mark R; Targia, Valerie; Extermann, Martine; Cohen, Harvey Jay; Hurria, Arti; Holmes, Holly

    2016-07-01

    Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population. PMID:26725537

  11. The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.

    PubMed Central

    Fuentes, Molly; Hart-Johnson, Tamera; Green, Carmen R.

    2007-01-01

    The association among race, neighborhood socioeconomic status (SES), and chronic pain has not been well examined in older people. Clinical data was obtained from older adults (>50 years old) presenting to a tertiary care pain center. The relative roles of race and neighborhood SES on the chronic pain experienced in older black and white adults were assessed. Older blacks experienced more affective pain, pain-related disability and mood disorder symptoms than older whites. Confirmatory factor analysis confirmed previously hypothesized factors for the McGill Pain Questionnaire pain dimensions and the Pain Disability Index. Exploratory and confirmatory factor analyses also identified factors in the Brief Symptom Inventory and neighborhood SES. Structural equation modeling showed black race was associated with lower neighborhood SES and also with increased affective pain, obligatory disability and mood disorders mediationally through neighborhood SES. It was indirectly associated with increased sensory and miscellaneous pain, and voluntary disability through low neighborhood SES. Racial interaction examination showed that neighborhood SES had the same relationship to outcomes by race. We found increasing neighborhood SES is associated with decreasing negative chronic pain outcomes for older blacks and whites. Our data provide evidence that both race and neighborhood SES are important factors to consider when examining the chronic pain experience among older Americans. PMID:17987920

  12. “All My Tears Were Gone”: Suffering and Cancer Pain in Southwest American Indians

    PubMed Central

    Haozous, Emily A; Knobf, M. Tish

    2012-01-01

    Context Although minority patients with cancer pain are more likely to be undermedicated for cancer pain than non-Hispanic Whites, little is known about the experience of cancer pain in American Indians (AIs). Objectives To describe the experience of cancer and cancer pain in a sample of southwestern AIs. Methods Ethnographic interviews were conducted with 13 patients and 11 health care providers, caregivers, and community members; two questionnaires were used to collect demographic and pain data. Results Barriers to pain control among AIs included difficulties describing pain, a belief that cancer pain is inevitable and untreatable, and an aversion to taking opioid pain medication. Prescriber inexperience also was cited as a barrier to pain management. AIs described a strong desire to protect their privacy regarding their illness, and many felt that expressing pain was a sign of weakness. The inability to participate in spiritual and cultural activities caused AIs distress, and some discontinued treatment or missed chemotherapy appointments to engage in these activities. Conclusion Results revealed new knowledge about the cancer pain experience in AIs. The observation of the close relationship between treatment compliance and the patient’s ability to participate in ceremonial and spiritual activities provides new insight into the problem of incomplete cancer treatment in this population. The finding that AI patients have a multidimensional conceptualization of pain will assist clinicians with obtaining more detailed and informative pain assessments. PMID:22940564

  13. Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group.

    PubMed

    Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T

    2009-05-19

    Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8-55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes. PMID:19401688

  14. Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

    PubMed Central

    Apolone, G; Corli, O; Caraceni, A; Negri, E; Deandrea, S; Montanari, M; Greco, M T

    2009-01-01

    Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes. PMID:19401688

  15. Management of cancer pain: 1. Wider implications of orthodox analgesics

    PubMed Central

    Lee, Susannah K; Dawson, Jill; Lee, Jack A; Osman, Gizem; Levitin, Maria O; Guzel, Refika Mine; Djamgoz, Mustafa BA

    2014-01-01

    In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA “mimetics” (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients. PMID:24470767

  16. Management of cancer pain: 1. Wider implications of orthodox analgesics.

    PubMed

    Lee, Susannah K; Dawson, Jill; Lee, Jack A; Osman, Gizem; Levitin, Maria O; Guzel, Refika Mine; Djamgoz, Mustafa Ba

    2014-01-01

    In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA "mimetics" (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients. PMID:24470767

  17. Acidic microenvironment and bone pain in cancer-colonized bone

    PubMed Central

    Yoneda, Toshiyuki; Hiasa, Masahiro; Nagata, Yuki; Okui, Tatsuo; White, Fletcher A

    2015-01-01

    Solid cancers and hematologic cancers frequently colonize bone and induce skeletal-related complications. Bone pain is one of the most common complications associated with cancer colonization in bone and a major cause of increased morbidity and diminished quality of life, leading to poor survival in cancer patients. Although the mechanisms responsible for cancer-associated bone pain (CABP) are poorly understood, it is likely that complex interactions among cancer cells, bone cells and peripheral nerve cells contribute to the pathophysiology of CABP. Clinical observations that specific inhibitors of osteoclasts reduce CABP indicate a critical role of osteoclasts. Osteoclasts are proton-secreting cells and acidify extracellular bone microenvironment. Cancer cell-colonized bone also releases proton/lactate to avoid intracellular acidification resulting from increased aerobic glycolysis known as the Warburg effect. Thus, extracellular microenvironment of cancer-colonized bone is acidic. Acidosis is algogenic for nociceptive sensory neurons. The bone is densely innervated by the sensory neurons that express acid-sensing nociceptors. Collectively, CABP is evoked by the activation of these nociceptors on the sensory neurons innervating bone by the acidic extracellular microenvironment created by bone-resorbing osteoclasts and bone-colonizing cancer cells. As current treatments do not satisfactorily control CABP and can elicit serious side effects, new therapeutic interventions are needed to manage CABP. Understanding of the cellular and molecular mechanism by which the acidic extracellular microenvironment is created in cancer-colonized bone and by which the expression and function of the acid-sensing nociceptors on the sensory neurons are regulated would facilitate to develop novel therapeutic approaches for the management of CABP. PMID:25987988

  18. PERSISTENT BREAST PAIN FOLLOWING BREAST CANCER SURGERY IS ASSOCIATED WITH PERSISTENT SENSORY CHANGES, PAIN INTERFERENCE, AND FUNCTIONAL IMPAIRMENTS

    PubMed Central

    Langford, Dale J.; Paul, Steven M.; West, Claudia; Levine, Jon D.; Hamolsky, Deborah; Elboim, Charles; Schmidt, Brian L.; Cooper, Bruce A.; Abrams, Gary; Aouizerat, Bradley E.; Miaskowski, Christine

    2014-01-01

    Inter-individual variability exists in persistent breast pain following breast cancer surgery. Recently, we used growth mixture modeling to identify three subgroups of women (n=398) with distinct persistent breast pain trajectories over six months following surgery (i.e., Mild, Moderate, Severe). Purposes of this study were to identify demographic and clinical characteristics that differed among the breast pain classes and, using linear mixed effects modeling, determine how changes over time, in sensitivity in the breast scar area, pain qualities, pain interference, and hand and arm function differed among these classes. Several demographic and clinical characteristics differentiated the breast pain classes. Of note, 60% to 80% of breast scar sites tested were much less sensitive than the unaffected breast. Significant group effects were observed for pain qualities and interference scores, such that, on average, women in the Severe Pain class reported higher scores than women in the Moderate Pain class. In addition, women in the Moderate Pain class reported higher scores than women in the Mild Pain class. Compared to the Mild Pain class, women in the Severe Pain class had significantly impaired grip strength and women in the Moderate and Severe Pain classes had impaired flexion and abduction. PMID:25439318

  19. Bedside charting of pain levels in hospitalized patients with cancer: a randomized controlled trial.

    PubMed

    Kravitz, R L; Delafield, J P; Hays, R D; Drazin, R; Conolly, M

    1996-02-01

    Despite advances in the technology of cancer pain assessment and control, cancer pain often remains undertreated even in hospital settings. To determine whether a graphical display of cancer patients' pain levels might improve their treatment, the investigators conducted a randomized controlled trial. Patients assigned to the intervention group (N = 40) had periodic pain assessments by study staff, who graphically recorded their reported pain-intensity levels on bedside wall charts. Control group patients (N = 38) had periodic pain assessments by study staff but did not have this information displayed. The results failed to show a significant beneficial effect of the intervention on pain control, sleep, cancer-related symptoms, or analgesic dosing, but confidence intervals were broad. More research is needed to improve the quality of care for inpatients with cancer-related pain. PMID:8907138

  20. [Pharmacotherapy of cancer pain : 2. Use of opioids.].

    PubMed

    Cherny, N I; Portenoy, R K; Raber, M; Zenz, M

    1995-01-01

    The adequate use of opioids in the treatment of chronic cancer pain requires sound knowledge of selection criteria for the various opioids, the routes of administration, dosages, dosing schemes and possible side effects. Drug selection depends on the intensity of pain rather than on the specific pathophysiology. Mild to moderate pain can often be treated effectively by so-called "weak" opioids. These include codeine, dihydrocodeine and dextropropoxyphene. Non-opioid analgesics, like acetylsalicylic acid or paracetamol can be added according to the "analgesic ladder" proposed by the World Health Organization (WHO). If adequate pain relief is not achieved "strong" opioids are required. The route of administration that is the safest and the least invasive for the patient should be chosen. Non-invasive (oral, rectal, sublingual, transdermal and intranasal) and invasive routes (intravenous, subcutaneous, spinal and epidural) are available (Table 8). Noninvasive routes are preferred, and most patients can be maintained on oral opioids. Alternatively, in some patients pain can be managed by the sublingual (buprenorphine) route. A transdermal preparation exists for fentanyl, but has not yet been approved for the German market. If the oral route cannot be used or if large doses are required, it will be necessary to change to an invasive route. Intravenous bolus injections provide the fastest onset of analgesic action. They are mostly used in very severe pain. Repeated injections can be avoided by using intravenous or subcutaneous infusions. Various types of pumps delivering analgesics at constant basal infusion rates with the option of rescue doses in case of breakthrough pain are available (patient-controlled analgesia=PCA). Opioids frequently used for s. c. infusion are morphine and hydromorphone. Adjuvant drugs (antiemetics, anxiolytics) can be added. Epidural or intrathecal administration of opioids should only be used in intractable pain or if severe side effects, such

  1. Sodium Channels in Pain and Cancer: New Therapeutic Opportunities.

    PubMed

    Luiz, Ana Paula; Wood, John N

    2016-01-01

    Voltage-gated sodium channels (VGSCs) underpin electrical activity in the nervous system through action potential propagation. First predicted by the modeling studies of Hodgkin and Huxley, they were subsequently identified at the molecular level by groups led by Catterall and Numa. VGSC dysfunction has long been linked to neuronal and cardiac disorders with some nonselective sodium channel blockers in current use in the clinic. The lack of selectivity means that side effect issues are a major impediment to the use of broad spectrum sodium channel blockers. Nine different sodium channels are known to exist, and selective blockers are now being developed. The potential utility of these drugs to target diseases ranging from migraine, multiple sclerosis, muscle, and immune system disorders, to cancer and pain is being explored. Four channels are potential targets for pain disorders. This conclusion comes from mouse knockout studies and human mutations that prove the involvement of Nav1.3, Nav1.7, Nav1.8, and Nav1.9 in the development and maintenance of acute and chronic pain. In this chapter, we present a short overview of the possible role of Nav1.3, Nav1.7, Nav1.8, and Nav1.9 in human pain and the emerging and unexpected role of sodium channels in cancer pathogenesis. PMID:26920012

  2. The role of morphine glucuronides in cancer pain.

    PubMed

    Mercadante, S

    1999-03-01

    Morphine metabolites are involved in various ways in determining the complex effects of morphine, both favourable and adverse, and may complicate the clinical use of morphine in the treatment of cancer pain. The production and effects of the principal morphine metabolites, morphine-3-glucuronide and morphine-6-glucuronide, in both normal and pathological states have been reviewed in the current literature. Therapeutic implications are also reviewed on the basis of experimental and clinical reports. The presence of these metabolites should be recognized in the chronic treatment of cancer pain with morphine, especially in the presence of renal impairment, and should be considered to have an important influence on opioid responsiveness, defined as a balance between the achievement of an optimal analgesia and the occurrence of adverse effects. PMID:10474692

  3. Abdominal pain as initial presentation of lung cancer

    PubMed Central

    Eisa, Naseem; Alhafez, Bishr; Alraiyes, Abdul Hamid; Alraies, M Chadi

    2014-01-01

    Isolated spleen metastasis (ISM) in general is very rare with a reported incidence of 2.3–7.1% for all solid cancers. Lung cancers rarely metastasise to the spleen. It is very atypical for ISM to be the initial presentation of lung cancer as well. In our case, a 55-year-old woman presented with a 3-week history of left-sided abdominal fullness and dull pain. Workup was remarkable for splenic mass that turns out to be adenocarcinoma with unknown primary tumour. Biopsy of the mass with immunohistochemistry and whole body position emission tomography scan was able to identify lung cancer as the primary tumour. The patient underwent splenectomy, wedge resection of the lung mass along with short-course of chemotherapy. She never had any recurrences since then. PMID:24835801

  4. Dissociation between the relief of skeletal pain behaviors and skin hypersensitivity in a model of bone cancer pain.

    PubMed

    Guedon, Jean-Marc G; Longo, Geraldine; Majuta, Lisa A; Thomspon, Michelle L; Fealk, Michelle N; Mantyh, Patrick W

    2016-06-01

    Recent studies have suggested that in humans and animals with significant skeletal pain, changes in the mechanical hypersensitivity of the skin can be detected. However, whether measuring changes in skin hypersensitivity can be a reliable surrogate for measuring skeletal pain itself remains unclear. To explore this question, we generated skeletal pain by injecting and confining GFP-transfected NCTC 2472 osteosarcoma cells unilaterally to the femur of C3H male mice. Beginning at day 7 post-tumor injection, animals were administered vehicle, an antibody to the P2X3 receptor (anti-P2X3) or anti-NGF antibody. Pain and analgesic efficacy were then measured on days 21, 28, and 35 post-tumor injection using a battery of skeletal pain-related behaviors and von Frey assessment of mechanical hypersensitivity on the plantar surface of the hind paw. Animals with bone cancer pain treated with anti-P2X3 showed a reduction in skin hypersensitivity but no attenuation of skeletal pain behaviors, whereas animals with bone cancer pain treated with anti-NGF showed a reduction in both skin hypersensitivity and skeletal pain behaviors. These results suggest that although bone cancer can induce significant skeletal pain-related behaviors and hypersensitivity of the skin, relief of hypersensitivity of the skin is not always accompanied by attenuation of skeletal pain. Understanding the relationship between skeletal and skin pain may provide insight into how pain is processed and integrated and help define the preclinical measures of skeletal pain that are predictive end points for clinical trials. PMID:27186713

  5. Caregiver Experiences of Supporting Adults with Intellectual Disabilities in Pain

    ERIC Educational Resources Information Center

    Findlay, Laura; Williams, Amanda C. de C.; Baum, Sandra; Scior, Katrina

    2015-01-01

    Background: Caregivers have an intimate knowledge of the individuals they care for and are therefore an important source of information on pain experiences. They are often relied upon to recognize pain-related behaviours and report them, but little is known as to how they experience their role. Methods: Information was collected from 11 caregivers…

  6. The Prevalence and Characteristics of Pain in Critically Ill Cancer Patients: A Prospective Nonrandomized Observational Study

    PubMed Central

    Gupta, Mayank; Sahi, Malvinder Singh; Bhargava, AK; Talwar, Vineet

    2015-01-01

    Context: Pain is a distressing symptom common to all stages and ubiquitous at all levels of care in cancer patients. However, there is a lack of scientific literature on prevalence, severity, predictors, and the quality of pain in cancer patients admitted to an Intensive Care Unit (ICU). Objectives: To elucidate the prevalence of pain, moderate to severe pain, neuropathic pain, chronic pain, and pain as the most distressing symptom in critically ill-cancer patients at the time of ICU admission. Methods: We prospectively interviewed 126 patients within first 24 h of admission to a medical ICU. The patients were assessed for the presence of pain, its severity, sites, duration, nature, and its impact as a distressing symptom. Numerical Rating Scale and self-report version of Leeds Assessment of Neuropathic Signs and Symptoms were used to elucidate intensity of pain and neuropathic pain, respectively. Demographic characteristics such as age and sex, primary site, and stage of cancer were considered for a possible correlation with the prevalence of pain. Results: Of 126 patients included in the study 95 (75.40%), 79 (62.70%), 34 (26.98%), and 17 (13.49%) patients had pain, moderate-severe, chronic, and neuropathic pain, respectively. The average duration of pain was 171.16 ± 716.50 days. Totally, 58 (46.03%) and 42 (42.01%) patients had at least one and more than equal to 2 neuropathic pain symptoms, respectively. The primary malignancies associated with the highest prevalence of pain were genitourinary, hematological, and head and neck whereas breast and lung cancers were associated with the highest prevalence of neuropathic and chronic pain, respectively. Conclusion: The prevalence of pain among critically ill-cancer patients is high. Assessment for pain at the time of ICU admission would ensure appropriate assessment for the presence, type, severity, and the significance imparted to it. PMID:26600692

  7. Characteristics and prognostic factors for pain management in 152 patients with lung cancer

    PubMed Central

    Shi, Lei; Liu, Yumei; He, Hua; Wang, Cong; Li, Hongwei; Wang, Nanya

    2016-01-01

    Objective The objective of this study was to analyze the pain characteristics and factors influencing the outcome of pain control in patients with lung cancer having pain. Methods Pain characteristics, the effectiveness, and prognostic factors for pain control were analyzed in 152 patients with lung cancer having moderate or severe chronic pain admitted to Cancer Center of The First Hospital of Jilin University, People’s Republic of China, between January 2012 and May 2013. Information about sex, age, pathological type, TNM stage, presence/absence of bone metastases, characteristics of pain, methods, and effectiveness of pain management was recorded. Results Patients with non-small-cell lung cancer and small-cell carcinoma accounted for 132/152 (86.8%) and 20/152 (13.2%) cases, respectively. Among them, moderate (72.4%) or severe pain (27.6%) was reported in 73.7% of the cases at stage IV, chest or back pain was reported in 76.3% of the cases, and pain in other locations in the rest of the cases. Bone metastases were apparent in 44.1% of the patients. Neuropathic pain was noted in 46.7% of the patients, and frequent breakthrough pain was noted in 25.7% of the patients. High pain intensity was associated with frequent breakthrough pain. Pain was adequately controlled in 81.6% of the patients prescribed 3 days of analgesics. More patients reported a KPS higher than or equal to 80 after 3 days of analgesic treatment (P<0.001). Severe pain, frequent breakthrough pain, and presence of bone metastases were independent risk factors for poor pain control. Severe pain, frequent breakthrough pain, or neuropathic pain in the patients using opioids required higher doses of analgesic for pain control. Opioids plus nonsteroidal anti-inflammatory drugs offered better pain control than opioids alone. Conclusion High pain intensity is associated with frequent breakthrough pain in patients with lung cancer, which can be largely controlled with analgesics. Severe pain, frequent

  8. The Walker 256 Breast Cancer Cell- Induced Bone Pain Model in Rats

    PubMed Central

    Shenoy, Priyank A.; Kuo, Andy; Vetter, Irina; Smith, Maree T.

    2016-01-01

    The majority of patients with terminal breast cancer show signs of bone metastasis, the most common cause of pain in cancer. Clinically available drug treatment options for the relief of cancer-associated bone pain are limited due to either inadequate pain relief and/or dose-limiting side-effects. One of the major hurdles in understanding the mechanism by which breast cancer causes pain after metastasis to the bones is the lack of suitable preclinical models. Until the late twentieth century, all animal models of cancer induced bone pain involved systemic injection of cancer cells into animals, which caused severe deterioration of animal health due to widespread metastasis. In this mini-review we have discussed details of a recently developed and highly efficient preclinical model of breast cancer induced bone pain: Walker 256 cancer cell- induced bone pain in rats. The model involves direct localized injection of cancer cells into a single tibia in rats, which avoids widespread metastasis of cancer cells and hence animals maintain good health throughout the experimental period. This model closely mimics the human pathophysiology of breast cancer induced bone pain and has great potential to aid in the process of drug discovery for treating this intractable pain condition.

  9. Management of persistent pain in older adults: the MOBILIZE Boston Study

    PubMed Central

    Stewart, Carrie; Leveille, Suzanne G.; Shmerling, Robert H.; Samelson, Elizabeth J.; Bean, Jonathan F.; Schofield, Pat

    2012-01-01

    Objectives To describe the prevalence of pharmacological (PS) and nonpharmacological (NPS) pain management approaches used by older adults with persistent pain, and identify characteristics associated with use of these approaches. Design Population-based cohort Setting Urban and suburban communities in the Boston, Massachusetts area. Participants 765 adults aged ≥64 years underwent a home interview and clinic exam. Those reporting any persistent pain were included in this analysis (N=599). Measurements All prescription and non-prescription medications were recorded during the home interview. NPS for pain management were assessed using a modification of the Pain Management Inventory. The baseline assessment included extensive measures of pain, health and functioning. Results More than one third (37.5%) of participants reported using both PS and NPS modalities. Thirty-one percent reported use of NPS alone and 11.5% used PS alone. NPS were reported more frequently than PS (68.4% vs. 49%). Women (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.26-3.82), those with knee OA (OR=3.07, 95%CI 1.6,- 5.9) and with moderate to severe pain (OR=5.02, CI-2.23,11.28) were more likely to report combined use of both PS and NPS. Characteristics associated with individual NPS modalities varied greatly. Conclusion Only one-third of older adults with persistent pain reported pain management strategies consistent with current guidelines. Further research is required to understand reasons behind choices, barriers to adherence and the benefits of multiple modalities used by older adults who have persistent pain. PMID:23126624

  10. The relationship between drug use, drug-related arrests, and chronic pain among adults on probation

    PubMed Central

    Walters, Scott T.; Lerch, Jennifer; Taxman, Faye S.

    2014-01-01

    The intersection between chronic health conditions, drug use, and treatment seeking behavior among adults in the criminal justice system has been largely understudied. This study examined whether chronic pain was associated with opiate use, other illicit drug use, and drug-related arrests in a sample of substance-using probationers. We expected that probationers with chronic pain-related diagnoses would report more opiate use and drug-related arrests. This study used baseline data from 250 adults on probation in Baltimore, Maryland and Dallas, Texas who were participating in a larger clinical trial. Eighteen percent of probationers in this sample reported suffering from chronic pain. In bivariate analyses, probationers with chronic pain reported more drug-related arrests (t=−1.81; p<0.05) than those without chronic pain. Multivariate analyses support the hypothesis that probationers who reported chronic pain were marginally more likely to use opiates (OR=2.37; 95% CI .89–1.05) and non-opiate illicit drugs (OR=3.11; 95% CI 1.03–9.39) compared to offenders without chronic pain. In summary, these findings suggest that adults under probation supervision who suffer from chronic pain may be involved in criminal activity (specifically, drug-related criminal activity) in an effort to self-medicate their physical health condition(s). Screening probationers for chronic pain in the probation setting and referring these adults to pain management treatment may be an important step in advancing public safety. PMID:25595302

  11. Sleep Quality, Pain and Self-Efficacy among Community-Dwelling Adults with Sickle Cell Disease.

    PubMed

    Adegbola, Maxine

    2015-07-01

    The aim of this paper was to report the findings of a study examining relationships among sleep, pain, self-efficacy, and demographic attributes of community-dwelling adults with sickle cell disease (SCD). Sleep difficulty has been self-reported among adults with chronic pain. Past studies have demonstrated that chronic pain results in sleep difficulties and other complications that threaten effective functioning. Community-dwelling adults with SCD are living longer and need to be evaluated for sleep quality, pain, and self-efficacy. Little is known about whether adults with SCD-related pain have disturbances in sleep and self-efficacy, and if these disturbances are affected by age and/or gender. The purpose of this descriptive, correlational study was to examine the relationships among sleep, pain, self-efficacy, and demographic attributes among community-dwelling adults with SCD, and who use support services of state SCD Associations in the United States. For this secondary data analysis, the study was conducted from June, 2014 to December, 2014 and used a descriptive correlational design to analyze data from a primary study of a convenience sample of 90 subjects with SCD, who were 18 years of age and older. Linear regression was used to compute the relationship between dependent and independent variables. All measures were self-reported. It was found that gender did not significantly affect reports of sleep, pain, or self-efficacy. Self-efficacy accounted for direct relationships with sleep and inverse relationships with pain. Some individuals (16.7%) reported sleeping very well, however, the majority (83.3%) was not sleeping very well, and a greater number of individuals (93.3%) reported having some pain. Among adults with chronic SCD pain, self-efficacy is important in maintaining a stable quality of health. Future assessments, interventions, and research should include comprehensive sleep and pain evaluations, and measures to improve self-efficacy and sleep

  12. Sleep Quality, Pain and Self-Efficacy among Community-Dwelling Adults with Sickle Cell Disease

    PubMed Central

    Adegbola, Maxine

    2016-01-01

    The aim of this paper was to report the findings of a study examining relationships among sleep, pain, self-efficacy, and demographic attributes of community-dwelling adults with sickle cell disease (SCD). Sleep difficulty has been self-reported among adults with chronic pain. Past studies have demonstrated that chronic pain results in sleep difficulties and other complications that threaten effective functioning. Community-dwelling adults with SCD are living longer and need to be evaluated for sleep quality, pain, and self-efficacy. Little is known about whether adults with SCD-related pain have disturbances in sleep and self-efficacy, and if these disturbances are affected by age and/or gender. The purpose of this descriptive, correlational study was to examine the relationships among sleep, pain, self-efficacy, and demographic attributes among community-dwelling adults with SCD, and who use support services of state SCD Associations in the United States. For this secondary data analysis, the study was conducted from June, 2014 to December, 2014 and used a descriptive correlational design to analyze data from a primary study of a convenience sample of 90 subjects with SCD, who were 18 years of age and older. Linear regression was used to compute the relationship between dependent and independent variables. All measures were self-reported. It was found that gender did not significantly affect reports of sleep, pain, or self-efficacy. Self-efficacy accounted for direct relationships with sleep and inverse relationships with pain. Some individuals (16.7%) reported sleeping very well, however, the majority (83.3%) was not sleeping very well, and a greater number of individuals (93.3%) reported having some pain. Among adults with chronic SCD pain, self-efficacy is important in maintaining a stable quality of health. Future assessments, interventions, and research should include comprehensive sleep and pain evaluations, and measures to improve self-efficacy and sleep

  13. Prenatal endotoxin exposure alters behavioural pain responses to lipopolysaccharide in adult offspring.

    PubMed

    Hodyl, Nicolette A; Walker, F Rohan; Krivanek, Klara M; Clifton, Vicki L; Hodgson, Deborah M

    2010-05-11

    Evidence suggests that exposure to bacterial endotoxin in early life can alter the production of pro-inflammatory cytokines in later life. This phenomenon may have significant consequences for pain and pain related behaviours as pro-inflammatory cytokines heighten pain sensitivity. This association has yet to be examined. As such, the aim of the present study was to characterize pain behaviours in adult rat offspring following prenatal endotoxin (PE) exposure. Pregnant F344 rats received endotoxin (200microg/kg, s.c.) or saline on gestational days 16, 18 and 20. Pain thresholds were assessed in the adult PE offspring (n=23) and control offspring (n=24) prior to and 4h following administration of lipopolysaccharide (LPS; 100microg/kg, s.c.). Three assays of pain were employed - the hot plate, tail immersion and von Frey tests. Results demonstrated sex-specific effects of prenatal endotoxin on the offspring, with PE males displaying unaltered pain thresholds on the von Frey test post-LPS administration (p<0.01), while male control offspring (n=24) displayed the expected hyperalgesia. Male PE offspring also displayed increased pain thresholds on the tail immersion test (p<0.01), while no change in pain sensitivity was observed in control males following LPS exposure. No difference in response was observed between the female PE and control offspring on the von Frey test, however PE female offspring displayed increased thresholds on the tail immersion test compared to baseline - an effect not observed in the control female offspring. Pain sensitivity on the hot plate test was unaffected by prenatal exposure to endotoxin. These data suggest that prenatal exposure to products associated with bacterial infection have the capacity to alter pain responses, which are evident in the adult offspring. PMID:20184906

  14. Pain

    MedlinePlus

    ... realize you have a medical problem that needs treatment. Once you take care of the problem, pain ... Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain. Pain ...

  15. Transcutaneous electrical nerve stimulation for phantom pain and stump pain in adult amputees.

    PubMed

    Mulvey, Matthew R; Radford, Helen E; Fawkner, Helen J; Hirst, Lynn; Neumann, Vera; Johnson, Mark I

    2013-04-01

    Following amputation, 50% to 90% of individuals experience phantom and/or stump pain. Transcutaneous electrical nerve stimulation (TENS) may prove to be a useful adjunct analgesic intervention, although a recent systematic review was unable to judge effectiveness owing to lack of quality evidence. The aim of this pilot study was to gather data on the effect of TENS on phantom pain and stump pain at rest and on movement. Ten individuals with a transtibial amputation and persistent moderate-to-severe phantom and/or stump pain were recruited. Inclusion criteria was a baseline pain score of ≥3 using 0 to 10 numerical rating scale (NRS). TENS was applied for 60 minutes to generate a strong but comfortable TENS sensation at the site of stump pain or projected into the site of phantom pain. Outcomes at rest and on movement before and during TENS at 30 minutes and 60 minutes were changes in the intensities of pain, nonpainful phantom sensation, and prosthesis embodiment. Mean (SD) pain intensity scores were reduced by 1.8 (1.6) at rest (P < 0.05) and 3.9 (1.9) on movement (P < 0.05) after 60 minutes of TENS. For five participants, it was possible to project TENS sensation into the phantom limb by placing the electrodes over transected afferent nerves. Nonpainful phantom sensations and prosthesis embodiment remained unchanged. This study has demonstrated that TENS has potential for reducing phantom pain and stump pain at rest and on movement. Projecting TENS sensation into the phantom limb might facilitate perceptual embodiment of prosthetic limbs. The findings support the delivery of a feasibility trial. PMID:22935086

  16. Pregabalin for acute and chronic pain in adults

    PubMed Central

    Moore, R Andrew; Straube, Sebastian; Wiffen, Philip J; Derry, Sheena; McQuay, Henry J

    2014-01-01

    Background Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. Objectives To assess analgesic efficacy and associated adverse events of pregabalin in acute and chronic pain. Search methods We searched MEDLINE, EMBASE, and CENTRAL to May 2009 for randomised controlled trials (RCTs). Additional studies were identified from the reference lists of retrieved papers and on-line clinical trial databases. Selection criteria Randomised, double blind trials reporting on the analgesic effect of pregabalin, with subjective pain assessment by the patient as either the primary or a secondary outcome. Data collection and analysis Two independent review authors extracted data and assessed trial quality. Numbers-needed-to-treat-to-benefit (NNTs) were calculated, where possible, from dichotomous data for effectiveness, adverse events and study withdrawals. Main results There was no clear evidence of beneficial effects of pregabalin in established acute postoperative pain. No studies evaluated pregabalin in chronic nociceptive pain, like arthritis. Pregabalin at doses of 300 mg, 450 mg, and 600 mg daily was effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia (19 studies, 7003 participants). Pregabalin at 150 mg daily was generally ineffective. Efficacy was demonstrated for dichotomous outcomes equating to moderate or substantial pain relief, alongside lower rates for lack of efficacy discontinuations with increasing dose. The best (lowest) NNT for each condition for at least 50% pain relief over baseline (substantial benefit) for 600 mg pregabalin daily compared with placebo were 3.9 (95% confidence interval 3.1 to 5.1) for postherpetic neuralgia, 5.0 (4.0 to 6.6) for painful diabetic neuropathy, 5.6 (3.5 to 14) for central neuropathic pain, and 11 (7.1 to 21) for fibromyalgia

  17. Forebrain GABAergic neuron precursors integrate into adult spinal cord and reduce injury-induced neuropathic pain

    PubMed Central

    Bráz, JM; Sharif-Naeini, R; Vogt, D; Kriegstein, A; Alvarez-Buylla, A; Rubenstein, JL; Basbaum, AI

    2012-01-01

    Neuropathic pain is a chronic debilitating disease characterized by mechanical allodynia and spontaneous pain. Because symptoms are often unresponsive to conventional methods of pain treatment, new therapeutic approaches are essential. Here, we describe a strategy that not only ameliorates symptoms of neuropathic pain, but is also potentially disease modifying. We show that transplantation of immature telencephalic GABAergic interneurons from the mouse medial ganglionic eminence (MGE) into the adult mouse spinal cord completely reverses the mechanical hypersensitivity produced by peripheral nerve injury. Underlying this improvement is a remarkable integration of the MGE transplants into the host spinal cord circuitry, in which the transplanted cells make functional connections with both primary afferent and spinal cord neurons. By contrast, MGE transplants were not effective against inflammatory pain. Our findings suggest that MGE-derived GABAergic interneurons overcome the spinal cord hyperexcitability that is a hallmark of nerve-injury induced neuropathic pain. PMID:22632725

  18. Blockade of Nerve Sprouting and Neuroma Formation Markedly Attenuates the Development of Late Stage Cancer Pain

    PubMed Central

    Mantyh, William G.; Jimenez-Andrade, Juan M.; Stake, James I.; Bloom, Aaron P.; Kaczmarska, Magdalena J.; Taylor, Reid N.; Freeman, Katie T.; Ghilardi, Joseph R.; Kuskowski, Michael A.; Mantyh, Patrick W.

    2010-01-01

    For many patients, pain is the first sign of cancer and, while pain can be present at any time, the frequency and intensity of pain tend to increase with advancing stages of the disease. Thus, between 75 and 90% of patients with metastatic or advanced-stage cancer will experience significant cancer-induced pain. One major unanswered question is why cancer pain increases and frequently becomes more difficult to fully control with disease progression. To gain insight into this question we used a mouse model of bone cancer pain to demonstrate that as tumor growth progresses within bone, Tropomyosin receptor kinase A (TrkA)-expressing sensory and sympathetic nerve fibers undergo profuse sprouting and form neuroma-like structures. To address what is driving the pathological nerve reorganization we administered an antibody to nerve growth factor (anti-NGF). Early sustained administration of anti-NGF, whose cognate receptor is TrkA, blocks the pathological sprouting of sensory and sympathetic nerve fibers, the formation of neuroma-like structures, and inhibits the development of cancer pain. These results suggest that cancer cells and their associated stromal cells release NGF, which induces a pathological remodeling of sensory and sympathetic nerve fibers. This pathological remodeling of the peripheral nervous system then participates in driving cancer pain. Similar to therapies that target the cancer itself, the data presented here suggest that the earlier that therapies blocking this pathological nerve remodeling are initiated, the more effective the control of cancer pain. PMID:20851743

  19. Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review

    PubMed Central

    Singh, Priyanka; Chaturvedi, Aditi

    2015-01-01

    Quality of life (QoL) encompasses the physical, psychosocial, social and spiritual dimensions of life lived by a person. Cancer pain is one of the physical component has tremendous impact on the QoL of the patient. Cancer pain is multifaceted and complex to understand and managing cancer pain involves a tool box full of pharmacological and non pharmacological interventions but still there are 50-70% of cancer patients who suffer from uncontrolled pain and they fear pain more than death. Aggressive surgeries, radiotherapy and chemotherapy focus more on prolonging the survival of the patient failing to realize that the QoL lived also matters equally. This paper reviews complementary and alternative therapy approaches for cancer pain and its impact in improving the QoL of cancer patients. PMID:25709198

  20. Obesity in older adults is associated with an increased prevalence and incidence of pain.

    PubMed

    Heim, Noor; Snijder, Marieke B; Deeg, Dorly J H; Seidell, Jaap C; Visser, Marjolein

    2008-11-01

    Cross-sectional studies suggest an association between BMI and pain. This prospective study investigated the associations of measured BMI and waist circumference with prevalent and incident pain in older adults. The study included participants of the Longitudinal Aging Study Amsterdam, aged 55-85 years at baseline (1992-1993). Pain was assessed using a subscale of the Nottingham Health Profile at baseline (N = 2,000), after 3 years (N = 1,478) and 6 years (N = 1,271) of follow-up. The overall prevalence of pain was 32.7% at baseline and increased significantly with higher quartiles of BMI or waist circumference. After adjustment for age, education, depression, smoking, physical activity, and chronic diseases, multiple logistic regression analyses showed odds ratios (ORs (95% confidence interval)) for prevalent pain of 2.16 (1.32-3.54) in men and 1.93 (1.26-2.95) in women comparing the highest with the lowest quartile of BMI. Of the participants without pain at baseline, those in the highest quartile of BMI had a twofold increased odds for incident pain after 3 years of follow-up. After 6 years of follow-up, ORs for incident pain were 2.34 (1.17-4.72) in men and 2.78 (1.36-5.70) in women. Additional adjustment for weight change did not change these associations. Similar results were found for the associations between waist circumference and pain. Exploring the reversed causal relation, analyses showed no significant associations between prevalent pain and weight gain. In conclusion, the prevalence of pain is higher among obese older men and women compared to their normal-weight peers. Furthermore, obese older adults are at increased odds to develop pain. PMID:18787527

  1. Relationships Between Weight, Physical Activity, and Back Pain in Young Adult Women.

    PubMed

    Brady, Sharmayne R E; Hussain, Sultana Monira; Brown, Wendy J; Heritier, Stephane; Billah, Baki; Wang, Yuanyuan; Teede, Helena; Urquhart, Donna M; Cicuttini, Flavia M

    2016-05-01

    Back pain causes enormous financial and disability burden worldwide, which could potentially be reduced by understanding its determinants to develop effective prevention strategies. Our aim was to identify whether modifiable risk factors, weight and physical activity, are predictive of back pain in young adult women.Women born between 1973 and 1978 were randomly selected from the national health insurance scheme database to participate in The Australian Longitudinal Study of Women's Health. Self-reported data on back pain in the last 12 months, weight, height, age, education status, physical activity, and depression were collected in 2000, 2003, 2006, 2009, and 2012. In 2000, 9688 women completed the questionnaire and 83% completed follow-up 12 years later.At baseline, median age was 24.6 years and 41% had self-reported back pain. For every 5 kg higher weight at baseline, there was a 5% (95% confidence interval [CI] 4%-6%) increased risk of back pain over the next 12 years. Higher weight at each survey also predicted back pain risk 3 years later (P < 0.001). The effects of weight on back pain were most significant in those with BMI ≥25 kg/m and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both P < 0.001), after adjusting for age, weight, height, and education status.Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity, and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young women and suggest potential opportunities for future prevention. PMID:27175634

  2. Relationships Between Weight, Physical Activity, and Back Pain in Young Adult Women

    PubMed Central

    Brady, Sharmayne R.E.; Hussain, Sultana Monira; Brown, Wendy J.; Heritier, Stephane; Billah, Baki; Wang, Yuanyuan; Teede, Helena; Urquhart, Donna M.; Cicuttini, Flavia M.

    2016-01-01

    Abstract Back pain causes enormous financial and disability burden worldwide, which could potentially be reduced by understanding its determinants to develop effective prevention strategies. Our aim was to identify whether modifiable risk factors, weight and physical activity, are predictive of back pain in young adult women. Women born between 1973 and 1978 were randomly selected from the national health insurance scheme database to participate in The Australian Longitudinal Study of Women's Health. Self-reported data on back pain in the last 12 months, weight, height, age, education status, physical activity, and depression were collected in 2000, 2003, 2006, 2009, and 2012. In 2000, 9688 women completed the questionnaire and 83% completed follow-up 12 years later. At baseline, median age was 24.6 years and 41% had self-reported back pain. For every 5 kg higher weight at baseline, there was a 5% (95% confidence interval [CI] 4%–6%) increased risk of back pain over the next 12 years. Higher weight at each survey also predicted back pain risk 3 years later (P < 0.001). The effects of weight on back pain were most significant in those with BMI ≥25 kg/m2 and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both P < 0.001), after adjusting for age, weight, height, and education status. Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity, and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young women and suggest potential opportunities for future prevention. PMID:27175634

  3. fMRI reveals neural activity overlap between adult and infant pain

    PubMed Central

    Goksan, Sezgi; Hartley, Caroline; Emery, Faith; Cockrill, Naomi; Poorun, Ravi; Moultrie, Fiona; Rogers, Richard; Campbell, Jon; Sanders, Michael; Adams, Eleri; Clare, Stuart; Jenkinson, Mark; Tracey, Irene; Slater, Rebeccah

    2015-01-01

    Limited understanding of infant pain has led to its lack of recognition in clinical practice. While the network of brain regions that encode the affective and sensory aspects of adult pain are well described, the brain structures involved in infant nociceptive processing are less well known, meaning little can be inferred about the nature of the infant pain experience. Using fMRI we identified the network of brain regions that are active following acute noxious stimulation in newborn infants, and compared the activity to that observed in adults. Significant infant brain activity was observed in 18 of the 20 active adult brain regions but not in the infant amygdala or orbitofrontal cortex. Brain regions that encode sensory and affective components of pain are active in infants, suggesting that the infant pain experience closely resembles that seen in adults. This highlights the importance of developing effective pain management strategies in this vulnerable population. DOI: http://dx.doi.org/10.7554/eLife.06356.001 PMID:25895592

  4. Self-Reported Pain Intensity with the Numeric Reporting Scale in Adult Dengue

    PubMed Central

    Wong, Joshua G. X.; Gan, Victor C.; Ng, Ee-Ling; Leo, Yee-Sin; Chan, Siew-Pang; Choo, Robin; Lye, David C.

    2014-01-01

    Background Pain is a prominent feature of acute dengue as well as a clinical criterion in World Health Organization guidelines in diagnosing dengue. We conducted a prospective cohort study to compare levels of pain during acute dengue between different ethnicities and dengue severity. Methods Demographic, clinical and laboratory data were collected. Data on self-reported pain was collected using the 11-point Numerical Rating Scale. Generalized structural equation models were built to predict progression to severe disease. Results A total of 499 laboratory confirmed dengue patients were recruited in the Prospective Adult Dengue Study at Tan Tock Seng Hospital, Singapore. We found no statistically significant differences between pain score with age, gender, ethnicity or the presence of co-morbidity. Pain score was not predictive of dengue severity but highly correlated to patients’ day of illness. Prevalence of abdominal pain in our cohort was 19%. There was no difference in abdominal pain score between grades of dengue severity. Conclusion Dengue is a painful disease. Patients suffer more pain at the earlier phase of illness. However, pain score cannot be used to predict a patient’s progression to severe disease. PMID:24788828

  5. A Personalized Approach to Assessing and Managing Pain in Patients With Cancer

    PubMed Central

    Hui, David; Bruera, Eduardo

    2014-01-01

    Pain is one of the most common and distressing symptoms in patients with cancer. In this review, we discuss an evidence-based approach to personalized pain assessment and management. Recent insights into the pain expression pathway have led to a paradigm shift in pain management, allowing clinicians to deliver personalized treatments tailored to the individual's needs. Personalized pain management begins with systematic screening, followed by comprehensive pain assessment. Impeccable characterization of pain informs its etiology and the mechanism to guide treatment choices. Identification of modulators of pain expression such as psychological distress, alcoholism, substance use, and delirium allow clinicians to further tailor treatment recommendations. Documentation of a personalized pain goal provides an individualized response criterion. A multidimensional treatment plan is then formulated targeting the pain mechanism, etiologic factors, and modulators. Finally, longitudinal monitoring customized to the individual's needs allows clinicians to improve adherence and, ultimately, to optimize pain control over time. PMID:24799495

  6. Acute Pain and Depressive Symptoms: Independent Predictors of Insomnia Symptoms among Adults with Sickle Cell Disease.

    PubMed

    Moscou-Jackson, Gyasi; Allen, Jerilyn; Kozachik, Sharon; Smith, Michael T; Budhathoki, Chakra; Haywood, Carlton

    2016-02-01

    No studies to date have systematically investigated insomnia symptoms among adults with sickle cell disease (SCD). The purpose of this study was to (1) describe the prevalence of insomnia symptoms and (2) identify biopsychosocial predictors in community-dwelling adults with SCD. Cross-sectional analysis of baseline data from 263 African American adults with SCD (aged 18 years or older). Measures included the Insomnia Severity Index (ISI), Center for Epidemiologic Studies in Depression scale, Urban Life Stress Scale, Brief Pain Inventory, and a chronic pain item. SCD genotype was extracted from the medical record. A slight majority (55%) of the sample reported clinically significant insomnia symptomatology (ISI ≥ 10), which suggests that insomnia symptoms are prevalent among community-dwelling African American adults with SCD. While insomnia symptoms were associated with a number of biopsychosocial characteristics, depressive symptoms and acute pain were the only independent predictors. Given the high number of participants reporting clinically significant insomnia symptoms, nurses should screen for insomnia symptoms and explore interventions to promote better sleep among adults with SCD, with an emphasis on recommending treatment for pain and depression. In addition, current pain and depression interventions in this population could add insomnia measures and assess the effect of the intervention on insomnia symptomatology as a secondary outcome. PMID:26673730

  7. Catechol-O-methyltransferase genotype (Val158met) modulates cancer-related fatigue and pain sensitivity in breast cancer survivors.

    PubMed

    Fernández-de-las-Peñas, César; Fernández-Lao, Carolina; Cantarero-Villanueva, Irene; Ambite-Quesada, Silvia; Rivas-Martínez, Inés; del Moral-Avila, Rosario; Arroyo-Morales, Manuel

    2012-06-01

    Cancer-related fatigue and pain after surgery are the most frequent and most incapacitating cancer-related symptoms after breast cancer treatment. Genetic influence of cancer-related fatigue and pain has not been previously investigated. Our aim was to examine the influence of catechol-O-methyltransferase (COMT) Val158Met genotypes on cancer-related fatigue, post-mastectomy pain, and pressure pain hypersensitivity in breast cancer survivors. One-hundred and twenty-eight (n = 128) breast cancer survivors who were treated with radiotherapy and chemotherapy participated in this study. After amplifying Val158Met polymorphisms by polymerase chain reaction, COMT genotype was divided into Val/Val, valine/methionine (Val/Met), or Met/Met. The Piper fatigue scale (PFS) was used to assess cancer-related fatigue. Neck and shoulder/axillary pain intensity was assessed with a numerical pain rate scale (0-10). Finally, pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joints, deltoid muscles, second metacarpal, and tibialis anterior muscles. Breast cancer survivors carrying the Met/Met genotype reported higher levels of fatigue (all subscales, P < 0.001), higher neck pain intensity, and lower PPT over C5-C6 joints and deltoid muscles (all, P < 0.001) relative to those with Val/Met or Val/Val genotypes. The results suggest that breast cancer survivors carrying the Met/Met genotype exhibit higher fatigue, neck pain, and pressure pain hypersensitivity over the neck and shoulder area. This study is important because it strives to understand the factors that predispose some breast cancer survivors to more cancer-related fatigue and increased pain sensitivity. PMID:21898113

  8. Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review.

    PubMed

    Woo, Aaron; Lechner, Breanne; Fu, Terence; Wong, C Shun; Chiu, Nicholas; Lam, Henry; Pulenzas, Natalie; Soliman, Hany; DeAngelis, Carlo; Chow, Edward

    2015-10-01

    Defining cut points (CPs) for varying levels of pain intensity is important for assessing changes in patient's functional status, and guiding the development and evaluation of treatment options. We aimed to summarize CPs identified in the literature for mild, moderate, and severe pain on the numeric rating scale (NRS), and recommend optimal CPs for cancer and non-cancer patients. We searched MEDLINE and EMBASE (inception to May 2015) for studies that used CPs to classify pain intensity on the NRS among patients with cancer or non-cancer conditions leading to acute or chronic pain. A CP was defined as the upper bound of a mild or moderate pain category. Of 1,556 identified articles, 27 were included for review. Among patients with cancer pain, mild-moderate pain CPs ranged from 1 to 4 (mean, 3.5±1.08), with CP4 being the most recommended CP (80%). For moderate-severe pain, CPs ranged from 4 to 7 (mean, 6.2±0.92), and CP6 (50%) was the optimal CPs. Among patients with non-cancer pain, mild-moderate pain CPs ranged from 2 to 5 (mean, 3.62±0.78), and CP4 was the most frequently used CP (52.9%). For moderate-severe non-cancer pain, CPs ranged from 4 to 8 (mean, 6.5±0.99), and CP6 (41.2%) was the most frequently recommended CP. A wide range of CPs for mild, moderate, and severe pain categories were identified in the literature among both cancer and non-cancer patient populations. Further studies are needed to delineate more accurate and precise CPs for pain intensity. PMID:26541396

  9. Peer volunteers in an integrative pain management program for frail older adults with chronic pain: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Chronic pain is common among the older population. A literature review on pain management program showed that exercise, yoga, massage therapy, Tai Chi, and music therapy could significantly reduce pain. In spite of the proven benefits of pain management programs, these intervention programs were effective only in the short term, and older adults would resume their old habits. It has been suggested that interventions comprising some type of social support have great potential to increase the participation of older adults. Therefore, we propose the inclusion of peer volunteers in an integrated pain management program to relieve pain among frail older adults. This study aims to explore the effectiveness of an integrated pain management program supplemented with peer volunteers in improving pain intensity, functional mobility, physical activity, loneliness levels, happiness levels, and the use of non-pharmacological pain-relieving methods among frail older adults with chronic pain. Methods/Design We intend to recruit 30 nursing home residents and 30 peer volunteers from the Institute of Active Ageing in Hong Kong in a group trial for an 8-week group-based integrated pain management program. There will be 16 sessions, with two 1-hour sessions each week. The primary outcome will be pain levels, while secondary outcomes will be assessed according to functional mobility, physical activity, loneliness levels, happiness levels, the use of non-pharmacological pain-relieving methods, and through a questionnaire for volunteers. Discussion In view of the high prevalence of chronic pain among older adults and its adverse impacts, it is important to provide older adults with tools to control their pain. We propose the use of peer volunteers to enhance the effects of an integrated pain management program. It is expected that pain can be reduced and improvements can be achieved among older adults in the areas of physical activity, functional mobility, loneliness levels

  10. Body Pain Intensity and Interference in Adults (45-53 Years Old): A Cross-Sectional Survey in Chongqing, China.

    PubMed

    Xu, Xianglong; Li, Bing; Liu, Lingli; Zhao, Yong

    2016-01-01

    Culture and national care models matter both in reporting and treatment of pain status. However, most findings on body pain intensity and interference in adults are from Western studies, with little reliable evidence from China. This study aimed to assess body pain intensity and interference and its associations with demographic, socioeconomic characteristics, and health behaviors in adults. A cross-sectional survey was performed to collect data from 1224 adults, who were recruited via multistage stratified random sampling. The SF-36 quality-of-life instrument was used to investigate body pain intensity and interference. Ordinal logistic regression analysis was used in this study. Our results showed that 64.1% of the participants (males: 687; females: 537) reported body pain, and 45.7% of the participants reported body pain interference. Middle-aged respondents who were female, were unmarried/divorced or separated/widowed, had a negative relationship with their family, had poor sleep quality, and were not satisfied with their current living conditions had a higher body pain intensity rating (ordered logistic regression/six-level pain intensity criterion; odds ratios, p < 0.05). Respondents who were unmarried/divorced or separated/widowed, with a low education level, were unemployed, had lower incomes, had a negative relationship with their family, and were not satisfied with their current living conditions had a higher body pain interference rating (ordered logistic regression/five-level pain interference criterion; odds ratios, p < 0.05). In conclusion, an estimated 64.1% of middle-aged adults reported body pain, and 45.7% of middle-aged adults reported body pain interference. These results provide a clue for possible interventions for improving body pain intensity and interference in adults, especially among middle-aged people. These factors should be taken into consideration in the prevention of pain, pain management and treatment planning in order to help

  11. Can cancer patients influence the pain agenda in oncology outpatient consultations?

    PubMed

    Rogers, Margaret S; Todd, Chris

    2010-02-01

    Pain in cancer patients is common, yet it is often inadequately managed. Although poor assessment has been implicated, how patients contribute to this process has not been explicated. This study aims to uncover patients' contributions to discussions about pain during oncology outpatient consultations. Seventy-four medical encounters were observed and audiotaped. Verbatim transcriptions of pain talk were examined using conversational analysis. Thirty-nine of 74 patients talked about pain with 15 different doctors during consultations for follow-up or active treatment. Patients' talk about pain varied consistently according to how pain talk was initiated. In 20 consultations where pain was put on the agenda by patients, they used communication tactics that emphasized their pain experiences, seemingly to attract and maintain their doctors' attention. These tactics appear necessary, as the cancer treatment agenda restricts opportunities for patients to have supportive care needs addressed. On the other hand, in 19 consultations where doctors elicited information about pain, patients used communication tactics that minimized their pain experiences, seemingly to conceal potential disease progression or recurrence, the very focus of these specialist consultations. Where cancer was implicated as the source of pain, chemotherapy or radiotherapy was offered, and where cancer was suspected, referrals for investigations were made. Two of the 20 patients appeared to influence the treatment-focused agenda and were given referrals to pain clinic rather than further cancer therapy as initially recommended. PMID:19963336

  12. Innate Immune Signalling Genetics of Pain, Cognitive Dysfunction and Sickness Symptoms in Cancer Pain Patients Treated with Transdermal Fentanyl

    PubMed Central

    Barratt, Daniel T.; Klepstad, Pål; Dale, Ola; Kaasa, Stein; Somogyi, Andrew A.

    2015-01-01

    Common adverse symptoms of cancer and chemotherapy are a major health burden; chief among these is pain, with opioids including transdermal fentanyl the mainstay of treatment. Innate immune activation has been implicated generally in pain, opioid analgesia, cognitive dysfunction, and sickness type symptoms reported by cancer patients. We aimed to determine if genetic polymorphisms in neuroimmune activation pathways alter the serum fentanyl concentration-response relationships for pain control, cognitive dysfunction, and other adverse symptoms, in cancer pain patients. Cancer pain patients (468) receiving transdermal fentanyl were genotyped for 31 single nucleotide polymorphisms in 19 genes: CASP1, BDNF, CRP, LY96, IL6, IL1B, TGFB1, TNF, IL10, IL2, TLR2, TLR4, MYD88, IL6R, OPRM1, ARRB2, COMT, STAT6 and ABCB1. Lasso and backward stepwise generalised linear regression were used to identify non-genetic and genetic predictors, respectively, of pain control (average Brief Pain Inventory < 4), cognitive dysfunction (Mini-Mental State Examination ≤ 23), sickness response and opioid adverse event complaint. Serum fentanyl concentrations did not predict between-patient variability in these outcomes, nor did genetic factors predict pain control, sickness response or opioid adverse event complaint. Carriers of the MYD88 rs6853 variant were half as likely to have cognitive dysfunction (11/111) than wild-type patients (69/325), with a relative risk of 0.45 (95% CI: 0.27 to 0.76) when accounting for major non-genetic predictors (age, Karnofsky functional score). This supports the involvement of innate immune signalling in cognitive dysfunction, and identifies MyD88 signalling pathways as a potential focus for predicting and reducing the burden of cognitive dysfunction in cancer pain patients. PMID:26332828

  13. The problem of pain in children with cancer: a research review.

    PubMed

    Sutters, K A; Miaskowski, C

    1992-04-01

    Pain in a child with cancer poses significant challenges for nurses. However, little research has been conducted in the area of pediatric cancer pain to guide clinical assessments and interventions. The purpose of this paper is to present a review of the research studies conducted on pediatric cancer pain over 13-1/2 years. The review of the cancer pain research studies is organized around several concepts that include approaches to cancer pain assessment and management as well as the presentation, incidence, and etiology of pain associated with childhood malignancy. Relevant clinical findings from the review of the literature are highlighted. Emphasis is on the major nursing implications from these studies, and suggestions are made for future nursing research. PMID:1594467

  14. Back pain in adults living in quilombola territories of Bahia, Northeastern Brazil

    PubMed Central

    Santos, Luis Rogério Cosme Silva; Assunção, Ada Ávila; Lima, Eduardo de Paula

    2014-01-01

    OBJECTIVE To analyze the factors associated with back pain in adults who live in quilombola territories. METHODS A population-based survey was performed on quilombola communities of Vitória da Conquista, state of Bahia, Northeastern Brazil. The sample (n = 750) was established via a raffle of residences. Semi-structured interviews were conducted to investigate sociodemographics and employment characteristics, lifestyle, and health conditions. The outcome was analyzed as a dichotomous variable (Poisson regression). RESULTS The prevalence of back pain was of 39.3%. Age ≥ 30 years and being a smoker were associated with the outcome. The employment status was not related to back pain. CONCLUSIONS The survey identified a high prevalence of back pain in adults. It is suggested to support the restructuring of the local public service in order to outline programs and access to healthy practices, assistance, diagnosis, and treatment of spine problems. PMID:25372165

  15. Correlates of foot pain severity in adults with hallux valgus: a cross-sectional study

    PubMed Central

    2014-01-01

    Background Hallux valgus (HV) is highly prevalent and associated with progressive first metatarsophalangeal joint subluxation and osteoarthritis. The link between structural HV deformity and foot pain is unclear. This study investigated possible explanatory factors surrounding foot pain in HV, including radiographic HV angle and signs of joint degeneration. Methods Participants were 60 adults (53 female) with HV aged 20 to 75 years. Participant demographics and a range of radiographic, clinical and functional measures were considered potential correlates of foot pain. Self-reported foot pain (visual analogue scales and a dichotomous definition) was considered the dependent variable. Multivariate modelling was used to determine which characteristics and measures explained pain, with univariate analyses first used to screen potential variables. Results Approximately 20 to 30% of the variance in foot pain associated with HV could be explained by patient characteristics such as poorer general health status, lower educational attainment and increased occupational physical activity levels, in combination with some dynamic physical characteristics such as hallux plantarflexion weakness and reduced force-time integral under the second metatarsal during gait. Neither increasing lateral deviation of the hallux (HV angle) nor presence of first metatarsophalangeal joint osteoarthritis was associated with foot pain. Conclusions This study shows that passive structural factors, including HV angle, do not appear to be significant correlates of foot pain intensity in HV. Our data demonstrate the importance of considering patient characteristics such as general health and physical activity levels when assessing foot pain associated with HV. PMID:25028598

  16. Acute postoperative pain predicts chronic pain and long-term analgesic requirements after breast surgery for cancer.

    PubMed

    Fassoulaki, A; Melemeni, A; Staikou, C; Triga, A; Sarantopoulos, C

    2008-01-01

    Postoperative pain and analgesic requirements may be associated with chronic pain. The aim of the study was to investigate this association. We studied 98 patients who had cancer breast surgery and served as controls in four previous studies, receiving placebo. We compared the pain and analgesic requirements 0-9 h and 1-6 days postoperatively: a) between patients with chronic pain 3 months postoperatively versus patients without and b) between those patients who consumed analgesics at home versus those who did not. Patients with chronic pain had experienced higher intensity pain at rest the first 9 postoperative hours (VAS-rest p = 0.033). Patients requiring analgesics at home had consumed postoperatively more opioids (p = 0.005) and more paracetamol (p = 0.037). These patients had experienced pain of higher intensity the first 9 postoperative hours (VAS-rest p = 0.022, VAS-movement p = 0.009) as well as during the six postoperative days (VAS-rest p = 0.013, VAS-movement p = 0.001). Higher intensities of acute postoperative pain are associated with chronic pain development. Higher analgesic needs and higher acute postoperatively pain intensity are associated with long-term analgesic consumption. PMID:19235522

  17. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults.

    PubMed

    Atef, Ahmed; Fawaz, Ahmed Aly

    2008-03-01

    Tonsillectomy in adults is associated with significant postoperative pain. Intravenous paracetamol injection (Perfalgan) is marketed for the management of acute pain. This prospective placebo-controlled study was performed to evaluate the analgesic efficacy and safety of intravenous paracetamol in 76 adult patients undergoing elective standard bipolar diathermy tonsillectomy. After tonsillectomy was performed under general anesthesia, the patients were randomized to receive either intravenous paracetamol 1 g (Perfalgan) (n = 38) or 0.9% normal saline as a placebo (n = 38) at 6-h intervals. No other analgesic medication was permitted for postoperative pain during the study. Need for rescue analgesic during the first 24 h after surgery as well as all adverse events were recorded. The intravenous paracetamol group differed significantly from the placebo group regarding pain relief and median time to pethidine rescue. Intravenous paracetamol significantly reduced pethidine consumption over the 24-h period. The worst pain after surgery was also more severe in the placebo group than that in the paracetamol group. There was no significant difference between groups in the incidence of adverse events. Intravenous paracetamol administered regularly in adult patients with moderate to severe pain after tonsillectomy provided rapid and effective analgesia and was well tolerated. PMID:17891409

  18. [Management of adult abdominal pain in the Emergency Room].

    PubMed

    Chiche, L; Roupie, E; Delassus, P

    2006-01-01

    Abdominal pain is a commonplace reason for surgical consultation in the emergency department and is the the most common symptom which the digestive surgeon on-call must evaluate. He must understand the pathophysiologic basis of visceral pain and referred pain in order to appreciate its diverse manifestations. Abdominal pain can stem from many causes intestinal and non-intestinal, medical and surgical. Evaluation and management in the emergency department must be rapid and pragmatic; clinical history and physical examination should define the gravity of the case, direct the first diagnostic procedures and complementary examinations, and guide the therapeutic direction. Ultrasonography is a quick and effective diagnostic procedure in the diagnosis of biliary, urologic, and gynecologic pathologies; it can be useful for other digestive problems as well. The new generation spiral CT scanner gives excellent definition of digestive and vascular pathologies. The initial evaluation and management of the acute abdomen may determine the prognosis of the patient; it should lead to prompt symptomatic relief and to a well-directed treatment appropriate to the diagnosis. PMID:16609646

  19. A rare cause of chest pain in a cancer patient

    PubMed Central

    Welaya, Karim; Yousuf, Kabir; del Pilar Morales, Maria

    2016-01-01

    It is well known that cancer and hypercoagulability go hand in hand. Most thromboembolism is venous in nature although arterial thrombosis can occur. Arterial thrombosis secondary to malignancy is usually seen in the lower extremities; however, it can also be seen elsewhere. This is a case of bronchogenic carcinoma with no history of typical atherosclerotic risk factors including smoking, diabetes mellitus, hypertension, or hyperlipidemia presented with chest pain and was found to have an acute ST segment elevation myocardial infection. Coronary angiography showed a large thrombus in the left anterior descending artery in the absence of any atherosclerotic lesions. Malignancy is considered to be the major contributing factor for this myocardial infarction in the absence of both atherosclerotic risk factors and atherosclerotic lesions in the coronary angiography. We will focus on the relationship between cancer and thrombosis with special emphasis on arterial thromboembolism with subsequent development of myocardial infarction. PMID:27124166

  20. Parental substance abuse, reports of chronic pain and coping in adult patients with sickle cell disease.

    PubMed Central

    Edwards, Christopher; Whitfield, Keith; Sudhakar, Shiv; Pearce, Michele; Byrd, Goldie; Wood, Mary; Feliu, Miriam; Leach-Beale, Brittani; DeCastro, Laura; Whitworth, Elaine; Abrams, Mary; Jonassaint, Jude; Harrison, M. Ojinga; Mathis, Markece; Scott, Lydia; Johnson, Stephanie; Durant, Lauren; Holmes, Anita; Presnell, Katherine; Bennett, Gary; Shelby, Rebecca; Robinson, Elwood

    2006-01-01

    There is increasing interest from a social learning perspective in understanding the role of parental factors on adult health behaviors and health outcomes. Our review revealed no studies, to date, that have evaluated the effects of parental substance abuse on reports of chronic pain and coping in adult patients with sickle cell disease (SCD). We explored the effects of parental substance (alcohol or drug) abuse on reports of the sensory, affective and summary indices of pain in 67 adult patients, mean age 38.9 (13.5), with SCD. We also explored the effects of parental substance abuse on psychopathology associated with pain and active coping. Twenty-four percent of patients reported that their parent(s) abused substances. Patients whose parent(s) were characterized as substance abusers reported greater sensory (p=0.02), affective (p=0.01) and summary (VAS; p=0.02) indices of pain as compared to their counterparts, whose parent(s) were not characterized as substance abusers. Patients did not differ in average age, education or the propensity to respond in a socially acceptable manner. There was a significant trend towards patients who characterized their parents as abusers scoring higher than their counterparts on active coping. We propose a Social Learning Theory to explain the current findings and suggest a need for additional prospective research to simultaneously explore biological (genetic) and social factors that influence the interpretation, experience and reporting of chronic pain in adult patients with chronic disease. PMID:16573309

  1. Reduction of Pain Sensitivity After Somatosensory Therapy in Adults with Cerebral Palsy

    PubMed Central

    Riquelme, Inmaculada; Zamorano, Anna; Montoya, Pedro

    2013-01-01

    Objective: Pain and deficits in somatosensory processing seem to play a relevant role in cerebral palsy (CP). Rehabilitation techniques based on neuroplasticity mechanisms may induce powerful changes in the organization of the primary somatosensory cortex and have been proved to reduce levels of pain and discomfort in neurological pathologies. However, little is known about the efficacy of such interventions for pain sensitivity in CP individuals. Methods: Adults with CP participated in the study and were randomly assigned to the intervention (n = 17) or the control group (n = 20). The intervention group received a somatosensory therapy including four types of exercises (touch, proprioception, vibration, and stereognosis). All participants were asked to continue their standardized motor therapy during the study period. Several somatosensory (pain and touch thresholds, stereognosis, proprioception, texture recognition) and motor parameters (fine motor skills) were assessed before, immediately after and 3 months after the therapy (follow-up). Results: Participants of the intervention group showed a significant reduction on pain sensitivity after treatment and at follow-up after 3 months, whereas participants in the control group displayed increasing pain sensitivity over time. No improvements were found on touch sensitivity, proprioception, texture recognition, or fine motor skills. Conclusion: Data suggest the possibility that somatosensory therapy was effective in eliciting changes in central somatosensory processing. This hypothesis may have implications for future neuromodulatory treatment of pain complaints in children and adults with CP. PMID:23805086

  2. EMOTIONAL REACTIONS TO PAIN PREDICT PSYCHOLOGICAL DISTRESS IN ADULT PATIENTS WITH SICKLE CELL DISEASE (SCD)

    PubMed Central

    EDWARDS, CHRISTOPHER L.; KILLOUGH, ALVIN; WOOD, MARY; DOYLE, TODD; FELIU, MIRIAM; BARKER, CAMELA S.; UPPAL, PRIYANKA; DeCASTRO, LAURA; WELLINGTON, CHANTÉ; WHITFIELD, KEITH E.; TRAMBADIA, JAY; GUINYARD, DARIENE; MUHAMMAD, MALIK; O’GARO, KEISHA-GAYE N.; MORGAN, KAI; EDWARDS ALESII, LEKISHA Y.; BYRD, GOLDIE S.; McCABE, MELANIE; GOLI, VEERAINDAR; KEYS, ABIGAIL; HILL, LABARRON; COLLINS-McNEIL, JANICE; McDONALD, PATRICIA; SCHMECHEL, DONALD E.; ROBINSON, ELWOOD

    2015-01-01

    Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare

  3. The McGill University Health Centre Cancer Pain Clinic: A Retrospective Analysis of an Interdisciplinary Approach to Cancer Pain Management

    PubMed Central

    Perez, Jordi; Olivier, Sara; Rampakakis, Emmanouil; Borod, Manuel; Shir, Yoram

    2016-01-01

    Context. The McGill University Health Center (MUHC) Cancer Pain Clinic offers an interdisciplinary approach to cancer pain management for patients. The core team includes a nurse clinician specialist in oncology and palliative care, a palliativist, an anaesthetist, and a radiation oncologist. This tailored approach includes pharmacological and nonpharmacological therapies offered concurrently in an interdisciplinary fashion. Objectives. Description of the interdisciplinary MUHC cancer pain approach and analysis of treatments and outcomes. Methods. A retrospective analysis of new outpatients completing two subsequent visits (baseline and follow-ups: FU1, FU2) was conducted. Variables included (a) symptom severity measured by the Edmonton Symptom Assessment Scale, (b) pain and disability measured with the Brief Pain Inventory, and (c) analgesic plan implementation including pharmacological and nonpharmacological therapies. Results. 71 charts were reviewed. Significant pain relief was achieved consistently at FU1 and FU2. The average pain severity decreased by 2 points between initial assessment and FU2. More than half (53%) of patients responded with a pain reduction greater than 30%. Severity of other symptoms (i.e., fatigue, nausea, depression, and anxiety) and disability also decreased significantly at FU2. The total consumption of opioids remained stable; however, the consumption of short acting preparations decreased by 52% whereas the prescription of nonopioid agents increased. Beyond drug management, 60% of patients received other analgesic therapies, being the most common interventional pain procedures and psychosocial approaches. Conclusion. The MUHC interdisciplinary approach to cancer pain management provides meaningful relief of pain and other cancer-related symptoms and decreases patients' disability.

  4. Effect of Reiki Therapy on Pain and Anxiety in Adults: An In-Depth Literature Review of Randomized Trials with Effect Size Calculations

    PubMed Central

    Thrane, Susan; Cohen, Susan M.

    2013-01-01

    Objective To calculate the effect of Reiki therapy for pain and anxiety in randomized clinical trials. Data Sources A systematic search of PubMed, ProQuest, Cochrane, PsychInfo, CINAHL, Web of Science, Global Health, and Medline databases was conducted using the search terms pain, anxiety, and Reiki. The Center for Reiki Research was also examined for articles. Study Selection Studies that used randomization and a control or usual care group, used Reiki therapy in one arm of the study, published in 2000 or later in peer-reviewed journals in English, and measured pain or anxiety were included. Results After removing duplicates, 49 articles were examined and 12 articles received full review. Seven studies met the inclusion criteria: four articles studied cancer patients; one examined post-surgical patients; and two analyzed community dwelling older adults. Effect sizes were calculated for all studies using Cohen’s d statistic. Effect sizes for within group differences ranged from d=0.24 for decrease in anxiety in women undergoing breast biopsy to d=2.08 for decreased pain in community dwelling adults. The between group differences ranged from d=0.32 for decrease of pain in a Reiki versus rest intervention for cancer patients to d=4.5 for decrease in pain in community dwelling adults. Conclusions While the number of studies is limited, based on the size Cohen’s d statistics calculated in this review, there is evidence to suggest that Reiki therapy may be effective for pain and anxiety. Continued research using Reiki therapy with larger sample sizes, consistently randomized groups, and standardized treatment protocols is recommended. PMID:24582620

  5. Effect of Reiki therapy on pain and anxiety in adults: an in-depth literature review of randomized trials with effect size calculations.

    PubMed

    Thrane, Susan; Cohen, Susan M

    2014-12-01

    The objective of this study was to calculate the effect of Reiki therapy for pain and anxiety in randomized clinical trials. A systematic search of PubMed, ProQuest, Cochrane, PsychInfo, CINAHL, Web of Science, Global Health, and Medline databases was conducted using the search terms pain, anxiety, and Reiki. The Center for Reiki Research also was examined for articles. Studies that used randomization and a control or usual care group, used Reiki therapy in one arm of the study, were published in 2000 or later in peer-reviewed journals in English, and measured pain or anxiety were included. After removing duplicates, 49 articles were examined and 12 articles received full review. Seven studies met the inclusion criteria: four articles studied cancer patients, one examined post-surgical patients, and two analyzed community dwelling older adults. Effect sizes were calculated for all studies using Cohen's d statistic. Effect sizes for within group differences ranged from d = 0.24 for decrease in anxiety in women undergoing breast biopsy to d = 2.08 for decreased pain in community dwelling adults. The between group differences ranged from d = 0.32 for decrease of pain in a Reiki versus rest intervention for cancer patients to d = 4.5 for decrease in pain in community dwelling adults. Although the number of studies is limited, based on the size Cohen's d statistics calculated in this review, there is evidence to suggest that Reiki therapy may be effective for pain and anxiety. Continued research using Reiki therapy with larger sample sizes, consistently randomized groups, and standardized treatment protocols is recommended. PMID:24582620

  6. Topical NSAIDs for chronic musculoskeletal pain in adults

    PubMed Central

    Derry, Sheena; Moore, R Andrew; Rabbie, Roy

    2014-01-01

    Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly taken orally, but they are also available in topical preparations to be applied to or rubbed onto the skin of a painful joint, typically one affected by arthritis, with the aim of relieving pain locally. Topical NSAIDs are widely used in some parts of the world for acute and chronic painful conditions, but have not been universally accepted until recently. One of the problems has been that older clinical studies were generally short, lasting four weeks or less, and short duration studies are not regarded as adequate in ongoing painful conditions. Objectives To examine the use of topical NSAIDs in chronic musculoskeletal pain, focusing on studies of high methodological quality, and examining the measured effect of the preparations according to study duration. The principal aim was to estimate treatment efficacy in longer duration studies of at least 8 weeks. Search methods A series of electronic searches, together with bibliographic searches, and searches of in-house databases were combined with electronic searches of clinical trial registers and manufacturers of topical NSAIDs, or companies known to be actively researching topical NSAIDs. There had to be at least 10 participants in each treatment arm, with application of treatment at least once daily. Selection criteria Randomised, double blind studies with placebo or active comparators, where at least one treatment was a topical NSAID product, in any topical formulation (cream, gel, patch, solution), in studies lasting at least two weeks. Data collection and analysis Two review authors independently assessed study quality and validity, and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk (RR) and numbers needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. Main results Information was available from 7688 participants in 34 studies from 32 publications; 23 studies

  7. Hypnosis for the management of chronic and cancer procedure-related pain in children.

    PubMed

    Tomé-Pires, Catarina; Miró, Jordi

    2012-01-01

    The aim of this study was to review published controlled trials of hypnotic treatments for chronic and cancer procedure-related pain in children. Trials were included if participants were 18 years of age or below, were randomized and had populations with chronic pain or cancer procedure-related pain. After the studies were assessed, 12 were selected for review. Although the evidence is limited, the findings indicate that hypnosis is an effective pain-control technique when used with children suffering from cancer procedure-related pain or chronic pain. Further research into the use of hypnosis to manage chronic pain in children should be a priority so that empirically based conclusions can be drawn about the effects of hypnosis on children. PMID:22917107

  8. Gaps in nutritional research among older adults with cancer.

    PubMed

    Presley, Carolyn J; Dotan, Efrat; Soto-Perez-de-Celis, Enrique; Jatoi, Aminah; Mohile, Supriya G; Won, Elizabeth; Alibhai, Shabbir; Kilari, Deepak; Harrison, Robert; Klepin, Heidi D; Wildes, Tanya M; Mustian, Karen; Demark-Wahnefried, Wendy

    2016-07-01

    Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research. PMID:27197919

  9. Gaps in nutritional research among older adults with cancer

    PubMed Central

    Presley, Carolyn J.; Dotan, Efrat; Soto-Perez-de-Celis, Enrique; Jatoi, Aminah; Mohile, Supriya G.; Won, Elizabeth; Alibhai, Shabbir; Kilari, Deepak; Harrison, Robert; Klepin, Heidi D.; Wildes, Tanya M.; Mustian, Karen; Demark-Wahnefried, Wendy

    2016-01-01

    Nutritional issues among older adults with cancer are an understudied area of research despite significant prognostic implications for treatment side effects, cancer-specific mortality, and overall survival. In May of 2015, the National Cancer Institute and the National Institute on Aging co-sponsored a conference focused on future directions in geriatric oncology research. Nutritional research among older adults with cancer was highlighted as a major area of concern as most nutritional cancer research has been conducted among younger adults, with limited evidence to guide the care of nutritional issues among older adults with cancer. Cancer diagnoses among older adults are increasing, and the care of the older adult with cancer is complicated due to multimorbidity, heterogeneous functional status, polypharmacy, deficits in cognitive and mental health, and several other non-cancer factors. Due to this complexity, nutritional needs are dynamic, multifaceted, and dependent on the clinical scenario. This manuscript outlines the proceedings of this conference including knowledge gaps and recommendations for future nutritional research among older adults with cancer. Three common clinical scenarios encountered by oncologists include (1) weight loss during anti-cancer therapy, (2) malnutrition during advanced disease, and (3) obesity during survivorship. In this manuscript, we provide a brief overview of relevant cancer literature within these three areas, knowledge gaps that exist, and recommendations for future research. PMID:27197919

  10. Survivorship Care in Reducing Symptoms in Young Adult Cancer Survivors

    ClinicalTrials.gov

    2016-04-05

    Breast Carcinoma; Cancer Survivor; Depression; Fatigue; Leukemia; Lymphoma; Malignant Bone Neoplasm; Malignant Digestive System Neoplasm; Malignant Female Reproductive System Neoplasm; Malignant Male Reproductive System Neoplasm; Pain; Sleep Disorder; Soft Tissue Sarcoma

  11. Extenuating Circumstances in Perceptions of Suicide: Disease Diagnosis (AIDS, Cancer), Pain Level, and Life Expectancy.

    ERIC Educational Resources Information Center

    Martin, Stephen K.; Range, Lillian M.

    1991-01-01

    Examined whether illness type, pain level, and life expectancy affected reactions of undergraduates (n=160) toward a terminal illness suicide with Acquired Immune Deficiency Syndrome (AIDS) or cancer. AIDS patients were more stigmatized than cancer patients; suicide was more tolerated if victim was suffering greater pain. (Author/ABL)

  12. Opioids for cancer breakthrough pain: a pilot study reporting patient assessment of time to meaningful pain relief.

    PubMed

    Zeppetella, Giovambattista

    2008-05-01

    Breakthrough pain is a common and distinct component of cancer pain that is usually managed with normal release opioids (also known as rescue medication) either before or soon after its onset. A prospective survey of hospice inpatients with breakthrough pain was undertaken to characterize their pain and then compare the time to onset of pain relief of their rescue medication. Patients presented with, on average, 1.7 different types of breakthrough pains (range, 1-4). The average number of breakthrough pains was four per day (range, 1-8), and the average duration of breakthrough pain was 35 minutes (range, 15-60); most occurred suddenly and unpredictably. Patients used morphine, oxycodone, hydromorphone, methadone, or oral transmucosal fentanyl citrate as rescue medication and the average time to meaningful pain relief following their administration was 31 minutes (range, 5-75). No difference was found between morphine, oxycodone, and hydromorphone. Methadone appeared to work faster than morphine (P<0.01) but no faster than oxycodone or hydromorphone, whereas oral transmucosal fentanyl citrate worked faster than morphine, oxycodone, hydromorphone, and methadone (P<0.001). PMID:18258412

  13. Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy.

    PubMed

    Astrup, Guro Lindviksmoen; Rustøen, Tone; Miaskowski, Christine; Paul, Steven M; Bjordal, Kristin

    2015-05-01

    Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC. PMID:25719616

  14. Modifiable lifestyle factors are associated with lower pain levels in adults with knee osteoarthritis

    PubMed Central

    Connelly, A Erin; Tucker, Amy J; Kott, Laima S; Wright, Amanda J; Duncan, Alison M

    2015-01-01

    BACKGROUND: With no cure or effective treatments for osteoarthritis (OA), the need to identify modifiable factors to decrease pain and increase physical function is well recognized. OBJECTIVE: To examine factors that characterize OA patients at different levels of pain, and to investigate the relationships among these factors and pain. METHODS: Details of OA characteristics and lifestyle factors were collected from interviews with healthy adults with knee OA (n=197). The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain. Factors were summarized across three pain score categories, and χ2 and Kruskal-Wallis tests were used to examine differences. Multiple linear regression analysis using a stepwise selection procedure was used to examine associations between lifestyle factors and pain. RESULTS: Multiple linear regression analysis indicated that pain was significantly higher with the use of OA medications and higher body mass index category, and significantly lower with the use of supplements and meeting physical activity guidelines (≥150 min/week). Stiffness and physical function scores, bilateral knee OA, body mass index category and OA medication use were significantly higher with increasing pain, whereas self-reported health, servings of fruit, supplement use and meeting physical activity guidelines significantly lower. No significant differences across pain categories were found for sex, age, number of diseases, duration of OA, ever smoked, alcoholic drinks/week, over-the-counter pain medication use, OA supplement use, physical therapy use, servings of vegetables or minutes walked/week. CONCLUSIONS: Healthy weight maintenance, exercise for at least 150 min/week and appropriate use of medications and supplements represent important modifiable factors related to lower knee OA pain. PMID:26125195

  15. [Opioid use disorder in patients with chronic non-cancer pain].

    PubMed

    Brabant, Michel; Brissette, Suzanne; Lauzon, Pierre; Marsan, Stéphanie; Ouellet-Plamondon, Clairélaine; Pelletier, Marie-Chantal

    2014-01-01

    Epidemiology Canada now has the second highest number of opioid prescriptions per capita in the world. The rate of prescriptions has increased over the last decade, most notably in adults over 55 years of age. A recognition of the importance of treating pain has influenced this increase, but higher rates of opioid prescribing have produced undesirable outcomes including the misuse of medication as well as an increased number of deaths and emergency department visits attributable to opioids. Diverse psychiatric disorders, such as major depression, now also occur in 40% of those with an opioid use disorder (OUD). Neuroscience We now understand that addictive behaviors are caused by both environmental and genetic factors. Although OUD has historically been perceived as a weakness of character, it is now clear that it is a chronic disease, which results from a complex interaction between a substance, such as opioid, environmental factors, and an individual's genotype. Unfortunately, this evidence has yet to be successfully translated into clinical practice and most physicians are unable to diagnose and manage OUD patients appropriately.Clinical guidelines Many clinical guidelines for the management of chronic, non-cancer pain are available. All guidelines identify the need to assess the patient appropriately and screen for factors associated with misuse before prescribing opioids. Guidelines generally acknowledge that patients should not be denied appropriate pain management, but that some patients will require close supervision and frequent follow-up to prevent the misuse of prescription opioids. PMID:25590547

  16. Improving the quality of cancer pain management in an academic medical center emergency department.

    PubMed

    Won, Young Hwa; Choi, Yun Jung; Ahn, Shin; Lee, Jae-Lyun; Park, Jeong Yun; Kim, Sulhwa; Kim, Tae Won; Kim, Yeon Hee

    2014-12-01

    The impact and outcomes of the implementation of a pain management guideline and pain assessment standard operating procedure (SOP) in a cancer-specific emergency department are evaluated in this article. After implementation of the SOP, the number of pain assessments conducted per patient during hospitalization increased, as did the percentage of patients who underwent a pain assessment at admission, within one hour after analgesic medication was administered, and at regular intervals. PMID:25427696

  17. Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work.

    PubMed

    Morrissey, Mary Beth; Viola, Deborah; Shi, Qiuhu

    2014-01-01

    Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 ). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed. PMID:24628140

  18. The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery.

    PubMed

    McCaffrey, Ruth; Locsin, Rozzano

    2006-01-01

    The purpose of this study was to examine the effects of music listening in older adults following hip or knee surgery. Acute confusion and pain after surgery can increase length of stay and reduce function. Study results demonstrate a reduction in acute confusion and pain and improved ambulation and higher satisfaction scores in older adults who listened to music. PMID:16974175

  19. A Functional Role for VEGFR1 Expressed in Peripheral Sensory Neurons in Cancer Pain

    PubMed Central

    Selvaraj, Deepitha; Gangadharan, Vijayan; Michalski, Christoph W.; Kurejova, Martina; Stösser, Sebastian; Srivastava, Kshitij; Schweizerhof, Matthias; Waltenberger, Johannes; Ferrara, Napoleone; Heppenstall, Paul; Shibuya, Masabumi; Augustin, Hellmut G.; Kuner, Rohini

    2015-01-01

    Summary Cancer pain is a debilitating disorder and a primary determinant of the poor quality of life. Here, we report a non-vascular role for ligands of the Vascular Endothelial Growth Factor (VEGF) family in cancer pain. Tumor-derived VEGF-A, PLGF-2, and VEGF-B augment pain sensitivity through selective activation of VEGF receptor 1 (VEGFR1) expressed in sensory neurons in human cancer and mouse models. Sensory-neuron-specific genetic deletion/silencing or local or systemic blockade of VEGFR1 prevented tumor-induced nerve remodeling and attenuated cancer pain in diverse mouse models in vivo. These findings identify a therapeutic potential for VEGFR1-modifying drugs in cancer pain and suggest a palliative effect for VEGF/VEGFR1-targeting anti-angiogenic tumor therapies. PMID:26058077

  20. Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies.

    PubMed

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen; Damkier, Anette; Vejlgaard, Tove; Nauck, Friedemann; Radbruch, Lukas; Sjolund, Karl-Frederik; Stenberg, Mariann; Buchanan, Alison

    2011-08-01

    This study involved 320 cancer patients from four Northern European countries. Patients with breakthrough pain were questioned about the characteristics of their pain, the current management of their pain, and the acceptability/utility of alternative routes of administration. The median number of episodes was 3/day. Forty-four percent patients reported incident-type pain, 39% spontaneous-type pain, and 17% a combination of these pains. The median duration was 60 min, and the median time to peak intensity was 15 min. Three percent patients reported "mild" pain, 37% "moderate" pain, and 60% "severe" pain. Ninety percent patients stated that the pain interfered with their daily activities. All patients were using opioids as rescue medication (mainly oral morphine/oxycodone), whilst 28% patients were using non-opioids, and 50% patients were using non-pharmacological interventions. Only 55% patients took rescue medication every time they experienced breakthrough pain. Sixty-five percent patients would definitely consider using an oral transmucosal product; patients from Denmark were less likely to answer positively, and a positive response was associated with previous use of the route for breakthrough pain. Seventy-three percent patients reported regular oral problems. Forty-two percent patients would definitely consider using an intranasal product, with 26% patients stating they would definitely not use such a preparation; patients from Denmark and Sweden were less likely to answer positively, and a positive response was associated with male gender, and previous use of the route. Forty-four percent patients reported regular nasal problems. Sixty percent patients would definitely consider using a subcutaneous product, and 44% patients would definitely consider using an intrapulmonary product. PMID:21251860

  1. Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

    PubMed Central

    Skaer, Tracy L

    2014-01-01

    Opioids continue to be first-line pharmacotherapy for patients suffering from cancer pain. Unfortunately, subtherapeutic dosage prescribing of pain medications remains common, and many cancer patients continue to suffer and experience diminished quality of life. A large variety of therapeutic options are available for cancer pain patients. Analgesic pharmacotherapy is based on the patient’s self-report of pain intensity and should be tailored to meet the requirements of each individual. Most, if not all, cancer pain patients will ultimately require modifications in their opioid pharmacotherapy. When changes in a patient’s medication regimen are needed, adequate pain control is best maintained through appropriate dosage conversion, scheduling immediate release medication for withdrawal prevention, and providing as needed dosing for breakthrough pain. Transdermal opioids are noninvasive, cause less constipation and sedation when compared to oral opioids, and may improve patient compliance. A relative potency of 100:1 is recommended when converting the patient from oral morphine to transdermal fentanyl. Based on the limited data available, there is significant interpatient variability with transdermal buprenorphine and equipotency recommendations from oral morphine of 75:1–110:1 have been suggested. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75–100:1 potency ratio. This review outlines the prescribing of transdermal fentanyl and transdermal buprenorphine including how to safely and effectively convert to and use them for those with cancer pain. PMID:25170278

  2. Obese older adults suffer foot pain and foot-related functional limitation.

    PubMed

    Mickle, Karen J; Steele, Julie R

    2015-10-01

    There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals. PMID:26260010

  3. Intrathecal drug delivery for the management of pain and spasticity in adults: an executive summary of the British Pain Society’s recommendations for best clinical practice

    PubMed Central

    Duarte, Rui; Raphael, Jon; Eldabe, Sam

    2015-01-01

    This article provides a summary of the updated British Pain Society Guidance on Intrathecal Drug Delivery for the management of pain and spasticity in adults. We aim to highlight the areas of the guidance that have been updated and to provide a concise summary. PMID:27551415

  4. Factors affecting the psychological functioning of Australian adults with chronic pain.

    PubMed

    Viggers, Lorna C; Caltabiano, Marie L

    2012-12-01

    The role of resilience, for adults facing ongoing adversity in the form of chronic medical conditions, has received little attention in the past. This research investigated the impact of resilience and coping strategies on the psychological functioning of 87 Australian adults with chronic pain, using a self-report questionnaire. It included the McGill Pain Questionnaire, the Connor-Davidson Resilience Scale, the Coping Strategies Questionnaire, the 36-item Short Form Health Survey, and the Depression, Anxiety and Stress Scale. Using hierarchical regression, after the effects of pain severity, catastrophizing, and ignoring the pain were controlled for, resilience was significantly associated with mental health-related quality of life (β = 0.18, P < 0.05), depression (β = -0.31, P < 0.01), and anxiety (β = -0.20, P < 0.05). In the final model for depression, resilience had a stronger association than pain severity. Resilience did not, however, influence individual's perceptions of their physical health-related quality of life. The link between resilience and mental health-related quality of life outcomes provides initial evidence for the potential application of resilience related interventions to pain management programs. PMID:22994657

  5. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care

    PubMed Central

    Kumar, Senthil P

    2011-01-01

    Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain. PMID:21976851

  6. Snapshot of Adolescent and Young Adult Cancer

    MedlinePlus

    ... Partners & Collaborators Spotlight on Scientists Research Areas Cancer Biology Cancer Genomics Causes of Cancer Diagnosis Prevention Screening & ... Collaborators Spotlight on Scientists NCI Research Areas Cancer Biology Cancer Genomics Causes of Cancer Diagnosis Prevention Screening & ...

  7. The situation-specific theory of pain experience for Asian American cancer patients.

    PubMed

    Im, Eun-Ok

    2008-01-01

    Studies have indicated the need for theories that explain and target ethnic-specific cancer pain experiences, including those of Asian Americans. In this article, I present a situation-specific theory that explains the unique cancer pain experience of Asian Americans. Unlike other existing theories, this situation-specific theory was developed on the basis of evidence, including a systematic literature review and research findings, making it comprehensive and highly applicable to research and practice with Asian American patients with cancer. Thus, this theory would strengthen the interconnections among theory, evidence, and practice in pain management for Asian American cancer patients. PMID:19033747

  8. Neuropathic cancer pain: What we are dealing with? How to manage it?

    PubMed Central

    Esin, Ece; Yalcin, Suayib

    2014-01-01

    Cancer pain is a serious health problem, and imposes a great burden on the lives of patients and their families. Pain can be associated with delay in treatment, denial of treatment, or failure of treatment. If the pain is not treated properly it may impair the quality of life. Neuropathic cancer pain (NCP) is one of the most complex phenomena among cancer pain syndromes. NCP may result from direct damage to nerves due to acute diagnostic/therapeutic interventions. Chronic NCP is the result of treatment complications or malignancy itself. Although the reason for pain is different in NCP and noncancer neuropathic pain, the pathophysiologic mechanisms are similar. Data regarding neuropathic pain are primarily obtained from neuropathic pain studies. Evidence pertaining to NCP is limited. NCP due to chemotherapeutic toxicity is a major problem for physicians. In the past two decades, there have been efforts to standardize NCP treatment in order to provide better medical service. Opioids are the mainstay of cancer pain treatment; however, a new group of therapeutics called coanalgesic drugs has been introduced to pain treatment. These coanalgesics include gabapentinoids (gabapentin, pregabalin), antidepressants (tricyclic antidepressants, duloxetine, and venlafaxine), corticosteroids, bisphosphonates, N-methyl-D-aspartate antagonists, and cannabinoids. Pain can be encountered throughout every step of cancer treatment, and thus all practicing oncologists must be capable of assessing pain, know the possible underlying pathophysiology, and manage it appropriately. The purpose of this review is to discuss neuropathic pain and NCP in detail, the relevance of this topic, clinical features, possible pathology, and treatments of NCP. PMID:24790459

  9. Adult Perceptions of Pain and Hunger Cries: A Synchrony of Arousal.

    ERIC Educational Resources Information Center

    Zeskind, Philip Sanford; And Others

    1985-01-01

    Male and female nonparent adults rated tape-recordings of initial, middle, and final 10-second segments of pain and hunger cries on four 7-point Likert-type scale items describing how urgent, arousing, aversive, and sick cry segments sounded. Results suggest that different segments of cries resulting from the same stimulus provide different…

  10. Suicidal ideation and suicide attempts in older adults: Influences of chronic illness, functional limitations, and pain.

    PubMed

    Kim, Su Hyun

    2016-01-01

    This study aimed to examine the associations between suicidal behavior in older Korean adults and chronic illnesses, functional limitations, and pain. Data were obtained and analyzed for 8500 adults over 65 years of age from the 2007-2012 Korea National Health and Nutrition Examination Survey IV and V. Multivariate logistic regression analyses were conducted to examine the associations between suicidal behavior, chronic illness, functional limitations, and pain. The presence of arthritis and renal failure were significantly associated with a higher risk of suicidal ideation and suicide attempts. Moderate limitation in usual activities and extreme pain significantly increased the risk of both suicidal ideation and suicide attempts, over and above the existence of chronic illnesses and depression status. PMID:26318163

  11. Epigenetic regulation in adult stem cells and cancers

    PubMed Central

    2013-01-01

    Adult stem cells maintain tissue homeostasis by their ability to both self-renew and differentiate to distinct cell types. Multiple signaling pathways have been shown to play essential roles as extrinsic cues in maintaining adult stem cell identity and activity. Recent studies also show dynamic regulation by epigenetic mechanisms as intrinsic factors in multiple adult stem cell lineages. Emerging evidence demonstrates intimate crosstalk between these two mechanisms. Misregulation of adult stem cell activity could lead to tumorigenesis, and it has been proposed that cancer stem cells may be responsible for tumor growth and metastasis. However, it is unclear whether cancer stem cells share commonalities with normal adult stem cells. In this review, we will focus on recent discoveries of epigenetic regulation in multiple adult stem cell lineages. We will also discuss how epigenetic mechanisms regulate cancer stem cell activity and probe the common and different features between cancer stem cells and normal adult stem cells. PMID:24172544

  12. Pain Reports by Older Hospice Cancer Patients and Family Caregivers: The Role of Cognitive Functioning

    PubMed Central

    Allen, Rebecca S.; Haley, William E.; Small, Brent J.; McMillan, Susan C.

    2009-01-01

    Purpose Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. Design and Methods We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. Results Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. Implications Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management. PMID:12145378

  13. 11th Annual NIH Pain Consortium Symposium on Advances in Pain Research | Division of Cancer Prevention

    Cancer.gov

    The NIH Pain Consortium will convene the 11th Annual NIH Pain Consortium Symposium on Advances in Pain Research, featuring keynote speakers and expert panel sessions on Innovative Models and Methods. The first keynote address will be delivered by David J. Clark, MD, PhD, Stanford University entitled “Challenges of Translational Pain Research: What Makes a Good Model?” |

  14. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

    PubMed Central

    Temkit, M’hamed; Ewais, MennatAllah M.; Luckritz, Todd C.; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley D.; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.

    2016-01-01

    Background Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients’ pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. Conclusions Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.

  15. BDNF signaling contributes to oral cancer pain in a preclinical orthotopic rodent model

    PubMed Central

    Chodroff, Leah; Bendele, Michelle; Valenzuela, Vanessa; Henry, Michael

    2016-01-01

    The majority of patients with oral cancer report intense pain that is only partially managed by current analgesics. Thus, there is a strong need to study mechanisms as well as develop novel analgesics for oral cancer pain. Current study employed an orthotopic tongue cancer model with molecular and non-reflexive behavioral assays to determine possible mechanisms of oral cancer pain. Human oral squamous cell carcinoma cells line, HSC2, was injected into the tongue of male athymic mice and tumor growth was observed by day 6. Immunohistological analyses revealed a well-differentiated tumor with a localized immune response and pronounced sensory and sympathetic innervation and vascularization. The tumor expressed TMPRSS2, a protein previously reported with oral squamous cell carcinoma. ATF3 expression in trigeminal ganglia was not altered by tumor growth. Molecular characterization of the model demonstrated altered expression of several pain-related genes, out of which up-regulation of BDNF was most striking. Moreover, BDNF protein expression in trigeminal ganglia neurons was increased and inhibition of BDNF signaling with a tyrosine kinase B antagonist, ANA-12, reversed pain-like behaviors induced by the oral tumor. Oral squamous cell carcinoma tumor growth was also associated with a reduction in feeding, mechanical hypersensitivity in the face, as well as spontaneous pain behaviors as measured by the conditioned place preference test, all of which were reversed by analgesics. Interestingly, injection of HSC2 into the hindpaw did not reproduce this spectrum of pain behaviors; nor did injection of a colonic cancer cell line into the tongue. Taken together, this orthotopic oral cancer pain model reproduces the spectrum of pain reported by oral cancer patients, including higher order cognitive changes, and demonstrates that BDNF signaling constitutes a novel mechanism by which oral squamous cell carcinoma induces pain. Identification of the key role of tyrosine kinase B

  16. Perceived Injustice Predicts Stress and Pain in Adults with Sickle Cell Disease

    PubMed Central

    Molokie, Robert E.; Wilkie, Diana J.; Suarez, Marie L.; Yao, Yingwei

    2014-01-01

    Background Research evidence shows that perceived injustice is a context-based unfair treatment that has negative influence on health outcomes. Aims We examined the contribution of patients’ perceived injustice regarding interactions with healthcare providers to stress and pain in adults with sickle cell disease (SCD). Design This study was a cross-sectional correlational pilot study. Setting Included in the study were adults with SCD who received their care from a university-affiliated Comprehensive Sickle Cell Clinic. Participants/Subjects Participants were 52 adults whose mean age was 34 ±11 years (minimum [min] 20 years, maximum [max] 70 years). Most of the patients were African Americans (n = 48, 92%) and female (n = 41, 79%). Forty-eight patients (92%) reported having a high school diploma or higher. Methods Participants completed the perceived injustice questionnaire, perceived stress questionnaire, and the PAINReportIt, which includes questions to measure pain and demographics. We analyzed the data using the linear regression analyses. Results Perceived injustice from doctors was a significant predictor of perceived stress, p<.001 and pain, p=.002. Perceived injustice from nurses also was a significant predictor of perceived stress, p<.001 and pain, p=.02. The procedural, distributive, and informational domains of perceived injustice attributed to both doctors and nurses consistently predicted patients’ perceived stress, but only the procedural and distributive domains of perceived injustice consistently predicted patients’ pain. Conclusions Findings suggest that perceived injustice was negatively associated with stress and pain in adults with SCD and warrant further investigation in a larger sample. PMID:25439119

  17. Postural correction reduces hip pain in adult with acetabular dysplasia: a case report

    PubMed Central

    Lewis, Cara L.; Khuu, Anne; Marinko, Lee

    2015-01-01

    Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient’s posture, the patient’s pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology. PMID:25731688

  18. Vitamin D for the treatment of chronic painful conditions in adults

    PubMed Central

    Straube, Sebastian; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions. Objectives To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews. Selection criteria Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults. Data collection and analysis Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data. Main results Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain. Authors’ conclusions The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research. PMID:20091647

  19. Effects of reflexotherapy on acute postoperative pain and anxiety among patients with digestive cancer.

    PubMed

    Tsay, Shiow-Luan; Chen, Hsiao-Ling; Chen, Su-Chiu; Lin, Hung-Ru; Lin, Kuan-Chia

    2008-01-01

    Even after receiving analgesia, patients with gastric and liver cancer still report moderate levels of postoperative pain. The purpose of the study was to investigate the efficacy of foot reflexotherapy as adjuvant therapy in relieving pain and anxiety in postoperative patients with gastric cancer and hepatocellular cancer. The study design was a randomized controlled trial. Data were collected from 4 surgical wards of a medical center in 2005 in Taipei, Taiwan. Sixty-one patients who had received surgery for gastric cancer or hepatocellular carcinoma were randomly allocated to an intervention (n = 30) or control (n = 31) group. Patients in the intervention group received the usual pain management plus 20 minutes of foot reflexotherapy during postoperative days 2, 3, and 4. Patients in the control group received usual pain management. Outcome measures included the short-form McGill Pain Questionnaire, visual analog scale for pain, summary of the pain medications consumed, and the Hospital Anxiety and Depression Scale. Results demonstrated that studied patients reported moderately high levels of pain and anxiety postoperatively while patients were managed with patient-controlled analgesia. Using generalized estimation equations and controlling for confounding variables, less pain (P < .05) and anxiety (P < .05) over time were reported by the intervention group compared with the control group. In addition, patients in the intervention group received significantly less opioid analgesics than the control group (P < .05). Findings from this study provide nurses with an additional treatment to offer postoperative digestive cancer patients. PMID:18490886

  20. A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain

    PubMed Central

    Pergolizzi, Joseph V.; Zampogna, Gianpietro; Taylor, Robert; Gonima, Edmundo; Posada, Jose; Raffa, Robert B.

    2016-01-01

    Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations. PMID:26973529

  1. Performance and quality indicators for the management of non-cancer chronic pain: a scoping review protocol

    PubMed Central

    Zidarov, Diana; Visca, Regina; Gogovor, Amédé; Ahmed, Sara

    2016-01-01

    Introduction Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. Methods and analysis The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations’ websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. Ethics and dissemination The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies

  2. Resting-State EEG Delta Power is Associated with Psychological Pain in Adults with a History of Depression

    PubMed Central

    Meerwijk, Esther L.; Ford, Judith M.; Weiss, Sandra J.

    2015-01-01

    Psychological pain is a prominent symptom of clinical depression. We asked if frontal alpha asymmetry, frontal EEG power, and frontal fractal dimension asymmetry predicted psychological pain in adults with a history of depression. Resting-state frontal EEG (F3/F4) was recorded while participants (N=35) sat upright with their eyes closed. Frontal delta power predicted psychological pain while controlling for depressive symptoms, with participants who exhibited less power experiencing greater psychological pain. Frontal fractal dimension asymmetry, a nonlinear measure of complexity, also predicted psychological pain, such that greater left than right complexity was associated with greater psychological pain. Frontal alpha asymmetry did not contribute unique variance to any regression model of psychological pain. As resting-state delta power is associated with the brain’s default mode network, results suggest that the default mode network was less activated during high psychological pain. Findings are consistent with a state of arousal associated with psychological pain. PMID:25600291

  3. Occupational Therapy Use by Older Adults With Cancer

    PubMed Central

    Pergolotti, Mackenzi; Cutchin, Malcolm P.; Weinberger, Morris; Meyer, Anne-Marie

    2014-01-01

    Occupational therapy may significantly improve cancer survivors’ ability to participate in activities, thereby improving quality of life. Little is known, however, about the use of occupational therapy services by adults with cancer. The objective of this study was to understand what shapes patterns of occupational therapy use to help improve service delivery. We examined older (age >65 yr) adults diagnosed with breast, prostate, lung, or melanoma (skin) cancer between 2004 and 2007 (N = 27,131) using North Carolina Central Cancer Registry data linked to Medicare billing claims. Survivors who used occupational therapy within 1 yr before their cancer diagnosis were more likely to use occupational therapy after diagnosis but also experienced the highest levels of comorbidities. Survivors with Stage 4 cancers or lung cancer were less likely to use occupational therapy. These findings suggest possible disparities in utilization of occupational therapy by older adults with cancer. PMID:25184473

  4. Concepts within the Chinese culture that influence the cancer pain experience.

    PubMed

    Chen, Lih-Mih; Miaskowski, Christine; Dodd, Marylin; Pantilat, Steven

    2008-01-01

    The purpose of this article is to describe some of the concepts within the Chinese culture that influence the sociocultural dimension of the cancer pain experience. The major concepts that influence Chinese patients' perspectives on cancer pain and its management include Taoism/energy, Buddhism, and Confucianism. Within the beliefs of Taoism/energy, pain occurs if Qi, or blood circulation, is blocked. To relieve pain, the blockage of Qi/blood must be removed and the person needs to maintain harmony with the universe. Within the beliefs of Buddhism, pain/suffering is a power, unwanted but existent, that comes from a barrier in the last life; from the objective world; from a person's own sensation; or from other people, animals, and materials. Only by following the 8 right ways (ie, right view, right intention, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration) can an individual end the path of pain/suffering. A Confucian believes that pain is an essential element of life, a "trial" or a "sacrifice." Therefore, when a person suffers with pain, he or she would rather endure the pain and not report it to a clinician until the pain becomes unbearable. Oncology nurses who care for Chinese patients need to understand the fundamental beliefs that influence the sociocultural dimension of the pain experience for these patients. This information will assist the oncology nurse in developing a more effective pain management plan. PMID:18490884

  5. Celiac plexus neurolysis for the treatment of upper abdominal cancer pain

    PubMed Central

    Teixeira, Manoel Jacobsen; Neto, Eloy Rusafa; da Nóbrega, José Cláudio Marinho; dos Ângelos, Jairo Silva; Martin, Miguel San; de Monaco, Bernardo Assumpção; Fonoff, Erich Talamoni

    2013-01-01

    Optimal treatment of oncologic pain is a challenge to all professionals who deal with cancer and its complications. The management of upper abdominal pain is usually difficult and it is often refractory to conservative therapies. In this context, celiac plexus neurolysis (CPN) appears to be an important and indispensable tool because it alleviates pain, gives comfort to patients and is a safe procedure. In this study, the importance of CPN is reviewed by a retrospective study of 74 patients with pain due to upper abdominal cancer. Almost all cases evaluated (94.6%) had an excellent result after CPN and the majority of side effects were transitory. PMID:23983470

  6. Daily Variations in Objective Nighttime Sleep and Subjective Morning Pain in Older Adults with Insomnia: Evidence of Covariation Over Time

    PubMed Central

    Dzierzewski, Joseph M.; Williams, Jacob M.; Roditi, Daniela; Marsiske, Michael; McCoy, Karin; McNamara, Joseph; Dautovich, Natalie; Robinson, Michael E.; McCrae, Christina S.

    2010-01-01

    Objectives To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia. The goal of the paper was to not only examine the sleep-pain association between-persons (mean-level over 14 days), but also to investigate the within-person, day-to-day association. Design Cross-sectional. Setting North-Central Florida. Participants Fifty community-dwelling older adults (Mage = 69.10 years, SDage = 7.02 years, range = 60 – 90 years) with insomnia participated in the study. Measurements This study employed daily home-based assessment utilizing nightly actigraphic measurement of sleep and daily self-report of pain. Measures were completed over fourteen consecutive days. Results Between persons, average sleep over 14 days was not associated with average levels of rated pain. However, following a night in which an older adult with insomnia experienced above-average total sleep time s/he subsequently reported below-average pain ratings. The model explained approximately 24% of the within-person and 8% of the between-person variance in pain ratings. Conclusions Sleep and pain show day-to-day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie both the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep. PMID:20406316

  7. Age and race effects on pain sensitivity and modulation among middle-aged and older adults

    PubMed Central

    Riley, Joseph L.; Cruz-Almeida, Yenisel; Glover, Toni L.; King, Christopher D.; Goodin, Burel R.; Sibille, Kimberly T.; Bartley, Emily J.; Herbert, Matthew S.; Sotolongo, Adriana; Fessler, Barri J.; Redden, David T.; Staud, Roland; Bradley, Laurence A.; Fillingim, Roger B

    2014-01-01

    This study tested the effects of aging and race on responses to noxious stimuli using a wide range of stimulus modalities. The participants were 53 non-Hispanic Blacks and 138 non-Hispanic White adults, ages 45 to 76. The participants completed a single 3-hour sensory testing session where responses to thermal, mechanical, and cold stimuli were assessed. The results suggest that there are selected age differences, with the older group less sensitive to warm and painful heat stimuli than middle-aged participants, particularly at the knee. This site effect supports the hypothesis that the greatest decrement in pain sensitivity associated with aging occurs in the lower extremities. In addition, there were several instances where age and race effects were compounded, resulting in greater race differences in pain sensitivity among the older participants. Overall, the data suggest that previously reported race differences in pain sensitivity emerged in our older samples, and this study contributes new findings in that these differences may increase with age in non-Hispanic Blacks for temporal summation and both heat and cold immersion tolerance. We have added to the aging and pain literature by reporting several small to moderate differences in responses to heat stimuli between middle and older age adults. PMID:24239561

  8. Efficacy, safety, and tolerability of fentanyl pectin nasal spray in patients with breakthrough cancer pain

    PubMed Central

    Ueberall, Michael A; Lorenzl, Stefan; Lux, Eberhard A; Voltz, Raymond; Perelman, Michael

    2016-01-01

    Objective Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS) in the treatment of breakthrough cancer pain (BTcP) in routine clinical practice. Methods A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up) of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to “time to first effect”, “time to maximum effect”, BTcP relief, as well as changes in BTcP-related impairment of daily life activities, quality-of-life restrictions, and health care resource utilization. Results A total of 235 patients were recruited of whom 220 completed all questionnaires and reported on 1,569 BTcP episodes. Patients reported a significant reduction of maximum BTcP intensity (11-stage numerical rating scale [0= no pain, 10= worst pain conceivable]) with FPNS (mean ± standard deviation = 2.8±2.3) compared with either that reported at baseline (8.5±1.5), experienced immediately before FPNS application (7.4±1.7), or that achieved with previous BTcP medication (6.0±2.0; P<0.001 for each comparison). In 12.3% of BTcP episodes, onset of pain relief occurred ≤2 minutes and in 48.4% ≤5 minutes; maximum effects were reported within 10 minutes for 37.9% and within 15 minutes for 79.4%. By the end of the study, there had been significant improvements versus baseline in BTcP-related daily life activities (28.3±16.9 vs 53.1±11.9), physical (35.9±8.4 vs 26.8±6.5), and mental quality of life (38.7±8.5 vs 29.9±7.9) (P<0.001 for each comparison vs baseline); in addition, health care resource utilization requirements directly related to BTcP were reduced by 67.5%. FPNS was well tolerated; seven patients (3.2%) experienced eight treatment-emergent adverse events of which none was serious. There were no indicators of misuse or abuse

  9. Novel Telemedicine Technologies in Geriatric Chronic Non-Cancer Pain: Primary Care Providers’ Perspectives

    PubMed Central

    Levine, Mimi; Richardson, Joshua E.; Granieri, Evelyn; Reid, M. Cary

    2015-01-01

    Objective We sought to identify primary care providers’ interest in, as well as perceived barriers and facilitators to, using novel telemedicine technologies (e.g., smartphones) for managing chronic non-cancer pain (CNCP) in older adults. Design Six focus groups were conducted with 25 primary care providers. Setting Two academically affiliated primary care practices serving older adults with CNCP in New York City. Methods The investigators used content analysis to analyze transcribed focus group data and identify specific themes. Results While most providers reported limited use of telemedicine, they expressed substantial interest in trying devices such as smartphones in the management of older patients with CNCP. Perceived barriers to implementation of telemedicine tools included information overload, lack of mobile device usability among patients and clinicians, liability issues, and cost. To overcome these barriers, participants suggested implementing electronic or human-based pre-analysis of data (e.g., a computer or a person that triages patient data), creating a low-cost and user-friendly mobile device design, and targeting appropriate user populations. Conclusions Primary care providers are interested in applying telemedicine when caring for older adults with CNCP. Although they perceived multiple barriers to device implementation, they offered innovative solutions to address these barriers. Providers felt that novel telemedicine technologies may improve the management of CNCP but wanted evidence that the devices were both cost- and time-efficient, and led to improved patient outcomes before adopting their use in practice. PMID:24341423

  10. Analgesic effects of adenylyl cyclase inhibitor NB001 on bone cancer pain in a mouse model

    PubMed Central

    Kang, Wen-bo; Yang, Qi; Guo, Yan-yan; Wang, Lu; Wang, Dong-sheng; Cheng, Qiang; Li, Xiao-ming; Tang, Jun; Zhao, Jian-ning; Liu, Gang; Zhuo, Min

    2016-01-01

    Background Cancer pain, especially the one caused by metastasis in bones, is a severe type of pain. Pain becomes chronic unless its causes and consequences are resolved. With improvements in cancer detection and survival among patients, pain has been considered as a great challenge because traditional therapies are partially effective in terms of providing relief. Cancer pain mechanisms are more poorly understood than neuropathic and inflammatory pain states. Chronic inflammatory pain and neuropathic pain are influenced by NB001, an adenylyl cyclase 1 (AC1)-specific inhibitor with analgesic effects. In this study, the analgesic effects of NB001 on cancer pain were evaluated. Results Pain was induced by injecting osteolytic murine sarcoma cell NCTC 2472 into the intramedullary cavity of the femur of mice. The mice injected with sarcoma cells for four weeks exhibited significant spontaneous pain behavior and mechanical allodynia. The continuous systemic application of NB001 (30 mg/kg, intraperitoneally, twice daily for three days) markedly decreased the number of spontaneous lifting but increased the mechanical paw withdrawal threshold. NB001 decreased the concentrations of cAMP and the levels of GluN2A, GluN2B, p-GluA1 (831), and p-GluA1 (845) in the anterior cingulate cortex, and inhibited the frequency of presynaptic neurotransmitter release in the anterior cingulate cortex of the mouse models. Conclusions NB001 may serve as a novel analgesic to treat bone cancer pain. Its analgesic effect is at least partially due to the inhibition of AC1 in anterior cingulate cortex. PMID:27612915

  11. Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults

    PubMed Central

    Boerner, Katelynn E.; Birnie, Kathryn A.; Taddio, Anna; McMurtry, C. Meghan; Noel, Melanie; Shah, Vibhuti; Pillai Riddell, Rebecca

    2015-01-01

    Background: This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). Design/Methods: Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). Results: No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, “ready?”) as compared with signaling of impending pain (eg, “sharp scratch”) demonstrated lower pain when signaled about the procedure (n=199): SMD=−0.97 (95% CI, −1.26, −0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, −0.48, 0.27), or fear: SMD=−0.25 (95% CI, −0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=−0.57 (95% CI, −1.82, 0.68), or fear (n=81): SMD=−0.05 (95% CI, −0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=−0.82 (95% CI, −1.21, −0.43). The quality of evidence across all trials was very low. Conclusions: There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction. PMID:26352921

  12. Non-pharmacologic management of pain in the person with cancer.

    PubMed

    Mayer, D K

    1985-07-01

    Management of pain in the person with cancer is a high priority in nursing. Although the actual incidence and severity is not well documented, pain may be experienced at some point by the majority of persons with cancer. Pharmacologic management, by itself, is often not adequate. Nurses must become familiar with non-pharmacologic interventions, to be used alone or in combination with analgesics, for the successful management of cancer pain. This paper discusses various non-pharmacologic options and includes a nursing protocol. More research is warranted to better define those most likely to benefit from these interventions. PMID:3900169

  13. The Relationship Between Ethnicity and the Pain Experience of Cancer Patients: A Systematic Review

    PubMed Central

    Kwok, Wingfai; Bhuvanakrishna, Thakshyanee

    2014-01-01

    Background: Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient's ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship. Materials and Methods: A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1) Medline (1946–2013), (2) Embase (1980–2012), (3) The Cochrane Library, (4) Pubmed, and (5) Psycinfo (1806–2013). The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background. Results: Two main themes were identified from the included quantitative and qualitative studies, and ethnic differences were found in: (1) The management of cancer pain and (2) The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior. Conclusion: There is an evidence to suggest that the cancer pain experience is different between

  14. Methadone, Morphine, or Oxycodone in Treating Pain in Patients With Cancer

    ClinicalTrials.gov

    2012-11-09

    Brain and Central Nervous System Tumors; Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

  15. Magnetic Acupressure in Reducing Pain in Cancer Patients Undergoing Bone Marrow Aspiration and Biopsy

    ClinicalTrials.gov

    2010-04-09

    Brain and Central Nervous System Tumors; Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

  16. Opioid Titration Order Sheet or Standard Care in Treating Patients With Cancer Pain

    ClinicalTrials.gov

    2012-08-04

    Brain and Central Nervous System Tumors; Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

  17. Fighting Chronic Pain

    MedlinePlus

    ... pain, bone pain from spread of cancer, fibromyalgia, chronic fatigue syndrome Neurologic: "Phantom limb" pain after amputation, nerve pain from diabetes Read More "Chronic Pain" Articles Easing Chronic Pain: Better Treatments and ...

  18. Mechanisms of PDGF siRNA-mediated inhibition of bone cancer pain in the spinal cord.

    PubMed

    Xu, Yang; Liu, Jia; He, Mu; Liu, Ran; Belegu, Visar; Dai, Ping; Liu, Wei; Wang, Wei; Xia, Qing-Jie; Shang, Fei-Fei; Luo, Chao-Zhi; Zhou, Xue; Liu, Su; McDonald, JohnW; Liu, Jin; Zuo, Yun-Xia; Liu, Fei; Wang, Ting-Hua

    2016-01-01

    Patients with tumors that metastasize to bone frequently suffer from debilitating pain, and effective therapies for treating bone cancer are lacking. This study employed a novel strategy in which herpes simplex virus (HSV) carrying a small interfering RNA (siRNA) targeting platelet-derived growth factor (PDGF) was used to alleviate bone cancer pain. HSV carrying PDGF siRNA was established and intrathecally injected into the cavum subarachnoidale of animals suffering from bone cancer pain and animals in the negative group. Sensory function was assessed by measuring thermal and mechanical hyperalgesia. The mechanism by which PDGF regulates pain was also investigated by comparing the differential expression of pPDGFRα/β and phosphorylated ERK and AKT. Thermal and mechanical hyperalgesia developed in the rats with bone cancer pain, and these effects were accompanied by bone destruction in the tibia. Intrathecal injection of PDGF siRNA and morphine reversed thermal and mechanical hyperalgesia in rats with bone cancer pain. In addition, we observed attenuated astrocyte hypertrophy, down-regulated pPDGFRα/β levels, reduced levels of the neurochemical SP, a reduction in CGRP fibers and changes in pERK/ERK and pAKT/AKT ratios. These results demonstrate that PDGF siRNA can effectively treat pain induced by bone cancer by blocking the AKT-ERK signaling pathway. PMID:27282805

  19. Mechanisms of PDGF siRNA-mediated inhibition of bone cancer pain in the spinal cord

    PubMed Central

    Xu, Yang; Liu, Jia; He, Mu; Liu, Ran; Belegu, Visar; Dai, Ping; Liu, Wei; Wang, Wei; Xia, Qing-Jie; Shang, Fei-Fei; Luo, Chao-Zhi; Zhou, Xue; Liu, Su; McDonald, JohnW.; Liu, Jin; Zuo, Yun-Xia; Liu, Fei; Wang, Ting-Hua

    2016-01-01

    Patients with tumors that metastasize to bone frequently suffer from debilitating pain, and effective therapies for treating bone cancer are lacking. This study employed a novel strategy in which herpes simplex virus (HSV) carrying a small interfering RNA (siRNA) targeting platelet-derived growth factor (PDGF) was used to alleviate bone cancer pain. HSV carrying PDGF siRNA was established and intrathecally injected into the cavum subarachnoidale of animals suffering from bone cancer pain and animals in the negative group. Sensory function was assessed by measuring thermal and mechanical hyperalgesia. The mechanism by which PDGF regulates pain was also investigated by comparing the differential expression of pPDGFRα/β and phosphorylated ERK and AKT. Thermal and mechanical hyperalgesia developed in the rats with bone cancer pain, and these effects were accompanied by bone destruction in the tibia. Intrathecal injection of PDGF siRNA and morphine reversed thermal and mechanical hyperalgesia in rats with bone cancer pain. In addition, we observed attenuated astrocyte hypertrophy, down-regulated pPDGFRα/β levels, reduced levels of the neurochemical SP, a reduction in CGRP fibers and changes in pERK/ERK and pAKT/AKT ratios. These results demonstrate that PDGF siRNA can effectively treat pain induced by bone cancer by blocking the AKT-ERK signaling pathway. PMID:27282805

  20. Current aproach to cancer pain management: Availability and implications of different treatment options

    PubMed Central

    Nersesyan, Hrachya; Slavin, Konstantin V

    2007-01-01

    Despite tremendous progress in medicine during last couple of decades, cancer still remains the most horrifying diagnosis for anybody due to its almost inevitable futility. According to American Cancer Society Statistics, it is estimated that only in the United States more than half a million people will die from cancer in 2006. For those who survive, probably the most fearsome symptom regardless of cancer type will be the pain. Although most pain specialists and oncologists worldwide are well aware of the importance to adequately treat the pain, it was yet established that more than half of cancer patients have insufficient pain control, and about quarter of them actually die in pain. Therefore, in this review article we attempted to provide the comprehensive information about different options available nowadays for treating cancer pain focusing on most widely used pharmacologic agents, surgical modalities for intractable pain control, their potential for adverse effects, and ways to increase the effectiveness of treatment maximally optimizing analgesic regimen and improving compliance. PMID:18488078

  1. Increased Anandamide Uptake by Sensory Neurons Contributes to Hyperalgesia in a Model of Cancer Pain

    PubMed Central

    Khasabova, Iryna A.; Holman, Michelle; Morse, Tim; Burlakova, Natalya; Coicou, Lia; Harding-Rose, Catherine; Simone, Don A.; Seybold, Virginia S.

    2013-01-01

    Opioids do not effectively manage pain in many patients with advanced cancer. Because anandamide (AEA) activation of cannabinoid type-1 receptors (CB1R) on nociceptors reduces nociception, manipulation of AEA metabolism in the periphery may be an effective alternative or adjuvant therapy in the management of cancer pain. AEA is hydrolyzed by the intracellular enzyme fatty acid amide hydrolase (FAAH), and this enzyme activity contributes to uptake of AEA into neurons and to reduction of AEA available to activate CB1R. We used an in vitro preparation of adult murine dorsal root ganglion (DRG) neurons co-cultured with fibrosarcoma cells to investigate how tumors alter the uptake of AEA into neurons. Evidence that the uptake of [3H]AEA into dissociated DRG cells in the co-culture model mimicked the increase in uptake that occurred in DRG cells from tumor-bearing mice supported the utility of the in vitro model to study AEA uptake. Results with the fluorescent AEA analog CAY10455 confirmed that an increase in uptake in the co-culture model occurred in neurons. One factor that contributed to the increase in [3H]AEA uptake was an increase in total cellular cholesterol in the cancer condition. Treatment with the FAAH inhibitor URB597 reduced CAY10455 uptake in the co-culture model to the level observed in DRG neurons maintained in the control condition (i.e., in the absence of fibrosarcoma cells), and this effect was paralleled by OMDM-1, an inhibitor of AEA uptake, at a concentration that had no effect on FAAH activity. Maximally effective concentrations of the two drugs together produced a greater reduction than was observed with each drug alone. Treatment with BMS309403, which competes for AEA binding to fatty acid binding protein-5, mimicked the effect of OMDM-1 in vitro. Local injection of OMDM-1 reduced hyperalgesia in vivo in mice with unilateral tumors in and around the calcaneous bone. Intraplantar injection of OMDM-1 (5 µg) into the tumor-bearing paw reduced

  2. Cancer-Related Pain Management and the Optimal Use of Opioids.

    PubMed

    Reis-Pina, Paulo; Lawlor, Peter G; Barbosa, António

    2015-01-01

    Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics - by a registered medical practitioner for absolute pain control - is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management. PMID:26421791

  3. Clinical pharmacy in a multidisciplinar team for chronic pain in adults.

    PubMed

    Bauters, T G M; Devulder, J; Robays, H

    2008-01-01

    The aim of this study was to evaluate the role and the impact of a clinical pharmacist as a member of a multidisciplinary pain team. Although physicians have a good knowledge of pharmacotherapy in the field of pain medication, pharmacy interventions were necessary to enhance the quality of prescribing. On a population of 93 patients, a total of 120 interventions were recorded. The different types of interventions included: provision of information (10.0%), clinical intervention (89.2%) and the provision of a specific product (0.8%). Out of the 107 clinical interventions, a total of 95.3 % interventions were accepted by the physicians. The results highlight the clinical importance of the pharmacy in optimizing drug therapy for adult patients with chronic pain. PMID:19048702

  4. A structural equation model relating physical function, pain, impaired mobility (IM), and falls in older adults.

    PubMed

    Dai, Boyi; Ware, William B; Giuliani, Carol A

    2012-01-01

    The current study used a structural equation model to investigate the interrelationships among physical function, pain, IM, and falls in 511 American older adults. The model included 11 measurement variables (tandem stance, single leg stance, 360° turn, chair stand, arm curl, sit and reach, back scratch, normative score of 6-min walk or 2-min step, timed up and go, pain, and fall) and four latent variables (balance, strength, flexibility, and IM). The final model with the combined sample demonstrated good fit with the participant data (χ(2)(31)=30.0, N=499, p=0.52; Goodness of Fit Index (GFI)=0.99). Balance had a significant and the largest effect on IM (standardized regression weights=-1.05, p<0.001). Strength, endurance, flexibility, and pain had small effects on IM (standardized regression weights<0.2). The findings suggest that balance and mobility testing should be a priority in fall screening and prevention programs. PMID:22766209

  5. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review

    PubMed Central

    Carlson, Cathy L

    2016-01-01

    Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity. PMID:27524918

  6. Epidural buprenorphine or morphine for the relief of head and neck cancer pain.

    PubMed Central

    Hashimoto, Y.; Utsumi, T.; Tanioka, H.; Rigor, B. M.

    1991-01-01

    We present three cases in which epidural buprenorphine or morphine was used for intractable cancer pain of the head and neck. Excellent pain relief and minimal side effects offered by epidural opioids were of significant benefit. The use of epidural opioids prior to the administration of high doses of oral morphine may be the treatment of choice for pain from malignancy of the head and neck, especially when there is tumor extension or distant metastasis. PMID:1811431

  7. Towards a pain free hospital: an in-depth qualitative analysis of the pain experiences of head and neck cancer patients undergoing radiotherapy

    PubMed Central

    Pattison, Natalie; Brown, Matthew RD; Gubbay, Anthony; Peacock, Janet; Ross, Joy R; Chapman, Suzanne; Sauzet, Odile; Williams, John

    2015-01-01

    Background: Treatment for head and neck cancer can frequently be a painful experience with implications for patients in terms of quality of life, nutrition and ultimately treatment outcomes. Pain may arise for a number of reasons in this patient group including the influence of localised tissue damage from radiotherapy, the effects of chemotherapeutic agents as well as the disease process itself. Early identification of cancer pain, through screening and early analgesic and pain management are thought to be the most appropriate approaches to the problem. Aim: To explore in-depth, patients’ views of the experience of pain related to radiotherapy for head and neck cancer, within the context of a randomised controlled trial (RCT) of pain screening and intervention. Sample: A purposive sample of head and neck cancer patients undergoing radiotherapy who were participating in a separate RCT of a proactive pain screening intervention. Methods: A qualitative design using one-off, face-to-face, in-depth interviews. Data were inductively analysed for themes using thematic analysis. Data were collected from September 2012 to January 2013. Findings: Eight participants were interviewed. Several issues around pain management arose and the influence of various factors became apparent. Four dominant themes emerged: facets of radiotherapy pain in head and neck cancer, facilitators and barriers to pain management, pain services and finally interdisciplinary working. Conclusion: The specific issues faced by head and neck cancer patients undergoing radiotherapy highlight the need for pain relieving interventions delivered by pain specialists, in tandem with the development of robust self-management strategies. An integrated approach to care is optimal, comprising pain screening at each outpatient encounter, and review by specialists as necessary. PMID:27551409

  8. A randomized controlled trial of a nurse-administered educational intervention for improving cancer pain management in ambulatory settings.

    PubMed

    Yates, Patsy; Edwards, Helen; Nash, Robyn; Aranda, Sanchia; Purdie, David; Najman, Jake; Skerman, Helen; Walsh, Anne

    2004-05-01

    The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies. This randomized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aimed to optimize patients' ability to manage pain. One week post-intervention, patients receiving the pain management intervention (PMI) had a significantly greater increase in self-reported pain knowledge, perceived control over pain, and number of pain treatments recommended. Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain, concerns about addiction and side effects, being a "good" patient, and tolerance to pain relieving medication. The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes, which can potentially act as barriers to effective pain management. PMID:15140463

  9. Feasibility of a Patient-Controlled Cognitive Behavioral Intervention for Pain, Fatigue, and Sleep Disturbance in Cancer

    PubMed Central

    Kwekkeboom, Kristine L.; Abbott-Anderson, Kristen; Wanta, Britt

    2009-01-01

    Purpose To evaluate the feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance during treatment for advanced cancer, and to assess initial efficacy of the intervention in controlling symptoms. Design One-group pretest-posttest design. Setting Outpatient oncology clinics at a Comprehensive Cancer Center in the Midwestern United States. Sample 30 adults with advanced (recurrent or metastatic) colorectal, lung, prostate, or GYN cancer receiving chemotherapy or radiotherapy. Methods Participants completed baseline measures (demographics, symptom inventory) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies (e.g., relaxation exercises, guided imagery, nature sound recordings). Participants used the strategies as needed for symptom management over the following 2-weeks, keeping a log of symptom ratings with each use. Following the two-week intervention, participants completed a second symptom inventory and an evaluation of the intervention. Main Research Variables Feasibility, patient-controlled cognitive-behavioral intervention, pain, fatigue, sleep disturbance. Findings 73% of the 43 eligible patients agreed to participate (N=30) and of these, 90% (n=27) completed the study. The majority of participants reported that they enjoyed the intervention, had learned useful skills, and perceived improvement in their symptoms. Symptom scores at 2-weeks did not differ significantly from baseline, however significant reductions in pain, fatigue, and sleep disturbance severity were found in ratings made immediately before and after use of a cognitive-behavioral strategy. Conclusions The patient-controlled cognitive-behavioral intervention appears feasible for further study and could reduce day-to-day severity of co-occurring pain, fatigue, and sleep disturbance. Implications for Nursing A randomized controlled trial is necessary to test efficacy of the intervention for co

  10. A cross-sectional study of elite adult Irish dancers: biopsychosocial traits, pain, and injury.

    PubMed

    Cahalan, Roisin; Purtill, Helen; O'Sullivan, Peter; O'Sullivan, Kieran

    2015-03-01

    Despite its growing popularity, scant research exists concerning musculoskeletal pain and injury in Irish dancing (ID). This study aimed to record the biopsychosocial characteristics of elite adult Irish dancers and to investigate potential relationships between these characteristics and musculoskeletal pain and injury. One hundred and four professional Irish dancers, elite competitive Irish dancers, and dancers in full time education studying ID completed a questionnaire providing data on dance and activity levels, physical and psychological health, and pain and injury history. Of these subjects, 84 underwent 1. a physical screening of lower limb flexibility, which involved balance and endurance; 2. a number of functional tests; and 3. anthropometric, biomechanical, and anatomical assessments. Subjects were divided into "significantly injured (SI)" and "not significantly injured (NSI)" categories based on the severity and impact of self-reported pain and injury. Thirty-three (31.7%) subjects were classified as SI and 71 (68.3%) as NSI. The factors significantly associated with being SI were female sex (p = 0.036), higher number of subjective general health (p = 0.001) and psychological (p = 0.036) complaints, low mood (p = 0.01), heightened catastrophizing (p = 0.047), and failure always to complete a warm-up (p = 0.006). A self-reported injury rate of 76.9% over the previous 5 years was reported. The mean number of injuries sustained to all body parts over the previous 5 years was 1.49, with a mean of 126.1 days lost annually to injury. Foot and ankle injuries were most prevalent. It was concluded that there is a significant level of musculoskeletal pain and injury in elite adult ID. A complex combination of biopsychosocial factors appears to be associated with pain and injury. PMID:25741782

  11. The Pain Experience of Hispanic Patients With Cancer in the U.S.

    PubMed Central

    Im, Eun-Ok; Guevara, Enrique; Chee, Wonshik

    2008-01-01

    Background: Several plausible reasons for inadequate cancer pain management among Hispanic patients with cancer in the U.S. have been postulated; however, this issue is understudied. Purpose: The purpose of the study was to explore Hispanic patients' cancer pain experience from a feminist perspective in order to find explanations for inadequate pain management for Hispanic patients with cancer. Design: A qualitative online forum study. Setting: Both Internet and community settings. Participants: 15 Hispanic patients with cancer recruited using a convenience sampling method. Methods: A 6-month online forum was conducted using nine discussion topics, and the data were processed using a thematic analysis. Phenomenon of Interest: Cancer Pain Experience Findings: Four major themes emerged: lack of communication with health care providers regarding undermedication; because of traditional gender roles guiding their behaviors, both women and men were enduring pain; participants placed the highest priority on family during the diagnosis and treatment process, thus setting aside their needs for pain management; finally, participants were enduring inconvenience and unfair treatment in the U.S. health care system while simultaneously appreciating what treatment they had been given. Conclusions: Because of cultural factors and marginalized status in the U.S. as Hispanics and as immigrants, most of the participants could not adequately describe and manage their pain. Implications: Findings suggest a need for further investigation of the influences of multiple factors, including financial issues, cultural norms, and gender stereotypes, on cancer pain experience among diverse subgroups of Hispanic patients with cancer. Key Points: Because of their Hispanic identity or immigrant status in the U.S., financial difficulties, language barriers, and cultural values placing family as the highest priority, most of the Hispanic participants of this study could not adequately describe and

  12. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  13. Acupuncture for Pain Management in Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Hu, Caiqiong; Zhang, Haibo; Wu, Wanyin; Yu, Weiqing; Li, Yong; Bai, Jianping; Luo, Baohua; Li, Shuping

    2016-01-01

    Objective. To evaluate the effectiveness and safety of acupuncture for cancer-related pain. Methods. A systematic review of literatures published from database inception to February 2015 was conducted in eight databases. RCTs involving acupuncture for treatment of cancer-related pain were identified. Two researchers independently performed article selection, data extraction, and quality assessment of data. Results. 1,639 participants in twenty RCTs were analyzed. All selected RCTs were associated with high risk of bias. Meta-analysis indicated that acupuncture alone did not have superior pain-relieving effects as compared with conventional drug therapy. However, as compared with the drug therapy alone, acupuncture plus drug therapy resulted in increased pain remission rate, shorter onset time of pain relief, longer pain-free duration, and better quality of life without serious adverse effects. However, GRADE analysis revealed that the quality of all outcomes about acupuncture plus drug therapy was very low. Conclusions. Acupuncture plus drug therapy is more effective than conventional drug therapy alone for cancer-related pain. However, multicenter high-quality RCTs with larger sample sizes are needed to provide stronger evidence for the effectiveness of acupuncture in cancer-related pain due to the low data quality of the studies included in the current meta-analysis. PMID:26977172

  14. Cancer Pain Management and the Role of Social Work: Barriers and Interventions.

    ERIC Educational Resources Information Center

    Glajchen, Myra; And Others

    1995-01-01

    Discusses the prevalence of cancer-related pain and identifies the barriers that undermine effective pain relief. Develops a model for social work intervention in terms of communication, assessment, problem solving, and psychological support for the patient. Emphasizes skills such as communication, assessment, problem solving, and psychological…

  15. Head and Neck Cancer Pain: Systematic Review of Prevalence and Associated Factors

    PubMed Central

    Wirth, Tanja; Ranasinghe, Sriyani; Ah-See, Kim W.; Renny, Nick; Hurman, David

    2012-01-01

    ABSTRACT Objectives Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. Material and Methods The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. Results There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. Conclusions The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer. PMID:24422003

  16. Method for palliation of pain in human bone cancer using therapeutic tin-117m compositions

    DOEpatents

    Srivastava, Suresh C.; Meinken, George E.; Mausner, Leonard F.; Atkins, Harold L.

    1998-12-29

    The invention provides a method for the palliation of bone pain due to cancer by the administration of a unique dosage of a tin-117m (Sn-117m) stannic chelate complex in a pharmaceutically acceptable composition. In addition, the invention provides a method for simultaneous palliation of bone pain and radiotherapy in cancer patients using compositions containing Sn-117m chelates. The invention also provides a method for palliating bone pain in cancer patients using Sn-117m-containing compositions and monitoring patient status by imaging the distribution of the Sn-117m in the patients. Also provided are pharmaceutically acceptable compositions containing Sn-117m chelate complexes for the palliation of bone pain in cancer patients.

  17. Method for palliation of pain in human bone cancer using therapeutic tin-117m compositions

    DOEpatents

    Srivastava, S.C.; Meinken, G.E.; Mausner, L.F.; Atkins, H.L.

    1998-12-29

    The invention provides a method for the palliation of bone pain due to cancer by the administration of a unique dosage of a tin-117m (Sn-117m) stannic chelate complex in a pharmaceutically acceptable composition. In addition, the invention provides a method for simultaneous palliation of bone pain and radiotherapy in cancer patients using compositions containing Sn-117m chelates. The invention also provides a method for palliating bone pain in cancer patients using Sn-117m-containing compositions and monitoring patient status by imaging the distribution of the Sn-117m in the patients. Also provided are pharmaceutically acceptable compositions containing Sn-117m chelate complexes for the palliation of bone pain in cancer patients. 5 figs.

  18. Quantitative sensory testing of temperature, pain, and touch in adults with Down syndrome.

    PubMed

    de Knegt, Nanda; Defrin, Ruth; Schuengel, Carlo; Lobbezoo, Frank; Evenhuis, Heleen; Scherder, Erik

    2015-12-01

    The spinothalamic pathway mediates sensations of temperature, pain, and touch. These functions seem impaired in children with Down syndrome (DS), but have not been extensively examined in adults. The objective of the present study was to compare the spinothalamic-mediated sensory functions between adults with DS and adults from the general population and to examine in the DS group the relationship between the sensory functions and level of intellectual functioning. Quantitative sensory testing (QST) was performed in 188 adults with DS (mean age 37.5 years) and 142 age-matched control participants (median age 40.5 years). Temperature, pain, and touch were evaluated with tests for cold-warm discrimination, sharp-dull discrimination (pinprick), and tactile threshold, respectively. Level of intellectual functioning was estimated with the Social Functioning Scale for Intellectual Disability (intellectual disability level) and the Wechsler Preschool and Primary Scale of Intelligence--Revised (intelligence level). Overall, the difference in spinothalamic-mediated sensory functions between the DS and control groups was not statistically significant. However, DS participants with a lower intelligence level had a statistically significant lower performance on the sharp-dull discrimination test than DS participants with higher intelligence level (adjusted p=.006) and control participants (adjusted p=.017). It was concluded that intellectual functioning level is an important factor to take into account for the assessment of spinothalamic-mediated sensory functioning in adults with DS: a lower level could coincide with impaired sensory functioning, but could also hamper QST assessment. PMID:26460852

  19. Exploring the lived experience of adults using prescription opioids to manage chronic noncancer pain

    PubMed Central

    Brooks, Erica A; Unruh, Anita; Lynch, Mary E

    2015-01-01

    BACKGROUND: Chronic noncancer pain (CNCP) and prescription opioid use is a highly complex and growing health care issue in Canada. Many quantitative research studies have investigated the effectiveness of opioids for chronic pain; however, gaps remain in the literature regarding the personal experience of using opioids and their impact on those experiencing CNCP. OBJECTIVE: To explore the lived experience of adults using prescription opioids to manage CNCP, focusing on how opioid medication affected their daily lives. METHODS: In-depth qualitative interviews were conducted with nine adults between 40 and 68 years of age who were using prescription opioids daily for CNCP. Interviews were audiorecorded and transcribed, and subsequently analyzed using interpretive phenomenological analysis. RESULTS: Six major themes identified positive and negative aspects of opioid use associated with social, physical, emotional and psychological dimensions of pain management. These themes included the process of decision making, and physical and psychosocial consequences of using opioids including pharmacological side effects, feeling stigmatized, guilt, fears, ambivalence, self-protection and acceptance. CONCLUSION: Although there were many negative aspects to using opioids daily, the positive effects outweighed the negative for most participants and most of the negative aspects were socioculturally induced rather than caused by the drug itself. The present study highlighted the complexities involved in using prescription opioids daily for management of CNCP for individuals living with pain. PMID:25562838

  20. The Effects of Inflammatory Tooth Pain on Anxiety in Adult Male Rats

    PubMed Central

    Raoof, Maryam; Ebrahimnejad, Hamed; Abbasnejad, Mehdi; Amirkhosravi, Ladan; Raoof, Ramin; Esmaeili Mahani, Saeed; Ramazani, Mohsen; Shokouhinejad, Noushin; Khoshkhounejad, Mehrfam

    2016-01-01

    Introduction: This study aimed to examine the effects of induced inflammatory tooth pain on anxiety level in adult male rats. Methods: The mandibular incisors of 56 adult male rats were cut off and prefabricated crowns were fixed on the teeth. Formalin and capsaicin were injected intradentally to induce inflammatory tooth pain. Diazepam treated group received diazepam 30 minutes before intradental injection. The anxiety-related behavior was evaluated with elevated plus maze test. Results: Intradental application of chemical noxious stimuli, capsaicin and formalin, significantly affected nociceptive behaviors (P<0.001). Capsaicin (P<0.001) and formalin (P<0.01) significantly increased the anxiety levels in rats by decrease in the duration of time spent in open arm and increase in the duration of time spent in closed arm. Rats that received capsaicin made fewer open arm entries compared to the control animals (P<0.05). Capsaicin (P<0.001) and formalin (P<0.01) treated rats showed more stretch attend postures compared to the control and sham operated animals. In diazepampretreated rats, capsaicin induced algesic effect was prevented (P<0.001). Conclusion: Inflammatory pulpal pain has anxiogenic effect on rats, whereas diazepam premedication showed both anxiolytic and pain reducing effects. PMID:27563419

  1. Behavioral, medical imaging and histopathological features of a new rat model of bone cancer pain.

    PubMed

    Doré-Savard, Louis; Otis, Valérie; Belleville, Karine; Lemire, Myriam; Archambault, Mélanie; Tremblay, Luc; Beaudoin, Jean-François; Beaudet, Nicolas; Lecomte, Roger; Lepage, Martin; Gendron, Louis; Sarret, Philippe

    2010-01-01

    Pre-clinical bone cancer pain models mimicking the human condition are required to respond to clinical realities. Breast or prostate cancer patients coping with bone metastases experience intractable pain, which affects their quality of life. Advanced monitoring is thus required to clarify bone cancer pain mechanisms and refine treatments. In our model of rat femoral mammary carcinoma MRMT-1 cell implantation, pain onset and tumor growth were monitored for 21 days. The surgical procedure performed without arthrotomy allowed recording of incidental pain in free-moving rats. Along with the gradual development of mechanical allodynia and hyperalgesia, behavioral signs of ambulatory pain were detected at day 14 by using a dynamic weight-bearing apparatus. Osteopenia was revealed from day 14 concomitantly with disorganization of the trabecular architecture (µCT). Bone metastases were visualized as early as day 8 by MRI (T(1)-Gd-DTPA) before pain detection. PET (Na(18)F) co-registration revealed intra-osseous activity, as determined by anatomical superimposition over MRI in accordance with osteoclastic hyperactivity (TRAP staining). Pain and bone destruction were aggravated with time. Bone remodeling was accompanied by c-Fos (spinal) and ATF3 (DRG) neuronal activation, sustained by astrocyte (GFAP) and microglia (Iba1) reactivity in lumbar spinal cord. Our animal model demonstrates the importance of simultaneously recording pain and tumor progression and will allow us to better characterize therapeutic strategies in the future. PMID:21048940

  2. Under- or overtreatment of pain in the patient with cancer: how to achieve proper balance.

    PubMed

    Paice, Judith A; Von Roenn, Jamie H

    2014-06-01

    Achieving balance in the appropriate use of opioids for the treatment of cancer pain is complex. The definition of "balance" is continually being modified. Palliative care professionals, pain specialists, and oncologists have long been advocating for the aggressive management of pain for patients with advanced cancer. Some progress has been made in this arena but barriers persist. Fear of addiction by patients, family members, and oncology professionals presents a serious obstacle to the provision of adequate pain control. This is further complicated by societal factors that receive extensive media coverage, such as diversion of prescribed opioids for recreational use and increasing deaths as a result of this inappropriate use of prescription opioids. This growing concern has led to more opioid regulation, which increases obstacles to pain management in this population. Another evolving concern is whether the long-term use of opioids is safe and effective. Data from the chronic nonmalignant pain literature suggest that toxicities may result and misuse has been underestimated, yet little information is available in the cancer population. These issues lead to serious questions regarding how balance might be successfully achieved for patients in an oncology setting. Can pain relief be provided while reducing negative consequences of treatment? Which patient should be prescribed what medications, in what situations, for what kind of pain, and who should be managing the pain? PMID:24799468

  3. Pain in castration-resistant prostate cancer with bone metastases: a qualitative study

    PubMed Central

    2011-01-01

    Background Bone metastases are a common painful and debilitating consequence of castration-resistant prostate cancer (CPRC). Bone pain may predict patients' prognosis and there is a need to further explore CRPC patients' experiences of bone pain in the overall context of disease pathology. Due to the subjective nature of pain, assessments of pain severity, onset and progression are reliant on patient assessment. Patient reported outcome (PRO) measures, therefore, are commonly used as key endpoints for evaluating the efficacy of CRPC treatments. Evidence of the content validity of leading PRO measures of pain severity used in CRPC clinical trials is, however, limited. Methods To document patients' experience of CRPC symptoms including pain, and their impact on health-related quality of life (HRQL), semi-structured in-depth qualitative interviews were conducted with 17 patients with CRPC and bone metastases. The content validity of the Present Pain Intensity (PPI) scale from the McGill Pain Questionnaire (MPQ), and the 'Average Pain' and 'Worst Pain' items of the Brief Pain Inventory Short-Form (BPI-SF) was also assessed. Results Patients with CRPC and bone metastases present with a constellation of symptoms that can have a profound effect on HRQL. For patients in this study, bone pain was the most prominent and debilitating symptom associated with their condition. Bone pain was chronic and, despite being generally well-managed by analgesic medication, instances of breakthrough cancer pain (BTcP) were common. Cognitive debriefing of the selected PRO measures of pain severity highlighted difficulties among patients in understanding the verbal response scale (VRS) of the MPQ PPI scale. There were also some inconsistencies in the way in which the BPI-SF 'Average Pain' item was interpreted by patients. In contrast, the BPI-SF 'Worst Pain' item was well understood and interpreted consistently among patients. Conclusions Study findings support the importance of PRO

  4. Prevalence and correlates of pain interference in older adults: Why treating the whole body and mind is necessary

    PubMed Central

    Przekop, Peter; Haviland, Mark G.; Oda, Keiji; Morton, Kelly R.

    2015-01-01

    Summary Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults. PMID:25892375

  5. Prevalence and correlates of pain interference in older adults: why treating the whole body and mind is necessary.

    PubMed

    Przekop, Peter; Haviland, Mark G; Oda, Keiji; Morton, Kelly R

    2015-04-01

    Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults. PMID:25892375

  6. Benzodiazepine (BZD) use in community-dwelling older adults: Longitudinal associations with mobility, functioning, and pain.

    PubMed

    Petrov, Megan E; Sawyer, Patricia; Kennedy, Richard; Bradley, Laurence A; Allman, Richard M

    2014-01-01

    The aim of the study was to determine the prospective association between baseline BZD use and mobility, functioning, and pain among urban and rural African-American and non-Hispanic white community-dwelling older adults. From 1999 to 2001, a cohort of 1000 community-dwelling adults, aged ≥ 65 years, representing a random sample of Medicare beneficiaries, stratified by ethnicity, sex, and urban/rural residence were recruited. BZD use was assessed at an in-home visit. Every six months thereafter, study outcomes were assessed via telephone for 8.5-years. Mobility was assessed with the Life-Space Assessment (LSA). Functioning was quantified with level of difficulty in five basic activities of daily living (ADL: bathing, dressing, transferring, toileting, eating), and six instrumental activities of daily living (IADL: shopping, managing money, preparing meals, light and heavy housework, telephone use). Pain was measured by frequency per week and the magnitude of interference with daily tasks. All analytic models were adjusted for relevant covariates and mental health symptoms. After multivariable adjustment, baseline BZD use was significantly associated with greater difficulty with basic ADL (Estimate=0.39, 95% confidence interval (CI): 0.04-0.74), and more frequent pain (Estimate=0.41, 95%CI: 0.09-0.74) in the total sample and declines in mobility among rural residents (Estimate=-0.67, t(5,902)=-1.98, p=0.048), over 8.5 years. BZD use was prospectively associated with greater risk for basic ADL difficulties and frequent pain among African-American and non-Hispanic white community-dwelling older adults, and life-space mobility declines among rural-dwellers, independently of relevant covariates. These findings highlight the potential long-term negative impact of BZD use among community-dwelling older adults. PMID:24880195

  7. Chronic pain: the help-seeking behavior, attitudes, and beliefs of older adults living in the community.

    PubMed

    Cornally, Nicola; McCarthy, Geraldine

    2011-12-01

    Psychologic variables such as attitudes and beliefs may account for patients choosing not to seek treatment for pain; however, there is a dearth of empirical research to support this contention. The aim of this study was to explore the help-seeking behavior, individual characteristics, attitudes, and beliefs of older adults with chronic pain in an Irish community setting. A descriptive correlational design was used. A convenience sample of 72 older adults with chronic pain were recruited through two primary care practices. The research instruments used were a demographic questionnaire, the Level of Expressed Need Questionnaire, which measured help-seeking behavior, the Pain Attitudes Questionnaire, and the Pain Beliefs Questionnaire. Results revealed that individual characteristics associated with help-seeking behavior were female gender, increasing age, higher education, living alone, and severe pain. High levels of stoicism were reported, indicating that participants were more likely to believe they had superior pain control and courage in the face of pain and were not willing to disclose their pain to others. These attitudes were significantly associated with lower levels of expressed need for treatment. Participants had moderate age-related beliefs about the origin of pain, but those who believed pain had an organic cause were more likely to seek help. PMID:22117752

  8. Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Sakamoto, Hiroki; Miyata, Takeshi; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Omoto, Shunsuke; Kadosaka, Kumpei; Sakurai, Toshiharu; Nishida, Naoshi; Chiba, Yasutaka; Kudo, Masatoshi

    2016-01-01

    Background: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain. Methods: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications. Results: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications. Conclusions: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment. PMID:27366217

  9. Relation between pain and skeletal metastasis in patients with prostate or breast cancer.

    PubMed

    Levren, Gabriella; Sadik, May; Gjertsson, Peter; Lomsky, Milan; Michanek, Annika; Edenbrandt, Lars

    2011-05-01

    The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600 MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p = 0.01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p = 0.02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer. PMID:21114613

  10. Pain and Anxiety versus Sense of Family Support in Lung Cancer Patients

    PubMed Central

    Lekka, Dimitra; Pachi, Argiro; Zafeiropoulos, Georgios; Evmolpidi, Argiri; Ilias, Ioannis; Karkanias, Athanasios; Moussas, Georgios; Tzanakis, Nikolaos; Syrigos, Konstantinos N.

    2014-01-01

    Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient's quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger's State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain. PMID:25126424

  11. Percutaneous Vertebroplasty in Adult Degenerative Scoliosis for Spine Support: Study for Pain Evaluation and Mobility Improvement

    PubMed Central

    Filippiadis, Dimitrios K.; Papagelopoulos, Panagiotis; Kitsou, Maria; Oikonomopoulos, Nikolaos; Brountzos, Elias; Kelekis, Nikolaos; Kelekis, Alexis

    2013-01-01

    We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3 NVS units), the morning after (mean value 3.11 ± 1.2 NVS units), at 12 (mean value 1.67 ± 1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5 NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6 NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine. PMID:24260742

  12. Persistent Smoking after a Diagnosis of Lung Cancer is Associated with Higher Reported Pain Levels

    PubMed Central

    Daniel, Marcella; Keefe, Francis J.; Lyna, Pauline; Peterson, Bercedis; Garst, Jennifer; Kelley, Mike; Bepler, Gerald; Bastian, Lori A.

    2009-01-01

    The purpose of this study is to evaluate the impact of smoking status after a diagnosis of lung cancer on reported pain levels. We conducted a telephone survey of patients with lung cancer identified from four participating sites between September 2004 and July 2006. Patients were asked to rate their usual pain level over the past week on a 0-10 rating scale on which 0 was ‘no pain’ and 10 ‘pain as bad as you can imagine’. We operationally defined persistent smokers as patients who reported continuing to smoke after their lung cancer diagnosis. A logistic regression analyses was used to test the hypothesis that persistent smokers report higher usual pain levels than non-smokers. Overall, 893 patients completed the survey. The majority (76%) was found to have advanced cancer (Stages IIIb and IV). The mean age was 63 (SD=10). Seventeen percent of the patients studied were categorized as persistent smokers. The mean pain score for the study sample was 3.1 (sd=2.7) and 41% reported moderate (4-6) or severe pain (7-10). A greater proportion of persistent smokers reported moderate or severe pain than non-smokers or former smokers (p<.001). Logistic regression analysis revealed that, smoking status was associated with the usual pain even after adjusting for age, perceived health status and other lung cancer symptoms such as dyspnea, fatigue and trouble eating. In conclusion, patients who continue to smoke after a diagnosis of lung cancer report higher levels of usual pain than non-smokers or former smokers. More research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression in late-stage lung cancer. Perspective This article examines the relationship between pain and persistent smoking in patients with lung cancer. Although more research is needed to understand the mechanisms that relate nicotine intake to pain and disease progression, physicians can promote smoking cessation in patients with lung cancer to improve

  13. BREAST CANCER-INDUCED BONE REMODELING, SKELETAL PAIN AND SPROUTING OF SENSORY NERVE FIBERS

    PubMed Central

    Bloom, Aaron P.; Jimenez-Andrade, Juan M.; Taylor, Reid N.; Castañeda-Corral, Gabriela; Kaczmarska, Magdalena J.; Freeman, Katie T.; Coughlin, Kathleen A.; Ghilardi, Joseph R.; Kuskowski, Michael A.; Mantyh, Patrick W.

    2011-01-01

    Breast cancer metastasis to bone is frequently accompanied by pain. What remains unclear is why this pain tends to become more severe and difficult to control with disease progression. Here we test the hypothesis that with disease progression sensory nerve fibers that innervate the breast cancer bearing bone undergo a pathological sprouting and reorganization, which in other non-malignant pathologies has been shown to generate and maintain chronic pain. Injection of human breast cancer cells (MDA-MB-231-BO) into the femoral intramedullary space of female athymic nude mice induces sprouting of calcitonin gene-related peptide (CGRP+) sensory nerve fibers. Nearly all CGRP+ nerve fibers that undergo sprouting also co-express tropomyosin receptor kinase A (TrkA+) and growth associated protein-43 (GAP43+). This ectopic sprouting occurs in periosteal sensory nerve fibers that are in close proximity to breast cancer cells, tumor-associated stromal cells and remodeled cortical bone. Therapeutic treatment with an antibody that sequesters nerve growth factor (NGF), administered when the pain and bone remodeling were first observed, blocks this ectopic sprouting and attenuates cancer pain. The present data suggest that the breast cancer cells and tumor-associated stromal cells express and release NGF, which drives bone pain and the pathological reorganization of nearby CGRP+ / TrkA+ / GAP43+ sensory nerve fibers. PMID:21497141

  14. A Korean Nationwide Survey for Breakthrough Cancer Pain in an Inpatient Setting

    PubMed Central

    Baek, Sun Kyung; Kim, Do Yeun; Kang, Seok Yun; Sym, Sun Jin; Kim, Young Sung; Lee, June Young

    2016-01-01

    Purpose We evaluated the prevalence and characteristics of breakthrough cancer pain (BTcP) in Korean patients admitted with cancer pain. Materials and Methods In-hospital patients with cancer pain completed a questionnaire concerning severity of background cancer pain (BCP), prevalence and treatment for BTcP, sleep disorders, and satisfaction with cancer pain treatment. Medical records showing medications for BCP and BTcP were also evaluated. Results Total 609 patients with controlled BCP enrolled. Mean age of the patients was 59.5 years old, and 59% were male. Of all patients, 177 (29%) complained of BTcP. No clinical characteristic predicted BTcP. Of the 177 patients with BTcP, 56% did not receive treatment for BTcP. Patients with BTcP showed significant association with a sleep disorder and dissatisfaction with pain control, compared to those without BTcP (p < 0.0001 and p=0.0498, respectively). Oxycodone-immediate release was the most commonly used short-acting analgesic, followed by intravenous morphine. Conclusion The prevalence of BTcP was 29% in patients admitted with controlled BCP. Although the patients had well-controlled BCP, BTcP showed association with a lower quality of life in patients with cancer. More medical attention is needed for detection and management of BTcP. PMID:26511815

  15. Dimethyl sulfoxide and sodium bicarbonate in the treatment of refractory cancer pain.

    PubMed

    Hoang, Ba X; Tran, Dao M; Tran, Hung Q; Nguyen, Phuong T M; Pham, Tuan D; Dang, Hong V T; Ha, Trung V; Tran, Hau D; Hoang, Cuong; Luong, Khue N; Shaw, D Graeme

    2011-01-01

    Pain is a major concern of cancer patients and a significant problem for therapy. Pain can become a predominant symptom in advanced cancers. In this open-label clinical study, the authors have treated 26 cancer patients who have been declared as terminal without the option of conventional treatment. These patients suffered from high levels of pain that was poorly managed by all available interventional approaches recommended by World Health Organization (WHO) guideline. The results indicate that intravenous infusion of dimethyl sulfoxide (DMSO) and sodium bicarbonate (SB) solution can be a viable, effective, and safe treatment for refractory pain in cancer patients. These patients had pain due to the disease progression and complication of chemotherapy and radiation. Moreover, the preliminary clinical outcome of 96-day follow-up suggests that the application of DMSO and SB solution intravenously could lead to better quality of life for patients with nontreatable terminal cancers. The data of this clinical observation indicates that further research and application of the DMSO and SB combination may help the development of an effective, safe, and inexpensive therapy to manage cancer pain. PMID:21426213

  16. 186Re-HEDP for metastatic bone pain in breast cancer patients.

    PubMed

    Lam, Marnix G E H; de Klerk, John M H; van Rijk, Peter P

    2004-06-01

    Two-thirds of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer-related pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pain palliation with bone-seeking radiopharmaceuticals has proven to be an effective treatment modality in patients with metastatic bone pain. These bone-seeking radiopharmaceuticals are extremely powerful in treating scattered painful bone metastases, for which external beam radiotherapy is impossible because of the large field of irradiation. (186)Re-hydroxyethylidene diphosphonate (HEDP) is a potentially useful radiopharmaceutical for this purpose, having numerous advantageous characteristics. Bone marrow toxicity is limited and reversible, which makes repetitive treatment safe. Studies have shown encouraging clinical results of palliative therapy using (186)Re-HEDP, with an overall response rate of ca. 70% in painful bone metastases. It is effective for fast palliation of painful bone metastases from various tumours and the effect tends to last longer if patients are treated early in the course of their disease. (186)Re-HEDP is at least as effective in breast cancer patients with painful bone metastases as in patients with metastatic prostate cancer. It is to be preferred to radiopharmaceuticals with a long physical half-life in this group of patients, who tend to have more extensive haematological toxicity since they have frequently been pretreated with bone marrow suppressive chemotherapy. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. PMID:15118846

  17. Study of Physical and Mental Health of Older Patients With Newly Diagnosed Cancer

    ClinicalTrials.gov

    2015-10-01

    Cognitive/Functional Effects; Depression; Hematopoietic/Lymphoid Cancer; Malnutrition; Pain; Psychosocial Effects of Cancer and Its Treatment; Unspecified Adult Solid Tumor, Protocol Specific; Weight Changes

  18. Single dose oral tiaprofenic acid for acute postoperative pain in adults

    PubMed Central

    Moore, R Andrew; Derry, Sheena; Moore, Maura; McQuay, Henry J

    2014-01-01

    Background Tiaprofenic acid is a a non-steroidal anti-inflammatory drug (NSAID). It is widely available around the world, with indications for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, periarticular disorders, and strains and sprains. This review sought to evaluate the efficacy and safety of oral tiaprofenic acid in acute postoperative pain, using clinical studies of patients with established pain, and with outcomes measured primarily over 6 hours using standard methods. This type of study has been used for many decades to establish that drugs have analgesic properties. Objectives To assess the efficacy of single dose oral tiaprofenic acid in acute postoperative pain, and any associated adverse events. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to June 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered tiaprofenic acid in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned to use area under the “pain relief versus time” curve to derive the proportion of participants with tiaprofenic acid experiencing at least 50% pain relief over 4 to 6 hours, using validated equations; to use number needed to treat to benefit (NNT); the proportion of participants using rescue analgesia over a specified time period; time to use of rescue analgesia; information on adverse events and withdrawals. Main results Not one of eleven studies identified by the searches and examined in detail studied oral tiaprofenic acid against placebo in patients with established postoperative pain and therefore no results are available. Authors’ conclusions In the absence of evidence of efficacy for oral tiaprofenic acid in acute postoperative pain, its use in this indication is not justified at present. Because trials clearly

  19. Knowledge, Practices, and Perceived Barriers Regarding Cancer Pain Management Among Physicians and Nurses In Korea: A Nationwide Multicenter Survey

    PubMed Central

    Jho, Hyun Jung; Kim, Yeol; Kong, Kyung Ae; Kim, Dae Hyun; Choi, Jin Young; Nam, Eun Jeong; Choi, Jin Young; Koh, Sujin; Hwang, Kwan Ok; Baek, Sun Kyung; Park, Eun Jung

    2014-01-01

    Purpose Medical professionals’ practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. Methods A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pain management, the perceived barriers to cancer pain control, and processes perceived as the major causes of delay in opioid administration. Results A total of 333 questionnaires (149 physicians and 284 nurses) were analyzed. Nurses performed pain assessment and documentation more regularly than physicians did. Although physicians had better knowledge of pain management than did nurses, both groups lacked knowledge regarding the side effects and pharmacology of opioids. Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge. Physicians perceived patients’ reluctance to take opioids as a barrier to pain control, more so than did nurses, while nurses perceived patients’ tendency to under-report of pain as a barrier, more so than did physicians. Physicians and nurses held different perceptions regarding major cause of delay during opioid administration. Conclusions There were differences between physicians and nurses in knowledge and practices for cancer pain management. An effective educational strategy for cancer pain management is needed in order to improve medical professionals’ knowledge and clinical practices. PMID:25144641

  20. Higher Perceived Stress Scale scores are associated with higher pain intensity and pain interference levels in Older Adults

    PubMed Central

    White, Robert S.; Jiang, Julie; Hall, Charles B.; Katz, Mindy J.; Zimmerman, Molly E.; Sliwinski, Martin; Lipton, Richard B.

    2014-01-01

    Objectives To determine the prevalence of bodily pain measures (pain intensity and pain interference) in elderly people and their relationship with perceived stress scale (PSS) scores. Design Cross-sectional. Setting Community. Participants A representative community sample of 578 subjects aged 70 and older. Measurements The prevalence of pain intensity and pain interference and their relationship with perceived stress scale scores, demographic factors, past medical history, and neuropsychological testing scores were examined. Pain intensity and pain interference were measured by the SF-36 bodily pain questions. Results The study sample of 578 participants has a mean age of 78.8 years and is 63% female. Bivariate analysis for pain measures showed that higher scores on the perceived stress scale, lower neuropsychological test scores, and medical histories were associated with both pain intensity and interference. Logistic regression showed that higher scores on the perceived stress scale were significantly associated with increased odds of having moderate/severe pain intensity and moderate/severe pain interference (with and without the inclusion of for pain intensity in the models). Conclusion Higher PSS scores are associated with higher levels of pain intensity and pain interference. In this cross-sectional analysis, directionality cannot be determined. As both perceived stress and pain are potentially modifiable risk factors for cognitive decline and other poor health outcomes, future research should address temporality and the benefits of treatment. PMID:25516031

  1. Behavioral and neurochemical analysis of ongoing bone cancer pain in rats.

    PubMed

    Remeniuk, Bethany; Sukhtankar, Devki; Okun, Alec; Navratilova, Edita; Xie, Jennifer Y; King, Tamara; Porreca, Frank

    2015-10-01

    Cancer-induced bone pain is described as dull, aching ongoing pain. Ongoing bone cancer pain was characterized after intratibial injection of breast cancer cells in rats. Cancer produced time-dependent bone remodeling and tactile hypersensitivity but no spontaneous flinching. Conditioned place preference (CPP) and enhanced dopamine (DA) release in the nucleus accumbens (NAc) shell was observed after peripheral nerve block (PNB) selectively in tumor-bearing rats revealing nociceptive-driven ongoing pain. Oral diclofenac reversed tumor-induced tactile hypersensitivity but did not block PNB-induced CPP or NAc DA release. Tumor-induced tactile hypersensitivity, and PNB-induced CPP and NAc DA release, was blocked by prior subcutaneous implantation of a morphine pellet. In sham rats, morphine produced a modest but sustained increase in NAc DA release. In contrast, morphine produced a transient 5-fold higher NAc DA release in tumor bearing rats compared with sham morphine rats. The possibility that this increased NAc DA release reflected the reward of pain relief was tested by irreversible blockade of rostral anterior cingulate cortex (rACC) μ-opioid receptors (MORs). The rACC MOR blockade prevented the morphine-induced transient increased NAc DA release in tumor bearing rats but did not affect morphine-induced effects in sham-operated animals. Consistent with clinical experience, ongoing cancer pain was controlled by morphine but not by a dose of diclofenac that reversed evoked hypersensitivity. Additionally, the intrinsic reward of morphine can be dissociated from the reward of relief of cancer pain by blockade of rACC MOR. This approach allows mechanistic and therapeutic assessment of ongoing cancer pain with likely translation relevance. PMID:25955964

  2. Behavioral and neurochemical analysis of ongoing bone cancer pain in rats

    PubMed Central

    Remeniuk, Bethany; Sukhtankar, Devki; Okun, Alec; Navratilova, Edita; Xie, Jennifer Y.; King, Tamara; Porreca, Frank

    2015-01-01

    Abstract Cancer-induced bone pain is described as dull, aching ongoing pain. Ongoing bone cancer pain was characterized after intratibial injection of breast cancer cells in rats. Cancer produced time-dependent bone remodeling and tactile hypersensitivity but no spontaneous flinching. Conditioned place preference (CPP) and enhanced dopamine (DA) release in the nucleus accumbens (NAc) shell was observed after peripheral nerve block (PNB) selectively in tumor-bearing rats revealing nociceptive-driven ongoing pain. Oral diclofenac reversed tumor-induced tactile hypersensitivity but did not block PNB-induced CPP or NAc DA release. Tumor-induced tactile hypersensitivity, and PNB-induced CPP and NAc DA release, was blocked by prior subcutaneous implantation of a morphine pellet. In sham rats, morphine produced a modest but sustained increase in NAc DA release. In contrast, morphine produced a transient 5-fold higher NAc DA release in tumor bearing rats compared with sham morphine rats. The possibility that this increased NAc DA release reflected the reward of pain relief was tested by irreversible blockade of rostral anterior cingulate cortex (rACC) μ-opioid receptors (MORs). The rACC MOR blockade prevented the morphine-induced transient increased NAc DA release in tumor bearing rats but did not affect morphine-induced effects in sham-operated animals. Consistent with clinical experience, ongoing cancer pain was controlled by morphine but not by a dose of diclofenac that reversed evoked hypersensitivity. Additionally, the intrinsic reward of morphine can be dissociated from the reward of relief of cancer pain by blockade of rACC MOR. This approach allows mechanistic and therapeutic assessment of ongoing cancer pain with likely translation relevance. PMID:25955964

  3. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan

    PubMed Central

    Rau, Kun-Ming; Chen, Jen-Shi; Wu, Hung-Bo; Lin, Sheng-Fung; Lai, Ming-Kuen; Chow, Jyh-Ming; Huang, Ming-Lih; Wang, Cyuan-Jheng; Tai, Cheng-Jeng; Hwang, Wen-Li; Lu, Yin-Che; Chan, Chung-Huang; Hsieh, Ruey Kuen

    2015-01-01

    Objective To investigate the prevalence of pain in cancer patients at different disease statuses, the impact of pain on physical and psychiatric functions of patients and the satisfaction of pain control of patients at outpatient clinic department in Taiwan. Methods Short form of the Brief Pain Inventory was used as the outcome questionnaire. Unselected patients of different cancers and different disease statuses at outpatient clinic department were included. The impacts of their current pain control on physical function, psychiatric function and the satisfaction of doctors were evaluated. Logistic regression analyses were performed to evaluate whether the interference scale performed identically in the different analgesic ladders. The dependent variables were satisfaction toward physician and treatment. Results A total of 14 sites enrolled 2075 patients in the study. One thousand and fifty-one patients reported pain within the last 1 week. In patients whose diseases deteriorated, >60% of them need analgesics for pain control. Pain influenced physical and psychiatric functions of patients, especially in the deteriorated status. More than 80% of patients were satisfied about current pain control, satisfaction rate related to disease status, pain intensities and treatments for pain. Conclusion Our study found that different cancers at different statuses had pain at variable severity. Pain can influence physical and psychological functions significantly. More than 75% of subjects reported satisfaction over physician and pain management in outpatient clinic department patients with cancer pain in Taiwan. PMID:26292698

  4. A Smartphone-Based Pain Management App for Adolescents With Cancer: Establishing System Requirements and a Pain Care Algorithm Based on Literature Review, Interviews, and Consensus

    PubMed Central

    Stevens, Bonnie J; Nathan, Paul C; Seto, Emily; Cafazzo, Joseph A; Stinson, Jennifer N

    2014-01-01

    Background Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. Objective To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. Methods A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. Results The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the

  5. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice.

    PubMed

    Zeppetella, G; O'Doherty, C A; Collins, S

    2000-08-01

    A prospective survey was undertaken to determine the prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. Of 414 consecutive admissions, 33 patients were confused or too unwell to take part and 136 were pain-free. The remaining 245 reported 404 pains (range 1-5 per patient); of these patients, 218 (89%) had breakthrough pain and identified 361 pains (range 1-5 per patient). Breakthrough pain was classified as somatic (46%) visceral (30%), neuropathic (10%) or mixed etiology (16%). Thirty-eight percent of pains were severe or excruciating. The average number of daily breakthrough pain episodes was 4 [corrected] (range 1-14); 49% occurred suddenly. Most (59%) were unpredictable, and 72% lasted less than 30 minutes. Seventy-five percent of patients were dissatisfied with their pain control. Breakthrough pain is common among patients admitted to our hospice. It is frequent, short lasting, often unpredictable and not necessarily related to chronic pain making treatment difficult. PMID:10989246

  6. Improving Physician-Patient Communication About Cancer Pain With a Tailored Education-Coaching Intervention

    PubMed Central

    Street, Richard L.; Slee, Christina; Kalauokalani, Donna K; Dean, Dionne Evans; Tancredi, Daniel J; Kravitz, Richard L.

    2009-01-01

    Objective This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Methods Grounded in social-cognitive and communication theory, a tailored education coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients’ questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians’ communication. Results Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians’ information about pain were higher when patients talked more about their pain concerns. Conclusions The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Practice implications Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes. PMID:19962845

  7. Pharmacological strategies for the management of cancer pain in developing countries

    PubMed Central

    Omoti, Afekhide E.; Omoti, Caroline E.

    Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given ‘by the ladder,’ ‘by the clock’ and ‘by the appropriate route’ using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed. PMID:25247009

  8. Pharmacological strategies for the management of cancer pain in developing countries.

    PubMed

    Omoti, Afekhide E; Omoti, Caroline E

    2007-07-01

    Pain associated with cancer is often under treated especially in the developing countries where there are problems of poor economy, poor purchasing power of the citizens, absence of effective national health insurance schemes, poor manpower, fake adulterated and expired drugs, poor drug storage conditions; adverse temperature conditions combined with poor power supply which may affect drug efficacy. There is also poor understanding of the physiopharmacology of cancer pain management by health care providers. Assessment of the severity of the pain by location, oncological type, as well as psychosocial, emotional and environmental factors are necessary. The pain often occurs from malignancy, from procedures done to diagnose, stage and treat the malignancy, and from the toxicities of therapy used in treating the cancer. The first priority of treatment is to control pain rapidly and completely, as judged by the patient. The second priority is to prevent recurrence of pain. Analgesic drugs are given 'by the ladder,' 'by the clock' and 'by the appropriate route' using the analgesic ladder guideline proposed by the World Health Organization (WHO). The pharmacological aspects of various drugs used in the management of cancer pain are discussed. PMID:25247009

  9. Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations.

    PubMed

    Mirabile, A; Airoldi, M; Ripamonti, C; Bolner, A; Murphy, B; Russi, E; Numico, G; Licitra, L; Bossi, P

    2016-03-01

    Pain in head and neck cancer represents a major issue, before, during and after the oncological treatments. The most frequent cause of pain is chemo/radiation related oral mucositis, which involves 80% of the patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing and sometimes reducing the treatment compliance, the maximum dose intensity and thus the potential efficacy of treatment. Nevertheless pain is still often under estimated and undertreated. An Italian multidisciplinary group of head and neck cancer specialists met with the aim of reaching a consensus on pain management in this setting. The Delphi Appropriateness method was used for the consensus. External expert reviewers evaluated the final statements. The paper contains 30 consensus-reached statements about pain management in HNC patients and offers a review of recent literature in these topics. PMID:26712589

  10. Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study

    PubMed Central

    Hunt, Lauren J.; Covinsky, Kenneth E.; Yaffe, Kristine; Stephens, Caroline E.; Miao, Yinghui; Boscardin, W. John; Smith, Alex K.

    2016-01-01

    OBJECTIVES To report prevalence, correlates, and medication management of pain in community-dwelling older adults with dementia. DESIGN Cross-sectional. SETTING In-person interviews with self- or proxy respondents living in private residences or non-nursing home residential care settings. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study 2011 wave. MEASUREMENTS Dementia status was determined using a modified previously validated algorithm. Participants were asked whether they had had bothersome and activity-limiting pain over the past month. A multivariable Poisson regression model was used to determine the relationship between bothersome pain and sociodemographic and clinical characteristics. RESULTS Of the 7,609 participants with complete data on cognitive function, 802 had dementia (67.2% aged ≥80, 65.0% female, 67.9% white, 49.7% proxy response, 32.0% lived alone, 18.8% lived in residential care); 670 (63.5%) participants with dementia experienced bothersome pain, and 347 (43.3%) had pain that limited activities. These rates were significantly higher than in a propensity score–matched cohort without dementia (54.5% bothersome pain, P < .001, 27.2% pain that limited activity, P < .001). Proxies reported slightly higher rates of pain than self-respondents, but differences were statistically significant only for activity-limiting pain (46.6% proxy vs 40.1% self, P = .03). Correlates of bothersome pain included arthritis, heart and lung disease, less than high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Of those reporting pain, 30.3% stated that they rarely or never took any medications for pain. CONCLUSION Community-living older adults with dementia are at high risk of having pain. Creative interventions and programs are needed to manage pain adequately in this vulnerable population. PMID

  11. Development of a screening instrument for risk factors of persistent pain after breast cancer surgery

    PubMed Central

    Sipilä, R; Estlander, A-M; Tasmuth, T; Kataja, M; Kalso, E

    2012-01-01

    Background: Persistent postsurgical pain can have a significant effect on the quality of life of women being treated for breast cancer. The aim of this prospective study was to develop a screening tool to identify presurgical demographic, psychological and treatment-related factors that predict persistence of significant pain in the operated area after 6 months from surgery. Methods: Background and self-reported questionnaire data were collected the day before surgery and combined with treatment-related data. Pain in the operated area was assessed 6 months after surgery with a questionnaire. The Bayesian model was used for the development of a screening tool. Results: Report of preoperative chronic pain, more than four or more previous operations, preoperative pain in the area to be operated, high body mass index, previous smoking and older age were included in the six-factor model that best predicted significant pain at the follow-up in the 489 women studied. Conclusion: A six-factor risk index was developed to estimate the risk of developing significant pain after breast cancer surgery. Neither treatment- nor mood-related variables were included in the model. Identification of risk factors may lead to prevention of persistent postsurgery pain. This tool could be used for target prevention to those who are at the highest risk of developing persistent postsurgery pain. PMID:23093294

  12. [Two Cases of Caudal Alcohol Block for Perineal Pain that Occurred in Cancer End-of-Life].

    PubMed

    Takahashi, Masahiro; Takahara, Hiroshi; Wakabayashi, Takanobu

    2016-06-01

    We experienced two cases of end-of-life cancer patients with perineal pain, whose pain was relieved by 5 ml absolute ethanol caudal block. Although the first injection was ineffective, the second injection resulted in significant relief of pain in both cases. Although the indication should be carefully considered, alcohol caudal block is an analgesic method worth considering for the end-of-life cancer patients complaining of perineal pain. PMID:27483665

  13. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults

    PubMed Central

    Barden, Jodie; Derry, Sheena; McQuay, Henry J; Moore, R Andrew

    2014-01-01

    Background Ketoprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID) used to treat acute and chronic painful conditions. Dexketoprofen is the (S)-enantiomer, which is believed to confer analgesia. Theoretically dexketoprofen is expected to provide equivalent analgesia to ketoprofen at half the dose, with a consequent reduction in gastrointestinal adverse events. Objectives To assess efficacy, duration of action, and associated adverse events of single dose oral ketoprofen and dexketoprofen in acute postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to August 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered ketoprofen and dexketoprofen in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results Fourteen studies compared ketoprofen (968 participants) at mainly 25 mg and 50 mg with placebo (520 participants). Seven studies compared dexketoprofen (681 participants) at mainly 10 mg to 25 mg with placebo (289 participants). Studies were of adequate reporting quality, and participants had pain following dental, orthopaedic, obstetric, gynaecological and general surgery. There was considerable clinical heterogeneity between studies in dental and other types of surgery, particularly bunionectomy, which limited analysis

  14. Use of Animal Models in Understanding Cancer-induced Bone Pain

    PubMed Central

    Slosky, Lauren M; Largent-Milnes, Tally M; Vanderah, Todd W

    2015-01-01

    Many common cancers have a propensity to metastasize to bone. Although malignancies often go undetected in their native tissues, bone metastases produce excruciating pain that severely compromises patient quality of life. Cancer-induced bone pain (CIBP) is poorly managed with existing medications, and its multifaceted etiology remains to be fully elucidated. Novel analgesic targets arise as more is learned about this complex and distinct pain state. Over the past two decades, multiple animal models have been developed to study CIBP’s unique pathology and identify therapeutic targets. Here, we review animal models of CIBP and the mechanistic insights gained as these models evolve. Findings from immunocompromised and immunocompetent host systems are discussed separately to highlight the effect of model choice on outcome. Gaining an understanding of the unique neuromolecular profile of cancer pain through the use of appropriate animal models will aid in the development of more effective therapeutics for CIBP. PMID:26339191

  15. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer.

    PubMed

    Mystakidou, Kyriaki; Tsilika, Eleni; Parpa, Efi; Pathiaki, Maria; Patiraki, Elisabeth; Galanos, Antonis; Vlahos, Lambros

    2007-06-01

    The growing interest in the psychological morbidity of patients with cancer has been the major reason for conducting this study. The measurements used were the Beck Depression Inventory, the Beck Hopelessness Scale, the Mini Mental State Examination, the Greek Brief Pain Inventory, and the Spiritual Involvement and Beliefs Scale. The analysis was conducted in 82 patients with advanced cancer. Significant associations were found between pain interference in "mood" and in "enjoyment of life" and hopelessness, as well as between worse pain and pain interference items with depression and cognitive status. Significant correlations were found between hopelessness, depression, and cognitive condition. These findings demonstrate the physical, psychological, and cognitive aspects of patients with cancer. PMID:17556108

  16. Analysis of patient-related barriers in cancer pain management in Turkish patients.

    PubMed

    Bağçivan, Gülcan; Tosun, Nuran; Kömürcü, Seref; Akbayrak, Nalan; Ozet, Ahmet

    2009-11-01

    The purpose of this study was to evaluate the validity and reliability of the Barriers Questionnaire II (BQ-II) for Turkish patients and to define the patient-related barriers to cancer pain management in Turkey. For this, 170 patients with cancer who used or were still using analgesic medication for pain related to cancer participated in the study. It was found that patients have beliefs that may be barriers to optimal pain management, mostly in relation to addiction, and to a small extent, physical side effects. It was ascertained that male, unmarried patients, patients with cancer who also have another chronic disease, patients whose "average pain" intensity is more than 5 for the past 24 hours, and patients who use an inadequate analgesic have more beliefs that may be barriers to optimal pain management. It was concluded that the BQ-II is a valid and reliable scale in Turkey for defining patient-related barriers to cancer pain management. PMID:19692202

  17. Cytokines as Mediators of Pain-Related Process in Breast Cancer

    PubMed Central

    Panis, Carolina; Pavanelli, Wander Rogério

    2015-01-01

    Pain is a clinical sign of inflammation found in a wide variety of chronic pathologies, including cancer. The occurrence of pain in patients carrying breast tumors is reported and is associated with aspects concerning disease spreading, treatment, and surgical intervention. The persistence of pain in patients submitted to breast surgery is estimated in a range from 21% to 55% and may affect patients before and after surgery. Beyond the physical compression exerted by the metastatic mass expansion and tissue injury found in breast cancer, inflammatory components that are significantly produced by the host-tumor interaction can significantly contribute to the generation of pain. In this context, cytokines have been studied aiming to establish a cause-effect relationship in cancer pain-related syndromes, especially the proinflammatory ones. Few reports have investigated the relationship between pain and cytokines in women carrying advanced breast cancer. In this scenario, the present review analyzes the main cytokines produced in breast cancer and discusses the evidences from literature regarding its role in specific clinical features related with this pathology. PMID:26635447

  18. Therapeutic Education in Improving Cancer Pain Management: A Synthesis of Available Studies.

    PubMed

    Prevost, Virginie; Delorme, Claire; Grach, Marie-Christine; Chvetzoff, Gisèle; Hureau, Magalie

    2016-07-01

    This literature review aims to synthesize available studies and to update findings in order to obtain a current, comprehensive estimate of the benefits of pain education. Forty-four original articles obtained from the PubMed database were analyzed to investigate which protocols could be most effective in improving pain management. Recent studies indicate a growing interest in evaluating patients' skills and attitudes; these include satisfaction with cancer pain treatment, patient-reported improvement, and patient participation-all of which could be dependable benchmarks for evaluating the effectiveness of educational programs. Besides pain measurement, recent studies advance support for the importance of assessing newly developed outcome criteria. In this sense, patients' active participation and decision making in their pain management are probably the most relevant goals of pain education. PMID:25991567

  19. Prescription pain reliever misuse and levels of pain impairment: 3-year course in a nationally representative outpatient sample of US adults

    PubMed Central

    Novak, Scott P; Glasheen, Cristie; Roland, Carl L

    2016-01-01

    Background The primary aim of this work was to present the prevalence data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative 3-year longitudinal survey (ages 18+ years) that captured information on patterns of self-reported pain interference and prescription pain reliever misuse. A second aim was to assess the degree to which the risk of various types of opioid misuse (onset, desistance, and incidence of dependence) was related to the longitudinal course of self-reported pain interference over the 3-year period. Methods We used a two-wave, nationally representative sample of adults (aged 18+ years) in which the baseline data were collected during 2001–2002 and a single follow-up was obtained ~3 years later (2004–2005 with 34,332 respondents with complete data on study variables for both waves). Results Our findings indicated that ~10% reported high pain interference in the past month at each wave. There was tremendous stability in levels of pain, with ~5% reporting consistent levels of high impairment over the 3-year study, a proxy for chronic pain. Levels of pain were more strongly associated with prescription pain reliever misuse concurrently rather than prospectively, and the association was largely linear, with the likelihood of misuse increasing with levels of pain. Finally, health service factors were also prominent predictors of onset, but not the outcomes, of desistance or transitions to problem use. Conclusion This study is the first to use a nationally representative sample with measures of pain and drug use history collected over an extended period. These results may help provide clinicians with an understanding that the risk of misuse is greatest when pain is active and may help guide the selection of appropriate intervention materials and monitor strategies for those at greatest risk. PMID:27418863

  20. Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study

    PubMed Central

    2012-01-01

    Background Hallux valgus (HV) is a very common deformity of the first metatarsophalangeal joint that often requires surgical correction. However, the association between structural HV deformity and related foot pain and disability is unclear. Furthermore, no previous studies have investigated concerns about appearance and difficulty with footwear in a population with HV not seeking surgical correction. The aim of this cross-sectional study was to investigate foot pain, functional limitation, concern about appearance and difficulty with footwear in otherwise healthy adults with HV compared to controls. Methods Thirty volunteers with HV (radiographic HV angle >15 degrees) and 30 matched controls were recruited for this study (50 women, 10 men; mean age 44.4 years, range 20 to 76 years). Differences between groups were examined for self-reported foot pain and disability, satisfaction with appearance, footwear difficulty, and pressure-pain threshold at the first metatarsophalangeal joint. Functional measures included balance tests, walking performance, and hallux muscle strength (abduction and plantarflexion). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Results All self-report measures showed that HV was associated with higher levels of foot pain and disability and significant concerns about appearance and footwear (p < 0.001). Lower pressure-pain threshold was measured at the medial first metatarsophalangeal joint in participants with HV (MD = −133.3 kPa, CI: -251.5 to −15.1). Participants with HV also showed reduced hallux plantarflexion strength (MD = −37.1 N, CI: -55.4 to −18.8) and abduction strength (MD = −9.8 N, CI: -15.6 to −4.0), and increased mediolateral sway when standing with both feet with eyes closed (MD = 0.34 cm, CI: 0.04 to 0.63). Conclusions These findings show that HV negatively impacts on self-reported foot pain and function, and concerns about foot appearance and footwear in otherwise healthy adults. There

  1. The Adverse Events of Oxycodone in Cancer-Related Pain

    PubMed Central

    Ma, Hu; Liu, Yuan; Huang, Lang; Zeng, Xian-Tao; Jin, Su-Han; Yue, Guo-Jun; Tian, Xu; Zhou, Jian-Guo

    2016-01-01

    Abstract The adverse events (AEs) of oxycodone in cancer-related pain were controversial, so we conducted a meta-analysis to determine it. PubMed, Embase, CBM, CNKI, WanFang database, The Cochrane library, Web of Science, and the reference of included studies were searched to recognize pertinent studies. Relative risk (RR) with 95% confidence intervals (CIs) for all AEs were all extracted. The fixed-effects model was used to calculate pooled RRs and 95% CIs. Power calculation was performed using macro embedded in SAS software after all syntheses were completed. We identified 11 eligible trials involving 1211 patients: 604 patients included in oxycodone group and 607 patients involved in control group. Our quantitative analysis included 8 AEs, and the pooled analyses indicated that oxycodone compared with other opioids in cancer-related pain were not significantly decreased RRs of all AEs (dizziness RR = 0.94, 95% CI: 0.69–1.30, Z = 0.35, P = 0.72; nausea RR = 0.88, 95% CI: 0.72–1.07, Z = 1.26, P = 0.21; vomiting RR = 0.89, 95% CI: 0.70–1.15, Z = 0.9, P = 0.37; sleepiness RR = 0.86, 95% CI: 0.38–1.36, Z = 0.36, P = 0.72; constipation RR = 0.98, 95% CI: 0.81–1.19, Z = 0.21, P = 0.83; anorexia RR = 0.97, 95% CI = 0.58–1.62, Z = 0.11, P = 0.91; pruritus RR = 0.76, 95% CI: 0.44–1.30, Z = 1.01, P = 0.31; dysuria RR = 0.33, 95% CI: 0.07–1.62, Z = 1.36, P = 0.1)]. The subgroup analysis shown that Ox controlled-release (CR) had less sleepiness compared with MS-contin (Mc) CR (RR = 0.47, 95% CI: 0.25–0.90, P = 0.02). The power analysis suggests that all AEs have low statistical power. The present meta-analysis detected that no statistically significant difference were found among oxycodone and other opioids in all AEs, but Ox CR may had less sleepiness compared with Mc CR when subgroup analysis were conducted. PMID:27082588

  2. Clinically significant drug–drug interactions involving opioid analgesics used for pain treatment in patients with cancer: a systematic review

    PubMed Central

    Kotlinska-Lemieszek, Aleksandra; Klepstad, Pål; Haugen, Dagny Faksvåg

    2015-01-01

    Background Opioids are the most frequently used drugs to treat pain in cancer patients. In some patients, however, opioids can cause adverse effects and drug–drug interactions. No advice concerning the combination of opioids and other drugs is given in the current European guidelines. Objective To identify studies that report clinically significant drug–drug interactions involving opioids used for pain treatment in adult cancer patients. Design and data sources Systematic review with searches in Embase, MEDLINE, and Cochrane Central Register of Controlled Trials from the start of the databases (Embase from 1980) through January 2014. In addition, reference lists of relevant full-text papers were hand-searched. Results Of 901 retrieved papers, 112 were considered as potentially eligible. After full-text reading, 17 were included in the final analysis, together with 15 papers identified through hand-searching of reference lists. All of the 32 included publications were case reports or case series. Clinical manifestations of drug–drug interactions involving opioids were grouped as follows: 1) sedation and respiratory depression, 2) other central nervous system symptoms, 3) impairment of pain control and/or opioid withdrawal, and 4) other symptoms. The most common mechanisms eliciting drug–drug interactions were alteration of opioid metabolism by inhibiting the activity of cytochrome P450 3A4 and pharmacodynamic interactions due to the combined effect on opioid, dopaminergic, cholinergic, and serotonergic activity in the central nervous system. Conclusion Evidence for drug–drug interactions associated with opioids used for pain treatment in cancer patients is very limited. Still, the cases identified in this systematic review give some important suggestions for clinical practice. Physicians prescribing opioids should recognize the risk of drug–drug interactions and if possible avoid polypharmacy. PMID:26396499

  3. Gender Differences in Pain-Physical Activity Linkages among Older Adults: Lessons Learned from Daily Life Approaches

    PubMed Central

    Ho, Amy; Ashe, Maureen C.; DeLongis, Anita; Graf, Peter; Khan, Karim M.; Hoppmann, Christiane A.

    2016-01-01

    Background. Many older adults know about the health benefits of an active lifestyle, but, frequently, pain prevents them from engaging in physical activity. The majority of older adults experience pain, a complex experience that can vary across time and is shaped by sociocultural factors like gender. Objectives. To describe the time-varying associations between daily pain and physical activity and to explore differences in these associations between women and men. Methods. One hundred and twenty-eight community-dwelling older adults aged 65 years and older were asked to report their pain levels three times daily over a 10-day period and wear an accelerometer to objectively capture their daily physical activity (step counts and minutes of moderate to vigorous physical activity). Results. Increased daily step counts and minutes of moderate to vigorous physical activity were associated with increased daily pain, especially among women. Confirming past literature and contrasting findings for daily pain reports, overall pain levels across the study period were negatively associated with minutes of moderate to vigorous physical activity. Conclusions. Findings highlight that pain is significantly associated with physical activity in old age. The nature of this association depends on the time scale that is considered and differs between women and men. PMID:27445599

  4. Gender Differences in Pain-Physical Activity Linkages among Older Adults: Lessons Learned from Daily Life Approaches.

    PubMed

    Ho, Amy; Ashe, Maureen C; DeLongis, Anita; Graf, Peter; Khan, Karim M; Hoppmann, Christiane A

    2016-01-01

    Background. Many older adults know about the health benefits of an active lifestyle, but, frequently, pain prevents them from engaging in physical activity. The majority of older adults experience pain, a complex experience that can vary across time and is shaped by sociocultural factors like gender. Objectives. To describe the time-varying associations between daily pain and physical activity and to explore differences in these associations between women and men. Methods. One hundred and twenty-eight community-dwelling older adults aged 65 years and older were asked to report their pain levels three times daily over a 10-day period and wear an accelerometer to objectively capture their daily physical activity (step counts and minutes of moderate to vigorous physical activity). Results. Increased daily step counts and minutes of moderate to vigorous physical activity were associated with increased daily pain, especially among women. Confirming past literature and contrasting findings for daily pain reports, overall pain levels across the study period were negatively associated with minutes of moderate to vigorous physical activity. Conclusions. Findings highlight that pain is significantly associated with physical activity in old age. The nature of this association depends on the time scale that is considered and differs between women and men. PMID:27445599

  5. [Clinical evaluation of the efficacy of external therapies of traditional Chinese medicine in treatment of cancer pain].

    PubMed

    Zhu, Shi-jie; Jia, Li-qun; Li, Pei-wen

    2011-01-01

    There lack scientific methods for evaluating the treatment of cancer pain with external therapies of traditional Chinese medicine (TCM). The level of clinical study in this field needs to be improved. The authors assert that when external therapies of TCM are applied to treat cancer pain, different types of cancer pain should be distinguished and treatment should be applied according to such a differentiation. Under this framework scientific evaluation can be conducted. The authors also assert that the findings of randomized, blinded and controlled trials should be given particular attention, and it is necessary to include titration of morphine into clinical trails of external therapies for the treatment of cancer pain, not only complying with the three-ladder principle for treating cancer pain suggested by the World Health Organization, but also not influencing the effect evaluation of external therapies of TCM on cancer pain. Patient diaries recording pain were revised as observation indexes. The primary indicator of efficacy was the pain intensity score and the secondary indicators were the equivalent of morphine and the remission rate of pain. The time to onset, remission duration and comparison of assessment of pain influence can mirror the characteristics of external therapies of TCM on cancer pain. PMID:21227027

  6. Effect of Music Therapy on Pain and Anxiety Levels of Cancer Patients: A Pilot Study

    PubMed Central

    Krishnaswamy, Priyadharshini; Nair, Shoba

    2016-01-01

    Background: The pain associated with cancer is highly detrimental to the quality of life of the affected individuals. It also contributes to the anxiety of the patient. There is a need for a nonpharmacological approach in addition to the pharmacological therapy for the management of the pain for a more holistic improvement in the individual. With this study, we wish to achieve this through music. Objective: To assess the effect of music therapy on pain scores and anxiety levels of cancer patients with pain. Study Design: In this quantitative study, a comparative study was done on fourteen cancer patients admitted for pain relief under the Department of Pain and Palliative Medicine, of a tertiary care hospital, having moderate to severe pain (numerical pain rating scale [NRS] – of 4 to 10). Subjects and Methods: Convenience sampling was used. Patients were allocated to test group or control group nonrandomly. The test group patients were subjected to music therapy for 20 min while the control group patients were kept occupied by talking to them for 20 min. The NRS scale was used to assess the pre- and post-interventional pain scores and the Hamilton anxiety rating scale was used to assess the pre- and post-interventional anxiety scores in the two groups. Statistics: Student's t-test was used for comparing the pre- and post-interventional data. Two sample t-test was used to compare the data obtained from the control and study groups. Results: Statistically significant reduction seen in the pain scores in the test group after music therapy (P = 0.003). No statistically significant reduction seen in the pain score in the control group (P = 0.356). There was a statistically significant reduction in the postintervention pain scores in the test group compared to the control group (P = 0.034). The reduction in anxiety levels in both groups after intervention was not statistically significant. Conclusion: Music therapy was found to lower the pain score of a patient who

  7. Adult-onset painful axonal polyneuropathy caused by a dominant NAGLU mutation

    PubMed Central

    Tétreault, Martine; Gonzalez, Michael; Dicaire, Marie-Josée; Allard, Pierre; Gehring, Kalle; Leblanc, Diane; Leclerc, Nadine; Schondorf, Ronald; Mathieu, Jean; Zuchner, Stephan

    2015-01-01

    Late-onset painful sensory neuropathies are usually acquired conditions associated with common diseases. Adult presentations of known hereditary forms are often accompanied by other organ involvement. We recruited a large French-Canadian family with a dominantly inherited late-onset painful sensory neuropathy. The main clinical feature is recurrent leg pain that progresses to constant painful paraesthesias in the feet and later the hands. As it evolves, some patients develop a mild sensory ataxia. We selected four affected individuals for whole exome sequencing. Analysis of rare variants shared by all cases led to a list of four candidate variants. Segregation analysis in all 45 recruited individuals has shown that only the p.Ile403Thr variant in the α-N-acetyl-glucosaminidase (NAGLU) gene segregates with the disease. Recessive NAGLU mutations cause the severe childhood lysosomal disease mucopolysacharidosis IIIB. Family members carrying the mutation showed a significant decrease of the enzymatic function (average 45%). The late-onset and variable severity of the symptoms may have precluded the description of such symptoms in parents of mucopolysaccharidosis IIIB cases. The identification of a dominant phenotype associated with a NAGLU mutation supports that some carriers of lysosomal enzyme mutations may develop later in life much milder phenotypes. PMID:25818867

  8. Spider peptide Phα1β induces analgesic effect in a model of cancer pain.

    PubMed

    Rigo, Flavia Karine; Trevisan, Gabriela; Rosa, Fernanda; Dalmolin, Gerusa D; Otuki, Michel Fleith; Cueto, Ana Paula; de Castro Junior, Célio José; Romano-Silva, Marco Aurelio; Cordeiro, Marta do N; Richardson, Michael; Ferreira, Juliano; Gomez, Marcus V

    2013-09-01

    The marine snail peptide ziconotide (ω-conotoxin MVIIA) is used as an analgesic in cancer patients refractory to opioids, but may induce severe adverse effects. Animal venoms represent a rich source of novel drugs, so we investigated the analgesic effects and the side-effects of spider peptide Phα1β in a model of cancer pain in mice with or without tolerance to morphine analgesia. Cancer pain was induced by the inoculation of melanoma B16-F10 cells into the hind paw of C57BL/6 mice. After 14 days, painful hypersensitivity was detected and Phα1β or ω-conotoxin MVIIA (10-100 pmol/site) was intrathecally injected to evaluate the development of antinociception and side-effects in control and morphine-tolerant mice. The treatment with Phα1β or ω-conotoxin MVIIA fully reversed cancer-related painful hypersensitivity, with long-lasting results, at effective doses 50% of 48 (32-72) or 33 (21-53) pmol/site, respectively. Phα1β produced only mild adverse effects, whereas ω-conotoxin MVIIA induced dose-related side-effects in mice at analgesic doses (estimated toxic dose 50% of 30 pmol/site). In addition, we observed that Phα1β was capable of controlling cancer-related pain even in mice tolerant to morphine antinociception (100% of inhibition) and was able to partially restore morphine analgesia in such animals (56 ± 5% of inhibition). In this study, Phα1β was as efficacious as ω-conotoxin MVIIA in inducing analgesia in a model of cancer pain without producing severe adverse effects or losing efficacy in opioid-tolerant mice, indicating that Phα1β has a good profile for the treatment of cancer pain in patients. PMID:23718272

  9. Developmental Status and Intimacy in Adult Survivors of Childhood Cancer.

    ERIC Educational Resources Information Center

    Zevon, Michael A.; Corn, Barbara; Lowrie, Geoffrey; Green, Daniel M.

    Whereas aggressive multimodal therapies are responsible for improved survival rates of children and adolescents diagnosed with cancer, concern has grown regarding the potential for adverse and delayed developmental effects resulting from these treatments. In light of this concern, this study assessed 207 adult survivors of childhood cancer in…

  10. Hepatic cancer stem cells may arise from adult ductal progenitors

    PubMed Central

    Nikolaou, Kostas C; Talianidis, Iannis

    2016-01-01

    Cancer stem cells (CSCs) are defined as cells within tumors that can self-renew and differentiate into heterogeneous lineages of cancerous cells. The origin of CSCs is not well understood. Recent evidence suggests that CSCs in hepatocellular carcinoma could be generated via oncogenic transformation and partial differentiation of adult hepatic ductal progenitor cells.

  11. Administration of a tropomyosin receptor kinase inhibitor attenuates sarcoma-induced nerve sprouting, neuroma formation and bone cancer pain

    PubMed Central

    2010-01-01

    Pain often accompanies cancer and most current therapies for treating cancer pain have significant unwanted side effects. Targeting nerve growth factor (NGF) or its cognate receptor tropomyosin receptor kinase A (TrkA) has become an attractive target for attenuating chronic pain. In the present report, we use a mouse model of bone cancer pain and examine whether oral administration of a selective small molecule Trk inhibitor (ARRY-470, which blocks TrkA, TrkB and TrkC kinase activity at low nm concentrations) has a significant effect on cancer-induced pain behaviors, tumor-induced remodeling of sensory nerve fibers, tumor growth and tumor-induced bone remodeling. Early/sustained (initiated day 6 post cancer cell injection), but not late/acute (initiated day 18 post cancer cell injection) administration of ARRY-470 markedly attenuated bone cancer pain and significantly blocked the ectopic sprouting of sensory nerve fibers and the formation of neuroma-like structures in the tumor bearing bone, but did not have a significant effect on tumor growth or bone remodeling. These data suggest that, like therapies that target the cancer itself, the earlier that the blockade of TrkA occurs, the more effective the control of cancer pain and the tumor-induced remodeling of sensory nerve fibers. Developing targeted therapies that relieve cancer pain without the side effects of current analgesics has the potential to significantly improve the quality of life and functional status of cancer patients. PMID:21138586

  12. [Process and results of the development of an ICNP® Catalogue for Cancer Pain].

    PubMed

    de Carvalho, Marisaulina Wanderley Abrantes; da Nóbrega, Maria Miriam Lima; Garcia, Telma Ribeiro

    2013-10-01

    This was a methodological study conducted to describe the process and results of the development of an International Classification for Nursing Practice (ICNP®) Catalogue for Cancer Pain. According to the International Council of Nurses (ICN), this catalogue contains a subset of nursing diagnoses, outcomes, and interventions to document the implementation of the nursing process in cancer patients. This catalogue was developed in several steps according to the guidelines recommended by the ICN. As a result, 68 statements on nursing diagnoses/outcomes were obtained, which were classified according to the theoretical model for nursing care related to cancer pain into physical (28), psychological (29), and sociocultural and spiritual (11) aspects. A total of 116 corresponding nursing interventions were obtained. The proposed ICNP® Catalogue for Cancer Pain aims to provide safe and systematic orientation to nurses who work in this field, thus improving the quality of patient care and facilitating the performance of the nursing process. PMID:24346444

  13. Effect of Telecare Management on Pain and Depression in Patients with Cancer: A Randomized Trial

    PubMed Central

    Kroenke, Kurt; Theobald, Dale; Wu, Jingwei; Norton, Kelli; Morrison, Gwendolyn; Carpenter, Janet; Tu, Wanzhu

    2010-01-01

    Context Pain and depression are two of the most prevalent and treatable cancer-related symptoms, yet frequently go unrecognized and/or undertreated. Objective To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in cancer patients. Design, Setting, and Patients Randomized controlled trial conducted in 16 community-based urban and rural oncology practices across the state of Indiana. Recruitment occurred from March 2006 through August 2008 and follow-up concluded in August 2009. The 405 patients had depression (Patient Health Questionnaire-9 score ≥ 10), cancer-related pain (Brief Pain Inventory worst pain score ≥ 6), or both. Intervention Patients were randomly assigned to the intervention (n=202) or to usual care (n=203), stratified by symptom type. Intervention patients received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or internet. Main Outcome Measures Blinded assessment at baseline, 1, 3, 6, and 12 months for depression (20-item Hopkins Symptom Checklist [HSCL-20]) and pain (Brief Pain Inventory [BPI]) severity. Results There were 131 patients enrolled with depression only, 96 with pain only, and 178 with both depression and pain. Of the 274 patients enrolled for pain, the 137 intervention patients had greater improvements than the 137 usual care patients in BPI pain severity over the 12 months of the trial whether measured as a continuous severity score or as a categorical pain responder (P < .0001 for both). Similarly, of the 309 patients enrolled for depression, the 154 intervention patients had greater improvements than the 155 usual care patients in HSCL-20 depression severity over the 12 months of the trial whether measured as a continuous severity score (P < .0001) or as a categorical depression responder (P < .001). The standardized effect size for

  14. Intravenous Methadone for Severe Cancer Pain: A Presentation of 10 Cases

    PubMed Central

    Lossignol, D.; Libert, I.; Michel, B.; Rousseau, C.; Obiols-Portis, M.

    2013-01-01

    Purpose. Methadone, a synthetic opioid agonist, is an effective alternative to strong opioids (morphine, hydromorphone, oxycodone, and buprenorphine) and is widely available as an oral formulation. Few data have been published so far on the use of intravenous (i.v.) methadone for the management of severe or refractory cancer pain. Methods. We followed 10 consecutives cancer patients with severe pain, treated with IV methadone. All had advanced disease and had already received strong opioids, some in association with ketamine. Pain was assessed at T0, T24 hours, and at the end of the treatment. Results. All patients benefited from the switch to IV methadone with a reduction of pain on VAS after 24 hours (median: 4/10; range 0–5) until the end of the treatment (all cases <3/10). The median starting dose was 100 mg/day (range 20–400) and the final dose remained stable with a median of 100 mg/day (range 27–700). The median duration of IV methadone was 11 days (range 2–59). No cardiac toxicity had been observed. Conclusions. IV methadone is an effective pain relieving alternative for the treatment of severe cancer pain, especially in refractory pain syndrome. Moreover, we did not observe any toxicity (neurological or cardiac) or any other major side effects and the treatment was overall well tolerated. More extensive comparative studies should be planned. PMID:27335869

  15. Hypnosis for treatment of pain in children

    PubMed Central

    Rogovik, Alex L.; Goldman, Ran D.

    2007-01-01

    QUESTION Many children suffer from chronic and painful illnesses. Hypnosis was found to be effective for analgesia in adults. Is it effective for managing pain in children? ANSWER Children can be easier to hypnotize than adults. Studies have shown clinical hypnosis and self-hypnosis to be effective as adjunct treatments for children in pain. Examples include painful medical procedures, such as bone marrow aspiration and lumbar puncture in pediatric cancer patients, postoperative pain and anxiety in children undergoing surgery, and chronic headache. PMID:17872743

  16. [Effect of P2X7 receptor knock-out on bone cancer pain in mice].

    PubMed

    Zhao, Xin; Liu, Hui-Zhu; Zhang, Yu-Qiu

    2016-06-25

    Cancer pain is one of the most common symptoms in patients with late stage cancer. Lung, breast and prostate carcinoma are the most common causes of pain from osseous metastasis. P2X7 receptor (P2X7R) is one of the subtypes of ATP-gated purinergic ion channel family, predominately distributed in microglia in the spinal cord. Activation of P2X7Rs in the spinal dorsal horn has been associated with release of proinflammatory cytokines from glial cells, causing increased neuronal excitability and exaggerated nociception. Mounting evidence implies a critical role of P2X7R in inflammatory and neuropathic pain. However, whether P2X7R is involved in cancer pain remains controversial. Here we established a bone cancer pain model by injecting the Lewis lung carcinoma cells into the femur bone marrow cavity of C57BL/6J wild-type mice (C57 WT mice) and P2X7R knockout mice (P2rx7(-/-) mice) to explore the role of P2X7R in bone cancer pain. Following intrafemur carcinoma inoculation, robust mechanical allodynia and thermal hyperalgesia in C57 WT mice were developed on day 7 and 14, respectively, and persisted for at least 28 days in the ipsilateral hindpaw of the affected limb. CatWalk gait analysis showed significant decreases in the print area and stand phase, and a significant increase in swing phase in the ipsilateral hindpaw on day 21 and 28 after carcinoma cells inoculation. Histopathological sections (hematoxylin and eosin stain) showed that the bone marrow of the affected femur was largely replaced by invading tumor cells, and the femur displayed medullary bone loss and bone destruction on day 28 after inoculation. Unexpectedly, no significant changes in bone cancer-induced hypersensitivity of pain behaviors were found in P2rx7(-/-) mice, and the changes of pain-related values in CatWalk gait analysis even occurred earlier in P2rx7(-/-) mice, as compared with C57 WT mice. Together with our previous study in rats that blockade of P2X7R significantly alleviated bone cancer

  17. The role of ketamine in the treatment of chronic cancer pain

    PubMed Central

    ZGAIA, ARMEANA OLIMPIA; IRIMIE, ALEXANDRU; SANDESC, DOREL; VLAD, CATALIN; LISENCU, COSMIN; ROGOBETE, ALEXANDRU; ACHIMAS-CADARIU, PATRICIU

    2015-01-01

    Background and aim Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain. The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain. Method We reviewed the literature from the electronic databases of MEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998–2014), as well as chapters of specialized books (palliative care, pain management, anesthesia). Results A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive. Conclusions Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored. PMID:26733743

  18. Levo-Tetrahydropalmatine Attenuates Bone Cancer Pain by Inhibiting Microglial Cells Activation

    PubMed Central

    Zhang, Mao-yin; Liu, Yue-peng; Zhang, Lian-yi; Yue, Dong-mei; Qi, Dun-yi; Liu, Gong-jian; Liu, Su

    2015-01-01

    Objective. The present study is to investigate the analgesic roles of L-THP in rats with bone cancer pain caused by tumor cell implantation (TCI). Methods. Thermal hyperalgesia and mechanical allodynia were measured at different time points before and after operation. L-THP (20, 40, and 60 mg/kg) were administrated intragastrically at early phase of postoperation (before pain appearance) and later phase of postoperation (after pain appearance), respectively. The concentrations of TNF-α, IL-1β, and IL-18 in spinal cord were measured by enzyme-linked immunosorbent assay. Western blot was used to test the activation of astrocytes and microglial cells in spinal cord after TCI treatment. Results. TCI treatment induced significant thermal hyperalgesia and mechanical allodynia. Administration of L-THP at high doses significantly prevented and/or reversed bone cancer-related pain behaviors. Besides, TCI-induced activation of microglial cells and the increased levels of TNF-α and IL-18 were inhibited by L-THP administration. However, L-THP failed to affect TCI-induced astrocytes activation and IL-1β increase. Conclusion. This study suggests the possible clinical utility of L-THP in the treatment of bone cancer pain. The analgesic effects of L-THP on bone cancer pain maybe underlying the inhibition of microglial cells activation and proinflammatory cytokines increase. PMID:26819501

  19. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials.

    PubMed

    Lynch, Mary E; Campbell, Fiona

    2011-11-01

    Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone, dronabinol and a novel THC analogue. Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required. PMID:21426373

  20. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials

    PubMed Central

    Lynch, Mary E; Campbell, Fiona

    2011-01-01

    Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone, dronabinol and a novel THC analogue. Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required. Linked Article This article is linked to a themed issue in the British Journal of Pharmacology on Respiratory Pharmacology. To view this issue visit http://dx.doi.org/10.1111/bph.2011.163.issue-1 PMID:21426373

  1. A Traditional Chinese Medicine Xiao-Ai-Tong Suppresses Pain through Modulation of Cytokines and Prevents Adverse Reactions of Morphine Treatment in Bone Cancer Pain Patients

    PubMed Central

    Cong, Yan; Sun, Kefu; He, Xueming; Li, Jinxuan; Dong, Yanbin; Zheng, Bin; Tan, Xiao; Song, Xue-Jun

    2015-01-01

    Treating cancer pain continues to possess a major challenge. Here, we report that a traditional Chinese medicine Xiao-Ai-Tong (XAT) can effectively suppress pain and adverse reactions following morphine treatment in patients with bone cancer pain. Visual Analogue Scale (VAS) and Quality of Life Questionnaire (EORTC QLQ-C30) were used for patient's self-evaluation of pain intensity and evaluating changes of adverse reactions including constipation, nausea, fatigue, and anorexia, respectively, before and after treatment prescriptions. The clinical trials showed that repetitive oral administration of XAT (200 mL, bid, for 7 consecutive days) alone greatly reduced cancer pain. Repetitive treatment with a combination of XAT and morphine (20 mg and 30 mg, resp.) produced significant synergistic analgesic effects. Meanwhile, XAT greatly reduced the adverse reactions associated with cancer and/or morphine treatment. In addition, XAT treatment significantly reduced the proinflammatory cytokines interleukin-1β and tumor necrosis factor-α and increased the endogenous anti-inflammatory cytokine interleukin-10 in blood. These findings demonstrate that XAT can effectively reduce bone cancer pain probably mediated by the cytokine mechanisms, facilitate analgesic effect of morphine, and prevent or reduce the associated adverse reactions, supporting a use of XAT, alone or with morphine, in treating bone cancer pain in clinic. PMID:26617438

  2. Pain-related anxiety and marijuana use motives: a pilot test among active marijuana-using young adults.

    PubMed

    Hogan, Julianna; Gonzalez, Adam; Howell, Ashley; Bonn-Miller, Marcel O; Zvolensky, Michael J

    2010-01-01

    The present investigation examined pain-related anxiety in regard to marijuana use motives among a sample of young adult marijuana users (N = 180; 45% women; M(age) = 21.11 years, SD = 6.41). Hierarchical multiple regression analyses were used to determine the relations between pain-related anxiety and marijuana use motives. After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, current rate of alcohol consumption, level of bodily pain (current), and other marijuana use motives, pain-related anxiety was significantly and uniquely associated with coping and conformity motives for marijuana use. Pain-related anxiety was not significantly related to other marijuana use motives. These results offer novel empirical insight pertaining to a relation between pain-related anxiety and coping as well as conformity motives for marijuana use among active users. PMID:21038155

  3. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults

    PubMed Central

    Toms, Laurence; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background This is an updated version of the Cochrane review published in Issue 4, 1998. Combining drugs from different classes with different modes of action may offer opportunity to optimise efficacy and tolerability, using lower doses of each drug to achieve the same degree of pain relief. Previously we concluded that addition of codeine to paracetamol provided additional pain relief, but at expense of additional adverse events. New studies have been published since. This review sought to evaluate efficacy and safety of paracetamol plus codeine using current data, and compare findings with other analgesics evaluated similarly. Objectives Assess efficacy of single dose oral paracetamol plus codeine in acute postoperative pain, increase in efficacy due to the codeine component, and associated adverse events. Search methods We searched CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database in October 2008 for this update. Selection criteria Randomised, double-blind, placebo-controlled trials of paracetamol plus codeine, compared with placebo or the same dose of paracetamol alone, for relief of acute postoperative pain in adults. Data collection and analysis Two authors assessed trial quality and extracted data. The area under the “pain relief versus time” curve was used to derive proportion of participants with paracetamol plus codeine and placebo or paracetamol alone experiencing least 50% pain relief over four-to-six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated using 95% confidence intervals (CIs). Proportion of participants using rescue analgesia over a specified time period, and time to use of rescue analgesia, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Twenty-six studies, with 2295 participants, were included comparing paracetamol plus codeine with placebo. Significant dose response was seen for the outcome of at least 50% pain

  4. Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults

    PubMed Central

    Taddio, Anna; McMurtry, C. Meghan; Halperin, Scott A.; Noel, Melanie; Pillai Riddell, Rebecca; Chambers, Christine T.

    2015-01-01

    Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan. Design/Methods: Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk with 95% confidence intervals (CI). Results: Fifty-five studies that examined breastfeeding (which combines sweet-tasting solution, holding, and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of 2 versus 1 intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared with control, acute distress was lower for infants breastfed: (1) during vaccination (n=792): SMD −1.78 (CI, −2.35, −1.22) and (2) before vaccination (n=100): SMD −1.43 (CI, −2.14, −0.72). Compared with control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD −0.91 (CI, −1.36, −0.47) and self-reported pain in adults (n=60): SMD −0.85 (CI, −1.38, −0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD −0.76 (CI, −1.19, −0.34) or glucose (n=818): SMD −0.69 (CI, −1.03, −0.35) compared with placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185), SMD −0.78 (CI, −1.08, −0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared with topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared with

  5. Management of cancer pain with transdermal fentanyl: phase IV trial, University of Iowa.

    PubMed

    Maves, T J; Barcellos, W A

    1992-04-01

    A multicenter study was conducted to determine the patient and physician acceptability of transdermal fentanyl in the management of cancer-related pain. In this study, 10 cancer patients at the University of Iowa received transdermal fentanyl after discontinuing their prior opioid analgesic; 7 patients completed questionnaires before and at 2 and 4 wk following transdermal fentanyl application. There was no significant difference in visual analogue scale scores for pain or mood. Verbal pain descriptor scores improved at 2 wk (P less than .05). There was a nonsignificant tendency toward increased depression and nausea; however, patients spent less time thinking about their illness and felt their cancer was less disruptive to their closest friends/relatives. Constipation, appetite, drowsiness, and concentration were not statistically different. Patients reported improved sleep habits at 2 wk (P less than .05) and tended to require less help with eating, dressing, washing, and using the bathroom. All patients completing the study chose to continue transdermal fentanyl for their cancer pain management. In summary, these data demonstrate the analgesic efficacy of the transdermal fentanyl system and suggest that some patients with cancer-related pain could benefit from its use. PMID:1517636

  6. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

    PubMed Central

    Brkovic, Tonci; Burilovic, Eliana; Puljak, Livia

    2016-01-01

    Objectives Understanding the epidemiology of pain in patients on hemodialysis (HD) is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool. Results We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain. Conclusion The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain-related disability. PMID:27382261

  7. Massage Therapy vs. Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial

    PubMed Central

    Kutner, Jean S.; Smith, Marlaine C.; Corbin, Lisa; Hemphill, Linnea; Benton, Kathryn; Mellis, B. Karen; Beaty, Brenda; Felton, Sue; Yamashita, Traci E.; Bryant, Lucinda L.; Fairclough, Diane L.

    2008-01-01

    BACKGROUND Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms. OBJECTIVE Evaluate efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer. DESIGN Multi-site randomized clinical trial. SETTING Population-based Palliative Care Research Network (PoPCRN). PATIENTS 380 adults with advanced cancer experiencing moderate-severe pain; 90% were enrolled in hospice. INTERVENTION Six 30-minute massage or simple touch sessions over two weeks. MEASUREMENTS Primary outcomes were immediate (Memorial Pain Assessment Card, MPAC, 0 – 10 scale) and sustained (Brief Pain Inventory, BPI, 0 – 10 scales) change in pain. Secondary outcomes were immediate change in mood (MPAC 0 – 10 scale) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, MQOL, 0 – 10 scale), symptom distress (Memorial Symptom Assessment Scale, MSAS, 0 – 4 scale), and analgesic medication use (parenteral morphine equivalents (milligrams/24 hours). Immediate outcomes were obtained just prior to and following each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks. RESULTS 298 were included in the immediate outcome analysis and 348 in the sustained outcome analysis. 82 did not receive any allocated study treatments (37 massage, 45 control). Both groups demonstrated immediate improvement in pain (massage -1.87 points (CI, -2.07, -1.67), control -0.97 points (CI, -1.18, -0.76)) and mood (massage 1.58 points (CI, 1.40, 1.76), control 0.97 points (CI, 0.78, 1.16)). Massage was superior for both pain and mood (mean difference 0.90 and 0.61 points, respectively, P<0.001). There were no between group mean differences over time in pain (BPI Mean 0.07 (CI, -0.23, 0.37), BPI Worst -0.14 (CI, -0.59, 0.31)), quality of life (MQOL Overall 0.08 (CI, -0.37, 0.53)), symptom distress (MSAS Global Distress Index

  8. Association between dental pain and depression in Korean adults using the Korean National Health and Nutrition Examination Survey.

    PubMed

    Yang, S E; Park, Y G; Han, K; Min, J A; Kim, S Y

    2016-01-01

    The purpose of this study was to evaluate the relationships between the prevalence of depression and dental pain using a well characterised, nationally representative, population-based study. This study analysed data from the 2012 Korea National Health and Nutrition Examination Survey (n = 4886). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Depression was defined as the participant having been diagnosed as depression during the previous year. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI), controlling for a range of covariates. Results demonstrated that participants included in 'root canal treatment is necessary' showed higher prevalence of self-reported dental pain; in particular, participants with depression presented more dental pain than those without depression. After adjusting for sociodemographic factors, self-reported dental pain increased in participants with depression. The AOR (95% CI) for having self-reported dental pain was 1·58 (1·08-2·33) in dentists' diagnosis of no dental pain/depression group, 1·62 (1·32-1·98) in dentists' diagnosis of dental pain/no depression group and 2·84 (1·10-7·37) in dentists' diagnosis of dental pain/depression group. It was concluded that depression was associated with dental pain after adjustment for potential confounders in Korean adults. Thus, dentists should consider the possible presence of psychopathology when treating patients with dental pain. PMID:26337763

  9. Moderate chronic pain, weight and dietary intake in African-American adult patients with sickle cell disease.

    PubMed Central

    Pells, Jennifer J.; Presnell, Katherine E.; Edwards, Christopher L.; Wood, Mary; Harrison, Myleme O.; DeCastro, Laura; Johnson, Stephanie; Feliu, Miriam; Canada, Stephanie; Jonassaint, Jude C.; Barker, Camela; Leach-Beale, Brittani; Mathis, Markece J.; Applegate, Katherine; Holmes, Anita; Byrd, Goldie; Robinson, Elwood

    2005-01-01

    In this exploratory study, we evaluated weight status and dietary intake patterns during painful episodes in adult patients with SCD. Specifically, we explored the relation between pain severity and body mass index (BMI), and we tested the hypothesis that dietary intake would be reduced and dietary content altered during periods of increased pain. We conducted an analysis of survey data from 62 patients involved in a longitudinal evaluation of the relationship of medical and psychosocial factors to pain. Nearly half of patients with SCD were overweight, and 20% were obese. BMI was positively related to interference associated with pain. Although BMI was not statistically associated with reported pain severity, >40% of patients reported that they perceived their pain to be affected by their weight. Less than 20% of patients reported that they perceived that their weight affected their pain. Regarding dietary patterns, the majority of patients reported eating less during episodes of pain and significantly decreasing their intake of fats and proteins. We conclude that there is a need to better understand the relation among weight, dietary patterns and pain in patients with SCD in order to provide patients with accurate education and effective treatment recommendations for managing their disease and reducing current and future risks of lifestyle and disease-related morbidities. PMID:16396054

  10. Pancreatic stellate cells contribute pancreatic cancer pain via activation of sHH signaling pathway

    PubMed Central

    Han, Liang; Ma, Jiguang; Duan, Wanxing; Zhang, Lun; Yu, Shuo; Xu, Qinhong; Lei, Jianjun; Li, Xuqi; Wang, Zheng; Wu, Zheng; Huang, Jason H.; Wu, Erxi; Ma, Qingyong; Ma, Zhenhua

    2016-01-01

    Abdominal pain is a critical clinical symptom in pancreatic cancer (PC) that affects the quality of life for PC patients. However, the pathogenesis of PC pain is largely unknown. In this study, we show that PC pain is initiated by the sonic hedgehog (sHH) signaling pathway in pancreatic stellate cells (PSCs), which is activated by sHH secreted from PC cells, and then, neurotrophic factors derived from PSCs mediate the pain. The different culture systems were established in vitro, and the expression of sHH pathway molecules, neurotrophic factors, TRPV1, and pain factors were examined. Capsaicin-evoked TRPV1 currents in dorsal root ganglion (DRG) neurons were examined by the patch-clamp technique. Pain-related behavior was observed in an orthotopic tumor model. sHH and PSCs increased the expression and secretion of TRPV1, SP, and CGRP by inducing NGF and BDNF in a co-culture system, also increasing TRPV1 current. But, suppressing sHH pathway or NGF reduced the expression of TRPV1, SP, and CGRP. In vivo, PSCs and PC cells that expressed high levels of sHH could enhance pain behavior. Furthermore, the blockade of NGF or TRPV1 significantly attenuated the pain response to mechanical stimulation compared with the control. Our results demonstrate that sHH signaling pathway is involved in PC pain, and PSCs play an essential role in the process greatly by inducing NGF. PMID:26934446

  11. New Guidelines Issued for Cancer Patients' Post-Treatment Pain

    MedlinePlus

    ... treatments for pain. These include hypnosis, meditation and medical marijuana where it's legal. ASCO also cautioned doctors to ... said. In states where allowed, doctors can prescribe medical marijuana. But they should first consider the potential benefits ...

  12. Targeting A-type K(+) channels in primary sensory neurons for bone cancer pain in a rat model.

    PubMed

    Duan, Kai-Zheng; Xu, Qian; Zhang, Xiao-Meng; Zhao, Zhi-Qi; Mei, Yan-Ai; Zhang, Yu-Qiu

    2012-03-01

    Cancer pain is one of the most severe types of chronic pain, and the most common cancer pain is bone cancer pain. The treatment of bone cancer pain remains a clinical challenge. Here, we report firstly that A-type K(+) channels in dorsal root ganglion (DRG) are involved in the neuropathy of rat bone cancer pain and are a new target for diclofenac, a nonsteroidal anti-inflammatory drug that can be used for therapy for this distinct pain. There are dynamically functional changes of the A-type K(+) channels in DRG neurons during bone cancer pain. The A-type K(+) currents that mainly express in isolectin B4-positive small DRG neurons are increased on post-tumor day 14 (PTD 14), then faded but still remained at a higher level on PTD 21. Correspondingly, the expression levels of A-type K(+) channel Kv1.4, Kv3.4, and Kv4.3 showed time-dependent changes during bone cancer pain. Diclofenac enhances A-type K(+) currents in the DRG neurons and attenuates bone cancer pain in a dose-dependent manner. The analgesic effect of diclofenac can be reversed or prevented by A-type K(+) channel blocker 4-AP or pandinotoxin-Kα, also by siRNA targeted against rat Kv1.4 or Kv4.3. Repeated diclofenac administration decreased soft tissue swelling adjacent to the tumor and attenuated bone destruction. These results indicate that peripheral A-type K(+) channels were involved in the neuropathy of rat bone cancer pain. Targeting A-type K(+) channels in primary sensory neurons may provide a novel mechanism-based therapeutic strategy for bone cancer pain. PMID:22188869

  13. Improving the quality of survivorship for older adults with cancer.

    PubMed

    Mohile, Supriya G; Hurria, Arti; Cohen, Harvey J; Rowland, Julia H; Leach, Corinne R; Arora, Neeraj K; Canin, Beverly; Muss, Hyman B; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather G; Mustian, Karen M; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon K; Studenski, Stephanie A; Dale, William

    2016-08-15

    In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent the decline of or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) use standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the 2 prior U13 meetings, this conference provided the framework for future research to improve the evidence base for the clinical care of older adults with cancer. Cancer 2016;122:2459-68. © 2016 American Cancer Society. PMID:27172129

  14. Communicative responses to the painful self-disclosures of familial and non-familial older adults.

    PubMed

    Fowler, Craig; Soliz, Jordan

    2013-01-01

    Data from 365 college students were used to assess young adults' communicative responses to older persons' painful self-disclosures (PSDs). Coupland, Coupland, and Giles (1991) proposed that recipients of PSD may respond to such disclosures via a variety of"next moves." These responses may broadly be considered to reflect forms of pro-social engagement, passive disengagement, and active disengagement. We investigated whether young adults' tendency to use certain responses to PSD were influenced by their affective reactions to PSD, their communicative background and characteristics, and the sociorelational context of the encounter in which PSD occurred. Results are discussed with respect to their implications for intergenerational interaction, and interpreted through the lens of communication accommodation theory. PMID:24340871

  15. [The role of open neurosurgery in the treatment of cancer pain].

    PubMed

    Gottlieb, A

    1984-06-01

    After a brief foreword on the indication of open surgery in the treatment of neoplastic pain those procedures are detailed which are more effective and widely used: Posterior Rhizotomy, Cordotomy, Mediolongitudinal Mielotomy and Bulbar trigeminal tractotomy. Of each procedure main technical features, indications and complications are detailed. It is concluded that these techniques are still very useful in management of severe cancer pain. PMID:6588308

  16. Biologic and clinical characteristics of adolescent and young adult cancers: Acute lymphoblastic leukemia, colorectal cancer, breast cancer, melanoma, and sarcoma.

    PubMed

    Tricoli, James V; Blair, Donald G; Anders, Carey K; Bleyer, W Archie; Boardman, Lisa A; Khan, Javed; Kummar, Shivaani; Hayes-Lattin, Brandon; Hunger, Stephen P; Merchant, Melinda; Seibel, Nita L; Thurin, Magdalena; Willman, Cheryl L

    2016-04-01

    Adolescent and young adult (AYA) patients with cancer have not attained the same improvements in overall survival as either younger children or older adults. One possible reason for this disparity may be that the AYA cancers exhibit unique biologic characteristics, resulting in differences in clinical and treatment resistance behaviors. This report from the biologic component of the jointly sponsored National Cancer Institute and LiveStrong Foundation workshop entitled "Next Steps in Adolescent and Young Adult Oncology" summarizes the current status of biologic and translational research progress for 5 AYA cancers; colorectal cancer breast cancer, acute lymphoblastic leukemia, melanoma, and sarcoma. Conclusions from this meeting included the need for basic biologic, genomic, and model development for AYA cancers as well as translational research studies to elucidate any fundamental differences between pediatric, AYA, and adult cancers. The biologic questions for future research are whether there are mutational or signaling pathway differences (for example, between adult and AYA colorectal cancer) that can be clinically exploited to develop novel therapies for treating AYA cancers and to develop companion diagnostics. Cancer 2016;122:1017-1028. © 2016 American Cancer Society. PMID:26849082

  17. Breast cancer in adolescent and young adult women.

    PubMed

    Gewefel, Hanan; Salhia, Bodour

    2014-12-01

    Breast cancer is one of the most frequently diagnosed malignancy among adolescent and young adult (AYA) women, accounting for approximately 14% of all AYA cancer diagnoses and 7% of all breast cancer. Breast cancer in AYA women is believed to represent a more biologically aggressive disease, but aside from commonly known hereditary predispositions, little is still known about the underlying molecular genetic causes. This review examines the current trends of breast cancer in AYA women as they relate to clinical, social, genetic, and molecular pathologic characteristics. We highlight existing trends, treatment and imaging approaches, and health burdens as they relate to breast cancer in AYA women and provide a discussion on ways to help improve the overall management of this breast cancer cohort. PMID:25034440

  18. Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

    PubMed Central

    Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Łuczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Główka, Franciszek

    2014-01-01

    Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg−1) and bupivacaine in enema (1.820 mg·kg−1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL−1 and 235.7 ng·mL−1, respectively. Bupivacaine elimination was

  19. Selective inhibition of JNK with a peptide inhibitor attenuates pain hypersensitivity and tumor growth in a mouse skin cancer pain model.

    PubMed

    Gao, Yong-Jing; Cheng, Jen-Kun; Zeng, Qing; Xu, Zhen-Zhong; Decosterd, Isabelle; Xu, Xiaoyin; Ji, Ru-Rong

    2009-09-01

    Cancer pain significantly affects the quality of cancer patients, and current treatments for this pain are limited. C-Jun N-terminal kinase (JNK) has been implicated in tumor growth and neuropathic pain sensitization. We investigated the role of JNK in cancer pain and tumor growth in a skin cancer pain model. Injection of luciferase-transfected B16-Fluc melanoma cells into a hindpaw of mouse induced robust tumor growth, as indicated by increase in paw volume and fluorescence intensity. Pain hypersensitivity in this model developed rapidly (<5 days) and reached a peak in 2 weeks, and was characterized by mechanical allodynia and heat hyperalgesia. Tumor growth was associated with JNK activation in tumor mass, dorsal root ganglion (DRG), and spinal cord and a peripheral neuropathy, such as loss of nerve fibers in the hindpaw skin and induction of ATF-3 expression in DRG neurons. Repeated systemic injections of D-JNKI-1 (6 mg/kg, i.p.), a selective and cell-permeable peptide inhibitor of JNK, produced an accumulative inhibition of mechanical allodynia and heat hyperalgesia. A bolus spinal injection of D-JNKI-1 also inhibited mechanical allodynia. Further, JNK inhibition suppressed tumor growth in vivo and melanoma cell proliferation in vitro. In contrast, repeated injections of morphine (5 mg/kg), a commonly used analgesic for terminal cancer, produced analgesic tolerance after 1 day and did not inhibit tumor growth. Our data reveal a marked peripheral neuropathy in this skin cancer model and important roles of the JNK pathway in cancer pain development and tumor growth. JNK inhibitors such as D-JNKI-1 may be used to treat cancer pain. PMID:19445931

  20. Peculiarities of Anxiety Score Distribution in Adult Cancer Patients.

    PubMed

    Blank, Mikhail; Blank, Olga; Myasnikova, Ekaterina; Denisova, Daria

    2015-01-01

    The goal of the present research is to investigate and analyze possible peculiarities of the psychological state of cancer patients undergoing treatment. Scores characterizing the trait and state anxiety were acquired using the Integrative Anxiety Test from four groups: adults with no appreciable disease, pregnant women, cancer patients examined during the specific antitumor treatment, and cancer patients brought into lasting clinical remission. Statistical analysis of the testing results revealed the bimodal type of the distribution of scores. The only statistically significant exception was the distribution of the state anxiety scores in cancer patients undergoing treatment that was clearly unimodal. PMID:26176239

  1. Doxepin for Radiation Therapy-Induced Mucositis Pain in the Treatment of Oral Cancers

    PubMed Central

    Jayakrishnan, Ritujith; Chang, Kenneth; Ugurluer, Gamze; Miller, Robert C.

    2015-01-01

    Radiotherapy (RT), an integral part of the oncologic treatment for patients with head and neck cancer, can cause adverse side effects such as oral mucositis (OM). Pain from OM can impact a patient’s quality of life and interrupt RT treatment schedules, which decreases the probability for achieving cancer cure. Conventionally, RT-induced OM pain is treated with analgesics and/or mouthwash rinses. Doxepin, a traditional tricyclic antidepressant with analgesic and anesthetic properties when applied topically to the mucosa, has been shown to lower OM pain in multiple single-arm trials (Epstein et al.) and more recently, in a placebo-controlled crossover study (Leenstra and Miller et al.). Currently, a placebo-controlled study (Sio and Miller et al.) using doxepin for esophagitis pain caused by RT to the thorax is underway. Doxepin will also be further compared with magic mouthwash and a placebo solution in a three-arm trial (Miller and Sio et al.) with head and neck cancer patients with OM pain caused by RT. Doxepin may represent a new standard for treating RT-induced OM pain in the future. PMID:26779314

  2. A Case-Based Approach to Integrating Opioid Pharmacokinetic and Pharmacodynamic Concepts in Cancer Pain Management.

    PubMed

    Lam, Lisa H; Pirrello, Rosene D; Ma, Joseph D

    2016-07-01

    Opioids are prescribed for cancer pain. Over the past decade, the annual increase in opioid prescriptions has been accompanied by an increase in opioid-associated deaths. Health care professionals must be proficient in proper dosing, titrating, and monitoring of opioid medications. With the numerous opioid medications and formulations available, an understanding of pharmacokinetic (PK) and pharmacodynamic (PD) concepts is necessary to appropriately individualize opioid-based cancer pain regimens. The purpose of this review is to highlight PK/PD concepts that are clinically relevant to the use of opioids. By way of a cancer pain patient case scenario, PK/PD concepts that are relevant in the initiation, titration, and rotation of an opioid regimen are discussed. PMID:26626053

  3. Use of strong opioids for non-cancer pain in the community: a case study.

    PubMed

    Cowan, David T; While, Alison; Griffiths, Peter

    2004-02-01

    The continued extension of prescribing rights among nurses may necessitate that effective pain management will require more involvement of nurses in the prescription of controlled drugs. The prescription of strong opioid analgesic drugs for chronic non-cancer pain (CNCP) is viewed as controversial. Misconceptions about opioid drugs fuel this controversy. This case study highlights the knowledge gap that exists between pain and addiction medicine and highlights the problems that CNCP patients treated in the community with opioid therapy may encounter. Community nurses are in an ideal position to be instrumental in identifying such vulnerable patients and ensuring that appropriate interventions are available. PMID:15007281

  4. Effect of sex in the MRMT-1 model of cancer-induced bone pain

    PubMed Central

    Falk, Sarah; Al-Dihaissy, Tamara; Mezzanotte, Laura; Heegaard, Anne-Marie

    2015-01-01

    An overwhelming amount of evidence demonstrates sex-induced variation in pain processing, and has thus increased the focus on sex as an essential parameter for optimization of in vivo models in pain research. Mammary cancer cells are often used to model metastatic bone pain in vivo, and are commonly used in both males and females. Here we demonstrate that compared to male rats, female rats have an increased capacity for recovery following inoculation of MRMT-1 mammary cells, thus potentially causing a sex-dependent bias in interpretation of the data. PMID:26834983

  5. IDENTIFICATION OF PATIENT SUBGROUPS AND RISK FACTORS FOR PERSISTENT ARM/SHOULDER PAIN FOLLOWING BREAST CANCER SURGERY

    PubMed Central

    Miaskowski, Christine; Paul, Steven M.; Cooper, Bruce; West, Claudia; Levine, Jon D.; Elboim, Charles; Hamolsky, Deborah; Abrams, Gary; Luce, Judith; Dhruva, Anand; Langford, Dale J.; Merriman, John D.; Kober, Kord; Baggott, Christina; Leutwyler, Heather; Aouizerat, Bradley E.

    2014-01-01

    Purpose In this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n=398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated. Methods and sample Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery. Results Using growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class. Conclusions Findings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life. PMID:24485012

  6. Individual Difference Variables and the Effects of Progressive Muscle Relaxation and Analgesic Imagery Interventions on Cancer Pain

    PubMed Central

    Kwekkeboom, Kristine L.; Wanta, Britt; Bumpus, Molly

    2008-01-01

    Clinicians in acute care settings are often called upon to manage cancer pain unrelieved by medications. Cognitive-behavioral strategies, such as relaxation and imagery, are recommended for cancer pain management; however, there appear to be individual differences in their effects. This pilot study examined variation in pain outcomes achieved with progressive muscle relaxation (PMR) and analgesic imagery interventions among hospitalized patients with cancer pain, and assessed the influence of four individual difference variables (cognitive ability, outcome expectancy, previous experience, and concurrent symptoms) on pain relief achieved with each intervention. A crossover design was used in which 40 hospitalized cancer patients received two trials of PMR, two trials of analgesic imagery, and two trials of a control condition. In comparing means between treatment and control conditions, both PMR and analgesic imagery produced greater improvements in pain intensity, pain-related distress, and perceived control over pain than the control condition. However, individual responder analysis revealed that only half of the participants achieved a clinically meaningful improvement in pain with each intervention. Patients who achieved a meaningful improvement in pain with analgesic imagery reported greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms than those who did not achieve a meaningful reduction in pain. Similar relationships were not significant for the PMR intervention. Investigators should continue efforts to identify factors that moderate the effects of cognitive-behavioral pain coping strategies so that clinicians can identify the most beneficial treatments for individual patients. PMID:18504089

  7. Effects of Reiki on anxiety, depression, pain, and physiological factors in community-dwelling older adults.

    PubMed

    Richeson, Nancy E; Spross, Judith A; Lutz, Katherine; Peng, Cheng

    2010-07-01

    The purpose of this study was to evaluate the effect of Reiki as an alternative and complementary approach to treating community-dwelling older adults who experience pain, depression, and/or anxiety. Participants (N = 20) were randomly assigned to either an experimental or wait list control group. The pre- and posttest measures included the Hamilton Anxiety Scale, Geriatric Depression Scale-Short Form, Faces Pain Scale, and heart rate and blood pressure. The research design included an experimental component to examine changes in these measures and a descriptive component (semi-structured interview) to elicit information about the experience of having Reiki treatments. Significant differences were observed between the experimental and treatment groups on measures of pain, depression, and anxiety; no changes in heart rate and blood pressure were noted. Content analysis of treatment notes and interviews revealed five broad categories of responses: Relaxation; Improved Physical Symptoms, Mood, and Well-Being; Curiosity and a Desire to Learn More; Enhanced Self-Care; and Sensory and Cognitive Responses to Reiki. PMID:20635803

  8. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy.

    PubMed

    Harrison, Andrew M; Heritier, Fabrice; Childs, Bennett G; Bostwick, J Michael; Dziadzko, Mikhail A

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored. PMID:26576425

  9. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy

    PubMed Central

    Harrison, Andrew M.; Heritier, Fabrice; Childs, Bennett G.; Bostwick, J. Michael; Dziadzko, Mikhail A.

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored. PMID:26576425

  10. Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer

    PubMed Central

    Jibb, Lindsay A; Nguyen, Cynthia; Nathan, Paul C; Maloney, Anne Marie; Dupuis, L Lee; Gerstle, J Ted; Alman, Benjamin; Hopyan, Sevan; Strahlendorf, Caron; Portwine, Carol; Johnston, Donna L; Orr, Mike

    2013-01-01

    Background Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent’s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results Thematic analysis of

  11. Cortical activity evoked by an acute painful tissue-damaging stimulus in healthy adult volunteers

    PubMed Central

    Williams, Gemma; Lee, Amy; Meek, Judith; Slater, Rebeccah; Olhede, Sofia; Fitzgerald, Maria

    2013-01-01

    Everyday painful experiences are usually single events accompanied by tissue damage, and yet most experimental studies of cutaneous nociceptive processing in the brain use repeated laser, thermal, or electrical stimulations that do not damage the skin. In this study the nociceptive activity in the brain evoked by tissue-damaging skin lance was analyzed with electroencephalography (EEG) in 20 healthy adult volunteers (13 men and 7 women) aged 21–40 yr. Time-frequency analysis of the evoked activity revealed a distinct late event-related vertex potential (lance event-related potential, LERP) at 100–300 ms consisting of a phase-locked energy increase between 1 and 20 Hz (delta-beta bands). A pairwise comparison between lance and sham control stimulation also revealed a period of ultralate stronger desynchronization after lance in the delta band (1–5 Hz). Skin application of mustard oil before lancing, which sensitizes a subpopulation of nociceptors expressing the cation channel TRPA1, did not affect the ultralate desynchronization but reduced the phase-locked energy increase in delta and beta bands, suggesting a central interaction between different modalities of nociceptive inputs. Verbal descriptor screening of individual pain experience revealed that lance pain is predominantly due to Aδ fiber activation, but when individuals describe lances as C fiber mediated, an ultralate delta band event-related desynchronization occurs in the brain-evoked activity. We conclude that pain evoked by acute tissue damage is associated with distinct Aδ and C fiber-mediated patterns of synchronization and desynchronization of EEG oscillations in the brain. PMID:23427303

  12. Complementary and Alternative Medicine Use in the US Adult Low Back Pain Population

    PubMed Central

    Johnson, Pamela Jo; Evans, Roni L.; Kreitzer, Mary Jo

    2016-01-01

    Background: Many people suffering from low back pain (LBP) have found conventional medical treatments to be ineffective for managing their LBP and are increasingly turning to complementary and alternative medicine (CAM) to find pain relief. A comprehensive picture of CAM use in the LBP population, including all of the most commonly used modalities, is needed. Study Objective: To examine prevalence and perceived benefit of CAM use within the US LBP population by limiting vs nonlimiting LBP and to evaluate the odds of past year CAM use within the LBP population Methods: Data are from the 2012 National Health Interview Survey, Alternative Health Supplement. We examined a nationally representative sample of US adults with LBP (N=9665 unweighted). Multiple logistic regression was used to estimate the odds of past year CAM use. Results: In all, 41.2% of the LBP population used CAM in the past year, with higher use reported among those with limiting LBP. The most popular therapies used in the LBP population included herbal supplements, chiropractic manipulation, and massage. The majority of the LBP population used CAM specifically to treat back pain, and 58.1% of those who used CAM for their back pain perceived a great deal of benefit. Conclusion: The results are indicative of CAM becoming an increasingly important component of care for people with LBP. Additional understanding of patterns of CAM use among the LBP population will help health professionals make more informed care decisions and guide investigators in development of future back pain–related CAM research. PMID:26937316

  13. Increasing Steps/Day Predicts Improvement in Physical Function and Pain Interference in Adults with Fibromyalgia

    PubMed Central

    Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.

    2014-01-01

    Objective To examine the concurrent and predictive associations between the number of steps taken per day (steps/day) and clinical outcomes in patients with fibromyalgia (FM). Methods 199 adults with FM [mean age = 46.1 yr; 95% females] enrolled in a randomized clinical trial wore a hip-mounted accelerometer for 1 week and completed self-report measures of physical function [Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI), SF-36 physical component score (SF-36 PCS)], pain intensity and interference (Brief Pain Inventory; BPI), and depressive symptoms (Patient Health Questionnaire-8; PHQ-8) as part of their baseline and follow-up assessments. Associations of steps/day with self-report clinical measures were evaluated from baseline to week 12 using multivariate regression models adjusted for demographic and baseline covariates. Results Study participants were primarily sedentary, averaging 4,019 ± 1,530 steps/day. Our findings demonstrate a linear relationship between the change in steps/day and improvement in health outcomes for FM. Incremental increases on the order of 1,000 steps/day were significantly associated with (and predictive of) improvements in FIQ-PI, SF-36 PCS, BPI pain interference, and PHQ-8 (all p<0.05). Although higher step counts were associated with lower FIQ and BPI pain intensity scores, these were not statistically significant. Conclusion Step counts is an easily obtained and understood objective measure of daily physical activity. An exercise prescription that includes recommendations to gradually accumulate at least 5,000 additional steps/day may result in clinically significant improvements in outcomes relevant to patients with FM. Future studies are needed to elucidate the dose-response relationship between steps/day and patient outcomes in FM. PMID:25049001

  14. Music as an adjuvant therapy in control of pain and symptoms in hospitalized adults: a systematic review.

    PubMed

    Cole, Linda C; LoBiondo-Wood, Geri

    2014-03-01

    The objective of this review is to evaluate the evidence regarding the use of music as an adjuvant therapy for pain control in hospitalized adults. The search terms music, music therapy, pain, adults, inpatient, and hospitalized were used to search the Cochrane Library, Cinahl, Medline, Natural Standard, and Scopus databases from January 2005 to March 2011. (A systematic review conducted by the Cochrane Collaboration has extensively covered the time frame from 1966 to 2004.) Seventeen randomized controlled trials met criteria for review and inclusion. Seven of the research studies were conducted with surgical patients, three with medical patients, one with medical-surgical patients, four with intensive care patients, and two with pregnant patients. The combined findings of these studies provide support for the use of music as an adjuvant approach to pain control in hospitalized adults. The use of music is safe, inexpensive, and an independent nursing function that can be easily incorporated into the routine care of patients. PMID:23107431

  15. Motivational Implications of Pain: Chronicity, Psychological Distress, and Work Goal Construal in a National Sample of Adults

    PubMed Central

    Karoly, Paul; Ruehlman, Linda S.

    2005-01-01

    A heterogeneous national sample of adults (mean age = 40 years) employed in management positions was contacted by random digit dialing procedures and interviewed about current pain experience, work-goal cognitions, and psychological status (depression and anxiety). In accord with predictions, persistent pain experience was differentially related to the construal of work-related goals. Specifically, individuals with both persistent and episodic pain (relative to those with no pain) reported lower levels of goal-centered value, self-efficacy, and positive arousal and heightened perceptions of goal-based self-criticism, negative arousal, and conflict between work and nonwork goals. Furthermore, regression analyses revealed that goal cognition accounted for unique variance in depression and anxiety over and above the contribution of pain chronicity. PMID:8891717

  16. Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors

    SciTech Connect

    Waldenstroem, Ann-Charlotte; Olsson, Caroline; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Al-Abany, Massoud; Palm, Asa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

    2011-07-15

    Purpose: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. Methods and Materials: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. Results: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses {>=}52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Conclusions: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.

  17. Chronic pain has a negative impact on sexuality in testis cancer survivors.

    PubMed

    Pühse, Gerald; Wachsmuth, Julia Urte; Kemper, Sebastian; Husstedt, Ingo W; Evers, Stefan; Kliesch, Sabine

    2012-01-01

    Testis cancer is a disease that directly affects a man's sense of masculinity and involves treatments compromising sexual function. The aim of this study was to investigate the prevalence of sexual dysfunction and the influence of chronic pain on sexuality in long-term testis cancer survivors. Thus, we examined 539 patients after they had one testis removed because of a testicular germ cell tumor. Having completed oncologic therapy, all patients received a detailed questionnaire asking about the occurrence and clinical presentation of testis pain before and after orchiectomy. In addition, items from the abridged International Index of Erectile Function and Brief Sexual Function Inventory were used to gain precise information on individual sexual function. Overall, 34.5% of our testicular cancer survivors complained of reduced sexual desire, and sexual activity was reduced in 41.6%. Erectile dysfunction was present in up to 31.5% of patients. In 24.4%, the ability to maintain an erection during intercourse was impaired. Ejaculatory disorders (premature, delayed, retrograde, or anejaculation) occurred in 84.9% of our testis cancer survivors. A total of 32.4% of our participants experienced a reduced intensity of orgasm, and 95.4% experienced reduced overall sexual satisfaction. There was a significant correlation between the occurrence of chronic pain symptoms and the relative frequency and intensity of erectile dysfunction, inability to maintain an erection, ejaculation disorders, and reduced intensity of orgasm. In conclusion, chronic pain has a negative impact on sexuality in testis cancer survivors. PMID:21474790

  18. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.

    PubMed

    Currow, David C; Phillips, Jane; Clark, Katherine

    2016-05-01

    Chronic non-cancer pain (lasting more than 3 months) is highly prevalent in Australia (17% of males and 20% of females) and its optimal management is crucial to the health and wellbeing of the community. For 5% of the population, such pain interferes markedly with daily function. Part of the treatment for acute non-cancer pain for many people will include opioid analgesics at least for days to weeks. However, as pain becomes chronic, evidence to support ongoing prescription of opioids is lacking. There is increasing pressure to ensure that prescribing opioid analgesics is minimised to reduce not only the risk of dependence and illicit diversion but also the potential harms associated with tolerance, side effects and complications. Frameworks for considering opioid prescribing include assessing suitability of the patient for opioids; initiating a trial of therapy; and monitoring long term use. There is limited evidence of the long term efficacy of opioids for chronic non-cancer pain, and documented clinical consequences beyond addiction include acceleration of loss of bone mineral density, hypogonadism and an association with increased risk of acute myocardial infarction. Careful clinical selection of patients can help optimise the evidence-based use of opioids for chronic non-cancer pain: only treat pain that has been as well defined as possible when non-opioid therapies have not been effective; consider referral to specialist services for assessment if doses are above 100 mg oral morphine equivalent per 24 hours or the duration of therapy is longer than 4 weeks; limit prescribing to only one practitioner; seek an agreement with the patient for the initiation and potential withdrawal of opioids if the therapeutic trial is not effective. PMID:27125804

  19. Evaluating the Orbach Mikulincer Mental Pain Scale among Late Adolescent and Early Adult African Americans: A Rasch Analysis.

    PubMed

    Trent Haines, R; Jackson, Avis D; Thomas, Erika L

    2015-01-01

    Although there are only a few psychometric investigations of mental pain measurement in the literature, there are no previous evaluations of mental pain scales among African Americans. The present study examined the Rasch measurement properties of the nine subscales contained in the Orbach-Mikulincer Mental Pain (OMMP) Scale among a sample of older adolescent and young adult African Americans. Results from the analyses suggest that three of the OMMP subscales meet the requirements of the Rasch model and hold promise for use in research and applied settings. Implications for further development and use of the remaining subscales are discussed. PMID:26514254

  20. Stabilized epoxygenated fatty acids regulate inflammation, pain, angiogenesis and cancer

    PubMed Central

    Zhang, Guodong; Kodani, Sean; Hammock, Bruce D.

    2014-01-01

    Epoxygenated fatty acids (EpFAs), which are lipid mediators produced by cytochrome P450 epoxygenases from polyunsaturated fatty acids, are important signaling molecules known to regulate various biological processes including inflammation, pain and angiogenesis. The EpFAs are further metabolized by soluble epoxide hydrolase (sEH) to form fatty acid diols which are usually less-active. Pharmacological inhibitors of sEH that stabilize endogenous EpFAs are being considered for human clinical uses. Here we review the biology of ω-3 and ω-6 EpFAs on inflammation, pain, angiogenesis and tumorigenesis. PMID:24345640

  1. Traumatic Exposure History as a Risk Factor for Chronic Pain in Adult Patients with Sickle Cell Disease.

    PubMed

    Works, Teresa; Jones, Sasia; Grady, James; Andemariam, Biree

    2016-02-01

    This article describes the impact of the integration of a licensed clinical social worker (LCSW) with expertise in behavioral health on identification of risk factors for chronic pain in a cohort of adults with sickle cell disease. Authors conducted a retrospective chart review of all visits to the adult sickle cell center during the first six months of LCSW integration. Demographics, clinical history, and LCSW notes were reviewed. Overall, 71 patients were introduced to the LCSW; 55 percent of them had chronic pain. Patients with chronic pain were older, used opioids daily, took hydroxyurea, reported higher daily pain scores, and underwent more acute care visits and hospitalizations for pain with longer stays. Fifty-eight (81 percent) patients requested concrete social work services such as transportation and housing. Thirty-two patients (55 percent) expressed a desire for mental health counseling while receiving concrete services. Twenty-two (69 percent) of these patients self-disclosed at least one traumatic experience. In fact, a statistically significant relationship between chronic pain and a history of trauma was identified (p = 0.001). Results suggest that sickle cell patients should receive clinical social work services to assess for traumatic exposures that may influence chronic pain. PMID:26946885

  2. Supportive Care in Older Adults with Cancer: Across the Continuum.

    PubMed

    Koll, Thuy; Pergolotti, Mackenzi; Holmes, Holly M; Pieters, Huibrie C; van Londen, G J; Marcum, Zachary A; MacKenzie, Amy R; Steer, Christopher B

    2016-08-01

    Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent. PMID:27342609

  3. Patterns of analgesic adherence predict health care utilization among outpatients with cancer pain

    PubMed Central

    Meghani, Salimah H; Knafl, George J

    2016-01-01

    Background Studies in chronic noncancer pain settings have found that opioid use increases health care utilization. Despite the key role of analgesics, specifically opioids, in the setting of cancer pain, there is no literature to our knowledge about the relationship between adherence to prescribed around-the-clock (ATC) analgesics and acute health care utilization (hospitalization) among patients with cancer pain. Purpose To identify adherence patterns over time for cancer patients taking ATC analgesics for pain, cluster these patterns into adherence types, combine the types into an adherence risk factor for hospitalization, identify other risk factors for hospitalization, and identify risk factors for inconsistent analgesic adherence. Materials and methods Data from a 3-month prospective observational study of patients diagnosed with solid tumors or multiple myeloma, having cancer-related pain, and having at least one prescription of oral ATC analgesics were collected. Adherence data were collected electronically using the medication event-monitoring system. Analyses were conducted using adaptive modeling methods based on heuristic search through alternative models controlled by likelihood cross-validation scores. Results Six adherence types were identified and combined into the risk factor for hospitalization of inconsistent versus consistent adherence over time. Twenty other individually significant risk factors for hospitalization were identified, but inconsistent analgesic adherence was the strongest of these predictors (ie, generating the largest likelihood cross-validation score). These risk factors were adaptively combined into a model for hospitalization based on six pairwise interaction risk factors with exceptional discrimination (ie, area under the receiver-operating-characteristic curve of 0.91). Patients had from zero to five of these risk factors, with an odds ratio of 5.44 (95% confidence interval 3.09–9.58) for hospitalization, with a unit

  4. [Chronic refractory pain in cancer patients. Value of the spinal injection of lysine acetylsalicylate. 60 cases].

    PubMed

    Pellerin, M; Hardy, F; Abergel, A; Boule, D; Palacci, J H; Babinet, P; Wingtin, L N; Glowinski, J; Amiot, J F; Mechali, D

    1987-09-19

    Several animal studies have demonstrated that pain is modulated by spinal mechanisms involving prostaglandins and that acetylsalicylic acid (ASA) administered intrathecally has an analgesic effect. We report our experience of this treatment in 60 patients with proven and advanced cancer. An isobaric solution of lysine acetylsalicylate was administered by lumbar puncture in doses ranging from 120 to 720 mg of ASA. The results were evaluated using the habitual criteria: scoring system, behaviour, consumption of analgesic drugs. In this trial the method proved astonishingly effective (78% of the cases). Analgesia was strong, almost immediate and without influence on motricity. No thermic or neurovegetative changes were noted. The effect of one injection lasted from 3 weeks to 1 month on average; it was reproduced and often more prolonged after a repeat injection. Pain associated with bone metastases seems to constitute the best indication, notably in breast and lung cancer and in myeloma. Visceral (pancreas) or neural pain requires higher doses to respond. Failures (22%) were due to such factors as insufficient dosage at the very beginning of our experience or severe depressive syndrome. The perineal and sphincteral pain of rectal cancer often resists treatment. This simple, inexpensive and very effective method with no other complication than a frequent tendency to fatigue should rank among other analgesic measures in cancer. The lack of respiratory depression is a major advantage over catheter spinal opiate analgesia. We consider that its main indications are pain associated with osteolytic metastases of adenocarcinomas, and myelomas. Owing to the absence of formal toxicological data, its use must be limited to cancer pain and to patients with a life expectancy of less than 2 years. PMID:2957675

  5. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland.

    PubMed

    Davies, Andrew N; Dickman, Andrew; Reid, Colette; Stevens, Anna-Marie; Zeppetella, Giovambattista

    2009-04-01

    A task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) was convened to produce some up-to-date, evidence-based, practical, clinical guidelines on the management of cancer-related breakthrough pain in adults. On the basis of a review of the literature, the task group was unable to make recommendations about any individual interventions, but was able to make a series of 12 recommendations about certain generic strategies. However, most of the aforementioned recommendations are based on limited evidence (i.e., case series, expert opinion). The task group also proposed a definition of breakthrough pain, and some diagnostic criteria for breakthrough pain. PMID:18707904

  6. Alteration of cancer pain-related signals by radiation: Proteomic analysis in an animal model with cancer bone invasion

    SciTech Connect

    Park, Hee Chul; Seong, Jinsil . E-mail: jsseong@yumc.yonsei.ac.kr; An, Jung Hee; Kim, Jiyoung; Kim, Un Jung; Lee, Bae Whan

    2005-04-01

    Purpose: Although radiotherapy is highly effective in relieving bone pain due to cancer invasion, its mechanism remains unclear. The aim of this study was to explore this mechanism in an animal model system. Methods and Materials: A hind paw model of cancer pain was developed by transplanting a murine hepatocarcinoma, HCa-1, into the periosteal membrane of the foot dorsum of C3H/HeJ mice. Bone invasion from HCa-1 was histopathologically confirmed from sequential tumor sampling. For three experimental groups, a control (N), tumor without radiation (T), and tumor with radiation (TR), the development and level of pain were objectively examined in mice with a growing tumor by assessing pain-associated behavior. The differential expression of pain-related signals in the spinal cord was analyzed by proteomic analysis using high-resolution two-dimensional gel electrophoresis (2-DE) and mass spectrometry, and those of proteins by Western blotting. The pain-mediating neurotransmitters in the spinal cord were also examined by immunohistochemical staining for calcitonin gene-related peptide (CGRP) and substance P. Results: In the histopathologic examinations, bone invasion from HCa-1 was seen from Day 7 and was evident at Day 14 after transplantation, and measurable pain-associated behaviors were developed from Day 7. After 25 Gy of radiation to the tumors, the objective level of pain in the TR group decreased, with higher thresholds to mechanical and thermal stimulation than in the T group. From the 2-DE of spinal cord, 107 spots were identified; 12 proteins were changed more than fivefold because of tumor formation but then reversed after radiation in the tumor-bearing mice. The proteins involved included secretagogin, syntenin, P2X purinoreceptor 6 (P2X6), and Ca{sup 2+}/Calmodulin-dependent protein kinase 1 (CaM kinase 1), the functions of which have been known to be involved in the Ca{sup 2+}-signaling cascade, ATP-mediated fast synaptic transmission, or control of

  7. Evidence-based practice for pain management for cancer patients in an acute care setting.

    PubMed

    Choi, Mona; Kim, Hee Sun; Chung, Su Kyoung; Ahn, Mee Jung; Yoo, Jae Yong; Park, Ok Sun; Woo, So Rah; Kim, So Sun; Kim, Sun Ah; Oh, Eui Geum

    2014-02-01

    The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted. PMID:24118273

  8. Inducible Lentivirus-Mediated siRNA against TLR4 Reduces Nociception in a Rat Model of Bone Cancer Pain

    PubMed Central

    Pan, Ruirui; Di, Huiting; Zhang, Jinming; Huang, Zhangxiang; Sun, Yuming; Yu, Weifeng; Wu, Feixiang

    2015-01-01

    Although bone cancer pain is still not fully understood by scientists and clinicians alike, studies suggest that toll like receptor 4 (TLR4) plays an important role in the initiation and/or maintenance of pathological pain state in bone cancer pain. A promising treatment for bone cancer pain is the downregulation of TLR4 by RNA interference; however, naked siRNA (small interference RNA) is not effective in long-term treatments. In order to concoct a viable prolonged treatment for bone cancer pain, an inducible lentivirus LvOn-siTLR4 (tetracycline inducible lentivirus carrying siRNA targeting TLR4) was prepared and the antinociception effects were observed in bone cancer pain rats induced by Walker 256 cells injection in left leg. Results showed that LvOn-siTLR4 intrathecal injection with doxycycline (Dox) oral administration effectively reduced the nociception induced by Walker 256 cells while inhibiting the mRNA and protein expression of TLR4. Proinflammatory cytokines as TNF-α and IL-1β in spinal cord were also decreased. These findings suggest that TLR4 could be a target for bone cancer pain treatment and tetracycline inducible lentivirus LvOn-siTLR4 represents a new potential option for long-term treatment of bone cancer pain. PMID:26556957

  9. Inducible Lentivirus-Mediated siRNA against TLR4 Reduces Nociception in a Rat Model of Bone Cancer Pain.

    PubMed

    Pan, Ruirui; Di, Huiting; Zhang, Jinming; Huang, Zhangxiang; Sun, Yuming; Yu, Weifeng; Wu, Feixiang

    2015-01-01

    Although bone cancer pain is still not fully understood by scientists and clinicians alike, studies suggest that toll like receptor 4 (TLR4) plays an important role in the initiation and/or maintenance of pathological pain state in bone cancer pain. A promising treatment for bone cancer pain is the downregulation of TLR4 by RNA interference; however, naked siRNA (small interference RNA) is not effective in long-term treatments. In order to concoct a viable prolonged treatment for bone cancer pain, an inducible lentivirus LvOn-siTLR4 (tetracycline inducible lentivirus carrying siRNA targeting TLR4) was prepared and the antinociception effects were observed in bone cancer pain rats induced by Walker 256 cells injection in left leg. Results showed that LvOn-siTLR4 intrathecal injection with doxycycline (Dox) oral administration effectively reduced the nociception induced by Walker 256 cells while inhibiting the mRNA and protein expression of TLR4. Proinflammatory cytokines as TNF-α and IL-1β in spinal cord were also decreased. These findings suggest that TLR4 could be a target for bone cancer pain treatment and tetracycline inducible lentivirus LvOn-siTLR4 represents a new potential option for long-term treatment of bone cancer pain. PMID:26556957

  10. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is ... injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow . Golfers ...

  11. Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis

    PubMed Central

    Vitiello, Michael V.; Rybarczyk, Bruce; Von Korff, Michael; Stepanski, Edward J.

    2009-01-01

    Study Objectives: Osteoarthritis pain affects more than half of all older adults, many of whom experience co-morbid sleep disturbance. Pain initiates and exacerbates sleep disturbance, whereas disturbed sleep maintains and exacerbates pain, which implies that improving the sleep of patients with osteoarthritis may also reduce their pain. We examined this possibility in a secondary analysis of a previously published randomized controlled trial of cognitive behavioral therapy for insomnia (CBT-I) in patients with osteoarthritis and co-morbid insomnia. Methods: Twenty-three patients (mean age 69.2 years) were randomly assigned to CBT-I and 28 patients (mean age 66.5 years) to an attention control. Neither directly addressed pain management. Twelve subjects crossed over to CBT-I after control treatment. Sleep and pain were assessed by self-report at baseline, after treatment, and (for CBT-I only) at 1-year follow-up. Results: CBT-I subjects reported significantly improved sleep and significantly reduced pain after treatment. Control subjects reported no significant improvements. One-year follow-up found maintenance of improved sleep and reduced pain for both the CBT-I group alone and among subjects who crossed over from control to CBT-I. Conclusions: CBT-I but not an attention control, without directly addressing pain control, improved both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and co-morbid insomnia. These results are unique in suggesting the long-term durability of CBT-I effects for co-morbid insomnia. They also indicate that improving sleep, per se, in patients with osteoarthritis may result in decreased pain. Techniques to improve sleep may be useful additions to pain management programs in osteoarthritis, and possibly other chronic pain conditions as well. Citation: Vitiello MV; Rybarczyk B; Von Korff M; Stepanski EJ. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults

  12. Skin Cancer Surveillance Behaviors among U.S. Hispanic Adults

    PubMed Central

    Coups, Elliot J.; Stapleton, Jerod L.; Hudson, Shawna V.; Medina-Forrester, Amanda; Rosenberg, Stephen A.; Gordon, Marsha; Natale-Pereira, Ana; Goydos, James S.

    2012-01-01

    Background Little skin cancer prevention research has focused on the U.S. Hispanic population. Objective This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. Methods A population-based sample of 788 Hispanic adults residing in five southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. Results The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. Limitations The cross-sectional design limits conclusions regarding the causal nature of observed associations. Conclusions Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors. PMID:23182066

  13. Effect of Low Level Laser Application at the End of Surgery to Reduce Pain after Tonsillectomy in Adults

    PubMed Central

    Aghamohammadi, Dawood; Eidi, Mohammad; Lotfi, Alireza; Hosseinzadeh, Hamzeh; Movasaghi, Reza; Motighini, Negar; Ayoub Bouraima, Stephane

    2013-01-01

    Introduction: Tonsillectomy is among commonest otorhinolaryngologic surgeries. Many methods have been used to control post surgical pain, but despite it, pain is still one of the problems related to this operation. Recently, due to the non invasiveness of low level lasers, this modality has attracted attention. The purpose of this study is to evaluate the effects of low level laser irradiation at the end of surgery on reduction of pain after tonsillectomy in adults. Methods: In a clinical trial, 60 adult patients, candidates for tonsillectomy were randomly assigned to two groups, A and B, and both groups were anesthetized similarly by the same technique. At the end of surgery, in the case group, the tonsils’ bed were irradiated by infrared laser with 980nm wavelength, 100Hz, 4J/cm2 from the infra mandibular angle. In the control group, the tonsils’ bed had laser therapy with a turned off probe. Following laser treatment, the patients were reversed and extubated and consciousness achieved, pain and odynophagia were assessed at 2, 4, 6, 8, 12 and 24h post surgery based on visual analog scale for pain (VAS) and analgesic consumption. Results: In the laser group frequency of patients with pain sensation in each evaluated hour was lower than in the control group. The amount of pain decrease and analgesic consumption reduction was significantly higher in patients who received laser (P=0.01). Conclusion: Based on the results of this study, use of low level lasers is effective in reducing tonsillectomy post surgical pain in adults. PMID:25606312

  14. [Acute abdominal pain in the emergency department - a clinical algorithm for adult patients].

    PubMed

    Trentzsch, H; Werner, J; Jauch, K-W

    2011-04-01

    adult patients with acute abdominal pain. PMID:21424993

  15. Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

    SciTech Connect

    Hird, Amanda; Chow, Edward Zhang Liying; Wong, Rebecca; Wu, Jackson; Sinclair, Emily; Danjoux, Cyril; Tsao, May; Barnes, Elizabeth; Loblaw, Andrew

    2009-09-01

    Purpose: To determine the incidence of pain flare following radiotherapy (RT) for painful bone metastases. Materials and Methods: Patients with bone metastases treated with RT were eligible. Worst pain scores and analgesic consumption were collected before, daily during, and for 10 days after treatment. Pain flare was defined as a 2-point increase in the worst pain score (0-10) compared to baseline with no decrease in analgesic intake, or a 25% increase in analgesic intake with no decrease in worst pain score. Pain flare was distinguished from progression of pain by requiring the worst pain score and analgesic intake return to baseline levels after the increase/flare (within the 10-day follow-up period). Results: A total of 111 patients from three cancer centers were evaluable. There were 50 male and 61 female patients with a median age of 62 years (range, 40-89 years). The primary cancers were mainly breast, lung, and prostate. Most patients received a single 8 Gy (64%) or 20 Gy in five fractions (25%). The overall pain flare incidence was 44/111 (40%) during RT and within 10 days following the completion of RT. Patients treated with a single 8 Gy reported a pain flare incidence of 39% (27/70) and, with multiple fractions, 41% (17/41). Conclusion: More than one third of the enrolled patients experienced a pain flare. Identifying at-risk individuals and managing potential pain flares is crucial to achieve an optimal level of care.

  16. Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

    PubMed Central

    Pal, Santanu; Dutta, Samrat; Adhikary, Shyam Sundar; Bhattacharya, Biswamit; Ghosh, Balaram; Patra, Niladri B.

    2014-01-01

    Background: The primary aim of this prospective non-randomized study was to evaluate the effect of hemi-body irradiation (HBI) on pain and quality of life in cancer patients with extensive bone metastases. The secondary aim was to evaluate side-effects and cost-effectiveness of the treatment. Materials and Methods: Between March 2008 and December 2010, a total of 23 (male = 14, female = 9, median age = 60 years) diagnosed cases of metastatic cancer patients (prostate = 11, breast = 6, and lung = 6) received HBI, which was delivered as lower (n = 7) (dose = 8 Gy), upper (n = 8) (dose = 6 Gy), or sequential HBI (n = 8) with a Telecobalt unit (Theratron 780C). Among them, one lung cancer patient died at 2 months and one prostate cancer patient defaulted after the second follow-up. Thus, 21 patients (male = 13, female = 8, median age = 65 years) (prostatic cancer = 10, breast cancer = 6, and lung cancer = 5) were followed up for a minimum of 6 months. Evaluations were performed before and at 2, 4, 8, 16, and 24 weeks after treatment. Pain evaluation was done by Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Percentage of Pain Relief (PRR), and Global Pain Score (GPS). Toxicity was assessed by CTC v-3 toxicity scores in the medical record. Assessment of oral morphine consumption was done before and after radiation using paired t-test, and correlation analysis was also done with decrease of morphine consumption and reduction of pain score using statistical analysis. Results: Response (control of pain) was partial (PR) in 67% and complete (CR) in 22% of patients. For most patients, the pain control lasted throughout the follow-up period (6 months). From 66.66% patients requiring 13 or more Morphine (10 mg) tablets per day prior to HBI, none of the patients required to consume 13 or more Morphine (10 mg) tablets per day following HBI, which was correlated with significant reduction in various pain scores (P < 0.05). One way ANOVA with Dunnett's Multiple Comparison

  17. The application of traditional Chinese medicine to the management of hepatic cancerous pain.

    PubMed

    Wang, G; Sun, G; Tang, W; Pan, X

    1994-06-01

    The authors summarized the application of traditional Chinese medicine to the management of hepatic cancerous pain in Beijing and Shanghai, and in Jiangsu and Zhejiang Provinces. The therapeutic principle was to invigorate blood circulation and reduce stasis and to soothe the liver and regulate qi, so as to dredge the channels and collaterals. The results were satisfactory. PMID:7967697

  18. Efficacy and Safety of Ropivacaine Addition to Intrathecal Morphine for Pain Management in Intractable Cancer

    PubMed Central

    Huang, Ying; Li, Xihan; Zhu, Tong; Lin, Jian; Tao, Gaojian

    2015-01-01

    Objective. Although intrathecal drug infusion has been commonly adopted for terminal cancer pain relief, its adverse effects have made many clinicians reluctant to employ it for intractable cancer pain. The objective of this study is to compare the efficacy and security of an intrathecal continuous infusion of morphine and ropivacaine versus intrathecal morphine alone for cancer pain. Methods. Thirty-six cancer patients received either a continuous morphine (n = 19) or morphine and ropivacaine (n = 17) infusion using an intrathecal catheter through a subcutaneous port. Numerical Rating Scale (NRS) scores and the Barthel Index were analyzed. Adverse effects and complications on postoperative days 1, 3, 7, and 15 were also analyzed. Results. All patients experienced pain relief. Compared to those who received morphine alone, patients receiving morphine and ropivacaine had significantly lower postoperative morphine requirements and higher Barthel Index scores on the 15th postsurgical day (P < 0.05). Patients receiving morphine and ropivacaine had lower NRS scores than patients receiving morphine alone on postoperative days 1, 3, 7, and 15 (P < 0.05). Negative postsurgical effects were similar in both groups. Conclusions. Morphine and ropivacaine administration through intrathecal access ports is efficacious and safe and significantly improves quality of life. PMID:26556955

  19. Pain Complaints in Latino Adults of Mexican Origin With and Without Major Depressive Episode: A Cross-Sectional Study

    PubMed Central

    Dilsaver, Steven C.; Benazzi, Franco; Manning, J. Sloan; Akiskal, Kareen K.; Akiskal, Hagop S.

    2008-01-01

    Background: The aim of this retrospective, cross-sectional study was to determine the prevalence of 5 pain complaints among Latino adults of Mexican origin meeting the criteria for major depressive episode (MDE). Method: In a mental health clinic for the indigent, consecutively evaluated Latino adults of Mexican origin received structured diagnostic psychiatric interviews based on modules extracted from the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version. All were specifically asked whether they had experienced headache, backache, abdominal pain, myalgia, or arthralgia “in the last week.” Patients meeting the criteria for MDE were compared to patients without MDE from the same clinic. Associations and statistical significance of the differences between groups were determined using logistic regression models. The data were collected between August 2003 and November 2004. Results: Two hundred ten patients had an MDE, and 35 individuals without an MDE comprised the comparison group. Eighty-eight percent of the patients with MDE versus 53% of the controls had at least 1 pain complaint (p < .0001). Patients with MDE were 8.3 times more likely to have 1 or more pain complaints than the comparison patients (p < .0001). The significant relationship between depression and pain applied when we examined those with ≥ 2, ≥ 3, and ≥ 4 pain complaints. Twenty-eight percent of the MDE subjects had all 5 pain complaints compared to 3% of subjects without MDE (p = .013). Conclusions: The method of assessment of the presence of pain led to the detection of a remarkably high prevalence of pain complaints. The findings presented have important implications not only for the practice of those who are widely recognized as being primary care physicians but also for practitioners of all clinical disciplines. PMID:18615171

  20. Pain and Interference of Pain with Function and Mood in Elderly Adults Involved in a Motor Vehicle Collision: A Pilot Study

    PubMed Central

    Platts-Mills, Timothy F.; Lee, Young M.; Swor, Robert A.; Zaleski, Erin Z.; Clauw, Daniel J.; McLean, Samuel A.

    2012-01-01

    Background/Study Context Musculoskeletal pain after motor vehicle collision is a substantial public health problem. The number of elderly individuals experiencing motor vehicle collision is increasing. We conducted analyses of data collected as part of a prospective observational study of outcomes after motor vehicle collision to estimates rates of persistent pain, pain interference, and change in physical function in patients 65 or older. Methods Adults presenting to one of four emergency departments following motor vehicle collision without severe or life-threatening injury were recruited. Outcomes were assessed using one month follow-up surveys. Results The frequencies of persistent moderate or severe pain resulting from the motor vehicle collision were similar among elderly and non-elderly participants, both in the neck region (27% vs. 30%) and in any region (60% vs. 56%). For both elderly and non-elderly patients, persistent pain was associated with high levels of interference with physical activity and mood. Conclusion Further studies of this vulnerable and rapidly increasing injury population are needed. PMID:22540386

  1. Managing Pain from a Broken Hip: A Guide for Adults and Their Caregivers

    MedlinePlus

    ... the pain is managed. Understanding Your Choices Usual care for pain from a broken hip Your doctor may give you medicines to treat the pain before or after an operation to repair the broken hip. Some ...

  2. Managing Osteoarthritis Pain with Medicines: A Review of the Research for Adults

    MedlinePlus

    ... a> Consumer Summary – Feb. 15, 2012 Managing Osteoarthritis Pain With Medicines: A Review of the Research for ... or have injured a joint. Why manage the pain of osteoarthritis? Osteoarthritis can be very painful and ...

  3. Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash

    PubMed Central

    Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

    2005-01-01

    OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to

  4. Pharmacokinetics and pharmacodynamics of methadone enantiomers in hospice patients with cancer pain.

    PubMed

    Auret, Kirsten; Roger Goucke, C; Ilett, Kenneth F; Page-Sharp, Madhu; Boyd, Fiona; Oh, Teik E

    2006-06-01

    Racemic methadone is increasingly used to manage cancer pain. The authors studied 13 terminally ill patients with cancer pain, who underwent switching (rotation) from morphine to methadone. The relationship between initial morphine dose and final methadone dose, the pharmacokinetics of R- and S- methadone, and the degree of pain control and side effects were investigated. Preswitching serum morphine concentrations and second daily plasma concentrations of methadone were measured. The brief pain inventory (BPI) was used to assess pain every second day. "Worst pain" as measured by the BPI improved by >/=20% in 6 of the 13 patients. The mean morphine to methadone conversion ratio was 5.2 with wide interpatient variability (range 1.3 to 11). Average steady-state concentrations were 197 (98 to 379) mug/L and 272 (55 to 378) mug/L for R- and S-methadone, respectively. Mean population pharmacokinetic parameters for a 1-compartment model were 455 L and 338 L for apparent volume of distribution and 53.3 hours and 31.5 hours for half-life for R- and S- methadone, respectively. Bayesian estimates of apparent oral clearance for individual patients were 0.082 (0.052 to 0.112) L/kg/h and 0.117 (0.061 to 0.173) L/kg/h for R- and S- methadone, respectively (mean and 95% confidence interval). The low and variable clearance values generally resulted in slow achievement of steady-state concentrations over several days; inappropriately high plasma methadone levels occurred in 1 patient. Whereas optimal pain control was achieved in 46% of patients, there was no relationship with plasma concentrations of methadone. Best practice for methadone use in this patient group should include monitoring of both pain and methadone concentration. PMID:16778720

  5. Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study.

    PubMed

    Tesarz, Jonas; Eich, Wolfgang; Treede, Rolf-Detlef; Gerhardt, Andreas

    2016-08-01

    Childhood maltreatment (CM) has been associated with an increased risk of nonspecific chronic low back pain (nsCLBP). However, the mechanisms underlying this association are unclear. Therefore, this study considered whether distinct types of CM are accompanied by specific alterations in somatosensory function. A total of 176 subjects with nsCLBP and 27 pain-free controls (PCs) were included. The Childhood Trauma Questionnaire (CTQ) was used to categorize patients into 2 groups (abused/neglected vs nonabused/nonneglected) for 5 types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was performed to obtain comprehensive profiles on somatosensory function, including detection and pain thresholds, pain sensitivity, and assessments of temporal summation (wind-up). Between 17.7% and 51.4% of subjects with nsCLBP reported CM, depending on the type of CM. Childhood Trauma Questionnaire subscores for emotional and sexual abuse were significantly higher in subjects with nsCLBP than in PCs. Compared with PCs, subjects with CM showed reduced pressure pain thresholds (PPTs), irrespective of the type of CM. Regarding distinct types of CM, subjects with nsCLBP with emotional abuse reported significantly higher wind-up than those without, and sexual abuse was accompanied by enhanced touch sensitivity. Our findings suggest that CM is nonspecifically associated with a decreased PPT in nsCLBP. Emotional abuse apparently leads to enhanced spinal pain summation, and sexual abuse leads to enhanced touch sensitivity. These results emphasize the importance of emotional abuse in nsCLBP and suggest that CM can induce long-term changes in adult somatosensory function. PMID:27075429

  6. Prevalence of Cigarette Smoking among Adult Cancer Survivors in Korea

    PubMed Central

    Park, Jin Joo

    2015-01-01

    Purpose Cigarette smoking is associated not only with increased risk of cancer incidence, but also influences prognosis, and the quality of life of the cancer survivors. Thus, smoking cessation after cancer diagnosis is necessary. However, smoking behavior among Korean cancer-survivors is yet unknown. Materials and Methods We investigated the smoking status of 23770 adults, aged 18 years or older, who participated in the Health Interview Survey of the Korea National Health and Nutrition Examination Survey from 2007 to 2010. Data on the cancer diagnosis and smoking history were obtained from an interview conducted by trained personals. "Cancer-survivor" was defined as anyone who has been diagnosed with cancer by a physician regardless of time duration since diagnosis. Smoking status was classified into "never-smoker", "former-smoker", and "current-smoker". Former-smoker was further divided into "cessation before diagnosis" and "cessation after diagnosis". Results Overall, 2.1% of Korean adults were cancer-survivors. The smoking rate of Korean cancer-survivors was lower than that of non-cancer controls (7.8±1.3% vs. 26.4±0.4%, p<0.001). However, 53.4% of the cancer-survivors continued to smoke after their cancer diagnosis. In multivariate analysis, male gender [odds ratio (OR), 6.34; 95% confidence interval (CI), 2.62-15.31], middle-aged group (OR, 2.74; 95% CI, 1.12-6.72), the lowest income (OR, 4.10; 95% CI, 1.19-14.15), living with smoking family member(s) (OR, 5.49; 95% CI, 2.42-12.48), and the poor self-perceived health status (OR, 2.78; 95% CI, 1.01-7.71) were independently associated with persistent smoking among Korean cancer-survivors. Conclusion The smoking rate among Korean cancer survivors is low. However, the smoking cessation rate after the cancer diagnosis is also low. This mandates comprehensive and systematic intervention for smoking cessation among cancer-survivors. PMID:25684009

  7. Topical treatment with Tong-Luo-San-Jie Gel alleviates bone cancer pain in rats

    PubMed Central

    Wang, Juyong; Zhang, Ruixin; Dong, Changsheng; Jiao, Liying; Xu, Ling; Liu, Jiyong; Wang, Zhengtao; Ying, Qi Liang Mao; Fong, Harry; Lao, Lixing

    2012-01-01

    Ethnopharmacological relevance The herbal analgesic gel Tong-Luo-San-Jie (TLSJ) and its modifications are used in traditional Chinese medicine to manage cancer pain. However, its mechanisms are still unknown. Aim of the study To investigate the effects and mechanisms of TLSJ gel on bone cancer pain in a rat model. Materials and Methods A bone cancer pain rat model was established by inoculating Walker 256 rat carcinoma cells directly into the right tibial medullary cavity of Sprague-Dawley rats (150–170 g); Phosphate buffered saline (PBS) tibial inoculation was used as control. Cancer-bearing rats were treated twice a day with external TLSJ gel (0.5 g/cm2/day) or inert gel control for 21 days (n=10/group). Behavioral tests such as mechanical threshold and paw withdrawal latency (PWL) were carried out. Osteoclastic activities were determined and carboxyterminal pyridinoline cross-linked type I collagen telopeptides (ICTP) and bone-specific alkaline phosphatase (BAP) concentrations were detected with ELISA after treatment. Adverse effects were monitored, and biochemical and histological tests were performed in naïve rats treated with local TLSJ gel for six weeks. Results TLSJ treatment significantly restored bone cancer-induced decrease of PWL and mechanical threshold compared to inert gel. It also decreased the level of blood serum ICTP and BAP and inhibited osteoclast activities. No adverse effects or abnormal biochemical and histological changes were detected after TLSJ treatment. Conclusion The present study shows that TLSJ significantly inhibits bone cancer-induced thermal and mechanical sensitization. It suggests that the gel may be useful in managing cancer pain and that it may act by inhibiting osteoclastic activity. PMID:22960543

  8. Health care expenditures associated with depression in adults with cancer

    PubMed Central

    Pan, Xiaoyun; Sambamoorthi, Usha

    2015-01-01

    Background The rates of depression in adults with cancer have been reported as high as 38%–58%. How depression affects overall health care expenditures in individuals with cancer is an under-researched area. Objective To estimate excess average total health care expenditures associated with depression in adults with cancer by comparing those with and without depression after controlling for demographic, socioeconomic, access to care, and other health status variables. Methods Cross-sectional data on 4,766 adult survivors of cancer from 2006–2009 of the nationally representative household survey, Medical Expenditure Panel Survey (MEPS), were used. The patients were older than 21 years. Cancer and depression were identified from the patients’ medical conditions files. Dependent variables consisted of total, inpatient, outpatient, emergency department, prescription drugs, and other expenditures. Ordinary least square (OLS) on logged dollars and generalized linear models with log-link function were performed. All analyses (SAS 9.3 and STATA12) accounted for the complex survey design of the MEPS. Results Overall, 14% of individuals with cancer reported having depression. In those with cancer and depression, the average annual health care expenditures were $18,401 compared with $12,091 in those without depression. After adjusting for demographic, socio-economic, access to care, and other health status variables, those with depression had about 31.7% greater total expenditures compared with those without depression. Total, outpatient, and prescription expenditures were higher in individuals with depression than in those without depression. Individuals with cancer and depression were significantly more likely to use emergency departments (adjusted odds ratio, 1.46) compared with their counterparts without depression. Limitations Cancer patients who died during the reporting year were excluded. The financial burden of depression may have been underestimated because

  9. Cancer literacy as a mediator for cancer screening behaviour in Korean adults.

    PubMed

    Lee, Hee Yun; Rhee, Taeho Greg; Kim, Nam Keol

    2016-09-01

    This study investigates the cancer literacy level in Korean adults and examines whether cancer literacy plays a mediating role in the relationship between population characteristics and cancer screening behaviours. We collected data from 585 community-dwelling adults in Korea using self-administered surveys and face-to-face interviews from October to December in 2009. Guided by Andersen's behavioural model, we used a structural equation model to estimate the effect of cancer literacy as a mediator and found that cancer literacy mediated cancer screening behaviour. In the individual path analysis models, cancer literacy played a significant mediating role for the use of eastern medicine, fatalism, health status and the number of chronic diseases. When controlling for other relevant covariates, we found that in the optimal path model, cancer literacy played a mediating role in the relationship between the use of eastern medicine and self-rated health status as well as cancer screening behaviour. Thus, developing community-based cancer education programmes and training clinical practitioners in eastern medicine clinics about the importance of informing their patients about regular cancer screening may be an option to boost cancer literacy and screening behaviour in Korea. PMID:25975449

  10. The most common nursing diagnosis among adults/seniors hospitalised with cancer: integrative review

    PubMed Central

    Jomar, Rafael Tavares; de Souza Bispo, Vitória Régia

    2014-01-01

    The nursing process, with emphasis on the diagnosis phase, is essential to oncology hospital services due to a high frequency of physical and psychological problems that compromise the quality of life of patients undergoing cancer treatment. The goal of this study was to identify, according to NANDA International, the most common nursing diagnosis among adults/seniors with cancer who are hospitalised. This study is an integrative review of the literature completed in 2013 using five electronic databases, resulting in the selection and analysis of nine articles. This review identified the following eight actual diagnoses and two risk diagnoses that are more common among hospitalised adults/seniors with cancer: anxiety, deficient knowledge, constipation, self-care deficit for bathing/hygiene, body image disturbance, acute/chronic pain, fear, disturbed sleep pattern, risk of infection, and risk of deficient fluid volume. The heterogeneity of the studies used in this review may not have allowed the identification of all the common nursing diagnoses in the practice of oncology nursing in hospitals. However, even though the results are not based on the highest possible level of scientific evidence, their correlation to clinical practice can contribute to the enhancement of the nursing process in oncology services provided by hospitals. PMID:25228918

  11. A Case of Advanced Descending Colon Cancer in an Adult Patient with Intestinal Malrotation

    PubMed Central

    Akiyama, Masaki; Sawatsubashi, Yusuke; Minagawa, Noritaka; Torigoe, Takayuki; Hirata, Keiji

    2016-01-01

    This report presents an operative case of advanced descending colon cancer in an adult patient with intestinal malrotation. A 63-year-old Japanese male was suffering from left side abdominal pain, abdominal distension, and constipation. An endoscopic examination revealed an advanced tumor in the descending colon. Computed tomography (CT) of the abdomen revealed the thickening of the descending colon wall and superior mesenteric vein rotation. An opaque enema detected severe stenosis of the descending colon. An abdominal X-ray examination revealed the dilation of the colon and small intestine with niveau. At the insertion of an ileus tube, the C-loop of the duodenum was observed to be absent and the small intestine was located on the right side of the abdomen. After the decompression of the bowel contents, laparotomy was performed. Descending colon cancer was observed to have directly invaded the left side of the transverse colon. Left hemicolectomy, lymph node dissection, and appendectomy were performed. The patient had an uneventful recovery and was discharged from the hospital on the 16th day after surgery. This report presents a rare operative case of descending colon cancer in an adult patient with intestinal malrotation. PMID:27042367

  12. Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients.

    PubMed

    Wu, Tsung-Hsiu; Chiu, Tai-Yuan; Tsai, Jaw-Shiun; Chen, Ching-Yu; Chen, Lih-Chi; Yang, Ling-Ling

    2008-01-01

    In addition to modern medicinal therapy, many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet. In this paper, the effect of a Taiwanese traditional herbal diet (TTHD) on pain in terminal cancer patients was investigated. A total of 2,466 patients diagnosed with a variety of cancers were included. The most common patient-reported symptoms included troublesome pain (79.2%), weakness (69.0%), anorexia (46.4%), fever (36.5%), dyspnea (31.1%), and leg edema (30.9%). The 2,466 terminal cancer patients included in the study were randomly divided into three groups. The TTHD group (n=1044; 42.3%) were given the TTHD consisting of analgesic herbs (paeony root: licorice root=1:1) and a Taiwanese tonic vegetable soup (Lilii bulbus, Nelumbo seed, and Jujube fruit). The remaining patients were divided into a reference group, given the regular hospital diet, (n=909, 36.9%) and a control group, given the Taiwanese tonic vegetable soup without analgesic herbs, (n=513, 20.8%). All patients maintained their assigned diets for one week. A verbal numerical scale was used to assess pain. Results revealed that the patients given TTHD reported enhanced pain relief (p<0.05) compared to the reference and control groups. We found that TTHD could alleviate the pain among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient's quality of life. Further research is warranted. PMID:18364321

  13. Correlation of pain with objective quantification of MR images in older adults with chronic low back pain

    PubMed Central

    Bechara, Bernard P; Agarwal, Vikas; Boardman, John; Perera, Subashan; Weiner, Debra K; Vo, Nam; Kang, James; Sowa, Gwendolyn A.

    2014-01-01

    Study Design Cross sectional study. Objective The goal of this study is to identify relationships between objectively measured and subjectively scored parameters and reported pain. Summary of Background Data Studies have demonstrated the unreliability of MRI based parameters to identify pathological pain generators of chronic low back pain patients, but they were based on visual inspection and subjective assessment of lumbar disc features. Advancements in computer image analysis provide objective measurements of lumbar disc features. Methods Two radiologists evaluated 39 axial and sagittal T1 and T2 weighted MRI images of chronic axial low back pain patients (age > 65 years) and graded 4 subjective lumbar disc parameters (T2 signal intensity, nucleus shape, Modic changes, and osteophyte formation) whose sum is the cumulative MRI score. Objective parameter, MRIindex, was calculated as the product of the measured lumbar disc area and total disc MRI signal intensity. Discs were sorted from least to most degenerated relative to each parameter. Pearson correlation coefficient and multiple linear regression analysis were performed between the reported pain score and each parameter. Results The most and least degenerated discs in each patient, as assessed by MRIindex, had the highest negative and positive correlation coefficient and regression weight contribution respectively. All subjective parameters had low correlation coefficients and regression goodness of fit. Conclusion Although limited by small sample size, the objective parameter, MRIindex, can be a potential imaging biomarker used to identify possible pain generators. This study presents a potential new application of MR imaging in identifying pain generators of chronic low back pain patients. PMID:24384652

  14. The experience of uncertainty in young adults with cancer.

    PubMed

    Corbeil, Amélie; Laizner, Andréa Maria; Hunter, Patricia; Hutchison, Nancy

    2009-01-01

    The purpose of this qualitative descriptive study was to describe the experience of uncertainty in young adults with cancer. A purposeful sample of 6 young adults between the ages of 19 and 30 years undergoing chemotherapy treatment was recruited. Participants were interviewed twice using semistructured interviews. The investigators used constant comparison to examine the content of the transcript for common words, phrases, statements, or units of text that related to uncertainty. Findings revealed 3 major emerging themes. The first one being "types of uncertainty," which includes uncertainty and efforts at the right place, uncertainty and aspects of treatment, uncertainty and personal abilities, and uncertainty and the feasibility of plans related to life goals. Uncertainty was also found to trigger the development of certainties, which led to the second theme, "certainties: helpful or not?" A third emerging theme, dealing with uncertainty, described a variety of strategies used by young adults that included living on a day-to-day basis, being selfish, believing, getting information, trusting the physician, concentrating on positive things, keeping energy by pacing oneself, choosing social support, and trying to live a normal life. A consequence of dealing with the uncertainty and the cancer journey is the "enlightened path." It emerged and revealed how the cancer journey changed their lives. A number of implications for nursing practice therefore warrant consideration, especially fostering a sense of normalcy by identifying common behaviors, feelings, or needs among these young adults with cancer. Sharing this information and facilitating interactions with other young adults with cancer has the potential to promote coping with uncertainty. PMID:19661789

  15. Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy

    SciTech Connect

    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Malmstroem, Per; Alsadius, David; Sundberg, Agnetha; Wilderaeng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2012-05-01

    Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, loco-regional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long

  16. Abdominal pain

    MedlinePlus

    ... threatening conditions, such as colon cancer or early appendicitis , may only cause mild pain or no pain. ... Food poisoning Stomach flu Other possible causes include: Appendicitis Abdominal aortic aneurysm (bulging and weakening of the ...

  17. Effects of Src-kinase inhibition in cancer-induced bone pain

    PubMed Central

    De Felice, Milena; Lambert, Daniel; Holen, Ingunn; Escott, K Jane

    2016-01-01

    Background Bone metastases occur frequently in advanced breast, lung, and prostate cancer, with approximately 70% of patients affected. Pain is a major symptom of bone metastases, and current treatments may be inadequate or have unacceptable side effects. The mechanisms that drive cancer-induced bone pain are not fully understood; however, it is known that there is sensitization of both peripheral bone afferents and central spinal circuits. It is well established that the N-methyl-D-aspartate receptor plays a major role in the pathophysiology of pain hypersensitivity. Inhibition of the non-receptor tyrosine kinase Src controls N-methyl-D-aspartate receptor activity and inhibiting Src reduces the hypersensitivity associated with neuropathic and inflammatory pains. As Src is also implicated in osteoclastic bone resorption, we have investigated if inhibiting Src ameliorates cancer-induced bone pain. We have tested this hypothesis using an orally bioavailable Src inhibitor (saracatinib) in a rat model of cancer-induced bone pain. Results Intra-tibial injection of rat mammary cancer cells (Mammary rat metastasis tumor cells -1), but not vehicle, in rats produced hindpaw hypersensitivity to thermal and mechanical stimuli that was maximal after six days and persisted for at least 13 days postinjection. Daily oral gavage with saracatinib (20 mg/kg) beginning seven days after intra-tibial injection reversed the thermal hyperalgesia but not the mechanical allodynia. The analgesic mechanisms of saracatinib appear to be due to an effect on the nervous system as immunoblotting of L2-5 spinal segments showed that mammary rat metastasis tumor cells-1 injection induced phosphorylation of the GluN1 subunit of the N-methyl-D-aspartate receptor, indicative of receptor activation, and this was reduced by saracatinib. Additionally, histology showed no anti-tumor effect of saracatinib at any dose and no significant effect on bone preservation. Conclusions This is the first

  18. An observation on combined use of chemotherapy and traditional Chinese medicine to relieve cancer pain.

    PubMed

    Lin, C; Lin, X; Yang, J

    1996-12-01

    We have treated 50 patients with stage III, VI malignant tumors confirmed by pathology. The patients were divided into two groups. One group was treated by combination of chemotherapy and traditional Chinese medicine (treatment group); the other only by chemotherapy (control group). The effect of cancer treatment was evaluated according to the criteria of WHO. The results showed that the effective rate was 80% in treatment group and 52% in control group. The pain relieving rate was 68% in treatment group and 40% in control group (P < 0.01). This fact demonstrates that the application of traditional Chinese medicine can invigorate blood circulation, eliminate blood stasis, soften hardness and dissolve the mass, nourish blood and increase vigor. This kind of application can not only enhance the effect of cancer treatment but also increase the cancer pain relieving rate. PMID:9389100

  19. The young adult hip: extra-articular causes of hip pain and how to pick the winners

    PubMed Central

    Bray, Edward D. R.; Sherafati, Milad; Cutts, Charlotte L.

    2015-01-01

    Hip pain in young adults is not always caused by intra-articular pathology, even in the presence of abnormal examination and imaging findings. Therefore, management of young adult hip pain requires processes that identify patients who are likely to benefit from surgical intervention. An important investigation in the diagnostic pathway is the intra-articular injection; a negative response to this should alert the surgeon to the presence of symptomatic extra-articular causes of hip pain. Our aim was to identify the proportion of patients referred with intra-articular pathology whose primary cause of pain was of extra-articular origin. A total of 143 intra-articular hip injections (local anaesthetic + corticosteroid) were performed over a 2-year period. Mean patient age was 41.95 (95% confidence interval: 39.50–44.41) years with a mean body mass index of 27 (95% confidence interval: 25.77–28.23); 26% of patients (n = 37) had no relief of symptoms after intra-articular injection. Of the patients with no relief, 81.1% (n = 30) were found to have extra-articular pathology as the cause of their pain and the remainder are under on-going investigation. Intra-articular hip injection is an important investigation in the diagnostic pathway of young adult hip pain, as it can highlight and differentiate those patients with referred pain from extra-articular pathology. This benefit may be further enhanced if injections are performed in theatres using image intensifier, under sedation, as it allows direct penetration into the joint without any local anaesthetic infiltration of surrounding tissue. The latter allows immediate objective assessment of symptom relief, eliminating the need to rely on retrospective patient recall of symptom change. PMID:27011814

  20. Impact of Osteopathic Treatment on Pain in Adult Patients with Cystic Fibrosis – A Pilot Randomized Controlled Study

    PubMed Central

    Hubert, Dominique; Soubeiran, Lucile; Gourmelon, Fabrice; Grenet, Dominique; Serreau, Raphaël; Perrodeau, Elodie; Zegarra-Parodi, Rafael; Boutron, Isabelle

    2014-01-01

    Background Pain is a common complication in patients with cystic fibrosis (CF) and is associated with shorter survival. We evaluated the impact of osteopathic manipulative treatment (OMT) on pain in adults with CF. Methods A pilot multicenter randomized controlled trial was conducted with three parallel arms: OMT (group A, 16 patients), sham OMT (sham treatment, group B, 8 patients) and no treatment (group C, 8 patients). Medical investigators and patients were double-blind to treatment for groups A and B, who received OMT or sham OMT monthly for 6 months. Pain was rated as a composite of its intensity and duration over the previous month. The evolution of chest/back pain after 6 months was compared between group A and groups B+C combined (control group). The evolution of cervical pain, headache and quality of life (QOL) were similarly evaluated. Results There was no statistically significant difference between the treatment and control groups in the decrease of chest/back pain (difference = −2.20 IC95% [−4.81; 0.42], p = 0.098); also, group A did not differ from group B. However, chest/back pain decreased more in groups A (p = 0.002) and B (p = 0.006) than in group C. Cervical pain, headache and QOL scores did not differ between the treatment and control groups. Conclusion This pilot study demonstrated the feasibility of evaluating the efficacy of OMT to treat the pain of patients with CF. The lack of difference between the group treated with OMT and the control group may be due to the small number of patients included in this trial, which also precludes any definitive conclusion about the greater decrease of pain in patients receiving OMT or sham OMT than in those with no intervention. Trial Registration ClinicalTrials.gov NCT01293019 PMID:25029347

  1. Incobotulinum Toxin-A Improves Post-Surgical and Post-Radiation Pain in Cancer Patients

    PubMed Central

    Rostami, Rezvan; Mittal, Shivam Om; Radmand, Reza; Jabbari, Bahman

    2016-01-01

    Cancer patients who undergo surgery or radiation can develop persistent focal pain at the site of radiation or surgery. Twelve patients who had surgery or radiation for local cancer and failed at least two analgesic medications for pain control were prospectively enrolled in a research protocol. Patients were injected up to 100 units of incobotulinum toxin A (IncoA) intramuscularly or subcutaneously depending on the type and location of pain (muscle cramp or neuropathic pain). Two patients passed away, one dropped out due to a skin reaction and another patient could not return for the follow up due to his poor general condition. All remaining 8 subjects (Age 31–70, 4 female) demonstrated significant improvement of Visual Analog Scale (VAS) (3 to 9 degrees, average 3.9 degrees) and reported significant satisfaction in Patients’ Global Impression of Change scale (PGIC) (7 out of 8 reported the pain as much improved). Three of the 8 patients reported significant improvement of quality of life. PMID:26771640

  2. Alternative medicine - pain relief

    MedlinePlus

    Acupuncture - pain relief; Hypnosis - pain relief; Guided imagery - pain relief ... you repeat a positive statement over and over. Hypnosis may help relieve pain for: After surgery or labor Arthritis Cancer Fibromyalgia ...

  3. Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

    PubMed Central

    Reid, M. C.; Bennett, David A.; Chen, Wen G.; Eldadah, Basil A.; Farrar, John T.; Ferrell, Bruce; Gallagher, Rollin M.; Hanlon, Joseph T.; Herr, Keela; Horn, Susan D.; Inturrisi, Charles E.; Lemtouni, Salma; Lin, Yu Woody; Michaud, Kaleb; Morrison, R. Sean; Neogi, Tuhina; Porter, Linda L.; Solomon, Daniel H.; Von Korff, Michael; Weiss, Karen; Witter, James; Zacharoff, Kevin L.

    2011-01-01

    Objective There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an “Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults” conference in September, 2010, to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and non-steroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. Design Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists’ slide presentations were reviewed to identify the gaps, and the types of studies and research methods panelists suggested could best address them. Results Fifteen gaps were identified in the areas of treatment(e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation(e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. Conclusions Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well being of older adults with chronic pain. PMID:21834914

  4. A commercialized dietary supplement alleviates joint pain in community adults: a double-blind, placebo-controlled community trial

    PubMed Central

    2013-01-01

    Background The purpose of this study was to assess the effect of 8-weeks ingestion of a commercialized joint pain dietary supplement (InstaflexTM Joint Support, Direct Digital, Charlotte, NC) compared to placebo on joint pain, stiffness, and function in adults with self-reported joint pain. InstaflexTM is a joint pain supplement containing glucosamine sulfate, methylsufonlylmethane (MSM), white willow bark extract (15% salicin), ginger root concentrate, boswella serrata extract (65% boswellic acid), turmeric root extract, cayenne, and hyaluronic acid. Methods Subjects included 100 men and women, ages 50-75 years, with a history (>3 months) of joint pain, and were randomized to Instaflex™ or placebo (3 colored gel capsules per day for 8 weeks, double-blind administration). Subjects agreed to avoid the use of non-steroidal anti-inflammatory drugs (NSAID) and all other medications and supplements targeted for joint pain. Primary outcome measures were obtained pre- and post-study and included joint pain severity, stiffness, and function (Western Ontario and McMaster Universities [WOMAC]), and secondary outcome measures included health-related quality of life (Short Form 36 or SF-36), systemic inflammation (serum C-reactive protein and 9 plasma cytokines), and physical function (6-minute walk test). Joint pain symptom severity was assessed bi-weekly using a 12-point Likert visual scale (12-VS). Results Joint pain severity was significantly reduced in Instaflex™ compared to placebo (8-week WOMAC, ↓37% versus ↓16%, respectively, interaction effect P = 0.025), with group differences using the 12-VS emerging by week 4 of the study (interaction effect, P = 0.0125). Improvements in ability to perform daily activities and stiffness scores in Instaflex™ compared to placebo were most evident for the 74% of subjects reporting knee pain (8-week WOMAC function score, ↓39% versus ↓14%, respectively, interaction effect P = 0.027; stiffness score, ↓30

  5. EFFECT OF THERAPEUTIC TOUCH ON PAIN RELATED PARAMETERS IN PATIENTS WITH CANCER: A RANDOMIZED CLINICAL TRIAL

    PubMed Central

    Tabatabaee, Amir; Tafreshi, Mansoureh Zagheri; Rassouli, Maryam; Aledavood, Seyed Amir; AlaviMajd, Hamid; Farahmand, Seyed Kazem

    2016-01-01

    Introduction: In patients with cancer, pain may influence their life style, and feeling of satisfaction and comfort, leading to fatigue, and cause impairment of their quality of life, personal relationships, sleep and daily activities. The aim of this study was to evaluate the effect of therapeutic touch (TT) on pain related parameters of in patients with cancer. Methods: In a randomized clinical trial a total of 90 male patients referring to Specialized Oncology Hospital in Mashhad, were conveniently selected and randomly divided into three intervention, placebo, and control groups. The intervention consisted of TT in 7 sessions for a 4-week period. The data were collected using a demographic questionnaire along with the Brief Pain Inventory, which were then analyzed and compared using Kruskal-Wallis and Mann-Whitney tests. Results: By comparing scores parameters of pain scales (general activity, mood, walking ability, relations with other people and sleep) in the three groups, there was no significant difference at the beginning of the first session. However, a significant difference was observed at the end of TT sessions between the three groups (p= 0.001). Furthermore, the groups were compared two-by-two by using Mann-Whitney test and Bonferroni correction, and the result indicated significant differences between the two intervention and placebo groups as well as between the two intervention and control groups. Conclusion: The results of the study showed that TT had a positive impact on the positive management of pain related parameters in cancer patients. Therefore, TT is suggested to be used by healthcare providers as a complementary method for managing pain and its parameters. PMID:27482166

  6. Prevalence and Impact of Pain among Older Adults in the United States: Findings from the 2011 National Health and Aging Trends Study

    PubMed Central

    Patel, Kushang V.; Guralnik, Jack M.; Dansie, Elizabeth J.; Turk, Dennis C.

    2013-01-01

    The study sought to determine the prevalence and impact of pain in a nationally representative sample of older adults in the United States (US). Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7,601 adults ages ≥65 years. The response rate was 71.0% and all analyses were weighted to account for the sampling design. The overall prevalence of bothersome pain in the last month was 52.9%, afflicting 18.7 million older adults in the US. Pain did not vary across age groups (P=0.21) and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy-responses, and residential care living status. Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms (P<0.001). The majority (74.9%) of older adults with pain endorsed multiple sites of pain. Several measures of physical capacity, including grip strength and lower extremity physical performance, were associated with pain and multisite pain. For example, self-reported inability to walk 3 blocks was 72% higher in participants with than without pain [adjusted Prevalence Ratio=1.72 (95% Confidence Interval: 1.56–1.90)]. Participants with 1, 2, 3, and >4 sites of pain had gait speeds that were 0.01, 0.03, 0.05, and 0.08 meters per second slower, respectively, than older adults without pain, adjusting for disease burden and other confounders (P<0.001). In summary, bothersome pain in the last month was reported by half of the older adult population of the US in 2011 and was strongly associated with decreased physical function. PMID:24287107

  7. Clinical Characteristics of Veterans Prescribed High Doses of Opioid Medications for Chronic Non-Cancer Pain

    PubMed Central

    Morasco, Benjamin J.; Duckart, Jonathan P.; Carr, Thomas P.; Deyo, Richard A.; Dobscha, Steven K.

    2010-01-01

    Little is known about patients prescribed high doses of opioids to treat chronic non-cancer pain, though these patients may be at higher risk for medication-related complications. We describe the prevalence of high-dose opioid use and associated demographic and clinical characteristics among veterans treated in a VA regional healthcare network. Veterans with chronic non-cancer pain prescribed high doses of opioids (>=180 mg/day morphine equivalent; n=478) for 90+ consecutive days were compared to two groups with chronic pain: Traditional-dose (5–179 mg/day; n=500) or no opioid (n=500). High-dose opioid use occurred in 2.4% of all chronic pain patients and in 3.4% of all chronic pain patients prescribed opioids long-term. The average dose in the high-dose group was 324.9 (SD=285.1) mg/day. The only significant demographic difference among groups was race (p=0.03) with black veterans less likely to receive high doses. High-dose patients were more likely to have four or more pain diagnoses and the highest rates of medical, psychiatric, and substance use disorders. After controlling for demographic factors and VA facility, neuropathy, low back pain, and nicotine dependence diagnoses were associated with increased likelihood of high-dose prescriptions. High-dose patients frequently did not receive care consistent with treatment guidelines: there was frequent use of short-acting opioids, urine drug screens were administered to only 40.8% of patients in the prior year, and 32.0% received concurrent benzodiazepine prescriptions, which may increase risk for overdose and death. Further study is needed to identify better predictors of high-dose usage, as well as the efficacy and safety of such dosing. PMID:20801580

  8. Chemical ablation of stellate ganglion for head and neck cancer pain.

    PubMed

    Ghai, A; Kaushik, T; Kumar, R; Wadhera, S

    2016-01-01

    We present a case of patient with orofacial cancer having pain on one side of face affecting her ability to speak, chew, swallow and sleep leading to emotional and behavioral deterioration. A diagnostic stellate ganglion block was performed followed by chemical neurolysis using phenol under ultrasound guidance, to prevent complications due to inadvertent spread of drug. Her pain scores decreased drastically, she was able to chew and swallow. Weighing the risk of permanent Horner's syndrome or motor paralysis with benefit of improvement in basic functioning of debilitated patients chemical neurolysis of stellate ganglion can be performed with advanced imaging modalities. PMID:27363209

  9. Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study.

    PubMed

    Krampe, Jean; Wagner, Joanne M; Hawthorne, Kelly; Sanazaro, Deborah; Wong-Anuchit, Choochart; Budhathoki, Chakra; Lorenz, Rebecca A; Raaf, Soren

    2014-01-01

    A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain. PMID:24795258

  10. The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

    PubMed

    Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

    2016-08-01

    Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain. PMID:26922802

  11. New insights into perineural invasion of pancreatic cancer: More than pain.

    PubMed

    Liang, Dingkong; Shi, Si; Xu, Jin; Zhang, Bo; Qin, Yi; Ji, Shunrong; Xu, Wenyan; Liu, Jiang; Liu, Liang; Liu, Chen; Long, Jiang; Ni, Quanxing; Yu, Xianjun

    2016-04-01

    Pancreatic cancer is one of the most malignant human tumors. Perineural invasion, whereby a cancer cell invades the perineural spaces surrounding nerves, is acknowledged as a gradual contributor to cancer aggressiveness. Furthermore, perineural invasion is considered one of the root causes of the recurrence and metastasis observed after pancreatic resection, and it is also an independent predictor of prognosis. Advanced research has demonstrated that the neural microenvironment is closely associated with perineural invasion in pancreatic cancer. Therapy targeting the molecular mechanism of perineural invasion may enable the durable clinical treatment of this formidable disease. This review provides an overview of the present status of perineural invasion, the relevant molecular mechanisms of perineural invasion, pain and hyperglycemia associated with perineural invasion in pancreatic cancer, and the targeted therapeutics based on these studies. PMID:26794395

  12. Income in Adult Survivors of Childhood Cancer

    PubMed Central

    Wengenroth, Laura; Sommer, Grit; Schindler, Matthias; Spycher, Ben D.; von der Weid, Nicolas X.; Stutz-Grunder, Eveline; Michel, Gisela; Kuehni, Claudia E.

    2016-01-01

    Introduction Little is known about the impact of childhood cancer on the personal income of survivors. We compared income between survivors and siblings, and determined factors associated with income. Methods As part of the Swiss Childhood Cancer Survivor Study (SCCSS), a questionnaire was sent to survivors, aged ≥18 years, registered in the Swiss Childhood Cancer Registry (SCCR), diagnosed at age <21 years, who had survived ≥5 years after diagnosis of the primary tumor. Siblings were used as a comparison group. We asked questions about education, profession and income and retrieved clinical data from the SCCR. We used multivariable logistic regression to identify characteristics associated with income. Results We analyzed data from 1’506 survivors and 598 siblings. Survivors were less likely than siblings to have a high monthly income (>4’500 CHF), even after we adjusted for socio-demographic and educational factors (OR = 0.46, p<0.001). Older age, male sex, personal and parental education, and number of working hours were associated with high income. Survivors of leukemia (OR = 0.40, p<0.001), lymphoma (OR = 0.63, p = 0.040), CNS tumors (OR = 0.22, p<0.001), bone tumors (OR = 0.24, p = 0.003) had a lower income than siblings. Survivors who had cranial irradiation, had a lower income than survivors who had no cranial irradiation (OR = 0.48, p = 0.006). Discussion Even after adjusting for socio-demographic characteristics, education and working hours, survivors of various diagnostic groups have lower incomes than siblings. Further research needs to identify the underlying causes. PMID:27213682

  13. Effectiveness of a clinical intervention in improving pain control in outpatients with cancer treated by radiation therapy

    SciTech Connect

    Vallieres, Isabelle . E-mail: isabelle.vallieres@mail.chuq.qc.ca; Aubin, Michele; Blondeau, Lucie; Simard, Serge; Giguere, Anik

    2006-09-01

    Purpose: To determine the effectiveness of a multicomponent clinical intervention to reduce pain in outpatients with cancer. Methods and Materials: Sixty-four patients were randomly assigned to receive either a clinical intervention including an information session, the use of a pain diary, and the possibility to contact a physician to adjust the pain medication, or the usual treatment of pain by the staff radiation oncologist. All patients reported their average and worst pain levels at baseline and 2 and 3 weeks after the start of the intervention. Results: The study groups were similar with respect to their baseline characteristics and pain levels at randomization. After 3 weeks, the average and worst pain experienced by patients randomized to the clinical intervention group was significantly inferior to the average pain experienced by patients in the control group (2.9/10 vs. 4.4/10 and 4.2/10 vs. 5.5/10, respectively). Results showed that the experimental group patients decreased their pain levels more than the control group patients did over time. Conclusion: An intervention including patient education, a pain diary, and defining a procedure for therapeutic adjustments can be effective to improve pain relief in outpatients with cancer.

  14. Influence of psychological intervention on pain and immune functions of patients receiving lung cancer surgery

    PubMed Central

    Zhao, Xinying; Cui, Limin; Wang, Wei; Su, Quanzhi; Li, Xiuzhi; Wu, Junben

    2016-01-01

    Objective: To observe the influence of psychological intervention on pain, immune system and adrenocortical functions of patients receiving lung cancer surgery. Methods: We selected 124 patients who received surgery for treating stage I or II lung cancer and divided into experimental group and control group. The experimental group received comprehensive psychological intervention while the control group was given conventional nursing intervention. Pain of patients in two groups was evaluated by visual analog scale (VAS). Before and after intervention, CD3+, CD4+, CD8+, CD4+/CD8+ and free cortisol level in serum were measured. Moreover, QLQ-C30, a life quality measurement scale developed by European Organization for Research and Treatment of Cancer (EORTC) was used. Results: Compared to control group, VAS of patients in experimental group remarkably decreased before anesthesia, 6 hour, 12 hour 24 hour and 48 hour after surgery (P<0.05), and moreover, OLQ-C30 score and various factor scores (except physical symptoms) in experimental group were much higher (P<0.05). No statistical significant difference was found in immune index between two groups before intervention (P>0.05). Differences of CD3+ and CD4+ before and after intervention were both statistically significant (P<0.05), so did free cortisol level (P<0.05). Conclusion: Comprehensive psychological intervention can effectively relieve pain, improve immune functions and enhance quality of life for patients suffering from lung cancer surgery. PMID:27022366

  15. Efficacy of a tobacco quitline among adult cancer survivors

    PubMed Central

    Klesges, Robert C.; Krukowski, Rebecca A.; Klosky, James L.; Liu, Wei; Srivastava, Deo Kumar; Boyett, James M.; Lanctot, Jennifer Q.; Hudson, Melissa M.; Folsom, Charla; Lando, Harry; Robison, Leslie L.

    2015-01-01

    Objective The purpose of the study (conducted 2010–2013) was to determine the efficacy of two common types of tobacco quitlines in adult cancer survivors who regularly smoked cigarettes. Method Adult onset cancer survivors in Memphis, Tennessee (n = 427, 67% female, 60% Caucasian) were randomized either to a Proactive (i.e., counselor-initiated calls) or Reactive (i.e., participant-initiated calls) quitline. Both conditions also received nicotine replacement therapy. The primary outcome was biochemically-verified (i.e., salivary cotinine) smoking cessation. Results While 12-month self-reported abstinence was consistent with other published studies of smoking cessation (22% and 26% point prevalence abstinence for Proactive and Reactive conditions, respectively), 48% of participants who were tested for cotinine failed biochemical verification, indicating a considerable falsification of self-reported cessation. Adjusted cessation rates were less than 5% in both intervention conditions. Conclusion Our results are consistent with other studies indicating that traditional smoking cessation interventions are ineffective among cancer survivors. Moreover, self-reports of cessation were unreliable in cancer survivors participating in a quitline intervention, indicating that future studies should include biochemical verification. Given the importance of smoking cessation among cancer survivors and low cessation rates in the current study, it may be necessary to design alternative interventions for this population. PMID:25572620

  16. Longitudinal analysis of pain in patients with metastatic prostate cancer using natural language processing of medical record text

    PubMed Central

    Heintzelman, Norris H; Taylor, Robert J; Simonsen, Lone; Lustig, Roger; Anderko, Doug; Haythornthwaite, Jennifer A; Ch