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Sample records for cancer pain management

  1. Pain Management in Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Michael Erdek

    2010-12-01

    Full Text Available A majority of pancreatic cancer patients present with pain at the time of diagnosis. Pain management can be challenging in light of the aggressive nature of this cancer. Apart from conventional pharmacotherapy, timely treatment with neurolytic celiac plexus block (NCPB has been shown to be of benefit. NCPB has demonstrated efficacious pain control in high quality studies with analgesic effects lasting one to two months. NCPB has also shown to decrease the requirements of narcotics, and thus decrease opioid related side effects. Another option for the control of moderate to severe pain is intrathecal therapy (IT. Delivery of analgesic medications intrathecally allows for lower dosages of medications and thus reduced toxicity. Both of the above mentioned interventional procedures have been shown to have low complication rates, and be safe and effective. Ultimately, comprehensive pancreatic cancer pain management necessitates understanding of pain mechanisms and delivery of sequential validated therapeutic interventions within a multidisciplinary patient care model.

  2. Pain management in cancer cervix

    Directory of Open Access Journals (Sweden)

    Palat Gayatri

    2005-01-01

    Full Text Available Cancer of the cervix uteri is a common cause of pain among women. On the physical realm, the cancer may cause somatic [soft tissue and bone], visceral and neuropathic pain [lumbosacral plexopathy]. Radiotherapy and chemotherapy may cause neuropathy too. Psychological, social and cultural factors modify the pain. Evaluation of the individual type of pain and a patient-centred approach are fundamental requirements for rational management. Disease modifying treatment like radiotherapy and chemotherapy must be considered when applicable. Pain control is usually achieved by the use of WHO three-step ladder, remembering that possible association of renal dysfunction would necessitate caution in the use of NSAIDs and opioids. Side effects must be anticipated, prevented when possible, and aggressively treated; nausea and vomiting may already be present, and constipation can worsen pain when there is a pelvic mass. Pain emergencies can be treated by quick titration with intravenous morphine bolus doses. Neuropathic pain may warrant the use of usual adjuvants, with particular reference to cortico-steroids and the NMDA antagonist, ketamine. In intractable pain, many neurolytic procedures are tried, but a solid evidence base to justify their use is lacking. Continuous epidural analgesia with local anaesthetic and opioid may be needed when drug therapy fails, and desperate situations may warrant interventions such as neurolysis. Such physical measures for pain relief must be combined with psychosocial support and adequate explanations to the patient and the family.

  3. Pain management in cancer survivorship

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per

    2015-01-01

    BACKGROUND: The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY: Chronic pain is one of the...... ETIOLOGY: Neuropathic pain seems to be the major pain etiology in cancer survivors and therefore adjuvant analgesics should be the first choice of analgesic treatment. CONTEXT: This article addresses the central aspects of pain epidemiology, mechanisms and the frequent pain syndromes met in cancer...... main problems in this population and prevalence varies between 16% and 50%. Most information derives from breast cancer patients assessed by surveys from national or local institutional databases. A Danish population-based survey estimated that 41.5% of all cancer survivors reported chronic pain. PAIN...

  4. Cancer pain management: Basic information for the young pain physicians

    Directory of Open Access Journals (Sweden)

    SPS Rana

    2011-01-01

    Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

  5. Hypnosis: Adjunct Therapy for Cancer Pain Management

    OpenAIRE

    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 us...

  6. Hypnosis: adjunct therapy for cancer pain management.

    Science.gov (United States)

    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

  7. Oxycodone controlled release in cancer pain management.

    Science.gov (United States)

    Biancofiore, Giuseppe

    2006-09-01

    illustrations of a lower incidence of side-effects in the central nervous system. It is therefore possible to conclude that oxycodone represents a valid alternative to morphine in the management of moderate to severe cancer pain, also as first-line treatment. PMID:18360598

  8. Psychological and Behavioral Approaches to Cancer Pain Management

    OpenAIRE

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

    2014-01-01

    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 ...

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    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

  11. Psychological and behavioral approaches to cancer pain management.

    Science.gov (United States)

    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

  12. An Implementation Study to Improve Cancer Pain Management in Jordan Using a Case Study

    OpenAIRE

    Al Qadire, Mohammad

    2011-01-01

    An Implementation Study to Improve Cancer Pain Management in Jordan using a Case StudyManaging the symptoms of cancer effectively is one of the most important challenges facing health care providers. Many symptoms are reported by cancer patients, including, pain, depression, distress and change in life style. Pain continues to be the most frequently reported symptom, however, cancer pain is treated inadequately and cancer patients continue to suffer pain. The use of pain assessment tools is e...

  13. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  15. Sympathetic blocks for visceral cancer pain management

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pal; Kurita, Geana Paula; Sjogren, Per; Giarratano, Antonino

    2015-01-01

    The neurolytic blocks of sympathetic pathways, including celiac plexus block (CPB) and superior hypogastric plexus block (SHPB) , have been used for years. The aim of this review was to assess the evidence to support the performance of sympathetic blocks in cancer patients with abdominal visceral...... effects in comparison with a conventional analgesic treatment. In one study patients treated with superior hypogastric plexus block (SHPB) had a decrease in pain intensity and a less morphine consumption, while no statistical differences in adverse effects were found. The quality of these studies was...... generally poor due to several limitations, including sample size calculation, allocation concealment, no intention to treat analysis. However, at least two CPB studies were of good quality. Data regarding the comparison of techniques or other issues were sparse and of poor quality, and evidence could not be...

  16. Canadian recommendations for the management of breakthrough cancer pain

    Science.gov (United States)

    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

  17. Management of breakthrough pain in children with cancer

    Directory of Open Access Journals (Sweden)

    Friedrichsdorf SJ

    2014-03-01

    Full Text Available Stefan J Friedrichsdorf,1,2 Andrea Postier1 1Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, 2University of Minnesota Medical School, Minneapolis, MN, USA Abstract: 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. Keywords: pediatric, cancer, breakthrough pain, opioid, adjuvant analgesia, integrative medicine

  18. Barriers to cancer pain management in danish and lithuanian patients treated in pain and palliative care units

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Samsanaviciene, Jurgita; Liubarskiene, Zita;

    2014-01-01

    -related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale, the...... poor adherence to pain medication and poor pain relief appear to be more country-specific problems....

  19. Review of cancer pain management in patients receiving maintenance methadone therapy.

    LENUS (Irish Health Repository)

    Rowley, Dominic

    2011-05-01

    Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented \\'\\'drug-seeking\\'\\' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.

  20. Successful management of a difficult cancer pain patient by appropriate adjuvant and morphine titration

    Directory of Open Access Journals (Sweden)

    Shiv PS Rana

    2011-01-01

    Full Text Available Morphine has been used for many years to relieve cancer pain. Oral morphine (in either immediate release or modified release form remains the analgesic of choice for moderate or severe cancer pain. The dose of oral morphine is titrated up to achieve adequate relief from pain with minimal side effects. Antidepressant and anticonvulsant drugs, when used in addition to conventional analgesics, give excellent relief from cancer pain. Most cancer pain responds to pharmacological measures with oral morphine but some pain like neuropathic and bony pain, pain in children and elderly age group, and advanced malignancy pain are very difficult to treat. Here, we report the management of a similar patient of severe cancer pain and the difficulty that we came across during dose titration of oral morphine and adjuvant analgesic.

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

    DEFF Research Database (Denmark)

    Davies, Andrew; Zeppetella, Giovambattista; Andersen, Steen;

    2011-01-01

    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...

  2. Patient and caregiver perspectives on managing pain in advanced cancer: A qualitative longitudinal study

    OpenAIRE

    Hackett, J; Godfrey, M.; Bennett, MI

    2015-01-01

    Background: Despite advances in treatment of pain in advanced cancer, it remains a major source of suffering with adverse effects on patients’ life quality. There is increasing understanding of its multi-dimensional nature and the variable responsiveness of medication to complex pain. Less clear is how patients and their caregivers respond to, and manage pain complexity. Aim: To explore patients’ and carers’ experiences of advanced cancer pain and the processes that they engage in to manage p...

  3. Cancer pain management by radiotherapists: a survey of radiation therapy oncology group physicians

    International Nuclear Information System (INIS)

    Purpose: Radiation Therapy Oncology Group (RTOG) physicians were surveyed to determine their approach to and attitudes toward cancer pain management. Methods and Materials: Physicians completed a questionnaire assessing their estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of pain management, and their report of how they manage pain in their own practice setting. Results: Eighty-three percent believed the majority of cancer patients with pain were undermedicated. Forty percent reported that pain relief in their own practice setting was poor or fair. Assessing a case scenario, 23% would wait until the patient's prognosis was 6 months or less before starting maximal analgesia. Adjuvants and prophylactic side effect management were underutilized in the treatment plan. Barriers to pain management included poor pain assessment (77%), patient reluctance to report pain (60%), patient reluctance to take analgesics (72%), and staff reluctance to prescribe opioids (41%). Conclusions: Physicians' perceptions of barriers to cancer pain management remain quite stable over time, and physicians continue to report inadequate pain treatment education. Future educational efforts should target radiation oncologists as an important resource for the treatment of cancer pain

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

    Directory of Open Access Journals (Sweden)

    Shi L

    2016-04-01

    Full Text Available Lei Shi,1,* Yumei Liu,2,* Hua He,1 Cong Wang,1 Hongwei Li,1 Nanya Wang1 1Cancer Center, The First Hospital of Jilin University, Changchun, 2Department of Hematology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work 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

  5. Pain management of opioid-treated cancer patients in hospital settings in Denmark

    DEFF Research Database (Denmark)

    Lundorff, L.; Peuckmann, V.; Sjøgren, Per

    2008-01-01

    AIM: To evaluate the performance and quality of cancer pain management in hospital settings. METHODS: Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids...... were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory. RESULTS: In total, 59 cancer patients were included. In 49 (83...... according to the duration of action. In 88% of the patients supplemental short-acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non-neuropathic pain received...

  6. Complementary and alternative medicine in cancer pain management: A systematic review

    Directory of Open Access Journals (Sweden)

    Priyanka Singh

    2015-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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. Psychological and behavioural predictors of pain management outcomes in patients with cancer

    DEFF Research Database (Denmark)

    2010-01-01

    analyse the impact of patient-related barriers on cancer pain management outcomes following this model. Thirty-three patients responded to the Brief Pain Inventory Pain scale, the Danish Barriers Questionnaire II (DBQ-II), the Hospital Anxiety and Depression scale (HADS), the Danish version of Patient...... Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish version of Medication Adherence Report Scale (DMARS-4). Statistical analysis was performed with SPSS 16.00. The results of the multivariable linear regression analyses showed that pain intensity...... was explained by patients' emotional distress (symptoms of anxiety and depression) and that pain relief was explained by cognitive barriers. In conclusion, interventions in emotional distress and patients' concerns may supposedly result in better cancer pain management outcomes....

  9. A Survey of Cancer Pain Management Knowledge and Attitudes of British Columbian Physicians

    OpenAIRE

    Gallagher, R; Hawley, P.; Yeomans, W

    2004-01-01

    INTRODUCTION: There are many potential barriers to adequate cancer pain management, including lack of physician education and prescription monitoring programs. The authors surveyed physicians about their specific knowledge of pain management and the effects of the regulation of opioids on their prescribing practices.METHODS: A questionnaire was mailed out to British Columbia physicians who were likely to encounter cancer patients. The survey asked for physicians' opinions about College of Phy...

  10. Cancer pain: A critical review of mechanism-based classification and physical therapy management in palliative care

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available 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.

  11. Patient-related barriers to cancer pain management: a systematic exploratory review

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring; Sjøgren, Per

    2009-01-01

    The aim of this review was to systemically explore the current evidence regarding patient-related barriers to cancer pain management to find new areas that might be important for better understanding of patient barriers' phenomenon. The method used in this study was a computerised literature search...... analgesic regimen were included and analysed. The dominant part of articles studied cognitive patient-related barriers to cancer pain management, while affective, sensory barriers, as well as pain communication and pain medication adherence were studied in much less extend. However, the findings from...... different studies regarding relationships between cognitive barriers and pain intensity were not consistent. On the contrary, the quality of pain communication was consistently found to be not satisfactory in some key areas. The associations between more expressed attitudinal as well as sensory barriers and...

  12. Role of intranasal fentanyl in breakthrough pain management in cancer patients

    OpenAIRE

    Leppert, Wojciech

    2010-01-01

    Wojciech LeppertDepartment of Palliative Medicine, Poznan University of Medical Sciences, Poznan, PolandAbstract: Fentanyl is a strong opioid analgesic, which is commonly used in the form of a transdermal patch for the treatment of chronic cancer pain. An intranasal route of fentanyl administration is a novel treatment for breakthrough cancer pain (BTCP). The prevalence, assessment, and management of BTCP is outlined in this paper, and basic pharmacodynamic and pharmacokinetic properties, dos...

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

    OpenAIRE

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

    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 pai...

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

    Science.gov (United States)

    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

  15. Methadone for Cancer Pain

    Directory of Open Access Journals (Sweden)

    Eric E. Prommer

    2010-07-01

    Full Text Available Pain is one of the most common and incapacitating symptoms experienced by patients with advanced cancer. Methadone is a potent opioid with strong affinity for the µ opioid receptor. In addition to being a potent µ opioid receptor ligand, methadone blocks the N-methyl-D-aspartic acid receptor and modulates neurotransmitters involved in descending pain modulation. These 3 properties enhance analgesic activity. Methadone’s lack of active metabolites makes it an attractive option when opioid responsiveness declines and renal insufficiency complicates opioid therapy. A lipophilic opioid, methadone can be given by multiple routes. Clinical trial data show equivalence with morphine as an analgesic in moderate to severe cancer pain. Further investigations are needed to define the role of methadone in the management of breakthrough pain and neuropathic pain and to determine whether it is truly superior to morphine, the gold standard of cancer analgesia.

  16. Pain characteristics and management of inpatients admitted to a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Kurita, G P; Tange, U B; Farholt, H; Sonne, N M; Strömgren, A S; Ankersen, L; Kristensen, L; Bendixen, L; Grønvold, Mogens; Petersen, M A; Nordly, M; Christrup, L; Niemann, C; Sjøgren, P

    2013-01-01

    AIMS: This prospective, cross-sectional study aimed to assess cancer pain and its management in an inpatient setting at a comprehensive cancer centre in Denmark. METHODS: One hundred and eighty-eight inpatients with cancer were invited to participate (May/June 2011). Demographics, diagnoses, World...... Health Organization performance status, health-related quality of life, pain and data regarding analgesic treatment were registered. RESULTS: One hundred and thirty-four (71.3%) patients agreed to participate in the study. Most frequent diagnoses were leukaemia (27.6%) and lung cancer (14.2%). A high.......5%. Adjuvant medication was sparsely used and not always correctly indicated. Out of 88 patients with pain, 62.5% were left untreated according to the Electronic Medication System. Higher health-related quality of life was associated with lower pain intensity. The use of opioids with or without adjuvants was...

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

    Science.gov (United States)

    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

  18. Animal Models of Cancer Pain

    OpenAIRE

    Pacharinsak, Cholawat; Beitz, Alvin

    2008-01-01

    Modern cancer therapies have significantly increased patient survival rates in both human and veterinary medicine. Since cancer patients live longer they now face new challenges resulting from severe, chronic tumor-induced pain. Unrelieved cancer pain significantly decreases the quality of life of such patients; thus the goal of pain management is to not only to alleviate pain, but also to maintain the patient's physiological and psychological well-being. The major impediment for developing n...

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

    Directory of Open Access Journals (Sweden)

    Omoti AE

    2007-09-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  1. Morphine and oxycodone in the management of cancer pain

    International Nuclear Information System (INIS)

    Morphine and oxycodone were administered to ten patients suffering from severe cancer pain in a double-blind cross-over study. The patients titrated themselves pain-free, first intravenously, using a patient-controlled analgesia device, and then orally. Each titration phase lasted for 48 hours. Blood samples were drawn after 36 hr of each administration phase. The plasma levels of morphine, morphine-6- and morphine-3 glucuronides were determined with high performance liquid chromatography (HPLC), whereas the oxycodone samples were assayed with gas chromatography (GC). Twin samples were analyzed for plasma opioid activity with a radioreceptor assay (RRA) using 3H-dihydromorphien and 3H-naloxone as radioligands. Adequate analgesia was achieved with both morphine and oxycodone. About 30% more oxycodone was needed intravenously, whereas 25% less oxycodone than morphine was consumed orally. There was a good linear correlation between the morphine concentrations measured with HPLC and RRA. The mean morphine-6-glucuronide to morphine concentration ratio was 2.3 after intravenous and 4.6 after oral administration. Results from RRA indicate that oxycodone in vivo is a potent μ-agonist and that a least part of its analgesic action is mediated by active metabolites. In vitro morphine glucuronides enhanced morphine in displacing radioligands from the opioid receptors, thus suggesting their complex interactions in vivo. (author)

  2. Physician-related barriers to cancer pain management with opioid analgesics

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Sjøgren, Per; Møldrup, Claus;

    2007-01-01

    OBJECTIVE: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics. METHODS: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full...... texts were not available in PUBMED were retrieved from the electronic databases of specific journals. RESULTS: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians' barriers to cancer pain management were studied in questionnaire surveys and in the reviews...... review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence...

  3. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy

    Directory of Open Access Journals (Sweden)

    Andrew M. Harrison

    2015-01-01

    Full Text Available 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.

  4. Management of cancer pain with transdermal fentanyl: phase IV trial, University of Iowa.

    Science.gov (United States)

    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

  5. Interventional Treatments of Cancer Pain.

    Science.gov (United States)

    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

  6. Breakthrough cancer pain – still a challenge

    OpenAIRE

    Margarit, Cesar; Juliá, Joaquim; López, Rafael; Anton, Antonio; Escobar, Yolanda; Casas, Ana; Cruz, Juan Jesús; Galvez, Rafael; Mañas, Ana; Zaragozá, Francisco

    2012-01-01

    Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%). According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough can...

  7. Supporting self-management of pain by patients with advanced cancer::Views of palliative care professionals

    OpenAIRE

    Hughes, Nicholas D.; Closs, S. José; Flemming, Katherine Ann; Bennett, Michael I.

    2016-01-01

    Purpose: To ascertain the views of specialist palliative care professionals on patient self-management of cancer pain in order to inform the development of a new educational intervention to support self-management. Methods: Qualitative research using focus group interviews. Results: Participants viewed self-management of cancer pain as desirable and achievable but also as something that could be problematic. Challenges to self-management were perceived in: patient attitudes and behaviours, pr...

  8. The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit

    OpenAIRE

    Lee, Ya-Ping; Wu, Chih-Hsun; Chiu, Tai-Yuan; Chen, Ching-Yu; Morita, Tatsuya; Hung, Shou-Hung; Huang, Sin-Bao; Kuo, Chia-Sheng; Tsai, Jaw-Shiun

    2015-01-01

    Background Although many cross-sectional studies have demonstrated the association between cancer pain and psychospiritual distress, the time-dependent relationship has not been fully explored. For that reason, this study aims to investigate the time-dependent relationship between psychospiritual distress and cancer pain management in advanced cancer patients. Methods This is a prospective observational study. Two hundred thirty-seven advanced cancer patients were recruited from a palliative ...

  9. Pain Management

    Science.gov (United States)

    ... opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in ... sensory and emotional experience associated with actual or potential tissue damage.” TODAY Pain affects more Americans than ...

  10. Cancer Pain Physiology

    DEFF Research Database (Denmark)

    Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

    2014-01-01

    Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells. This...... precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined to...... the mouse femur. This model prompted related approaches and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer induced bone pain results in progressive bone destruction, elevated osteoclast activity and...

  11. How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies

    OpenAIRE

    Latter, Susan; Hopkinson, Jane; Richardson, Alison; Hughes, James; Lowson, Elizabeth; Edwards, Deborah

    2016-01-01

    Background: Family carers play a significant role in managing pain and associated medicines for people with advanced cancer. Research indicates that carers often feel inadequately prepared for the tasks involved, which may impact on carer and patient emotional state as well as the achievement of optimal pain control. However, little is known about effective methods of supporting family carers with cancer pain medicines. Aims: To systematically identify and review studies of interventions...

  12. Palliative care - managing pain

    Science.gov (United States)

    End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...

  13. Mechanisms of cancer-induced bone pain

    OpenAIRE

    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 ...

  14. Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

    Directory of Open Access Journals (Sweden)

    Zaporowska-Stachowiak I

    2014-10-01

    Full Text Available Iwona Zaporowska-Stachowiak,1,2 Grzegorz Kowalski,3 Jacek Łuczak,2 Katarzyna Kosicka,4 Aleksandra Kotlinska-Lemieszek,3 Maciej Sopata,3 Franciszek Główka4 1Chair and Department of Pharmacology, Poznan University of Medical Sciences, Poznan, Poland; 2Palliative Medicine In-patient Unit, University Hospital of Lord's Transfiguration, Poznan University of Medical Sciences, Poznan, Poland; 3Palliative Medicine Chair and Department, Poznan University of Medical Sciences, Poznan, Poland; 4Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland 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 m

  15. Efficacy and Safety of Ropivacaine Addition to Intrathecal Morphine for Pain Management in Intractable Cancer

    OpenAIRE

    Ying Huang; Xihan Li; Tong Zhu; Jian Lin; Gaojian Tao

    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 ropivacain...

  16. A phase II trial of Reiki for the management of pain in advanced cancer patients.

    Science.gov (United States)

    Olson, Karin; Hanson, John; Michaud, Mary

    2003-11-01

    This trial compared pain, quality of life, and analgesic use in a sample of patients with cancer pain (n=24) who received either standard opioid management plus rest (Arm A) or standard opioid management plus Reiki (Arm B). Participants either rested for 1.5 hr on Days 1 and 4 or received two Reiki treatments (Days 1 and 4) one hour after their first afternoon analgesic dose. Visual analogue scale (VAS) pain ratings, blood pressure, heart rate, and respirations were obtained before and after each treatment/rest period. Analgesic use and VAS pain scores were reported for 7 days. Quality of life was assessed on Days 1 and 7. Participants in Arm B experienced improved pain control on Days 1 and 4 following treatment, compared to Arm A, and improved quality of life, but no overall reduction in opioid use. Future research will determine the extent to which the benefits attributed to Reiki in this study may have been due to touch. PMID:14585550

  17. [Physiological Basis of Pain Mechanisms for Pain Management].

    Science.gov (United States)

    Kawamata, Mikito

    2016-05-01

    Physician anesthesiologists should ensure a future leadership position in perioperative medicine and pain medicine. In order to establish the missions, anesthesiologists need to know how to relieve pain in surgical patients, critically ill patients and patients with cancer and non-cancer chronic pain. Thus, anesthesiologists should realize physiology of pain representation from pain management I will review physiological basis of pain mechanisms in this manuscript which includes 1) evolutional aspect of pain perception, 2) transduction of noxious stimuli, 3) the types of nociceptors and conduction of noxious stimuli, 4) the ascending pathway of pain and central modulation of pain, 5) the descending inhibitory pain system, and 6) various types of pain. Finally, anesthesiologists should manage pain from physiological basis of pain mechanisms. PMID:27319092

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

    OpenAIRE

    Shi L; Liu Y; He H.; Wang C.; Li H; Wang N.

    2016-01-01

    Lei Shi,1,* Yumei Liu,2,* Hua He,1 Cong Wang,1 Hongwei Li,1 Nanya Wang1 1Cancer Center, The First Hospital of Jilin University, Changchun, 2Department of Hematology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work 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 c...

  19. Cancer pain: Classification and pain syndromes

    Directory of Open Access Journals (Sweden)

    Grujičić Danica

    2004-01-01

    Full Text Available In spite the new information's about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of which vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullar pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors. Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.

  20. Management of neuropathic pain following treatment for breast cancer in the absence of recurrence: a challenge for the radiation oncologist

    International Nuclear Information System (INIS)

    This report reviews various management options for treatment-induced neuropathic pain in breast cancer. First-line options include tricyclic antidepressants and anticonvulsant drugs. Opioids should be prescribed according to published guidelines. Second-line treatments include lignocaine, mexiletine and ketamine. Sympatholytic therapies are available to patients with features of chronic regional pain syndrome. Anti-inflammatory agents are used for neurogenic inflammation. Surgical interventions are considered for refractory neuropathic pain. Interdisciplinary management is appropriate when persisting pain causes physical and psychosocial disabilities. Copyright (2004) Blackwell Science Pty Ltd

  1. Efficacy and safety of fentanyl buccal for cancer pain management by administration through a soluble film: an update

    International Nuclear Information System (INIS)

    More than half of patients receiving prescription medicine for cancer pain have been reported to experience inadequate pain relief or breakthrough pain. Buccal administration can deliver lipophilic opioids rapidly to the systemic circulation through the buccal mucosa, limiting gastrointestinal motility and first-pass metabolism. This review updates the safety and efficacy of fentanyl buccal soluble film (FBSF) in patients with cancer pain. Literature was identified through searches of Medline (PubMed). Search terms included combinations of the following: cancer pain, fentanyl, fentanyl buccal soluble film, pharmacology, kinetics, safety, efficacy and toxicity. FBSF is an oral transmucosal form of fentanyl citrate developed as a treatment of breakthrough pain in opioid-tolerant patients with cancer. Studies have shown that it is well tolerated in the oral cavity, with adequate bioavailability and safety in cancer patients. Further studies are warranted to evaluate, in comparison with other short-acting opioids, its efficacy in the management of breakthrough cancer pain, its addictive potential and its economic impact in cancer patients

  2. Cancer Pain Management Team in Pain Management of Elderly Cancer Patients%综合医院癌痛护理策略团队在老年癌痛管理中的实践

    Institute of Scientific and Technical Information of China (English)

    沈琼; 胡丽娟

    2013-01-01

    目的 探讨综合医院癌痛护理策略团队在老年癌症患者疼痛管理中的实践效果.方法 将92例老年癌痛患者随机分为两组各46例,常规组患者接受常规疼痛治疗和非团队护理人员护理,观察组患者接受常规疼痛治疗和癌痛护理策略团队实施的疼痛护理,评价干预2周后患者的疼痛强度、疼痛影响及生活质量.结果 干预2周后,两组患者疼痛强度、疼痛影响都有下降,整体生活质量得分上都有增加,但观察组效果优于常规组,差异均有统计学意义(P<0.05).结论 癌痛护理策略团队的护理实践能有效降低老年癌痛患者的疼痛强度、疼痛影响,提高患者的生活质量.%Objective To explore the effects of cancer pain management team in pain management of elderly cancer patients.Methods A total of 92 elderly patients with cancer pain were randomly divided into control group (n=46) and observation group (n=46).Patients in control group received routine pain treatment and nursing from non-team nurses,while those in observation group routine pain treatment and nursing care from cancer pain management team.The comparison was conducted in the aspects of pain intensity,pain interference and quality of life after 2 weeks.Results After 2 weeks,pain intensity and pain interference decreased significantly,and the score of the overall quality of life significantly increased in both groups,while the effects in observation group were better than those in control group,the differences of which were statistically significant (P<0.05).Conclusion Cancer pain management team in general hospitals is effective for reducing pain intensity,pain interference and increasing quality of life of elderly cancer patients with pain.

  3. Mechanism-based classification and physical therapy management of persons with cancer pain: A prospective case series

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2013-01-01

    Full Text Available Context: Mechanism-based classification (MBC was established with current evidence and physical therapy (PT management methods for both cancer and for noncancer pain. Aims: This study aims to describe the efficacy of MBC-based PT in persons with primary complaints of cancer pain. Settings and Design: A prospective case series of patients who attended the physiotherapy department of a multispecialty university-affiliated teaching hospital. Material and Methods: A total of 24 adults (18 female, 6 male aged 47.5 ± 10.6 years, with primary diagnosis of heterogeneous group of cancer, chief complaints of chronic disabling pain were included in the study on their consent for participation The patients were evaluated and classified on the basis of five predominant mechanisms for pain. Physical therapy interventions were recommended based on mechanisms identified and home program was prescribed with a patient log to ensure compliance. Treatments were given in five consecutive weekly sessions for five weeks each of 30 min duration. Statistical Analysis Used: Pre-post comparisons for pain severity (PS and pain interference (PI subscales of Brief pain inventory-Cancer pain (BPI-CP and, European organization for research and treatment in cancer-quality of life questionnaire (EORTC-QLQ-C30 were done using Wilcoxon signed-rank test at 95% confidence interval using SPSS for Windows version 16.0 (SPSS Inc, Chicago, IL. Results: There were statistically significant ( P < 0.05 reduction in pain severity, pain interference and total BPI-CP scores, and the EORTC-QLQ-C30. Conclusion: MBC-PT was effective for improving BPI-CP and EORTC-QLQ-C30 scores in people with cancer pain.

  4. Breakthrough cancer pain

    DEFF Research Database (Denmark)

    Davies, Andrew; Buchanan, Alison; Zeppetella, Giovambattista;

    2013-01-01

    Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients.......Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients....

  5. Treatments for Managing Pain

    Science.gov (United States)

    ... Expect Patient Stories FAQs Anesthesia Topics Treatments for Managing Pain Share PRINT Print Home > Anesthesia Topics > Detail Page Treatments for Managing Pain Medication alone may not be enough to ...

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

    Science.gov (United States)

    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

  7. A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home

    OpenAIRE

    McPherson, Christine J; Hadjistavropoulos, Thomas; Devereaux, Alana; Lobchuk, Michelle M

    2014-01-01

    Background Pain in advanced cancer is complex and multifaceted. In older patients comorbidities and age-related functional decline add to the difficulties in managing cancer pain. The current emphasis on care in the community, and preference by patients with life-limiting disease to receive care in the home, has meant that patients and their family caregivers have become increasingly responsible for the day-to-day management of cancer pain. An appreciation of patients’ and caregivers’ roles a...

  8. The global experience of cancer pain.

    Science.gov (United States)

    Brant, Jeannine M

    2010-01-01

    Pain is a significant problem in patients with cancer. Pain occurs in approximately 50% of patients at some point during the disease process and in up to 75% of patients with advanced cancer. Total pain impacts quality of life domains including physical, psychological, social, and spiritual realms. Unfortunately, pain is underappreciated and undermanaged throughout the world. Lack of knowledge among healthcare professionals, inadequate pain assessment, fears of addiction, and beliefs that pain is an inevitable component of cancer are common barriers. Education about comprehensive pain assessment and optimal management strategies and discussions about belief systems regarding pain can assist to bridge the gap between suffering and comfort. Self-report is the gold standard for pain assessment. Gathering information about the location(s), intensity, quality and temporal factors is essential. Intensity should be quantified on a rating scale to determine the amount of pain and the degree of relief from interventions. Quality can be used to diagnose the specific pain syndrome. Temporal factors provide input about how the pain is experienced over time and can offer input into the pain management plan of care. For patients who cannot self-report pain, non-verbal assessment tools are available to aid in assessment. The World Health Organization's Analgesic Ladder provides a template for the management of cancer pain. For step 1, pain can be managed with nonsteroidal anti-inflammatory drugs (NSAIDS) and other nonopioid analgesics. As pain persists or increases, step 2 involves managing pain with select opioids for mild to moderate pain along with NSAIDS and nonopioid analgesics. Step 3 of the ladder is applicable to many cancer pain syndromes, and includes opioids for moderate to severe pain in conjunction with NSAIDS and nonopioids. This 3 step approach can be 80-90% effective. This polypharmaceutical employed with behavioral complimentary techniques are often employed to

  9. EAU guidelines on pain management.

    Science.gov (United States)

    Francesca, Francesco; Bader, Pia; Echtle, Dieter; Giunta, Francesco; Williams, John

    2003-10-01

    Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic. Caregivers are to face pain in two main settings: after surgery and in cancer patients. These tasks require a multidisciplinary team, able to properly assess and treat pain. Postoperative pain is to be treated early and aggressively. Several drug options are available, to be tailored on the surgical procedure and the patient. Pain in cancer patients consists of different aspects: it can be caused by the cancer itself or may be secondary to muscular spasm or cancer treatments. The management involves mainly pharmacotherapy, but also primary treatments as surgery, radiochemotherapy or even antibiotics can provide an adequate relief. Analgesics are to be employed according to an ascending scale, but other options can be combined to improve the outcome when a satisfactory balance between relief and side effects is not achieved; they include invasive techniques, physical and psychological therapy. The mainstay of pain management entails a interdisciplinary cooperation; it requires a full knowledge of the methods of evaluation and treatment of this condition. PMID:14499670

  10. Cancer Treatment-Induced Mucositis Pain: Strategies for Assessment and Management

    OpenAIRE

    Harris, Debra J

    2006-01-01

    Mucositis pain is a major clinical problem associated with cancer treatment. Mucosal tissue injury is a dose-limiting side effect and also limits nutritional intake and oral function, resulting in weight loss and nutritional deficits for many patients. The pathophysiology of mucositis is thought to be a complex array of cytokine-mediated events, which begins with mucosal atrophy and eventually leads to the painful ulceration of the mucosa. This article reviews current research related to pain...

  11. Cancer treatment: dealing with pain

    Science.gov (United States)

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

    Science.gov (United States)

    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

  13. Psychiatric aspects of pain in cancer patients.

    Science.gov (United States)

    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

  14. Morphine for cancer pain

    OpenAIRE

    Klepstad, Pål

    2002-01-01

    The objectives of the present study were:I. To assess the effect from start of morphine treatment to cancer pain patients in respect to time needed for dose-finding, dose needed for pain control and adverse symptoms.II. To assess the effects from start of morphine treatment to cancer pain patients on health related quality of life.III. To compare the efficacy of start of morphine treatment with sustained vs. immediate release morphine.IV. To investigate the relationship between serum concentr...

  15. Developing Effective Cancer Pain Education Programs

    OpenAIRE

    Martin, Michelle Y.; Pisu, Maria; Kvale, Elizabeth A.; Johns, Shelley A.

    2012-01-01

    Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of d...

  16. Managing your chronic pain

    Science.gov (United States)

    ... your chronic back pain To use the sharing features on this page, please enable JavaScript. Managing chronic pain means finding ways to make your back pain tolerable so you can live your life. You may not be able to ...

  17. NATIONAL SURVEY ON PREVALENCE OF CANCER PAIN

    Institute of Scientific and Technical Information of China (English)

    刘志民; 连智; 周伟华; 穆悦; 吕宪祥; 赵苳; 蔡志基; 曹家琪; 任正洪

    2001-01-01

    Objective. To collect nationwide basic data about cancer related pain. Methods. Sixty cancer patients in each province were randomly selected to participate in this survey. The subjects represented all stages of cancer, tumor sites, and different demographic characteristics. Two selfdesignedstructured questionnaires including reasons, types of pain and pain management were used by patients and physicians respectively. Subjects were asked to report whether he/she had experienced any type of cancer related pain and fdled out the equivalent questionnaire. The severity of pain was assessed by using "visual analogue scale".Original data input and analysis were using EPI-INFO software package. Results. The result showed that 61.6% (958/1555) of patients had different types of cancer related pain.Majority of pain (85.1%) were caused by advanced cancer. The major reasons (64.4%) for poor management or impedimental factors of pain care are due to patient including over-concern on opioid analgesic addiction, reluc-tance to report pain or refused to use opioid analgesic until at times when pain is intolerable; 26. 8% belonged to physician' s reasons includiag fear to cause addiction on opioid and lack of knowledge about cancer pain management; 16. 2% are due to lack of different kinds of opioid analgesic for use and 16. 1% belonged to drug regulation. Conclusions. The results showed that majority of patients (61.6%) had different types of cancer related pain. In most of patients, cancer pain was relieved when they were treated. The major reason for under-treatmentor impeded factors for effective relief of cancer pain was fear of opioid addiction by both medical professionals andpatients.

  18. NATIONAL SURVEY ON PREVALENCE OF CANCER PAIN

    Institute of Scientific and Technical Information of China (English)

    刘志民; 连智; 周伟华; 穆悦; 吕宪祥; 赵苳; 蔡志基; 曹家琪; 任正洪

    2001-01-01

    Objective. To collect nationwide basic data about cancer related pain.``Methods. Sixty cancer patients in each province were randomly selected to participate in this survey. The subjects represented all stages of cancer, tumor sites, and different demographic characteristics. Two self-designed structured questionnaires including reasons, types of pain and pain management were used by patients and physicians respectively. Subjects were asked to report whether he/she had experienced any type of cancer related pain and filled out the equivalent questionnaire. The severity of pain was assessed by using "visual analogue scale".Original data input and analysis were using EPI-INFO software package.``Results. The result showed that 61.6% (958/1555) of patients had different types of cancer related pain.Majority of pain (85.1%) were caused by advanced cancer. The major reasons (64.4%) for poor management or impedimental factors of pain care are due to patient including over-concern on opioid analgesic addiction, reluctance to report pain or refused to use opioid analgesic until at times when pain is intolerable; 26. 8% belonged to physician' s reasons including fear to cause addiction on opioid and lack of knowledge about cancer pain management; 16. 2% are due to lack of different kinds of opioid analgesic for use and 16. 1% belonged to drug regulation.``Conclusions. The results showed that majority of patients (61.6%) had different types of cancer related pain. In most of patients, cancer pain was relieved when they were treated. The major reason for under-treatment or impeded factors for effective relief of cancer pain was fear of opioid addiction by both medical professionals and patients.

  19. 23. Pain in patients with cancer.

    Science.gov (United States)

    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

  20. Fentanyl transmucosal tablets: current status in the management of cancer-related breakthrough pain

    Directory of Open Access Journals (Sweden)

    Prommer E

    2012-06-01

    Full Text Available Eric Prommer, Brandy FicekDivision of Hematology/Oncology, Mayo Clinic College of Medicine, Mayo Clinic Hospital, Scottsdale, AZ, USAAbstract: Breakthrough pain is a newly recognized pain category that was first described by Portenoy and Hagen in 1990. The term describes pain that increases in intensity to “break through” chronic pain that is being controlled by a scheduled opioid regimen. The development of fluctuations in pain intensity is challenging due to their unpredictable nature, rapid onset, and need for rapid treatment intervention. Breakthrough pain has been treated by using an extra opioid dose in addition to the scheduled opioid being used for pain. Recommendations for dose and frequency are based on expert opinion only, and have included dosing based on a percentage of the total opioid dose. Other recommendations include increasing the regularly scheduled opioid dose. Clinical trials have now focused on delivery of opioids that have both potency and a rapid onset of action. Lipophilic opioids have received a substantial amount of study due to their quick absorption and rapid onset of analgesia. Lipophilic opioids that have been studied to date include transmucosal fentanyl, sublingual fentanyl, intranasal sufentanil, and oral and sublingual methadone. Initial clinical trials have established the superiority of transmucosal fentanyl as a breakthrough analgesic when compared with immediate-release oral opioid formulations. Problems with bioavailability have led to a search for newer formulations of transmucosal delivery. Newer formulations, such as fentanyl transmucosal tablets, have been developed to ensure superior delivery for the patient suffering from breakthrough pain. The purpose of this paper is to discuss the current status of transmucosal tablet formulations for cancer breakthrough pain.Keywords: fentanyl, transmucosal, tablets, pain, breakthrough, cancer

  1. Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients.

    Science.gov (United States)

    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 (ppain 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

  2. Pain Management: Post-Amputation Pain

    Science.gov (United States)

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  3. 末期癌症患儿疼痛管理%Pain management for the child with cancer in end of life care

    Institute of Scientific and Technical Information of China (English)

    王子红; 文彬

    2003-01-01

    Data is clear that many children with cancer at the end of life suffer substantially. Treatment was viewed as successful in only 27% of the patients. Pain in children who are dying of cancer can be complex and challenging to manage. Children and parenta are equal partners with members of the health care team in managing the patient's pain. Prevention and alleviation of pain is a primary goal of care in the child dying of cancer. Children dying of cancer may require aggressive dosing of analgesics. Medications that do not have a dose maximum should be escalated, sometimes rapidly, to achieve adequate pain control or to maintain pain control when tolerance has occurred. The nurse' s role in caring for children who are in pain at the end-of-life includes assessment, identifying expected outcomes, and planning, performing, and evaluating interventions.

  4. Pattern of palliative care, pain management and referral trends in patients receiving radiotherapy at a tertiary cancer center

    Directory of Open Access Journals (Sweden)

    Kuldeep Sharma

    2009-01-01

    Full Text Available Background: Pain is a common primary symptom of advanced cancer and metastatic disease, occurring in 50-75% of all patients. Although palliative care and pain management are essential components in oncology practice, studies show that these areas are often inadequately addressed. Materials and Methods: We randomly selected 152 patients receiving palliative radiotherapy (PRT from October 2006 to August 2008, excluding metastatic bone lesions. Patients′ records were studied retrospectively. Results: A median follow-up of 21 weeks was available for 119 males and 33 females with a median age of 55 years. Maximum (60% patients were of head and neck cancers followed by esophagus (14%, lung (10% and others. Dysphagia, growth/ulcer and pain were the chief indications for PRT. Pain was present in 93 (61% cases out of which, 56 (60% were referred to pain clinic. All except one consulted pain clinic with a median pain score of 8 (0-10 point scale. Fifty-three of these 56 patients (96% received opioid-based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only five (3% cases were referred to a hospice. Twenty-two (14% cases were considered for radical treatment following excellent response to PRT. Conclusion: In this selective sample, the standard of analgesic treatment was found to be satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients′ follow-up needs to be improved along with future studies evaluating those patients who were considered for further RT till radical dose. Programs to change the patients′ attitude towards palliative care, physicians′ (residents′ training to improve communication skills, and institutional policies may be promising strategies.

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

    Science.gov (United States)

    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

  6. Hypnosis for pain management.

    Science.gov (United States)

    Valente, Sharon M

    2006-02-01

    Nurses are in a key position to learn and use hypnosis with patients to reduce pain and enhance self-esteem. However, most nurses lack knowledge about the clinical effectiveness of hypnosis and may seek continuing education to become skilled in its use. Painful procedures, treatments, or diseases remain a major nursing challenge, and nurses need complementary ways to relieve pain from surgery, tumors, injuries, and chemotherapy. This article examines the evidence base related to hypnosis for pain management, as well as how to assess and educate patients about hypnosis. PMID:16526529

  7. Neonatal pain management

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla

    2014-01-01

    Full Text Available The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

  8. Pain and pain management in dermatology.

    Science.gov (United States)

    Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

    2015-10-01

    It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ▸ The fundamentals of the classification and neurophysiology of pain; ▸ Standards for pain documentation in children and adults; ▸ General standards for pharmaceutical pain management; ▸ Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO

  9. Hip fractures and pain following proton therapy for management of prostate cancer

    International Nuclear Information System (INIS)

    Background: Proton therapy (PT) for prostate cancer reduces rectal and bladder dose, but increases dose to the femoral necks. We assessed the risk of hip fracture and pain in men treated with PT for prostate cancer. Material and methods: From 2006 to 2008, 382 men were treated for prostate cancer and evaluated at six-month intervals after PT for toxicities at Univ. of Florida Proton Therapy Institute (UFPTI). The WHO Fracture Risk Assessment Tool (FRAX) generated annual hip-fracture risk for the cohort. The WHO FRAX tool was utilized to generate the expected number of patients with hip fractures and the observed-to-expected ratio; confidence intervals and p-value were generated with the mid-P exact test. Univariate analysis of hip pain as a function of several prognostic factors was accomplished with Fisher's exact test. Results. Median follow-up was four years (range, 0.1-5.5 years). Per FRAX, 3.02 patients were expected to develop a hip fracture without PT. Three PT patients actually developed fractures for a rate of 0.21 fractures per 100 person-years of follow-up. There was an observed-expected ratio of 0.99 (p-value not significant). Forty-eight patients (13%) reported new pain in the hip during follow-up; three required prescription analgesics. Conclusion. PT for prostate cancer did not increase hip-fractures in the first four years after PT compared to expected rates in untreated men

  10. Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms & distress

    OpenAIRE

    Porter, Laura S.; Keefe, Francis J.; Garst, Jennifer; McBride, Colleen M.; Baucom, Donald

    2007-01-01

    This study examined self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their caregivers, and associations between self-efficacy and patient and caregiver adjustment. 152 patients with early stage lung cancer completed measures of self-efficacy, pain, fatigue, quality of life, depression, and anxiety. Their caregivers completed a measure assessing their self-efficacy for helping the patient manage symptoms and measures of psychological distress and caregiv...

  11. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors.

    Science.gov (United States)

    Schreiber, Kristin L; Kehlet, Henrik; Belfer, Inna; Edwards, Robert R

    2014-01-01

    Persistent pain after breast cancer surgery (PPBCS) is increasingly recognized as a potential problem facing a sizeable subset of the millions of women who undergo surgery as part of their treatment of breast cancer. Importantly, an increasing number of studies suggest that individual variation in psychosocial factors such as catastrophizing, anxiety, depression, somatization and sleep quality play an important role in shaping an individual's risk of developing PPBCS. This review presents evidence for the importance of these factors and puts them within the context of other surgical, medical, psychophysical and demographic factors, which may also influence PPBCS risk, as well as discusses potential perioperative therapies to prevent PPBCS. PMID:25494696

  12. Tapentadol in the management of opioid-naïve patients with cancer pain

    Directory of Open Access Journals (Sweden)

    E. López Ramírez

    2016-02-01

    Full Text Available Introduction: Tapentadol is a centrally acting analgesic with two mechanisms of action (μ opioid agonism and norepinephrine reuptake inhibition. Patients and methods: Tapentadol in 53 cancer opioid-naïve patients with chronic and/or acute pain treated with tapentadol in 3 Radiotherapy Departments from October 2011 to February 2013. Results: Patients included 18 women (33.96 % and 35 men (66.04 % aged 28-85 years (mean: 62.7. Treatment was suspended due to death in 16.98 %, improvement in 5.66 %, pruritus in 1.9 % and dizziness in 1.9 %. Treatment was continued in 66.03 %, and doses increased in 26.41 % to achieve analgesia while 7.5 % were switched to another drug. a The most common cancers were head and neck in 32.1 %, lung in 24.5 % and breast in 13.2 %. b Pain was due to: 47.16 % tumor, 18.7 % bone metastases, 13.21 % radiation therapy, 7.55 % benign processes, 7.55 % neuropathic pain and 3.77 % visceral metastases. c Visual Analog Scale pain pre-treatment was 7.2 and post-treatment 3.3 (difference: 3.9 points, while 71.8 % progressed to mild pain (VAS ≤ 4. d The dose most used was: 50 mg (50.9 %. e Associated medications were: none (22.64 %, rapid-onset fentanyl (60.38 %, anticonvulsants (17 %, steroids (17 %, NSAIDs (13.2 %, morphine (5.66 %, anxiolytics (1.9 %, antidepressants (1.9 %, lidocaine 5 % (1.9 % and acupuncture (1.9 %. f Analgesic efficacy was achieved in 94.34 % of cases. Mean analgesia was reached by 58 % of patients and maximum analgesia was 87.5 % in one patient. g Tapentadol was well tolerated with mild side effects (pruritus, constipation and dizziness in 4 cases (10.7 %. Conclusions: Our data support the use of Tapentadol in cancer opioid-naïve patients with moderate-to-severe chronic or acute pain (VAS > 5. Tapentadol is an effective pain reliever with few side effects.

  13. Minimally invasive procedures for the management of vertebral bone pain due to cancer

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pål; Kurita, Geana Paula;

    2016-01-01

    systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according...... evidence favors the use of these procedures in a small select cohort of patients with severe and disabling back pain refractory to medical therapy....... to inclusion and exclusion criteria (low number of patients, retrospective series, proceedings). DISCUSSION: According to the present data a recommendation should be made to perform kiphoplasty in patients with vertebral tumors or metastases. However, the strength of this recommendation was based on...

  14. Optimal pain management for radical prostatectomy surgery

    DEFF Research Database (Denmark)

    Joshi, Grish P; Jaschinski, Thomas; Bonnet, Francis; Kehlet, Henrik

    2015-01-01

    evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally...... invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline.......BACKGROUND: Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains...

  15. Using hypnosis with children for pain management.

    Science.gov (United States)

    Valente, S M

    1991-01-01

    Although nurses are in a strategic position to use hypnosis to manage a child's cancer pain, many lack the knowledge, the skill, or the exposure to the clinical effectiveness of hypnosis. Hypnosis has been a potent analgesic and anesthetic agent for more than 100 years; it reduces a child's cancer pain and the pain associated with painful procedures. Nurses can use hypnosis to help children diminish pain and cope with lumbar punctures (LPs), bone marrow aspirations (BMAs), and nausea or vomiting from chemotherapy. This article's purpose is to discuss myths, contraindications, research, processes, and effectiveness of hypnosis as a strategy for managing the cancer pain of school-age children. Vignettes from the author's clinical practice illustrate concepts and procedures. PMID:2067959

  16. Hip fractures and pain following proton therapy for management of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Valery, Raul; Mendenhall, Nancy P.; Nichols, Romaine C. Jr.; Henderson, Randal; Morris, Christopher G.; Su, Zhong; Li, Zuofeng; Hoppe, Bradford S. [Univ. of Florida Proton Therapy Inst., Univ. of Florida Coll. of Medicine, Jacksonville (United States)], e-mail: bhoppe@floridaproton.org; Mendenhall, William M. [Dept. of Radiation Oncology, Coll. of Medicine, Univ. of Florida, Gainesville (United States); Williams, Christopher R. [Dept. of Surgery, Univ. of Florida Coll. of Medicine, Jacksonville (United States)

    2013-04-15

    Background: Proton therapy (PT) for prostate cancer reduces rectal and bladder dose, but increases dose to the femoral necks. We assessed the risk of hip fracture and pain in men treated with PT for prostate cancer. Material and methods: From 2006 to 2008, 382 men were treated for prostate cancer and evaluated at six-month intervals after PT for toxicities at Univ. of Florida Proton Therapy Institute (UFPTI). The WHO Fracture Risk Assessment Tool (FRAX) generated annual hip-fracture risk for the cohort. The WHO FRAX tool was utilized to generate the expected number of patients with hip fractures and the observed-to-expected ratio; confidence intervals and p-value were generated with the mid-P exact test. Univariate analysis of hip pain as a function of several prognostic factors was accomplished with Fisher's exact test. Results. Median follow-up was four years (range, 0.1-5.5 years). Per FRAX, 3.02 patients were expected to develop a hip fracture without PT. Three PT patients actually developed fractures for a rate of 0.21 fractures per 100 person-years of follow-up. There was an observed-expected ratio of 0.99 (p-value not significant). Forty-eight patients (13%) reported new pain in the hip during follow-up; three required prescription analgesics. Conclusion. PT for prostate cancer did not increase hip-fractures in the first four years after PT compared to expected rates in untreated men.

  17. Gene Therapy: A Potential Approach for Cancer Pain

    OpenAIRE

    Nicholas Boulis; Christina Krudy; Handy, Chalonda R.

    2011-01-01

    Chronic pain is experienced by as many as 9 0 % of cancer patients at some point during the disease. This pain can be directly cancer related or arise from a sensory neuropathy related to chemotherapy. Major pharmacological agents used to treat cancer pain often lack anatomical specificity and can have off-target effects that create new sources of suffering. These concerns establish a need for improved cancer pain management. Gene therapy is emerging as an exciting prospect. This paper discus...

  18. Pain management in photoepilation.

    Science.gov (United States)

    Aimonetti, Jean-Marc; Ribot-Ciscar, Edith

    2016-06-01

    The hair follicle is a complex, hormonally active structure with permanent and cyclically renewed parts which are highly innervated by myelinated and unmyelinated afferent fibers. Hair removal, a very ancient practice, affects this sensory network and causes both acute and diffuse pain associated with inflammatory reaction. Optic permanent hair removal is becoming a popular alternative to traditional methods such as shaving, waxing, among other methods. These optical removal devices thermally destroy the target chromophore, that is, melanin, without damaging the surrounding skin. The increase in the skin surface temperature causes mild-to-severe pain, and optical hair removal has to be combined with pain relieving devices. Pain management relies on topical anesthetic agents, cooling devices, or non-noxious cutaneous stimulation whose mechanisms of action and efficiency are discussed in this article. PMID:26589969

  19. Tapentadol in the management of opioid-naïve patients with cancer pain

    OpenAIRE

    E. López Ramírez; D. M. Muñoz Carmona; J. Contreras Martínez; A. de la Torre-Luque

    2016-01-01

    Introduction: Tapentadol is a centrally acting analgesic with two mechanisms of action (μ opioid agonism and norepinephrine reuptake inhibition). Patients and methods: Tapentadol in 53 cancer opioid-naïve patients with chronic and/or acute pain treated with tapentadol in 3 Radiotherapy Departments from October 2011 to February 2013. Results: Patients included 18 women (33.96 %) and 35 men (66.04 %) aged 28-85 years (mean: 62.7). Treatment was suspended due to death in 16.98 %, improvement in ...

  20. Hypnosis and pain management.

    Science.gov (United States)

    Sharma, Suresh K; Kaur, Jasbir

    2006-06-01

    Nurses have used complementary therapies for many years to relieve anxiety, promote comfort, and reduce or alleviate pain. Physical therapies are most commonly used in our scenario but behavioral approach had been less customary, since familiarity of health personnel is very less (36%) with these techniques (Zaza et al, 1999). Hypnosis is empirically proved best therapy for pain management. Hypnosis is a process involving a hypnotist and a subject who agrees to be hypnotized. Being hypnotized is usually characterized by intense concentration, extreme relaxation and high suggestibility. This paper initially address hypnosis from an historical perspective to give the reader a decent background in which to view current trends in research in the field. Then will explain how hypnosis work followed by the empirical evidences and problems encountered in use of hypnosis when used for pain management. PMID:17058581

  1. Cancer-Related Pain in Older Adults Receiving Palliative Care: Patient and Family Caregiver Perspectives on the Experience of Pain

    OpenAIRE

    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 percepti...

  2. Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer: A Randomized Study.

    Science.gov (United States)

    Kim, So Yeon; Kim, Nam Kyu; Baik, Seung Hyuk; Min, Byung Soh; Hur, Hyuk; Lee, Jinae; Noh, Hyun-Young; Lee, Jong Ho; Koo, Bon-Neyo

    2016-05-01

    There has been a rising interest in the possible association between perioperative opioid use and postoperative outcomes in cancer patients. Continuous surgical wound infiltration with local anesthetics is a nonopioid analgesic technique that can be used as a postoperative pain management alternative to opioid-based intravenous patient-controlled analgesia (IV PCA). The aim of this study was to compare the effects of an opioid-based analgesic regimen versus a local anesthetic wound infiltration-based analgesic regimen on immune modulation and short-term cancer recurrence or metastasis in patients undergoing laparoscopic resection of colorectal cancer.Sixty patients undergoing laparoscopic resection of colorectal cancer were randomly assigned to either the opioid group or the ON-Q group. For postoperative analgesia during the first 48 hours, the opioid group (n = 30) received fentanyl via IV PCA, whereas the ON-Q group (n = 30) received continuous wound infiltration of 0.5% ropivacaine with an ON-Q pump and tramadol via IV PCA. Pethidine for the opioid group and ketorolac or propacetamol for the ON-Q group were used as rescue analgesics. Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome was postoperative immune function assessed by natural killer cell cytotoxicity (NKCC) and interleukin-2. Secondary outcomes were postoperative complications, cancer recurrence, or metastasis within 1 year after surgery, and postoperative inflammatory responses measured by white blood cell count, neutrophil percentage, and C-reactive protein. Immune function and inflammatory responses were measured before surgery and 24 and 48 hours after surgery.Fifty-nine patients completed the study. In the circumstance of similar pain control efficacy between the opioid group and the ON-Q group, postoperative NKCC and interleukin-2 levels did not differ between the 2 groups. The incidence of postoperative complications and recurrence or

  3. Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Anthony J Michaels; Peter V Draganov

    2007-01-01

    Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding.At this time, the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

  4. A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

    Directory of Open Access Journals (Sweden)

    Malone Robert M

    2005-01-01

    Full Text Available Abstract Background Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI, the Center for Epidemiological Studies-Depression Scale scale (CESD and the Pain Disability Index (PDI. Patients were monitored for substance misuse. Results Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73% completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003. The mean PDI score improved to 39.3 (p Conclusions A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.

  5. Breakthrough cancer pain – still a challenge

    Directory of Open Access Journals (Sweden)

    Mañas A

    2012-11-01

    Full Text Available Cesar Margarit,1 Joaquim Juliá,2 Rafael López,3 Antonio Anton,4 Yolanda Escobar,5 Ana Casas,6 Juan Jesús Cruz,7 Rafael Galvez,8 Ana Mañas,9 Francisco Zaragozá101Pain Unit, Alicante University General Hospital, Alicante, Spain; 2Department of Integral Support-Palliative Care, Catalan Institute of Oncology (ICO, Germans Trias i Pujol University Hospital, Badalona, Spain; 3Department of Clinical Oncology, University Hospital Complex, Santiago de Compostela, Spain; 4Department of Clinical Oncology, Miguel Servet Hospital, Zaragoza, Spain; 5Department of Clinical Oncology, Gregorio Marañón Hospital, Madrid, Spain; 6Department of Oncology, Virgen Macarena Hospital, Seville, Spain; 7Department of Clinical Oncology, Salamanca Hospital, Salamanca, Spain; 8Pain and Palliative Care Unit, Virgen de las Nieves Hospital, Granada, Spain; 9Department of Oncology–Radiotherapy, La Paz Hospital, Madrid, Spain; 10Department of Pharmacology, University of Alcalá de Henares, SpainAbstract: Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%. According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing – affording rapid and effective analgesia with the added advantage of being easily administered by

  6. Chronic pain management: nonpharmacological therapies for chronic pain.

    Science.gov (United States)

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials. PMID:25970869

  7. Pain Management Following Spinal Cord Injury

    Science.gov (United States)

    ... makes the pain worse. The pain stems from Pain management usually includes treatment with compression of a nerve ... nerve root pain that is but an effective pain management program can lessen described as a burning feeling ...

  8. Ethical Tensions in the Pain Management of an End-Stage Cancer Patient with Evidence of Opioid Medication Diversion.

    Science.gov (United States)

    Venkat, Arvind; Kim, David

    2016-06-01

    At the end of life, pain management is commonly a fundamental part of the treatment plan for patients where curative measures are no longer possible. However, the increased recognition of opioid diversion for secondary gain coupled with efforts to treat patients in the home environment towards the end of life creates the potential for ethical dilemmas in the palliative care management of terminal patients in need of continuous pain management. We present the case of an end-stage patient with rectal cancer who required a continuous residential narcotic infusion of fentanyl for pain control due to metastatic disease. His functional status was such that he had poor oral intake and ability to perform other activities of daily living, but was able to live at home with health agency nursing care. The patient presented to this institution with a highly suspect history of having lost his fentanyl infusion in a residential accident and asking for a refill to continue home therapy. The treating physicians had concerns of diversion of the infusion medication by caregivers and were reluctant to continue the therapeutic relationship with the patient. This case exemplifies the tension that can exist between wanting to continue with palliative care management of an end-stage patient and the fear of providers when confronted by evidence of potential diversion of opioid analgesic medications. We elucidate how an ethical framework based on a combination of virtue and narrative/relationship theories with reference to proportionality can guide physicians to a pragmatic resolution of these difficult situations. PMID:25381648

  9. Toward freedom from cancer pain in Japan.

    Science.gov (United States)

    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

  10. Pain Management: Part 1: Managing Acute and Postoperative Dental Pain

    Science.gov (United States)

    Becker, Daniel E.

    2010-01-01

    Abstract Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series. PMID:20553137

  11. A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design

    Directory of Open Access Journals (Sweden)

    Gustafsson Markus

    2011-09-01

    Full Text Available Abstract Background Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted. Methods/design A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome, patient perception regarding pain (secondary outcome, together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention. Discussion Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that

  12. Striving to be prepared for the painful: Management strategies following a family member's diagnosis of advanced cancer

    Directory of Open Access Journals (Sweden)

    Hedberg Berith

    2011-10-01

    Full Text Available Abstract Background Cancer has consequences not only for the sick person but also for those who have a close relationship with that person. Greater knowledge about how family members manage the situation in the period immediately following the diagnosis means greater opportunity to provide the best possible support for the family. The purpose of this study was to explore management strategies that family members use when the patient is in the early stage of treatment for advanced cancer. Methods Twenty family members of cancer patients were included in the study shortly after the diagnosis. The patients had been diagnosed 8-14 weeks earlier with advanced lung cancer or gastrointestinal cancer. The data were collected in interviews with family members and subjected to qualitative latent content analysis. Through the identification of similarities and dissimilarities in the units of meaning, abstraction into codes and sub-themes became possible. The sub-themes were then brought together in one overarching theme. Results The overall function of management strategies is expressed in the theme Striving to be prepared for the painful. The family members prepare themselves mentally for the anticipated tragedy. Family relationships become increasingly important, and family members want to spend all their time together. They try to banish thoughts of the impending death and want to live as normal a life as possible. It becomes important to family members to live in the present and save their energy for the time when they will need it the most. How participants handle their worries, anxiety and sadness can be categorized into seven sub-themes or management strategies: Making things easier in everyday life, Banishing thoughts about the approaching loss, Living in the present, Adjusting to the sick person's situation, Distracting oneself by being with others, Shielding the family from grief, and Attempting to maintain hope. Conclusions The findings revealed

  13. Biofield therapies and cancer pain.

    Science.gov (United States)

    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

  14. Evaluation of Evidence-based Nursing Pain Management Practice.

    Science.gov (United States)

    Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

    2015-08-01

    It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

  15. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions of...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...

  16. Transcutaneous electrical nerve stimulation for cancer pain in adults.

    OpenAIRE

    Robb, Karen; Bennett, Michael I.; Johnson, Mark I.; Simpson, Karen H; Oxberry, Stephen G.

    2008-01-01

    Background Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown. Objectives The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. ...

  17. Psychosocial aspects of cancer pain.

    Science.gov (United States)

    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

  18. Pain Management: Part 1: Managing Acute and Postoperative Dental Pain

    OpenAIRE

    Becker, Daniel E

    2010-01-01

    Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pai...

  19. Psychological and behavioural predictors of pain management outcomes in patients with cancer

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring;

    2010-01-01

    Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish version of Medication Adherence Report Scale (DMARS-4). Statistical analysis was performed with SPSS 16.00. The results of the multivariable linear regression analyses showed that pain intensity...

  20. Management of chronic musculoskeletal pain.

    Science.gov (United States)

    Uhl, Richard L; Roberts, Timothy T; Papaliodis, Dean N; Mulligan, Michael T; Dubin, Andrew H

    2014-02-01

    Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain. PMID:24486756

  1. Cancer and treatment related pains in patients with cervical carcinoma

    Directory of Open Access Journals (Sweden)

    Das Saikat

    2005-01-01

    Full Text Available Pain in carcinoma cervix is a multidimensional experience with sensory, affective and cognitive-evaluative components. Many patients do not receive adequate pain management because of a lack of proper assessment, misconceptions regarding the pharmacologic and non pharmacologic methods of pain management and failure to distinguish between different types of pain. In our audit pelvic and nodal recurrence were the commonest cause of pain presenting as as pelvic pain, [42%], lumbosacral plexopathy [40%] and abdominal pain [34%] [n = 30]. Pain on defaecation caused by rectal obstruction, and suprapubic pain due to pyometra can be relieved by colostomy and drainage. Very little literature is available on the pain syndromes associated with carcinoma cervix. The present article is a review of cancer and treatment related pains in carcinoma cervix.

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

    Institute of Scientific and Technical Information of China (English)

    Ping Yang; Li-qiu Sun; Qian lu; Dong Pang; Yue Ding

    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.

  3. Pediatric pain management.

    Science.gov (United States)

    Lederhaas, G

    1997-01-01

    It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

  4. Pain management in veterinary patients

    Directory of Open Access Journals (Sweden)

    H. S. Vedpathak

    Full Text Available The veterinary practitioner has an ethical obligation to help alleviate animal pain. Although most veterinarians accept the fact that animals feel pain, still, postoperative pain relief is not a routine practice in all veterinary hospitals and clinics today. Nociception is a physiological process which involves transduction, transmission, modulation and perception of the noxious stimuli. Chemical mediators are important components of the nociceptive reflex and offer a target of pharmacologic modulation. Assessment of pain in animals is the most important step in the successful management of pain. Choosing appropriate method of pain control would depend upon the type of procedure followed, severity of pain and economic considerations for each individual circumstance. Our understanding of the pain in its manifestation, mechanisms, assessment and alleviation in animals is still although improving, limited. [Vet World 2009; 2(9.000: 360-363

  5. Hepatitis C: Managing Pain

    Science.gov (United States)

    ... using visualization techniques to change your focus from pain to something else self-hypnosis--a way of teaching your body to relax biofeedback--using a machine to measure how much certain muscles are tensed, and ... chronic or intermittent pain is very difficult. What's more, chronic pain often ...

  6. Controversies in cancer pain. Medical perspectives.

    Science.gov (United States)

    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

  7. Does pain acceptance predict physical and psychological outcomes in cancer outpatients with pain?

    Directory of Open Access Journals (Sweden)

    Evangelia Protopapa

    2013-09-01

    Full Text Available Background: Pain and psychological distress frequently co-exist in cancer patients. Pain acceptance has been associated with improved physical and psychosocial well-being in chronic non-malignant pain patients, however its effects are unclear in cancer outpatients with pain. Methods: The sample consisted of 116 outpatients recruited from a tertiary oncology centre, with various types of cancer and pain levels. To assess patients, we used the Brief Pain Inventory, the Hospital Anxiety and Depression Scale and the Chronic Pain Acceptance Questionnaire comprising of: Activity engagement and Pain willingness. The extent to which acceptance predicts physical and psychological outcomes was investigated using multiple regression analyses. Results: Adjusting for patient characteristics and outcomes, activity engagement and pain willingness significantly predicted pain interference with function (p=.033 and p=.041 respectively. However, only the activity engagement predicted anxiety (p=.001 and depression (p<.001. Conclusion: Components of pain acceptance predicted patient functional outcomes. Activity engagement in particular, shows promise in predicting psychological well-being. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain, and whether it should be included in cancer pain management interventions.

  8. Bone pain induced by metastatic cancer: pathophysiology and treatment

    International Nuclear Information System (INIS)

    Cancer patients who develop bone metastases are an estimated 60 to 84% . Of these 79% experienced pain syndromes are difficult to manage, of which 50% die without adequate pain relief and with a poor quality of life. Therefore, it is necessary to have accessible and effective medications for the management of this condition. The pathophysiology of pain in bone is reviewed and the drugs used most frequently in the management of this type of cancer pain are described. Furthermore an algorithm of 6 steps is presented and can guide the physician when making a therapeutic decision. (author)

  9. Testing an intervention designed to support pain self-management in cancer patients: a mixed methods study : a mixed methods study

    OpenAIRE

    Koller, Antje

    2012-01-01

    Cancer is the second most frequent cause of death in Germany1. Patients with cancer experience multiple symptoms throughout the different stages of their illness, with pain as one of the most frequent symptoms. Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"2. Cancer pain can occur at any time but the incidence increases over the course of the illness. Cancer pain managem...

  10. Postoperative pain and its management

    Directory of Open Access Journals (Sweden)

    Chaturvedi Sona

    2007-01-01

    Full Text Available Postoperative pain is both distressing and detrimental for the patient. The management of postoperative pain involves assessment of the pain in terms of intensity at rest and activity associated pain, treatment by pharmacological and non pharmacological means as well as monitoring induced side-effects. Besides being physically and emotionally disabling, the pain is associated with various physiological effects involving the increased perioperative stress response. The pain causes the patient to remain immobile, thus becoming vulnerable to DVT, pulmonary atelectasis, muscle wasting and urinary retention. Poor control of postoperative pain could be due to various reasons which may include uniformed prescribing without taking into consideration the individual patient′s physical status, the surgery that has been performed or the site and intensity of pain. Besides, the poor compliance of orders in administrating the analgesics prescribed and the fact that optimal pain relief is not aimed for may also contribute to the inadequate management of the pain occurring in the postoperative period. Thus, despite all efforts, there continues to be inadequate pain relief in a large majority of patients. The introduction of multimodal analgesia including opioids and non-opioids, delivered through various routes, neuraxial use of local anesthetics, either alone or in combination with other drugs, nerve blocks, antihyperalgesics and techniques such as patient controlled analgesia and pre-emptive analgesia have greatly improved the efficacy of pain-control while minimizing the side-effects of any one modality. The recent recommendation of planning the pain services in an organized manner and implementation of Acute Pain Services (APS has proven to be beneficial and rewarding.

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

    Science.gov (United States)

    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

  12. Can cancer influence the pain agenda in Oncology Outpatient Consultations?

    OpenAIRE

    Rogers, MS. Tood, C.

    2010-01-01

    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 ...

  13. [Pain management and music therapy].

    Science.gov (United States)

    Hoareau, Sophie Gwenaelle; De Diego, Emmanuelle; Guétin, Stéphane

    2016-01-01

    The benefit of music in the treatment of pain is now recognised. The U sequence is a music therapy technique specifically developed for this purpose. It improves the overall management of pain and facilitates patient support. Its standardised use by caregivers has been made possible thanks to the development of a digital application. PMID:26743370

  14. Use of Opiates to Manage Pain in the Seriously and Terminally Ill Patient

    Science.gov (United States)

    ... clinical guidelines for the management of pain were consistently followed, serious pain would be controlled acceptably 80-90% of the time. Yet pain remains under-treated. Studies have shown that among those suffering with cancer, ...

  15. Pain management in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Cathia Gachago; Peter V Draganov

    2008-01-01

    Abdominal pain is a major clinical problem in patients with chronic pancreatitis.The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and,therefore,a rigid standardized approach for pain control tends to lead to suboptimal results.Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations,low fat diet,alcohol and smoking cessation are encouraged.Analgesics alone are needed in almost all patients.Maneuvers aimed at suppression of pancreatic secretion are routinely tried.Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy,and resective or drainage surgery.The role of pain modifying agents (antidepressants,gabapentin,peregabalin),celiac plexus block,antioxidants,octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.

  16. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  17. Identifying MRI markers to evaluate early treatment-related changes post-laser ablation for cancer pain management

    Science.gov (United States)

    Tiwari, Pallavi; Danish, Shabbar; Madabhushi, Anant

    2014-03-01

    Laser interstitial thermal therapy (LITT) has recently emerged as a new treatment modality for cancer pain management that targets the cingulum (pain center in the brain), and has shown promise over radio-frequency (RF) based ablation which is reported to provide temporary relief. One of the major advantages enjoyed by LITT is its compatibility with magnetic resonance imaging (MRI), allowing for high resolution in vivo imaging to be used in LITT procedures. Since laser ablation for pain management is currently exploratory and is only performed at a few centers worldwide, its short-, and long-term effects on the cingulum are currently unknown. Traditionally treatment effects are evaluated by monitoring changes in volume of the ablation zone post-treatment. However, this is sub-optimal since it involves evaluating a single global parameter (volume) to detect changes pre-, and post-MRI. Additionally, the qualitative observations of LITT-related changes on multi-parametric MRI (MPMRI) do not specifically address differentiation between the appearance of treatment related changes (edema, necrosis) from recurrence of the disease (pain recurrence). In this work, we explore the utility of computer extracted texture descriptors on MP-MRI to capture early treatment related changes on a per-voxel basis by extracting quantitative relationships that may allow for an in-depth understanding of tissue response to LITT on MRI, subtle changes that may not be appreciable on original MR intensities. The second objective of this work is to investigate the efficacy of different MRI protocols in accurately capturing treatment related changes within and outside the ablation zone post-LITT. A retrospective cohort of studies comprising pre- and 24-hour post-LITT 3 Tesla T1-weighted (T1w), T2w, T2-GRE, and T2-FLAIR acquisitions was considered. Our scheme involved (1) inter-protocol as well as inter-acquisition affine registration of pre- and post-LITT MRI, (2) quantitation of MRI parameters

  18. Neuropathic pain management in children.

    LENUS (Irish Health Repository)

    Hyde, Catherine

    2012-10-01

    There are difficulties in assessing, managing, and evaluating neuropathic pain in dying children, particularly those with neurological impairment. Neuropathic pain in children often presents differently to how it presents in the adult population. Comprehensive assessment as well as pharmacological and non-pharmacological interventions are crucial to its successful management and frequently require input from an interdisciplinary team. Notwithstanding the need for further research, this paper brings together research papers, reviews, and clinical guidelines to present an exploration of existing evidence regarding care for children with neuropathic pain and their families.

  19. Acupuncture for cancer-induced bone pain?

    OpenAIRE

    Mark I Johnson; Bennett, Michael I; Paley, Carole A.

    2011-01-01

    Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing...

  20. Reducing Patient Barriers to Pain and Fatigue Management

    OpenAIRE

    Borneman, Tami; Koczywas, Marianna; Sun, Virginia; Piper, Barbara F.; Uman, Gwen; Ferrell, Betty

    2010-01-01

    Pain and fatigue are recognized as critical symptoms that impact quality of life (QOL) for cancer patients. The barriers to pain and fatigue relief have been classified into three categories: patient, professional and system barriers. The overall objective of this trial is to test the effects of the “Passport to Comfort” intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients. This intervention demonstrates innovation by translating the evidence-ba...

  1. Exposure to Fentanyl After Transdermal Patch Administration for Cancer Pain Management.

    Science.gov (United States)

    Bista, Sudeep R; Haywood, Alison; Hardy, Janet; Norris, Ross; Hennig, Stefanie

    2016-06-01

    This study aimed to describe exposure after fentanyl transdermal patch administration in patients with advanced cancer to quantify variability around the exposure. Patients (n  =  56) with advanced cancer who received transdermal fentanyl (Durogesic®; median dose, 50 μg/h; range, 12-200 μg/h) provided venous blood samples (n  =  163) at various times (0.5-72 hours) during several patch application intervals. Plasma fentanyl concentration was determined (median, 0.9 μg/L; range, 0.04-9.7 μg/L) by high-performance liquid chromatography coupled to tandem mass spectrometry. Pharmacokinetic analysis was performed using nonlinear mixed-effects modeling with NONMEM. A 1-compartment distribution model with first-order absorption and elimination described fentanyl exposure after transdermal patch administration. Fentanyl apparent clearance (between-subject variability [BSV], %) was estimated at 122 L/h/70 kg and 38.5%, respectively. The absorption rate constant was 0.013 h(-1) . Between-occasion variability on apparent clearance was 22.0%, which was lower than BSV, suggesting predictable exposure within the same patient and justifying therapeutic drug monitoring. Except for weight-based dosing, no other patient characteristic could be identified to guide initial fentanyl dose selection in patients with advanced cancer. PMID:26381285

  2. Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: Case studies and possible benefits.

    Science.gov (United States)

    Elkins, Gary; White, Joseph; Patel, Parita; Marcus, Joel; Perfect, Michelle M; Montgomery, Guy H

    2006-10-01

    This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients' levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time. PMID:16950684

  3. Intravenous paracetamol infusion: Superior pain management and earlier discharge from hospital in patients undergoing palliative head-neck cancer surgery

    Science.gov (United States)

    Majumdar, Saikat; Das, Anjan; Kundu, Ratul; Mukherjee, Dipankar; Hazra, Bimal; Mitra, Tapobrata

    2014-01-01

    Background: Paracetamol; a cyclooxygenase inhibitor; acts through the central nervous system as well as serotoninergic system as a nonopioid analgesic. A prospective, double-blinded, and randomized-controlled study was carried out to compare the efficacy of preoperative 1g intravenous (iv) paracetamol with placebo in providing postoperative analgesia in head-neck cancer surgery. Materials and Methods: From 2008 February to 2009 December, 80 patients for palliative head-neck cancer surgery were randomly divided into (F) and (P) Group receiving ivplacebo and iv paracetamol, respectively, 5 min before induction. Everybody received fentanyl before induction and IM diclofenac for pain relief at8 hourly for 24 h after surgery. Visual analogue scale (VAS) and amount of fentanyl were measured for postoperative pain assessment (24 h). Results and Statistical analysis: The mean VAS score in 1st, 2nd postoperative hour, and fentanyl requirement was less and the need for rescue analgesic was delayed in ivparacetamol group which were all statistically significant. Paracetamol group had a shorter surgical intensive care unit (SICU) and hospital stay which was also statistically significant. Conclusion: The study demonstrates the effectiveness of ivparacetamol as preemptive analgesic in the postoperative pain control after head-neck cancer surgery and earlier discharge from hospital. PMID:25276627

  4. Pain Management Programs

    Science.gov (United States)

    ... person with pain become part of the treatment team and take an active role in regaining control of his or her life ... program is ongoing and the responsibility of all team members Monitoring of ... and performance is provided to you, caregivers, significant others, and ...

  5. Orofacial pain management: current perspectives.

    Science.gov (United States)

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  6. Radiotherapy for pain management of bone metastases

    International Nuclear Information System (INIS)

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  7. Radiotherapy for pain management of bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: rezende.med@terra.com.br [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)

    2011-07-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  8. Evaluation of Evidence-Based Nursing Pain Management Practice

    Science.gov (United States)

    Song, Wenjia; Eaton, Linda H.; Gordon, Debra B.; Hoyle, Christine; Doorenbos, Ardith Z.

    2014-01-01

    Background It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. Aims This study aimed to (a) modify and test an evaluation tool for nursing cancer pain documentation, and (b) describe the frequency and quality of nursing pain documentation in one oncology unit via electronic medical system. Design and Setting A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Methods Medical records were examined for 37 adults hospitalized during April and May of 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. Results The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. Conclusions The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

  9. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    Science.gov (United States)

    Lalonde, Lyne; Choinière, Manon; Martin, Elisabeth; Lévesque, Lise; Hudon, Eveline; Bélanger, Danielle; Perreault, Sylvie; Lacasse, Anaïs; Laliberté, Marie-Claude

    2015-01-01

    Purpose There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. Results Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. PMID:25995648

  10. Managing chronic pain in family practice.

    OpenAIRE

    Librach, S. L.

    1993-01-01

    Pain is common in family practice. In dealing with chronic pain, both the family physician and the patient often have problems in defining and in understanding the origin of chronic pain and in providing effective pain relief. This article explores a practical, holistic approach to understanding and managing chronic pain.

  11. Treatment of Cancer Pain by Targeting Cytokines

    OpenAIRE

    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 relate...

  12. Pain and the ethics of pain management.

    Science.gov (United States)

    Edwards, R B

    1984-01-01

    In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192

  13. Nurses' attitudes towards management of pain.

    Science.gov (United States)

    Lloyd, G; McLauchlan, A

    This research was carried out to discover nurses' attitudes towards and perceptions of post-operative pain management; knowledge of pain assessment; awareness of different methods of pain relief; and view of the necessity for education in post-operative pain management. The major findings of the research correlated with the authors' observations while undertaking audit. That is, that there is a need for conformity of pain assessment and pain scoring. It also showed a need for a focused education programme in postoperative pain management. PMID:7984461

  14. Research progress of pain self management intervention in advanced cancer patients%晚期癌症患者疼痛自我管理干预的研究进展

    Institute of Scientific and Technical Information of China (English)

    李玉香; 白彩锋; 赵继军

    2012-01-01

    疼痛是晚期癌症患者最常见和最难忍受的症状之一.自我管理干预对于晚期癌症患者的疼痛及其相关症状管理具有非常重要的意义.本文通过对自我管理的概念、理论基础的阐述和癌痛自我管理干预应用效果的研究,指出癌痛患者自我管理干预研究设计应更加关注个体化的需求和健康结局的改善,并以期为其在癌痛控制中的应用提供参考依据.%Pain is one of the most common and intolerable symptoms in patient with advanced cancer. Self management intervention is considered significantly benefit, to the management of pain and its related symptoms in patient with advanced cancer. This article pointes out that study design of self management intervention in patients with cancer pain needs pay more attention to improve individualized demand and health outcome, through clarifying definition and theory of self-management, and studying the application effects of self management intervention in patients with cancer pain, in order to provide helpful basis for control of cancer pain.

  15. Nursing approaches in the postoperative pain management

    OpenAIRE

    Yüceer, Sevilay

    2011-01-01

    Patients frequently experience moderate to severe pain in the postoperative period. Although the pain management is an integral and important part of the nursing care, studies suggest that, nursing management of postoperative pain remains inadequate. Postoperative care nurses are responsible to assess the patient's pain, teach the patient strategies to deal with the pain, apply the analgesic treatment plan, monitor the results of treatment, educate the patient and the family on pa...

  16. Evidence of peripheral nerve blocks for cancer-related pain

    DEFF Research Database (Denmark)

    Klepstad, P; Kurita, G P; Mercadante, S; Sjøgren, P

    2015-01-01

    The European Association for Palliative Care has initiated a comprehensive program to achieve an over-all review of the evidence of multiple cancer pain management strategies in order to extend the current guideline for treatment of cancer pain. The present systematic review analyzed the existing...... good pain relief and no side effects. The use of peripheral blocks is based upon anecdotal evidence. However, this review only demonstrates the lack of studies, which does not equal a lack of effectiveness....... evidence of analgesic efficacy for peripheral nerve blocks in adult patients with cancer. A search strategy was elaborated with words related to cancer, pain, peripheral nerve and block. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. The number of abstracts...

  17. Opioid-prescribing practices in chronic cancer pain in a tertiary care pain clinic

    Directory of Open Access Journals (Sweden)

    Raghu S Thota

    2011-01-01

    Full Text Available Introduction: Under treatment of pain is a recognized global issue. Opioid analgesic medication is the mainstay of treatment in cancer patients as per the World Health Organization (WHO pain relief ladder, yet 50% of cancer patients worldwide do not receive adequate pain relief or are undertreated. Aim: The aim of this study was to audit the ongoing opioid-prescribing practices in our tertiary cancer pain clinic during January-June 2010. Materials& Methods: The prescribed type of opioid, dose, dosing interval, and laxatives details were analyzed. Results: Five hundred pain files were reviewed and 435 were found complete for audit. Three hundred forty-eight (80% patients were prescribed opioids. Two hundred fifty-nine (74.4% received weak opioids while 118 (33.9% received strong opioids. A total of 195 (45% patients had moderate and 184 (42% had severe pain. Ninety-three (26.7% patients received morphine; however, only 31.5% (58 of 184 in severe pain received morphine as per the WHO pain ladder. Only 73 of 93 (78.4% patients received an adequate dose of morphine with an adequate dosing interval and only 27 (29% were prescribed laxatives with morphine. Conclusion: This study shows that the under treatment of pain and under dosing of opioids coupled with improper side effect management are major issues.

  18. Morphine and oxycodone in the management of cancer pain: plasma levels determined by chemical and radioreceptor assays.

    Science.gov (United States)

    Kalso, E; Vainio, A; Mattila, M J; Rosenberg, P H; Seppälä, T

    1990-10-01

    Morphine and oxycodone were administered to ten patients suffering from severe cancer pain in a double-blind cross-over study. The patients titrated themselves pain-free, first intravenously, using a patient-controlled analgesia device, and then orally. Each titration phase lasted for 48 hours. Blood samples were drawn after 36 hr of each administration phase. The plasma levels of morphine, morphine-6- and morphine-3 glucoronides were determined with high performance liquid chromatography (HPLC), whereas the oxycodone samples were assayed with gas chromatography (GC). Twin samples were analyzed for plasma opioid activity with a radioreceptor assay (RRA) using 3H-dihydromorphine and 3H-naloxone as radioligands. Adequate analgesia was achieved with both morphine and oxycodone. About 30% more oxycodone was needed intravenously, whereas 25% less oxycodone than morphine was consumed orally. There was a good linear correlation between the morphine concentrations measured with HPLC and RRA. The mean morphine-6-glucuronide to morphine concentration ratio was 2.3 after intravenous and 4.6 after oral administration. Results from RRA indicate that oxycodone in vivo is a potent mu-agonist and that at least part of its analgesic action is mediated by active metabolites. In vitro morphine glucuronides enhanced morphine in displacing radioligands from the opioid receptors, thus suggesting their complex interactions in vivo. PMID:2077525

  19. Pressure pain sensitivity as a marker for stress and pressure pain sensitivity-guided stress management in women with primary breast cancer

    DEFF Research Database (Denmark)

    Axelsson, Christen K; Ballegaard, Søren; Karpatschof, Benny;

    2014-01-01

    employees was divided in a High Stress Group (HSG, n = 37) and a Low Stress Group (LSG, n = 128) to evaluate the association between PPS, questionnaire-related Quality of Life (QOL) and self-evaluated stress. (2) A PPS-guided stress management program (n = 40) was compared to a Psychosocial Group...... scores: (all p < 0.05). Between BC, HSG and LSG there was a significant and positive correlation with respect to PPS, SF 36 main scores, depression, and clinical stress scores (all p < 0.05). However, the BC group scored significantly lower than both HSG and LSG (both p < 0.05) with respect to self-evaluated...... stress. (2) The PPS-guided intervention group improved EORTC main score, pain and nausea, when compared to the control groups (all p < 0.05). CONCLUSIONS: PPS was positively associated with QOL, which was in contrast to self-evaluated stress. PPS-guided intervention improved QOL in women with breast...

  20. [Clonidine in the treatment of cancer pain

    DEFF Research Database (Denmark)

    Nielsen, Jonas Bøje; Sjøgren, Per

    2008-01-01

    Clonidine is an alpha2-adrenergic agonist with analgetic properties. Due to its side-effects, the drug is administered via the epidural or spinal route. A literature search yielded nine controlled studies on clonidine as a supplemental drug in the epidural or spinal treatment of cancer pain. These...... studies were systematically reviewed to evaluate the evidence of efficacy in patients with cancer pain. CONCLUSION: Despite weak evidence, clonidine may be a useful adjunct in epidural or spinal morphine therapy of cancer pain Udgivelsesdato: 2008/11/3...

  1. Acupuncture for Cancer-Induced Bone Pain?

    Directory of Open Access Journals (Sweden)

    Carole A. Paley

    2011-01-01

    Full Text Available Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing strategies for pain relief and it is known to be relatively free of harmful side-effects. Although acupuncture is used in palliative care settings for all types of cancer pain the evidence-base is sparse and inconclusive and there is very little evidence to show its effectiveness in relieving cancer-induced bone pain (CIBP. The aim of this critical review is to consider the known physiological effects of acupuncture and discuss these in the context of the pathophysiology of malignant bone pain. The aim of future research should be to produce an effective protocol for treating CIBP with acupuncture based on a sound, evidence-based rationale. The physiological mechanisms presented in this review suggest that this is a realistic objective.

  2. Pain Control In Cancer Patients By Opiate Use

    Directory of Open Access Journals (Sweden)

    Mohagheghi M A

    2003-07-01

    Full Text Available Opioids are increasingly being recognized as the primary treatment for cancer pain management. Optimal treatment of cancer pain involves assessing its characteristics, considering different management strategies, evaluating side effects and adverse drug reactions and establishing the most appropriate therapeutic regimen. This study was designed to review the current status of pain management for advanced cancer cases using opioid analgesics."nMaterials and Methods: A questionnaire was used to collect data on demographics, disease characteristics, and opioids use indicators in 700 cases of advanced cancer patients."nResults: A total of 700 cancer cases, 42 percent females and 58 percent males, between 17-80 years age range (Mean age of 57.25 were studied retrospectively. Cancers of breast (21 percent, colorectal (12 percent, lung (7 percent, stomach (7 percent and bone either primary or metastatic (6 percent in women and stomach (17 percent, lung (12 percent, colorectal (11 percent, prostate (9 percent , and bone (8 percent in men were the most common causes of opioids prescription in study group respectively. Advanced primary cancer (in 52 percent, bone metastasis (in 32 percent, and treatment complications (in 7 percent were considered as physical basis for pain in patients. Morphine (by injection, Opium (by oral intake and methadone (injection and/or oral were the most common opioids prescribed. Using equianalgesic conversion chart, the daily dosages and therapeutics schedules of morphine administration were as follows:"n43 percent received 21-30 mg. in 2-4 divided doses"n27 percent received >30 mg. in 3-5 divided doses"n21 percent received 11-20 mg. in 2-3 divided doses"n9 percent received 5-10 mg. in 1-2 divided doses"nConclusion: Pain management of cancer patients is not adequate and opioid use is not rational. New educational and managerial strategies are needed to optimize cancer pain treatment in routine medical practice. To overcome

  3. Opioids, adjuvants, and interventional options for pain management of symptomatic metastases.

    Science.gov (United States)

    Ghosh, Amrita; Berger, Ann

    2014-07-01

    Cancer pain is a complex issue that unfortunately affects a majority of cancer patients, the assessment and treatment of which are equally essential in alleviating many facets of this pain. The objective of this section is to address the many facets of cancer pain: its assessment, management, and its varied treatment modalities. We will discuss characteristics of pain, essential aspects of the patient interview, and management using opioids, adjuvants, and interventional and invasive strategies as well as side effects of these techniques. Many of these modalities are used for palliation but may and should be used in cancer patients who experience side effects from both their cancer and their chemotherapeutics. PMID:25841694

  4. Neuropathic pain in the cancer patient.

    Science.gov (United States)

    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

  5. Pain Management and the Amputee

    Science.gov (United States)

    ... have very individual beliefs about pain and its meaning. When you have severe pain, it may be ... trapped by other tissue, such as muscle. In contrast, phantom pain is thought to originate in the ...

  6. The role of opioids in cancer pain

    OpenAIRE

    Quigley, Columba

    2005-01-01

    Columba Quigley, as a specialist in palliative medicine, works in a hospital based support team. She also works with a community based palliative care team and in a hospice, where patients are admitted for terminal care, respite, and control of symptoms. Pain occurs often in patients with cancer, particularly those with advanced disease. In addition, pain is one of the most feared symptoms in people with a diagnosis of cancer. Using analgesics (particularly opioids) appropriately effectively ...

  7. Código de buena práctica para el control del dolor oncológico Good practice code for the management of cancer pain

    Directory of Open Access Journals (Sweden)

    J. R. González-Escalada

    2011-04-01

    Full Text Available En muchas ocasiones, los pacientes con cáncer no expresan su dolor por miedo a que el médico desvíe su atención hacia este síntoma, en lugar de centrarse en el tratamiento de su enfermedad principal. No obstante, el paciente debe saber que el tratamiento de su dolor no solo no interfiere con la terapia curativa, sino que colabora con ella. Entre los enfermos, es habitual el temor a que el avance de la enfermedad les lleve a situaciones de sufrimiento insostenible que supere todas las posibilidades médicas, pero es nuestro deber ayudarles a ser conscientes de que la medicina ofrece un abanico de terapias capaces de aliviar su dolor y evitar su sufrimiento. Este conocimiento es esencial para aumentar su confianza en el tratamiento y mejorar la relación médico-paciente. Frente a este desafío, SECPAL (Sociedad Española de Cuidados Paliativos, SED (Sociedad Española del Dolor, SEOM (Sociedad Española de Oncología Médica y SEOR (Sociedad Española de Oncología Radioterápica unen sus esfuerzos y crean ALIADO (Alianza Contra el Dolor Oncológico, un grupo de trabajo interdisciplinario que nace con el objetivo de concienciar e implicar a todo el colectivo médico en la necesidad de mejorar la calidad de vida del paciente con dolor oncológico. La primera iniciativa de ALIADO en este sentido es la elaboración del Código de buena praxis para el tratamiento del dolor oncológico, que pretende contribuir al avance en el conocimiento y el manejo de estos pacientes.Patients with cancer often fail to talk about their pain fearing that their doctor might draw his or her attention to that symptom rather than focus on the management of their underlying disease. However, patients should know that pain management will not interfere with their curative therapy but will supplement it. Fear that the advancing disease will lead to unbearable suffering situations beyond medical possibilities is common among patients, and it is our duty to help them

  8. Jordanian patients' satisfaction with pain management.

    Science.gov (United States)

    Darawad, Muhammad W; Al-Hussami, Mahmoud; Saleh, Ali M; Al-Sutari, Manal

    2014-03-01

    Pain is still undertreated among hospitalized patients. Recently, patient satisfaction with pain management has received significant attention. This field has not yet been explored among Jordanian patients. The purpose of this study was to determine the knowledge regarding pain characteristics, beliefs, and satisfaction that can be included in planning pain management strategies and protocols within Jordanian hospitals. Using descriptive cross-sectional methodology, the American Pain Society Patient Outcome Questionnaire (APS-POQ) was used to survey 375 inpatients from Jordanian hospitals. Participants reported relatively severe pain and pain interferences while being hospitalized and seemed to be well informed regarding pain and pain management. Participants reported high levels of pain management satisfaction. Also, the Arabic version of the APS-POQ was found to be reliable among the Jordanian population. Findings of this study are similar to those reported by earlier studies in other countries and support the need for applying the caring attitude in managing patients' reports of having pain. This study is the first in Jordan, opening the door for future studies to be conducted in this important field. PMID:23273825

  9. Pharmacological pain management in the elderly patient

    Directory of Open Access Journals (Sweden)

    Gary McCleane

    2007-01-01

    Full Text Available Gary McCleaneRampark Pain Centre, Lurgan, Northern Ireland, United KingdomAbstract: With the increasing number of elderly patients the issue of pain management for older people is of increasing relevance. The alterations with aging of the neurobiology of pain have impacts of pain threshold, tolerance and treatment. In this review the available evidence from animal and human experimentation is discussed to highlight the differences between young and older subjects along with consideration of how these changes have practical effect on drug treatment of pain. Cognitive impairment, physical disability and social isolation can also impact on the accessibility of treatment and have to be considered along with the biological changes with ageing. Conventional pain therapies, while verified in younger adults cannot be automatically applied to the elderly without consideration of all these factors and in no other group of patients is a holistic approach to treatment more important.Keywords: pain, analgesia, pain threshold, pain tolerance

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

    Science.gov (United States)

    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)

  11. Pain management in patients with vascular disease.

    Science.gov (United States)

    Seretny, M; Colvin, L A

    2016-09-01

    Vascular disease covers a wide range of conditions, including arterial, venous, and lymphatic disorders, with many of these being more common in the elderly. As the population ages, the incidence of vascular disease will increase, with a consequent increase in the requirement to manage both acute and chronic pain in this patient population. Pain management can be complex, as there are often multiple co-morbidities to be considered. An understanding of the underlying pain mechanisms is helpful in the logical direction of treatment, particularly in chronic pain states, such as phantom limb pain or complex regional pain syndrome. Acute pain management for vascular surgery presents a number of challenges, including coexisting anticoagulant medication, that may preclude the use of regional techniques. Within the limited evidence base, there is a suggestion that epidural analgesia provides better pain relief and reduced respiratory complications after major vascular surgery. For carotid endarterectomy, there is again some evidence supporting the use of local anaesthetic analgesia, either by infiltration or by superficial cervical plexus block. Chronic pain in vascular disease includes post-amputation pain, for which well-known risk factors include high pain levels before amputation and in the immediate postoperative period, emphasizing the importance of good pain control in the perioperative period. Complex regional pain syndrome is another challenging chronic pain syndrome with a wide variety of treatment options available, with the strongest evidence being for physical therapies. Further research is required to gain a better understanding of the underlying pathophysiological mechanisms in pain associated with vascular disease and the best analgesic approaches to manage it. PMID:27566812

  12. Pain management in pediatric age group

    Directory of Open Access Journals (Sweden)

    R Namrata

    2009-01-01

    Full Text Available The management of pain in palliative care of children is somewhat different from that in adults.The use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of opioids, illustrated by WHO Guidelines is essential for adequate management of pain in children with life limiting conditions.

  13. Pain management instruction in nursing curricula.

    Science.gov (United States)

    Zalon, M L

    1995-09-01

    The persistent problem of inadequate assessment of pain, undermedication for pain by nurses, and reports of nurses themselves that they are unprepared to manage various types of pain provided direction for this study. The purpose was to investigate time allocated to pain content, the nature of the theoretical content and clinical experiences in nursing curricula, and faculty satisfaction with their graduates' preparation for pain management in baccalaureate and associate degree programs. The 80% response rate included 177 associate degree and 174 baccalaureate nursing programs. No significant differences between associate degree and baccalaureate programs for the amount of time allocated to pain content, pharmacological management of pain and nonpharmacological pain relief methods were found. Nonpharmacological methods are introduced to students, but most programs do not provide in-depth instruction. The majority of respondents indicated they were satisfied with their graduates' preparation for pain management, but less satisfied with the amount of time allocated to pain content in the curriculum. Implications for education and research are discussed. PMID:7472637

  14. Pain management in critically ill obese patients.

    Science.gov (United States)

    Astle, Sonia M

    2009-09-01

    Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient. PMID:19840712

  15. Management of a blind painful eye.

    Science.gov (United States)

    Merbs, Shannath L

    2006-06-01

    Debilitating ocular pain poses a significant challenge to the ophthalmologist. When the pain is intractable and the eye has very poor vision and is disfigured, surgical removal of the eye has traditionally been the definitive treatment of choice. Because many people are uncomfortable psychologically with removal of their eye, however painful, and other patients are not good surgical candidates, an alternative to enucleation is sometimes warranted, and injection of a neurolytic substance can often induce long-lasting anesthesia for a blind painful eye. This article reviews a range of options for management of blind painful eye from anesthesia to enucleation. PMID:16701166

  16. A survey of advanced medical students' knowledge towards cancer pain management%高年级临床医学生癌症疼痛治疗知识认知现况调查

    Institute of Scientific and Technical Information of China (English)

    Yi Cheng; Shiying Yu

    2012-01-01

    Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced medical students'cognitive level towards cancer pain management. Methods: Randomly selected the respondents from a medical school in Wuhan, China. The educational background of the respondents should belong to one of these conditions: (1) clinical master degree candidate; (2) clinical doctor degree candidate; (3) the sixth or seventh year of clinical medicine for seven years. The respondents should also spend more than one year on internship. The self-developed questionnaire papers were distributed to respondents in the unit of dorms selected randomly and recovered them immediately after they're finished. The categorical data were expressed at the form of frequency (rate or constituent ratio). Chi-square test was required only as needed.Results: The survey was anonymous. We distributed 300 papers, recovered 300 papers and weeded out 8 invalid papers.Finally there were 292 valid papers, and the valid recovery rate was 97.3%. The 96.7% of oncological medical students and 47.6% non-oncological medical students relied on patients' description for cancer pain assessments; 90.0% of oncological medical students and 53.0% of non-oncological medical students prescribed strong opioid drugs firstly for patients suffering severe cancer pain; only 24.1% of non-oncological medical students recognized that pethidine was not safe and effective to treat cancer pain, which was much lower than oncological medical students (90.0%); 73.3% of oncological medical students and 28.9% of non-oncological medical students had the correct impression of drug addiction; 85.5% of non-oncological medical students worried about the drug addiction, while 60.0% of oncological medical students worried about the strict control over opioid. In respect of the details of cancer pain management

  17. Unilateral facial pain and lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shakespeare, T.P.; Stevens, M.J. [Royal North Shore Hospital, Crows Nest, NSW (Australia)

    1996-02-01

    Facial pain in lung cancer patients may be secondary to metastatic disease to the brain or skull base. Since 1983 there have been 19 published reports of hemi-facial pain as a non-metastatic complication of lung carcinoma. This report describes an additional case in whom unilateral face pain preceded the diagnosis of lung cancer by 9 months. A clinical diagnosis of trigeminal neuralgia was made after a normal brain CT scan. Later on the patient complained of global lethargy, weight loss and haemoptysis. A chest X-ray disclosed a 6 cm right hilar mass that was further defined with a whole body CT scan. The neural mechanism of the unilateral facial pain is discussed and the literature reviewed. 14 refs., 1 tab.

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

    Science.gov (United States)

    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

  19. Pain management in sickle cell disease.

    Science.gov (United States)

    Jacob, E

    2001-12-01

    The unpredictable, recurrent, intense, and frequently persistent nature of pain associated with sickle cell disease poses a difficult challenge in terms of management. A wide variability exists in the way painful episodes are managed. Variations in practice reflect different views about the suitability of opioids, the efficacy of parenteral administration, and the risk of dependence on opioids. Consequently, the acute and chronic pain associated with sickle cell disease often is undertreated or inappropriately managed. Although medical staff fear that patients might abuse pain medication and become psychologically dependent, patients are more concerned about the side effects associated with analgesics. Some patients may persuade staff to give them more analgesics, engage in clock-watching, and request specific medications or dosages; these patients often are perceived as manipulative or demanding. However, these patients are knowledgeable about their medications and doses that have worked in the past. Requests for specific medications and dosages should not be interpreted as indications of drug-seeking behavior, but clinicians should communicate with these patients, make accurate assessments, and provide adequate doses of opioid analgesics. The American Pain Society recognized that the undertreatment of pain and inappropriate management of pain in sickle cell disease seem to be common. A Clinical Practice Guideline was developed to provide evidence-based recommendations that could potentially improve pain management. The purpose of this report is to describe the pharmacologic strategies used to manage pain associated with sickle cell disease, examine issues and challenges related to pain management as well as concerns and fears related to addiction, and explain the administration of opioids as recommended by the American Pain Society. PMID:11748547

  20. Pain Management After Total Joint Arthroplasty.

    Science.gov (United States)

    McDonald, Lisa T; Corbiere, Nicole C; DeLisle, Jay A; Clark, Alexander Martin; Kuxhaus, Laurel

    2016-06-01

    Controlling pain after total joint arthroplasty (TJA) is critical to minimizing complications, decreasing costs, and expediting patients' return to function. We implemented a TJA multimodal pain management protocol at a Level III trauma center in a small, rural community in New York. We retrospectively reviewed 266 patient charts and collected patient demographics, pain management information, and discharge data. Our primary goals were to quantify the total number of narcotic medication doses used and length of hospital stay. The multimodal pain management protocol significantly reduced the number of narcotic doses used (P pain management after TJA can reduce narcotic use and hospital length of stay, thereby also reducing the incidence of side effects from narcotics. PMID:27234795

  1. Managing Pediatric Pain in the Emergency Department.

    Science.gov (United States)

    Bailey, Benoit; Trottier, Evelyne D

    2016-08-01

    Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs. PMID:27260499

  2. Comparative legal aspects of pain management.

    Science.gov (United States)

    Vansweevelt, T

    2008-12-01

    Administering pain medication to terminal patients can cause legal problems when it has a life-shortening effect, because according to some authors it equates with manslaughter. The legal basis of the acceptance of pain alleviation with life-shortening effect can be found on the grounds of necessity. In different countries physicians have been prosecuted because of their pain management, which to the public prosecutor was in fact a sort of euthanasia. On the other hand, it is not unknown that physicians administer opioids to mask euthanasia. Pain management needs some rules, which can reassure the physician who alleviates pain. The physician who alleviates pain with life-shortening effect will have to act with due care to avoid a liability risk. This implies at least an informed consent, to observe the proportionality rule, and to keep a medical record. PMID:19202862

  3. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    Directory of Open Access Journals (Sweden)

    Lalonde L

    2015-04-01

    Full Text Available Lyne Lalonde,1–4 Manon Choinière,3,5 Elisabeth Martin,3 Lise Lévesque,3 Éveline Hudon,2,3,6 Danielle Bélanger,2 Sylvie Perreault,1,7 Anaïs Lacasse,8 Marie-Claude Laliberté1,9 1Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada; 3Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, QC, Canada; 4Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada; 5Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 6Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 7Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 8Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada; 9AbbVie Corporation, St-Laurent, QC, Canada Purpose: There is evidence that the management of chronic non-cancer pain (CNCP in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods: Using the Chronic Care Model as a conceptual framework, physicians (n=6, pharmacists (n=6, nurses (n=6, physiotherapists (n=6, psychologists (n=6, pain specialists (n=6, patients (n=3, family members (n=3, decision makers and managers (n=4, and pain researchers (n=7 took part in seven focus groups and five nominal groups. Results: Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem

  4. Persistent pain and sensory disturbances after treatment for breast cancer

    DEFF Research Database (Denmark)

    Mejdahl, Mathias Kvist; Andersen, Kenneth Geving; Gärtner, Rune;

    2013-01-01

    To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain.......To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain....

  5. Effect of music therapy on pain and anxiety levels of cancer patients: A pilot study

    OpenAIRE

    Priyadharshini Krishnaswamy; Shoba Nair

    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 ...

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

    OpenAIRE

    Slosky, Lauren M.; Tally M. Largent-Milnes; 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 ...

  7. Intravenous infusions in chronic pain management.

    Science.gov (United States)

    Kosharskyy, Boleslav; Almonte, Wilson; Shaparin, Naum; Pappagallo, Marco; Smith, Howard

    2013-01-01

    In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. PMID:23703410

  8. Levorphanol for excruciating pain from oral cancer: a case report.

    Science.gov (United States)

    McNulty, Jack P

    2007-01-01

    In the United States the most common cancers of the head and neck are those of the oral cavity and pharynx. In 2007, oral cancer will be diganosed in more than 37,000 Americans and will claim more than 7,500 lives. The report presented here describes a case of extrarodinary pain in a woman with metastatic adenocarcinoma of the hard palate. At the time of her referral for hospice care, she was experiencing excruciating, unremitting, chronic pain graded 10 of 10 on a standard pain scale. Her analgesic treatment consisted of opioids prescribed in increasingly higher doses until they were ineffective, the effects of treatment could not be tolerated, or she could not swallow the quantity or oral medication needed to provide relief. Only the opioid levorphanol has provided effective analgesia with few adverse effects, and the patient's malignant pain is manageable with far fewer doses of oral medication. Comments from the patient's physician, the pain management specialist who provided the successful conversion between analgesic therapies, the patient's husband, and the compounding pharmacist who used his own funds to pay in advance for treatment are provided. Formulations of compounded levorphanol are also featured, and the patient described in this report kindly discusses the results of her treatment. PMID:23996023

  9. The Role of Traditional Chinese Medicine in the Management of Chronic Pain: A Biopsychosocial Approach

    Directory of Open Access Journals (Sweden)

    John Burns

    2015-11-01

    Full Text Available The National Institute of Medicine revealed that chronic pain affects more than 100 million adults in the United States, citing chronic pain as the leading reason patients seek medical care. Pain is also an extremely costly problem, with $635 billion per year spent nationally, more than cancer, heart disease and diabetes combined. The biomedical model of chronic pain management has largely revolved around the use of narcotic analgesics for pain control. Unfortunately, this corresponds to a growth in the rate of abuse, misuse and overdose of these drugs. Additionally, there is an inherent failure rate to the myriad procedures used to control pain, such as spinal epidural injections and insertion of indwelling narcotic delivery systems, largely because these procedures fail to comprehensively address the multiple facets of pain generation. With its roots in the biopsychosocial model of pain management, traditional Chinese medicine may be a useful systematic or adjunct approach in the management of chronic pain.

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

    Science.gov (United States)

    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

  11. Trends in management of myofacial pain

    OpenAIRE

    Pal, Uma Shanker; Kumar, Lakshya; Mehta, Gagan; Singh, Nimisha; Singh, Geeta; Singh, Mayank; Yadav, Hemant Kumar

    2014-01-01

    We systematically reviewed the myofascial pain publications in the literature. The aim of this article is to review the methods of management and their outcome and factors associated with prognosis. The topics of interest in the diagnostic process are myofascial trigger points electromyography, jaw tracking, joint sound recorder, sonography, and vibratography, exclusion of other orofacial pain and temporomandibular disorders. Management modalities are occlusal therapy, physiotherapy, multidim...

  12. Modern Techniques of Pain Management

    OpenAIRE

    Perlman, Susan L.

    1988-01-01

    Even clinicians who keep up with the research literature on pain mechanisms may find themselves uncertain when trying to bring these new theories down to practical application for a patient with pain. The areas of dysfunction to be attacked should be systematically outlined, a complementary set of treatments be decided on, and follow-through be done in a reasonable number of visits. Physicians must also know when to refer a patient who goes beyond their own assessment and treatment skills.

  13. Management of predictable pain using fentanyl pectin nasal spray in patients undergoing radiotherapy

    OpenAIRE

    Bell, Brent

    2013-01-01

    Brent C Bell, E Brian Butler Department of Radiation Oncology, Houston Methodist Hospital, The Texas Medical Center, Houston, TX, USA Background: Studies report the need for improved pain management in the radiation oncology setting. Many patients with well controlled background pain experience breakthrough pain in cancer (BTPc) that can interrupt their treatment schedule with a potentially negative impact on outcomes. BTPc can be unpredictable and predictable; both types of pain can be mana...

  14. Effectiveness of pain management following electrical injury.

    Science.gov (United States)

    Li, Adrienne L K; Gomez, Manuel; Fish, Joel S

    2010-01-01

    The purpose of this study was to evaluate the effectiveness of pain management after electrical injury. A retrospective hospital chart review was conducted among electrically injured patients discharged from the outpatient burn clinic of a rehabilitation hospital (July 1, 1999, to July 31, 2008). Demographic data, numeric pain ratings (NPRs) at initial assessment and discharge, medications, nonpharmacologic modalities, and their effects before admission and after rehabilitation were collected. Pain management effects were compared between high (> or =1000 v) and low (low voltage (n = 32, 58.2%), and the rest caused by high voltage (n = 18, 32.7%). Electrical contact was more common (54.5%) than electrical flash (45.5%). Pain was a chief complaint (92.7%), and hands were the most affected (61.8%), followed by head and neck (38.2%), shoulders (38.2%), and back torso (38.2%). Before rehabilitation, the most common medication were opioids (61.8%), relieving pain in 82.4%, followed by acetaminophen (47.3%) alleviating pain in 84.6%. Heat treatment was the most common nonpharmacologic modality (20.0%) relieving pain in 81.8%, followed by massage therapy (14.5%) alleviating pain in 75.0%. During the rehabilitation program, antidepressants were the most common medication (74.5%), relieving pain in 22.0%, followed by nonsteroidal antiinflammatory drugs (61.8%), alleviating pain in 70.6%. Massage therapy was the most common nonpharmacologic modality (60.0%), alleviating pain in 75.8%, and then cognitive behavioral therapy (54.5%), alleviating pain in 40.0%. There were pain improvements in all anatomic locations after rehabilitation except for the back torso, where pain increased 0.7 +/- 2.9 points. Opioids were more commonly used in high voltage (P low-voltage injuries (P Pain in electrically injured patients remains an important issue and should continue to be addressed in a multimodal way. It is hoped that this study will guide us to design future interventions for pain

  15. Pain Assessment

    Science.gov (United States)

    Introduction Types of Pain Pain Assessment Pain Treatments Integrative Pain Therapy Pain Management Recommendations References September 04, 2016 Pain Assessment Effective pain management begins with a comprehensive ...

  16. Effectiveness of fentanyl transdermal patch (fentanyl-TTS, durogegic) for radiotherapy induced pain and cancer pain: multi-center trial

    International Nuclear Information System (INIS)

    To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. Our study was open labelled prospective phase IV multi-center study, the study population included patients with more 4 numeric rating scale (NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups: patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief: second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, ρ = 0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There wa no major side effect

  17. Effectiveness of fentanyl transdermal patch (fentanyl-TTS, durogegic) for radiotherapy induced pain and cancer pain: multi-center trial

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Seong Soo; Choi, Eun Kyung [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae [Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)] (and others)

    2006-12-15

    To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. Our study was open labelled prospective phase IV multi-center study, the study population included patients with more 4 numeric rating scale (NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups: patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief: second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, {rho} = 0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There wa no major side effect.

  18. Current issues in postoperative pain management.

    Science.gov (United States)

    Rawal, Narinder

    2016-03-01

    Postoperative pain has been poorly managed for decades. Recent surveys from USA and Europe do not show any major improvement. Persistent postoperative pain is common after most surgical procedures, and after thoracotomy and mastectomy, about 50% of patients may experience it. Opioids remain the mainstay of postoperative pain treatment in spite of strong evidence of their drawbacks. Multimodal analgesic techniques are widely used but new evidence is disappointing. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Current evidence suggests that epidural analgesia can no longer be considered the 'gold standard'. Perineural techniques are good alternatives for major orthopaedic surgery but remain underused. Infiltrative techniques with or without catheters are useful for almost all types of surgery. Simple surgeon-delivered local anaesthetic techniques such as wound infiltration, preperitoneal/intraperitoneal administration, transversus abdominis plane block and local infiltration analgesia can play a significant role in improvement of postoperative care, and the last of these has changed orthopaedic practice in many institutions. Current postoperative pain management guidelines are generally 'one size fits all'. It is well known that pain characteristics such as type, location, intensity and duration vary considerably after different surgical procedures. Procedure-specific postoperative pain management recommendations are evidence based, and also take into consideration the role of anaesthetic and surgical techniques, clinical routines and risk-benefit aspects. The role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging. The need for upgrading the role of surgical ward nurses and collaboration with surgeons to implement enhanced recovery after surgery protocols with regular audits to improve postoperative outcome cannot be overstated. PMID:26509324

  19. Preoperative distress predicts persistent pain after breast cancer treatment

    DEFF Research Database (Denmark)

    Mejdahl, Mathias Kvist; Mertz, Birgitte Goldschmidt; Bidstrup, Pernille Envold Hansen;

    2015-01-01

    PURPOSE: Persistent pain after breast cancer treatment (PPBCT) affects 25% to 60% of breast cancer survivors and is recognized as a clinical problem, with 10% to 15% reporting moderate to severe pain several years after treatment. Psychological comorbidity is known to influence pain perception, and...

  20. Application of Botulinum Toxin in Pain Management

    OpenAIRE

    Sim, Woo Seog

    2011-01-01

    Botulinum toxin has been used for the treatment of many clinical disorders by producing temporary skeletal muscle relaxation. In pain management, botulinum toxin has demonstrated an analgesic effect by reducing muscular hyperactivity, but recent studies suggest this neurotoxin could have direct analgesic mechanisms different from its neuromuscular actions. At the moment, botulinum toxin is widely investigated and used in many painful diseases such as myofascial syndrome, headaches, arthritis,...

  1. Classification of neuropathic pain in cancer patients

    DEFF Research Database (Denmark)

    Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein;

    2014-01-01

    and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were...... good agreement was found on the statement "the pathophysiology of NP due to cancer can be different from non-cancer NP" (MED=9, IQR=2). Satisfactory consensus was reached for the first 3 NeuPSIG criteria (pain distribution, history, and sensory findings; MEDs⩾8, IQRs⩽3), but not for the fourth one...

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

    OpenAIRE

    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 periphe...

  3. Effect Analysis of Pain Education on Pain Management in Patients with Cancer%疼痛教育对癌症患者疼痛控制的效果及分析

    Institute of Scientific and Technical Information of China (English)

    陈芳芳

    2015-01-01

    目的分析疼痛教育在癌症患者疼痛管理中的临床效果。方法回顾性分析2008年1月至2013年12月在院治疗的癌症疼痛患者156例作为研究对象,采用随机数字表法将156例患者随机平均分为两组,对照组78例,接受常规健康教育;试验组78例,在对照组基础上接受癌症疼痛教育项目。比较两组癌症疼痛患者的疼痛程度、疼痛控制的满意度以及疼痛对患者生活质量的影响。结果初次疼痛评比两组间不存在显著性差异,再次疼痛评估结果显示对照组(2.89±1.27)分与试验组(2.43±1.22)分存在显著性差异(P0.05);疼痛对患者生活质量的影响结果显示试验组在情绪、工作、社交、睡眠、行走能力、日常生活、生活乐趣方面评分均明显低于对照组(P 0.05). The influence of pain on patients' quality of life suggested that the scores of the treatment group in terms of mood, work, social activity, sleep, walking ability, daily life and the fun of life were significantly lower than those in the control group (P < 0.05). Conclusion It's helpful to improve the understanding of cancer pain through the implementation of pain education on patients with cancer pain and their family members so as to reduce the pain of patients and the impact of pain on patients' quality of life and improve patients' satisfaction of treatment for the cancer pain.

  4. Ethical issues in the management of chronic nonmalignant pain.

    Science.gov (United States)

    Pappagallo, M; Heinberg, L J

    1997-01-01

    Chronic pain represents a challenge to patients, families, employers, and the physicians who care for these individuals. Opioids remain the mainstay of the analgesic medications for the treatment of both acute and chronic pain. Controlled release preparations of morphine, oxycodone, fentanyl and long acting opioid agents such as methadone and levorphanol have been medically and ethically accepted in managing chronic cancer pain. However, the continued use of these medications for patients with chronic noncancer pain has been fiercely debated. This article attempts to reconcile the medical and ethical dilemma of using opioid medications for chronic noncancer pain. Growing clinical experience in the field of pain medicine has helped to clarify: (1) the misunderstanding of addiction, physical dependence and analgesic tolerance, (2) the misconception that chronic opioid therapy inevitably causes personality changes, depression, and impairment of cognitive and physical function, (3) the lack of information on the correct use of opioid analgesics with regard to titration and management of related side effects. The behavioral management of pain patients undergoing chronic opioid therapy is also discussed. A protocol for optimal patient management is proposed. Particular emphasis is given to the consent form, behavioral contracting, and the consequences of noncompliance. The importance of psychologic evaluation before a long-term opioid trial, to minimize future complications, is stressed. Although most patients on the opioid regimen do well, special attention must be given to patients with current addiction, a past history of addiction, or current misuse of opioid medications. Pharmacologic and conservative interventions are often warranted in those patients with significant behavioral problems. If such strategies fail, and chronic opioid therapy is deemed necessary, some treatment guidelines are offered. PMID:9311061

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

    Science.gov (United States)

    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

  6. Paediatric Pain Management: Using Complementary and Alternative Medicine

    OpenAIRE

    Evans, Subhadra; Tsao, Jennie C. I.; Zeltzer, Lonnie K

    2008-01-01

    Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Altho...

  7. Evidence-based management of pain after haemorrhoidectomy surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Neugebauer, E A M; Kehlet, Henrik

    2010-01-01

    Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery.......Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery....

  8. Managing chronic pain in survivors of torture.

    Science.gov (United States)

    Amris, Kirstine; Williams, Amanda C de C

    2015-01-01

    All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor. PMID:25537694

  9. Managing chronic pain in survivors of torture

    DEFF Research Database (Denmark)

    Amris, Kirstine; Williams, Amanda C de C

    2015-01-01

    All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and...... welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive...... focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor....

  10. Diffusion of standards of care for cancer pain.

    OpenAIRE

    Hagen, N; Young, J; Macdonald, N.

    1995-01-01

    The authors report the results of a symposium on improving the standards of care for patients with cancer pain. The symposium was sponsored by the Advisory Committee on Cancer Control of the National Cancer Institute of Canada and was held Apr. 8 to 10, 1994, in Toronto. Participants included experts on control of cancer pain and on diffusion techniques, patients with cancer and representatives of regulatory agencies. They suggested the following strategies to improve outcomes in patients wit...

  11. Pain Experiences and Pain Management in Postoperative Patients

    OpenAIRE

    Suza, Dewi Elizadiani

    2010-01-01

    Pain is a subjective experience that can be perceived directly only by the sufferer. It is a multidimensional phenomenon that can be described by pain location, intensity, quality, impact, and meaning. Acute pain following a surgical procedure is the combination of pain as a specific sensation due to a nociceptive response to tissue damage and pain as suffering. Uncontrolled pain in the postoperative period could have detrimental physiologic effects. It can slow the patients’ recovery from su...

  12. Notes on burn nursing : aspects of pain management

    NARCIS (Netherlands)

    Jong, A.E.E. de

    2013-01-01

    Adequate management of burn pain may influence pain resistance, analgesic requirements, sensitivity to pain over time, wound healing and the development of delirium and posttraumatic stress symptoms. Efforts should be made to optimize pain management. An important step is effect evaluation of interv

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

    Science.gov (United States)

    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. Efficacy and Safety of Acupuncture in the Management of Cancer

    Institute of Scientific and Technical Information of China (English)

    Henry Liming LIANG

    2005-01-01

    @@ Acupuncture, as a complementary therapy, has been used to manage the cancer associated symptoms of cancer patients. To identify the efficacy and safety of acupuncture in the management of cancer, this review critically analyses the relevant publications including both experimental and clinical studies. The majority of studies suggest that acupuncture effectively relieves some cancer related symptoms such as cancer pain, and some adverse effects caused by the cancer conventional treatments such as nausea, vomiting, neutropenia and xerostomia.

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

    OpenAIRE

    Alice Running

    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 m...

  16. Management of chronic visceral pain

    DEFF Research Database (Denmark)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S;

    2016-01-01

    psychological interventions, thereby providing a mechanism-orientated approach to treatment. Patients can frequently become disenfranchised, and subsequently disengaged, with healthcare providers leading to repeated consultations. Thus, a key aspect of management is to break this cycle by validating patients...

  17. The relationship between ethnicity and the pain experience of cancer patients: A systematic review

    Directory of Open Access Journals (Sweden)

    Wingfai Kwok

    2014-01-01

    Full Text Available 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

  18. Barriers to Pain Management: Caregiver Perceptions and Pain Talk by Hospice Interdisciplinary Teams

    OpenAIRE

    OLIVER, DEBRA PARKER; Wittenberg-Lyles, Elaine; Demiris, George; Washington, Karla; Porock, Davina; Day, Michele

    2008-01-01

    As patients are cared for in their home by family caregivers, several challenges arise in effective pain and symptom management. Despite hospice’s reputation as the gold standard for terminal care, there is still a need to improve pain management practices including challenges that caregivers face, related to pain assessment, reluctance and fear of administering medication, noncompliance with pain medicine regimens, and hesitance to report pain. The hospice philosophy of care promotes service...

  19. Pain Control: Support for People with Cancer

    Science.gov (United States)

    ... talk about your pain with your health care team How to make your pain control plan work for you Pain control medicines and side effects Medicine tolerance is not addiction Other ways to control pain ...

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

    Science.gov (United States)

    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. Management of chronic pain in the elderly: focus on transdermal buprenorphine

    OpenAIRE

    Vadivelu, Nalini

    2008-01-01

    Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration ...

  2. P2X receptors: New players in cancer pain

    Institute of Scientific and Technical Information of China (English)

    Alessia; Franceschini; Elena; Adinolfi

    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 P2 X receptor are adenosine triphosphate(ATP) gated ion channels expressed by several cells including neurons, cancer and immune cells. Purinergic signaling through P2 X 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 P2 X 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 P2 X 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 genesisof cancer pain and to the function of P2X7 in tumor growth and metastasis. Therapeutic implications of the administration of different P2 X receptor blockers to alleviate cancer-associated pain sensations contemporarily reducing tumor progression are also discussed.

  3. Management of patients with neck pain

    Directory of Open Access Journals (Sweden)

    E. A. Chechet

    2016-01-01

    Full Text Available Neck pain (cervicalgia occupies one of the leading places among the reasons for outpatient visits, 75% of people have experienced neck pain at least once in their lives. In most cases, neck pain regresses; however, it recurs in almost one half of patients. The paper gives data on the risk factors, mechanisms, course, and prognosis of cervicalgia. It discusses the issues of differential diagnosis, examination, and approaches to treating this condition in these patients. Nonsteroidal anti-inflammatory drugs are most effective in treating patients with acute cervicalgia. Therapeutic exercises and manual therapy are indicated in patients with chronic cervicalgia. There is evidence on the efficacy and safety of meloxicam for the management of acute and chronic cervicalgia.

  4. Notes on burn nursing : aspects of pain management

    OpenAIRE

    Jong, A.E.E. de

    2013-01-01

    Adequate management of burn pain may influence pain resistance, analgesic requirements, sensitivity to pain over time, wound healing and the development of delirium and posttraumatic stress symptoms. Efforts should be made to optimize pain management. An important step is effect evaluation of interventions by pain measurement. Another step is to disclose the latest insights from the literature, especially on non-pharmacological interventions during wound care. In these two steps, burn care nu...

  5. Effects of Herbal Acupuncture(Soyeum on Cancer Patients Accompanied by Pain

    Directory of Open Access Journals (Sweden)

    Hwa-Seung Yoo

    2003-02-01

    Full Text Available Objectives : This study was designed to evaluate effects of "Soyeum" on cancer patients accompanied by pain. Materials and Methods : We retrospectively analyzed the medical records of 9 patients accompanied by pain who had been injected with "Soyeum" for over 14 days continuously in East-West Cancer Center of Oriental Hospital of Daejeon University from June 2002 through August 2002. Results : The statistical significance between the pre-treatment and post-treatment results (Changes of Cytokine Level, QOL, BPQ and Pain relief after pain management were analyzed. Analysis of cytokines (IL-12, IFN-γ level showed that the percentage of increase of IL-12 is 60.0%, IFN-γ is 60.0%. Analysis of QOL showed that the percentage of maintenance and improvement is 77.8%. 55.5% of the patients reported a "worst pain" intensity score of 3 or greater, 44.5% reported a "least pain" intensity score of 2 or greater, and 66.7% reported "average pain" intensity score of 2 or greater. 33.3% of the patients were in pain at the time of interview and 22.2% had a current intensity score of 2 or greater. Analysis of pain relief after pain management showed that the percentage of pain relief score of 2 and 3 is 55.6%. The data was expressed as Mean±SE by using descriptive statistics. Statistical significance examined by using paired t-test. Conclusions : It is suggested that "Soyeum" has effects on pain of cancer patients, also expected that "Soyeum" is useful to improve immunoactivity and for cancer patients.

  6. Radiation-induced mucositis pain in mesopharyngeal and hypopharyngeal cancer

    International Nuclear Information System (INIS)

    Radiation therapy in head and neck malignancy often triggers painful mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). To better understand how radiation-induced pain develops over time, we studied numerical rating scale (NRS 0-5) pain scores in 27 subjects undergoing 60-72 Gy radiation therapy for newly diagnosed cancer- 13 with mesopharynx and 14 with hypopharynx. Mucositis severity was evaluated using Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0) based on mucositis pain, analgesic administration, and oral feedings of our subjects, with 8 mesopharyngeal and 10 with hypopharyngeal cancer had been pain-free before radiation therapy. The mucositis and pain course was severer in mesopharyngeal than in hypopharyngeal cancer. NSAIDs and opioid use was similar in both cancer types, which also required tube feeding in 7 subjects (38.9%). (author)

  7. Single-dose fentanyl sublingual spray for breakthrough cancer pain

    OpenAIRE

    Taylor DR

    2013-01-01

    Donald R Taylor Comprehensive Pain Care PC, Marietta, GA, USA Abstract: Breakthrough cancer pain (BTCP) is defined as a transient exacerbation of pain that arises in patients with otherwise controlled persistent pain. BTCP typically has a rapid onset and relatively short duration, but it causes a significant amount of physical and psychological distress for patients. Several rapid-onset fentanyl formulations have been introduced in the USA to replace traditional oral opioids for the treatment...

  8. Single-dose fentanyl sublingual spray for breakthrough cancer pain

    OpenAIRE

    Taylor, Donald

    2013-01-01

    Donald R Taylor Comprehensive Pain Care PC, Marietta, GA, USA Abstract: Breakthrough cancer pain (BTCP) is defined as a transient exacerbation of pain that arises in patients with otherwise controlled persistent pain. BTCP typically has a rapid onset and relatively short duration, but it causes a significant amount of physical and psychological distress for patients. Several rapid-onset fentanyl formulations have been introduced in the USA to replace traditional oral opioids for the treatmen...

  9. Chronic pain management as a barrier to pediatric palliative care.

    Science.gov (United States)

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

  10. Management of patients with low back pain

    DEFF Research Database (Denmark)

    Debarle, Michel; Aigron, Rémi; Depernet, Laure;

    2014-01-01

    strategies were identified for each scenario. Appropriateness of the chosen management strategy was assessed using predetermined "best practice" for each scenario. Consensus was arbitrarily defined as "moderate" when 50- 69% of respondents agreed on the same management choice for a scenario, and "excellent......" when 70% or more provided the same answer. RESULTS: Excellent consensus was achieved for only one scenario, and moderate consensus for two scenarios. For five of the nine scenarios, the most common answers were in agreement with the "best practice" management strategies. Consensus between the French......BACKGROUND: Little is known about the level of consensus within the French chiropractic profession regarding management of clinical issues. A previous Swedish study showed that chiropractors agreed relatively well on the management strategy for nine low back pain scenarios. We wished to investigate...

  11. Depression and quality of life in cancer patients with and without pain: the role of pain beliefs

    Directory of Open Access Journals (Sweden)

    Tavoli Zahra

    2008-06-01

    Full Text Available Abstract Background Pain is said to be one of the most feared and distressing symptoms of cancer and one that disrupts all aspects of life. The purposes of this study were: 1 to compare depression and quality of life among Iranian cancer patients with and without pain; and 2 to determine the relationships between pain beliefs and depression and quality of life. Method A consecutive sample of gastrointestinal cancer patients attending to Tehran Cancer Institute were entered into the study. Three standard instruments were used to measure quality of life (the EORTC QLQ-C30, depression (the HADS and pain beliefs (the PBPI. Results A total of 142 hospitalized gastrointestinal cancer patients, 98 with pain and 44 without pain were studied. The main findings of this study were that cancer patients with pain reported significantly lower levels of role functioning, emotional functioning and global quality of life. They also showed higher levels of depression than cancer patients who did not experience pain. Among patients with pain, higher scores on pain permanence and pain consistency were positively and significantly associated with higher depression. Also, higher scores on pain consistency were negatively and significantly associated with global quality of life. Conclusion This study has demonstrated the effect of cancer pain on patients' quality of life and emotional status and has supported the multidimensional notion of the cancer pain experience in cancer patients. Although these data are correlational, they provide additional support for a biopsychosocial model of chronic pain.

  12. Barriers in the management of cancer-related pain and strategies to overcome them: findings of a qualitative research involving physicians and nurses in Italy

    Directory of Open Access Journals (Sweden)

    Cesarina Prandi

    2015-03-01

    Full Text Available Introduction and aims. There are many barriers and obstacles that even today lead to an inadequate treatment of cancer-related pain. The aim is to describe the experiences of a group of Italian physicians and nurses as far as the nature of these barriers is concerned and the possible tools to be used to overcome them. Material and method. We run 5 focus groups with 42 healthcare professionals (11 physicians, 31 nurses working in 5 hospitals in Italy. The findings of the focus groups were analysed according to the “Content Analysis” method. Results. Five main items emerged: the importance of communication, the need for education regarding pain therapy, the ethnic/cultural/religious differences, the mutual trust and support within the working group, the daily challenges. Conclusion. In harmony with the most recent literature, physicians and nurses voice above all their need for an education more directly aimed at overcoming the prevailing barriers rooted in ignorance, prejudice and fears.

  13. Pain and Nociception

    DEFF Research Database (Denmark)

    Falk, Sarah; Dickenson, Anthony H

    2014-01-01

    Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditional...... therapies are often only partially effective. Until recently, knowledge of cancer pain mechanisms was poor compared with understanding of neuropathic and inflammatory pain states. We now view cancer-induced bone pain as a complex pain state involving components of both inflammatory and neuropathic pain but...... also exhibiting elements that seem unique to cancer pain. In addition, the pain state is often unpredictable, and the intensity of the pain is highly variable, making it difficult to manage. The establishment of translational animal models has started to reveal some of the molecular components involved...

  14. Pain Management in Children with Collaborative Parents and Healthcare Team

    Directory of Open Access Journals (Sweden)

    Rahim Vakili

    2015-04-01

    Full Text Available Most children in hospital have pain. Seeing your child in pain or discomfort is incredibly difficult. Pain in children is a public health concern of major significance in most parts of the world. We have learned that unrelieved pain causes the body to release certain chemicals that may actually delay healing, so it's important to work with child's nurses and doctors to help children for control the pain. On the other side, medication is not the only way to relieve pain. Pain in children should always be managed and pain expression is dependent on the child’s age, cognitive development, and socio cultural context and it is important to pay particular attention to developmental variations in any behavioural manifestations of pain. In this study to explain some ways for parents and healthcare team to manage pain in children.

  15. Teaching Pain Management to Student Nurses: A Literature Review

    Directory of Open Access Journals (Sweden)

    Ekatrina Wijayanti

    2014-04-01

    Full Text Available Purpose: To provide nursing students knowledge of pain prior, during, and post- surgery, recovery and rehabilitation. Methods: Review articles published during 2005 until 2012 that focused on pain assessment and pain management. The databases used in this study were Medline and CINAHL.Results: Postoperative pains need special approach and care. It needs teach patient how to adapt pain, control pain, monitor result of treatment. Conclusion: Nursing students need to learn how to assess pain using appropriate tools for each age level and in patients with special needs. The students also need to learn about pain management including pharmacology and non-pharmacology means and consider pain as the fifth vital sign. As student nurses learn pain assessment, they should be considerate about culture, and different languages that might happen during practical rotations.

  16. Application of pain assessment management informationization in cancer pain standardized demonstration ward%疼痛评估管理信息化在癌痛规范化示范病房中的应用

    Institute of Scientific and Technical Information of China (English)

    冯丹; 张庆; 周俊; 陈萍

    2013-01-01

    This study aimed to promote medical and health informationization construction, strengthen the top-level design, construct a standard of medical and health information, and develop an information sharing and safety management system. For the reform of integrated hospital and clinical information systems, the Tumor Research Institute of the Second Affiliated Hospital of the Third Military Medical University aimed to solve the existing problem using pain assessment management (PAM). The PAM information platform is affiliated with the Military's No. 1 Basic Information System, which can manage PAM information. Moreover, PAM can optimize the pain assessment process and costs, and improve the work efficiency of nurses, Thus, PAM can achieve basic goals, such as data sharing, individualized records, and smart reminders, and encourages the use of pain management information systems outside the hospitals.%为推进医疗卫生信息化建设,加强顶层设计,统筹制定医疗卫生信息化相关业务规范和信息共享安全管理体系,第三军医大学第二附属医院肿瘤研究所从医院临床信息系统集成改造角度,针对疼痛评估管理业务环节存在的问题,将疼痛评估管理信息化平台外挂于院内军字一号系统,对疼痛评估管理进行信息化管理,实现了优化疼痛评估流程、节约成本、提高护理工作效率、体现数据共享、个性化记录、智能提醒等基本目标,并提出院外疼痛管理的信息系统规划。

  17. A Cognitive-Behavioral Approach to Chronic Pain Management.

    Science.gov (United States)

    Grant, Lynda D.; Haverkamp, Beth E.

    1995-01-01

    Provides counselors with an introduction to the role of psychosocial processes in the experience of pain and offers assessment and intervention recommendations based on a cognitive-behavioral therapy approach to pain management. (JPS)

  18. Insufficient pain management after spine surgery

    DEFF Research Database (Denmark)

    Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Dahl, Jørgen Berg;

    2014-01-01

    INTRODUCTION: A prospective observational quality assurance study was performed at Glostrup Hospital, Denmark, to describe patients undergoing spine surgery with regard to perioperative analgesic management, post-operative pain, opioid consumption and side effects. MATERIAL AND METHODS: Patients...... patients were included. For instrumented lumbar fusion patients (n = 24), the VAS pain scores at 1, 4 and 24 h after surgery were (median (interquartile range)) 5 (0-7), 2.5 (0-8) and 5.5 (0-9) at rest and 5 (0-8), 3 (0-9) and 7 (3-9) during mobilisation, respectively. The other surgical subgroups......, especially for instrumented lumbar fusion surgery. Future work should focus on optimising treatment plans. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  19. Multimodal pain management after arthroscopic surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten

    Multimodal Pain Management after Arthroscopic Surgery By Sten Rasmussen, M.D. The thesis is based on four randomized controlled trials. The main hypothesis was that multimodal pain treatment provides faster recovery after arthroscopic surgery. NSAID was tested against placebo after knee arthroscopy...... ankle arthroscopy. Oral NSAID reduced time to work from 17 to 14 days after knee arthroscopy. Intra-articular treatment with bupivacaine plus morphine and bupivacaine plus morphine plus steroid after arthroscopic knee meniscectomy reduced time to work from 10 to 5 to 3 days. Intraarticular treatment...... return to work after knee and ankle arthroscopy with the use of oral NSAIDs combined with bupivacaine plus morphine or combined with bupivacaine, morphine plus steroid....

  20. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain. PMID:27208716

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

    Science.gov (United States)

    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

  2. Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial

    OpenAIRE

    Thoke-Colberg Anette; Kuss Oliver; Kukk Ene; Renz Petra; Kitzmantel Maria; Jahn Patrick; Horn Ingrid; Landenberger Margarete

    2010-01-01

    Abstract Background Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN prog...

  3. Management of lumbar zygapophysial (facet) joint pain

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Falco, Frank JE; Boswell, Mark V

    2016-01-01

    AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain. METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V

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

    Science.gov (United States)

    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

  5. [The role of open neurosurgery in the treatment of cancer pain].

    Science.gov (United States)

    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

  6. Opioid use for chronic pain management in Italy: results from the Orthopedic Instant Pain survey project

    OpenAIRE

    Guido Fanelli; Paolo Cherubino; Christian Compagnone

    2014-01-01

    Pain is a common symptom in orthopedic patients, but is managed sub-optimally, partly due to scarce opioid use in severe cases. The aim of the Orthopedic Instant Pain Survey (POIS) was to evaluate changes in pain management in Italian orthopedic practice 2 years after a legislative change (Law 38/2010) simplifying opioid access for pain control. A web-based survey on the knowledge of this law and trends observed in clinical practice for severe pain treatment was administered to 143 Italian or...

  7. Arthritis and pain. Psychosocial aspects in the management of arthritis pain

    OpenAIRE

    Backman, Catherine L

    2006-01-01

    The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent evidence for psychosocial approaches to managing arthritis pain. By definition, psychosocial factors refer to two dimensions of experience: the psychological (cognitive, affective) and social (interacting with others, engaging in life activities). Psychosocial factors influence the perception of pain and the presence of pain influences psychological well-being and social partici...

  8. Post-thoracotomy Pain Management Problems

    OpenAIRE

    Gerner, Peter

    2008-01-01

    Pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered t...

  9. Intervention treatments for chronic pain syndrome in cancer patients

    OpenAIRE

    V. V. Bryuzgin

    2010-01-01

    Noninvasive treatments for chronic pain syndrome benefit in 80-90% of cancer patients. Invasive, intervention procedures for analgesia should be used in other cases. These include neuroablative and neuromodulatory measures. Neuroablation is defined as the physical suspension of painful impulse transmission pathways by a surgical, chemical, or thermal method and comprises lytic and other blocks. Neuromodulation is the dynamic and functional suppression of pain impulse pathways by the intraspin...

  10. Many Patients with Cancer Need Better Treatments for Pain

    Science.gov (United States)

    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.

  11. A Pain Management Decision Support System for Nurses

    OpenAIRE

    Heriot, Cathy; Graves, Judith; Bouhaddou, Omar; Armstrong, Margaret; Wigertz, Gudrun; Ben Said, Mohamed

    1988-01-01

    This paper describes the development and uses of the Nursing Pain Management Consultation System, a prototype demonstration project for Integrated Academic Information Management System (IAIMS) at the University of Utah. A knowledge base representing the best current thinking regarding management of acute pain secondary to total hip arthroplasty (THA) is the knowledge core of the expert system. The decisions modeled range from assessment of the severity of pain to decisions related to both ph...

  12. Spinal cord injury pain: mechanisms and management.

    Science.gov (United States)

    Finnerup, Nanna Brix; Baastrup, Cathrine

    2012-06-01

    Patients with spinal cord injury (SCI) may experience several types of chronic pain, including peripheral and central neuropathic pain, pain secondary to overuse, painful muscle spasms, and visceral pain. An accurate classification of the patient's pain is important for choosing the optimal treatment strategy. In particular, neuropathic pain appears to be persistent despite various treatment attempts. In recent years, we have gained increasing knowledge of SCI pain mechanisms from experimental models and clinical studies. Nevertheless, treatment remains difficult and inadequate. In line with the recommendations for peripheral neuropathic pain, evidence from randomized controlled treatment trials suggests that tricyclic antidepressants and pregabalin are first-line treatments. This review highlights the diagnosis and classification of SCI pain and recent improvements in the understanding of underlying mechanisms, and provides an update on treatment of SCI pain. PMID:22392531

  13. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management.

    Science.gov (United States)

    Sjövall, Sari; Kokki, Merja; Kokki, Hannu

    2015-11-01

    Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals. PMID:26493289

  14. Evidence of peripheral nerve blocks for cancer-related pain

    DEFF Research Database (Denmark)

    Klepstad, P; Kurita, G P; Mercadante, S; Sjøgren, P

    2015-01-01

    evidence of analgesic efficacy for peripheral nerve blocks in adult patients with cancer. A search strategy was elaborated with words related to cancer, pain, peripheral nerve and block. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. The number of abstracts...... good pain relief and no side effects. The use of peripheral blocks is based upon anecdotal evidence. However, this review only demonstrates the lack of studies, which does not equal a lack of effectiveness....

  15. Effect of pamidronate on pain control in breast cancer patients

    International Nuclear Information System (INIS)

    Objective: One of the common complaints in advanced breast cancer is pain. This is due to osseous metastasis. Analgesics, along with chemotherapy and hormonal therapy, are the mainstay of treatment. Multifocal bone disease that is refractory to above routine treatments can benefit from a series of agents like Pamidronate. Design: Prospective comparative study. Place and Duration of Study: Study was carried out from February 1998 to January 2001 in the Department of Radiotherapy / Oncology, Services Hospital, Lahore. Subjects and Methods: Sixty patients suffering from metastatic breast cancer (mainly to bones) initially treated with chemotherapy or hormonal therapy and analgesics were treated with 60-90 mg of injection Pamidronate by 4-hour intravenous infusion once a month for three or more months. The intensity of pain was assessed by the memorial symptom assessment scale and marked on the pain control performa according to frequency of pain, severity of pain or interference in daily activities due to pain at the start and after six months time of inclusion in the study. Difference in frequency of pain, severity or interference in daily routine was measured for each patient individually. Results: Marked pain relief was reported by 60% of patients who were additionally taking Pamidronate as compared to 43.3% patients who were not taking Pamidronate. Reduction in pain and analgesic demand is noted more in chemotherapy group with Pamidronate as compared to hormonal therapy group. Conclusion: Pamidronate can be additionally used in resistant cases for pain control. (author)

  16. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

    OpenAIRE

    te Boveldt Nienke; Engels Yvonne; Besse Kees; Vissers Kris; Vernooij-Dassen Myrra

    2011-01-01

    Abstract Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation stra...

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

    Science.gov (United States)

    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

  18. Oral morphine prescribing practices in severe cancer pain

    Directory of Open Access Journals (Sweden)

    B Barathi

    2009-01-01

    Full Text Available Background: Nearly one million cancer patients in India need oral morphine for pain relief. Despite doctors prescribing oral morphine in our center, many cancer patients with severe pain found to be not facilitated with adequate pain relief. Aim: This audit was conducted to look at the "oral morphine prescribing practices for severe cancer pain" at a tertiary care hospital. Materials and Methods: Twenty case files of patients, who were admitted with severe cancer pain, and receiving oral morphine were analyzed in pre- and posteducational session. Local standards were set to assess the adequacy of pain relief. Deficiency in achieving analgesia was found in preinterventional audit. A clinical audit was conducted before and after the educational session on oral morphine prescribing. The education for doctors and nurses focused on starting patients on morphine, titration, and administering rescue dose. Then local guidelines on oral morphine prescribing were circulated. And analysis of following factors were done following pre- and posteducational session: Pain intensity at the beginning of treatment, starting dose of morphine, increments in morphine dose, number of rescue doses given, and fall in pain intensity at the end of 1 week. The outcomes were compared with the standards. Results: Preintervention audit showed that only 50% of patients achieved adequate pain relief. Rescue dose was administered in only 20% of patients. While reaudit following the educational session showed that 80% of patients achieved adequate pain relief and 100% received rescue doses. Conclusion: Educational sessions have significant impact on improving oral morphine prescribing practice among doctors and nurses. It was found failing to administer regular as well as rescue doses resulted in inadequate pain relief in patients receiving oral morphine.

  19. Tapentadol extended release in the management of peripheral diabetic neuropathic pain

    Science.gov (United States)

    Vadivelu, Nalini; Kai, Alice; Maslin, Benjamin; Kodumudi, Gopal; Legler, Aron; Berger, Jack M

    2015-01-01

    Tapentadol, a μ-opioid agonist and norepinephrine reuptake inhibitor, has been found to be an effective medication for a wide variety of chronic pain conditions, including back pain, cancer-related pain, and arthritic pain. It has also been found to have fewer gastrointestinal side effects than more traditional opioid-based therapies. More recently, tapentadol extended release has been demonstrated to be effective in the management of painful diabetic neuropathy, an often debilitating condition affecting approximately one-third of all patients with diabetes. This review highlights the most up-to-date basic and clinical studies by focusing on the mechanisms of action of tapentadol and its clinical efficacy, especially with regard to painful diabetic neuropathy. PMID:25609974

  20. Pediatric pain management: the multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Odell S

    2013-11-01

    Full Text Available Shannon Odell,1,2 Deirdre E Logan1,21Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Department of Psychiatry, Harvard Medical School, Boston, MA, USAAbstract: Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain rehabilitation centers. This review offers a summary of the challenges faced by these programs and areas for future study.Keywords: pediatric pain rehabilitation, pediatric chronic pain, interdisciplinary, pain associated disability

  1. Evaluating pain management delivered by direct care nurses.

    Science.gov (United States)

    Tapp, Jane; Kropp, Denise

    2005-01-01

    It is difficult to assess the effectiveness of the delivery of pain management care because pain management is a complex process. This article describes a quality assurance study that was conducted on a surgical unit at a community teaching hospital, which is a member of a 1200 licensed inpatient beds multihospital system, to determine the effectiveness of pain management at the unit level. For the study, a Chart Audit Analysis Tool was developed and used to review second postoperative day charts of patients who had undergone a major abdominal surgery. The Chart Audit Analysis Tool quantifies by weighted indicators 2 outcomes measures, nurses' care delivery and pharmacologic management. The Chart Audit Analysis Tool, along with the results of a test of the nurses' knowledge and attitudes about pain management, provides nurse managers a quick and easy method to identify strengths and weaknesses of pain management at the unit level. PMID:15839297

  2. Psychosocial assessment and self-management of chronic pain

    OpenAIRE

    Voerman, Jessica

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed to provide answers to two important questions: 1. How to improve early signaling and assessment of chronic pain in adolescents? and 2. How to improve self-management of chronic pain in both adolesc...

  3. Use of strong opioids for non-cancer pain in the community: a case study.

    Science.gov (United States)

    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. Managing Chronic Pain in Children and Adolescents: A Clinical Review.

    Science.gov (United States)

    Landry, Bradford W; Fischer, Philip R; Driscoll, Sherilyn W; Koch, Krista M; Harbeck-Weber, Cynthia; Mack, Kenneth J; Wilder, Robert T; Bauer, Brent A; Brandenburg, Joline E

    2015-11-01

    Chronic pain in children and adolescents can be difficult for a single provider to manage in a busy clinical setting. Part of this difficulty is that pediatric chronic pain not only impacts the child but also the families of these children. In this review article, we discuss etiology and pathophysiology of chronic pain, along with variables that impact the severity of chronic pain and functional loss. We review diagnosis and management of selected chronic pain conditions in pediatric patients, including headache, low back pain, hypermobility, chronic fatigue, postural orthostatic tachycardia syndrome, abdominal pain, fibromyalgia, and complex regional pain syndrome. For each condition, we create a road map that contains therapy prescriptions, exercise recommendations, and variables that may influence pain severity. Potential medications for these pain conditions and associated symptoms are reviewed. A multidisciplinary approach for managing children with these conditions, including pediatric pain rehabilitation programs, is emphasized. Lastly, we discuss psychological factors and interventions for pediatric chronic pain and potential complementary and alternative natural products and interventions. PMID:26568508

  5. Management of chronic pain in osteoporosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Paolucci T

    2016-04-01

    Full Text Available Teresa Paolucci,* Vincenzo Maria Saraceni, Giulia Piccinini* Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy *These authors contributed equally to this work Abstract: Osteoporosis (OP is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. Keywords: physical therapy, exercise, pharmacological treatment, posture and balance

  6. Management of chronic pain in osteoporosis: challenges and solutions

    Science.gov (United States)

    Paolucci, Teresa; Saraceni, Vincenzo Maria; Piccinini, Giulia

    2016-01-01

    Osteoporosis (OP) is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. PMID:27099529

  7. Arthritis and pain. Psychosocial aspects in the management of arthritis pain.

    Science.gov (United States)

    Backman, Catherine L

    2006-01-01

    The purpose of this review is to summarize psychosocial factors associated with arthritis pain and highlight recent evidence for psychosocial approaches to managing arthritis pain. By definition, psychosocial factors refer to two dimensions of experience: the psychological (cognitive, affective) and social (interacting with others, engaging in life activities). Psychosocial factors influence the perception of pain and the presence of pain influences psychological well-being and social participation. After discussing the impact of arthritis pain on participation in work, family life, and leisure, evidence for psychosocial interventions is summarized, emphasizing reviews and studies published from January 2000 to August 2006. PMID:17169138

  8. Critical issues on opioids in chronic non-cancer pain

    DEFF Research Database (Denmark)

    Eriksen, Jørgen; Sjøgren, Per; Bruera, Eduardo;

    2006-01-01

    The aim of the study was epidemiologically to evaluate the long-term effects of opioids on pain relief, quality of life and functional capacity in long-term/chronic non-cancer pain. The study was based on data from the 2000 Danish Health and Morbidity Survey. As part of a representative National...... random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health...... employment, higher use of the health care system, and a negative influence on quality of life as registered in all items in SF-36. Because of the cross-sectional nature causative relationships cannot be ascertained. However, it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not...

  9. Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial

    Directory of Open Access Journals (Sweden)

    Thoke-Colberg Anette

    2010-03-01

    Full Text Available Abstract Background Pain is one of the most frequent and distressing symptoms in cancer patients. For the majority of the patients, sufficient pain relief can be obtained if adequate treatment is provided. However, pain remains often undertreated due to institutional, health care professional and patient related barriers. Patients self management skills are affected by the patients' knowledge, activities and attitude to pain management. This trial protocol is aimed to test the SCION-PAIN program, a multi modular structured intervention to improve self management in cancer patients with pain. Methods 240 patients with diagnosed malignancy and pain > 3 days and average pain ≥ 3/10 will participate in a cluster randomized trial on 18 wards in 2 German university hospitals. Patients from the intervention wards will receive, additionally to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic pain management, nonpharmacologic pain management and discharge management. The intervention will be conducted by specially trained oncology nurses and includes components of patient education, skills training and counseling to improve self care regarding pain management beginning with admission followed by booster session every 3rd day and one follow up telephone counseling within 2 to 3 days after discharge. Patients in the control group will receive standard care. Primary endpoint is the group difference in patient related barriers to management of cancer pain (BQII, 7 days after discharge. Secondary endpoints are: pain intensity & interference, adherence, coping and HRQoL. Discussion The study will determine if the acquired self management skills of the patients continue to be used after discharge from hospital. It is hypothesized that patients who receive the multi modular structured intervention will have less patient related barriers and a better self management of cancer pain. Trial Registration ClinicalTrials NCT

  10. Effect of music therapy on pain and anxiety levels of cancer patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Priyadharshini Krishnaswamy

    2016-01-01

    Full Text Available 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

  11. Effect of Music Therapy on Pain and Anxiety Levels of Cancer Patients: A Pilot Study

    Science.gov (United States)

    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

  12. Determining the Incidence of Pain Flare Following Palliative Radiotherapy for Symptomatic Bone Metastases: Results From Three Canadian Cancer Centers

    International Nuclear Information System (INIS)

    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.

  13. The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring;

    2009-01-01

    OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated into...... measuring the quality of patient-physician pain communication, and the Danish Brief Pain Inventory pain severity scale. RESULTS: A factor analysis of the DMARS-4 resulted in one factor. Mean (SD) score on the cumulative scale ranging from 4 to 20, with higher scores indicating better medication adherence......, was 17.8 (0.42). The DMARS-4 scores were related to the measures of patients' concerns about pain management and patients' pain communication. The internal consistency of the DMARS-4 was 0.70. CONCLUSIONS: The DMARS-4 seems to be a valid and reliable measure of self-reported adherence to analgesic...

  14. Review of oral oxymorphone in the management of pain

    Directory of Open Access Journals (Sweden)

    Paul Sloan

    2008-09-01

    Full Text Available Paul SloanUniversity of Kentucky Medical Center, Department of Anesthesiology, Lexington, KY, USAAbstract: Chronic cancer and nonmalignant pain (CNMP is a common and major health problem afflicting approximately 40 million persons in the US. Most cancer patients, and many patients with CNMP, require opioid analgesics to obtain adequate pain relief. Oral oxymorphone is a new formulation of an existing parenteral opioid that has become available for the treatment of significant pain: acute postoperative, chronic arthritis, chronic low back, and chronic cancer pain. Oxymorphone is a typical mu-opioid agonist that is effective in both immediate- and extended-release (IR and ER formulations. Oxymorphone is more lipid soluble than morphine, resulting in a rapid onset of action when given in tablet formulation, with a duration of action of approximately 4–6 hours in IR and 12 hours in ER preparations. Oxymorphone provides excellent pain relief for significant pain, with typical opioid side effects that are usually mild or moderate in intensity. Multiple double-blind, prospective, placebo-controlled clinical trials have demonstrated the clinical efficacy and safety of this new oral opioid preparation. Oral oxymorphone is an effective opioid that provides a new therapeutic option for the physician.Keywords: chronic pain, oxymorphone, opioids, extended-release, sustained-release, cancer pain

  15. The Danish version of the questionnaire on pain communication: preliminary validation in cancer patients

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring;

    2009-01-01

    BACKGROUND: The modified version of the patients' Perceived Involvement in Care Scale (M-PICS) is a tool designed to assess cancer patients' perceptions of patient-health care provider pain communication process. The objective of this study was to examine the psychometric properties of the......-PICS seems to be a reliable and valid measure of perceived patient-health care provider communication in the context of cancer pain....... shortened Danish version of the M-PICS (SDM-PICS). METHODS: The validated English version of the M-PICS was translated into Danish following the repeated back-translation procedure. Cancer patients were recruited for the study from specialized pain management facilities. RESULTS: Thirty-three patients...

  16. Paediatric Pain Management: Using Complementary and Alternative Medicine.

    Science.gov (United States)

    Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K

    2008-09-01

    Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies. PMID:26525515

  17. Therapeutic management of locally unresectable pancreatic cancer

    International Nuclear Information System (INIS)

    Pancreatic cancer still have bad prognosis. At the time of diagnosis, less than 10 % of patients can undergo surgery with an overall 5-year survival rate of less than 2 %. For patients with localized pancreatic adenocarcinoma, the combination of radiation therapy and chemotherapy has been shown to control symptoms and to enhance patient survival. This treatment should be proposed to all the patients with good performance status and without icterus. Pain management should be optimized and often need morphinic and co-antalgic (anticonvulsants, steroids) consumption. The celiac plexus block with alcohol gives an excellent pain relief and should be more frequently used. (author)

  18. Tapentadol extended release in the management of peripheral diabetic neuropathic pain

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2015-01-01

    Full Text Available Nalini Vadivelu,1 Alice Kai,2 Benjamin Maslin,1 Gopal Kodumudi,3 Aron Legler,1 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Stony Brook University School of Medicine, Stony Brook, NY, USA; 3Department of Structural and Cellular Biology, Tulane University, New Orleans, LA, USA; 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Tapentadol, a µ-opioid agonist and norepinephrine reuptake inhibitor, has been found to be an effective medication for a wide variety of chronic pain conditions, including back pain, cancer-related pain, and arthritic pain. It has also been found to have fewer gastrointestinal side effects than more traditional opioid-based therapies. More recently, tapentadol extended release has been demonstrated to be effective in the management of painful diabetic neuropathy, an often debilitating condition affecting approximately one-third of all patients with diabetes. This review highlights the most up-to-date basic and clinical studies by focusing on the mechanisms of action of tapentadol and its clinical efficacy, especially with regard to painful diabetic neuropathy. Keywords: chronic pain, neuropathic pain, pharmacology, analgesia, pain management

  19. Pharmacologic management of neuropathic pain: Evidence-based recommendations

    DEFF Research Database (Denmark)

    Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav;

    2007-01-01

    Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered...

  20. Pediatric pain management: the multidisciplinary approach

    OpenAIRE

    Odell, Shannon

    2013-01-01

    Shannon Odell,1,2 Deirdre E Logan1,21Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Department of Psychiatry, Harvard Medical School, Boston, MA, USAAbstract: Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain r...

  1. Pediatric pain management: the multidisciplinary approach

    OpenAIRE

    Odell S; Logan DE

    2013-01-01

    Shannon Odell,1,2 Deirdre E Logan1,21Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 2Department of Psychiatry, Harvard Medical School, Boston, MA, USAAbstract: Chronic pain in children and adolescents is a growing problem and one that is increasingly being addressed with multidisciplinary treatment teams. This review summarizes different multidisciplinary clinics, focusing specifically on intensive pediatric pain rehab...

  2. Pain Management in Functional Gastrointestinal Disorders

    OpenAIRE

    Vigano, Antonio; Bruera, Eduardo

    1995-01-01

    Pain is a common feature in functional gastrointestinal disorders (FGID). An abnormally low visceral sensory threshold, as well as a number of central, spinal and peripheral pain-modulating abnormalities, have been proposed for this syndrome. Clinical aspects of pain associated with irritable esophagus, functional dyspepsia, biliary dysmotility, inflammatory bowel syndrome and proctalgia fugax are reviewed. Because of its unclear pathophysiology, pain expression is the main target for the suc...

  3. Hypnotherapy for the Management of Chronic Pain

    OpenAIRE

    Elkins, Gary; Jensen, Mark P.; Patterson, David R.

    2007-01-01

    This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than ...

  4. Pediatric pain: prevalence, assessment, and management in a teaching hospital

    Directory of Open Access Journals (Sweden)

    M.B.M. Linhares

    2012-12-01

    Full Text Available The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents, their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28% answered the questionnaire and for the other 72% (unable to communicate, the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49% had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

  5. Pain management in patients with hidradenitis suppurativa

    NARCIS (Netherlands)

    Horvath, Barbara; Janse, Ineke C.; Sibbald, Gary R.

    2015-01-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose o

  6. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline;

    2014-01-01

    OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...

  7. Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model.

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

    Directory of Open Access Journals (Sweden)

    Maria de Fatima Guerreiro Godoy

    2014-01-01

    Full Text Available 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.

  9. Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society

    OpenAIRE

    Moulin, DE; Boulanger, A; AJ Clark; Clarke, H.; Dao, T; GA Finley; Furlan, A.; Gilron, I; Gordon, A.; PK Morley-Forster; BJ Sessle; Squire, P; Stinson, J; Taenzer, P.; Velly, A

    2014-01-01

    BACKGROUND: Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians. OBJECTIVE: To review the randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence-based consensus statement on its management. METHODS: RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP ...

  10. Dental restoration induced orofacial pain and its management

    Directory of Open Access Journals (Sweden)

    Xiuxin Liu

    2015-01-01

    Full Text Available Dental procedure induced pain may develop into a chronic condition that accompanied with functional or neuropathy changes in the nerve system. In this case, severe persistent pain gradually developed after repeatedly placing a subgingival amalgam restoration in the right second molar. Hyperalgesia and allodynia were present at the affected region. A provisional diagnosis of chronic orofacial pain with peripheral and central sensitization was considered. After re-contouring, local debridement and occlusal adjustment the pain disappeared. The underlying mechanism in this case is neuronal sensitization and peripheral Aβ-fiber mechanoreceptor activation. Its diagnosis and management depend on identification and treatment of the cause for pain generation and sensitization.

  11. [Nursing management of wound care pain].

    Science.gov (United States)

    Chin, Yen-Fan

    2007-06-01

    Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject. PMID:17554674

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Alice Running

    2015-01-01

    Full Text Available 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.

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

    Science.gov (United States)

    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

  15. Arthroscopic management of painful first metatarsophalangeal joint

    Directory of Open Access Journals (Sweden)

    Debnath U

    2005-01-01

    Full Text Available Background: Arthroscopy of the great toe MTP joint has been practiced with favourable outcomes. A range of indications have been described ranging from synovitis to osteochondral defects. The purpose of the present study was to describe our technique and to assess the functional outcome following arthroscopic management of Hallux MTP disorders using AOFAS scoring system. Methods: We describe the technique of Hallux MTP joint arthroscopy in twenty patients. Indications included hallux rigidus with osteophytes, chondromalacia, OCDs, loose bodies, arthrofibrosis, synovitis, tophaceous gout arthritis and intra-articular fractures of MTP joint. All patients had been evaluated clinically and radiologically with record of their AOFAS scores pre-operatively. At a minimum follow-up of two years the clinical assessment was carried out with AOFAS scores. Results: The mean pre-operative and post-operative AOFAS score were 47 (range 10-78 and 97 (87 -100 respectively. The patient with intra-articular fracture had an excellent outcome following arthroscopic reduction of the fracture. Conclusion: Arthroscopic management of painful hallucial MTP joint is a specialized technique, which if performed for the right indications, gives a favourable outcome with minimal complications.

  16. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, RR; Nielsen, CK; Nasser, A; Thomsen, SI; Eghorn, LF; Pham, Y; Schulenburg, C; Syberg, S; Ding, Ming; Stojilkovic, SS; Jorgensen, NR; Heegaard, AM

    2011-01-01

    were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... with and without astrocyte activation (BALB/cJ or C3H mice inoculated with 4T1 mammary cancer cells or NCTC 2472 osteosarcoma cells, respectively), suggesting that astrocytic P2X7 receptors play a negligible role in bone cancer pain. The results support the hypothesis that bone cancer pain is a...

  17. Cannabinoids in the management of difficult to treat pain.

    Science.gov (United States)

    Russo, Ethan B

    2008-02-01

    This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. Tetrahydrocannabinol (THC, Marinol((R))) and nabilone (Cesamet((R))) are currently approved in the United States and other countries, but not for pain indications. Other synthetic cannabinoids, such as ajulemic acid, are in development. Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation. Sativex((R)), a cannabis derived oromucosal spray containing equal proportions of THC (partial CB(1) receptor agonist ) and cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB(1) receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006. Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise. PMID:18728714

  18. Biologic Mechanisms of Oral Cancer Pain and Implications for Clinical Therapy

    OpenAIRE

    Viet, C.T.; SCHMIDT, B.L.

    2012-01-01

    Cancer pain is an ever-present public health concern. With innovations in treatment, cancer patients are surviving longer, but uncontrollable pain creates a poor quality of life for these patients. Oral cancer is unique in that it causes intense pain at the primary site and significantly impairs speech, swallowing, and masticatory functions. We propose that oral cancer pain has underlying biologic mechanisms that are generated within the cancer microenvironment. A comprehensive understanding ...

  19. Pharmacologic management of pain at the end of life.

    Science.gov (United States)

    Groninger, Hunter; Vijayan, Jaya

    2014-07-01

    Although many patients experience debilitating pain at the end of life, there are many options to improve analgesia and quality of life. Pain assessment using a validated tool, with attention to patient function and specific goals, helps tailor individual treatment plans. The World Health Organization pain ladder offers a stepwise guideline for approaching pain management. However, for many patients with terminal illness, strong opioids are necessary for efficient and effective analgesia. Equianalgesic dosing tables and expert guidelines aid in initiating, monitoring, and adjusting doses of oral and parenteral opioids. Clinicians should feel comfortable administering a repeat dose after the time to peak analgesic effect if the patient is still in pain. In patients with constant pain, using scheduled long-acting opioids may significantly improve pain control. Among pain subtypes, visceral pain management usually requires multiple drugs. Neuropathic pain responds well to adjuvant pharmacotherapies, such as anticonvulsants or antidepressants, in addition to opioids. Opioid-induced hyperalgesia can occur with any dose of an opioid, but is more common with higher doses of parenteral morphine and hydromorphone. With appropriate counseling, most patients with a history of substance abuse will comply with a pain treatment plan. PMID:25077499

  20. Pain assessment and management in surgical nursing: a literature review.

    Science.gov (United States)

    Bell, Liz; Duffy, Anita

    Although postoperative pain assessment and management is an integral part of surgical nursing practice, it remains ad hoc despite numerous costly empirical research studies. Patients have a right to pain relief; however, the barriers to assessing and managing patient pain in practice have not as yet been overcome. A literature review to establish the main barriers to effective postoperative pain relief in clinical practice was carried out. The findings suggest that time management, and attitudes and beliefs of both patients and nurses are significant factors hampering practice. The authors conclude that future research in this area is futile, and suggest that nurses should focus on auditing their own practice to improve the effectiveness of pain management in practice and enhance standards of care. PMID:19223798

  1. Current Challenges in Pain Management in Hip Fracture Patients.

    Science.gov (United States)

    Sanzone, Anthony G

    2016-05-01

    The high incidence of hip fracture, together with considerable associated morbidity, mortality, and cost of care, makes this injury a major clinical challenge. Of particular importance is the pain associated with hip fracture, which can have potentially severe consequences and may lead to delayed recovery. The prevailing opioid-dependent model of analgesia, however, presents multiple drawbacks and risks that can compromise outcomes in the hip fracture population. The pain management process has essential preoperative, intraoperative, and postoperative components, yet data on the comparative effectiveness of different pain management interventions in patients undergoing surgery for hip fracture are not clear cut. A Cochrane database review that included 83 different pain management studies indicated that there are not enough well-designed studies to show unequivocally which pain management approaches work well after hip fracture surgery. Yet a growing body of data on certain interventions, such as nerve blocks and multimodal analgesia, supports consideration of these options. PMID:27101319

  2. Managing chronic pain with nonopioid analgesics: a multidisciplinary consult.

    Science.gov (United States)

    Clauw, Daniel; McCarberg, Bill H

    2012-05-01

    As detailed in this online CME activity (www.cmeaccess.com/AJM/ChronicPain04), determining pain mechanism is an important aspect guiding treatment selection for chronic musculoskeletal pain states. Although broad classifications provide a framework, any combination of mechanisms may be present in a chronic pain patient, and there is growing evidence that pain states generally considered nociceptive may also involve elements of augmented central nervous system pain processing. Nonopioid analgesics, including serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and alpha-2-delta ligand anticonvulsants, are the treatments of choice for fibromyalgia and other central neuropathic pain states. Additionally, studies have now shown that certain SNRIs can be effective in treating "classic" nociceptive pain states, such as osteoarthritis, and also are effective for low back pain. In addition to considering biological mechanisms, chronic pain management also involves recognizing and evaluating the contribution of psychological and sociocultural factors that can influence pain chronicity and patient prognosis. A multimodal/multidisciplinary approach incorporating pharmacologic and nonpharmacologic therapy into a program that includes more than 1 discipline is important to improve outcomes in patients with chronic pain. PMID:22482859

  3. Opioids Switching with Transdermal Systems in Chronic Cancer Pain

    OpenAIRE

    Barbarisi M; Sansone P; Pota V; Pace MC; Aurilio C; Grella E; Passavanti MB

    2009-01-01

    Abstract Background Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy Objective To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. Methods A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switche...

  4. Epigenomics in cancer management

    Directory of Open Access Journals (Sweden)

    Fabricio F Costa

    2010-10-01

    Full Text Available Fabricio F CostaCancer Biology and Epigenomics Program, Children’s Memorial Research Center and Northwestern University’s Feinberg School of Medicine, 2430 N. Halsted St, Box 220, Chicago, IL, USAAbstract: The identification of all epigenetic modifications implicated in gene expression is the next step for a better understanding of human biology in both normal and pathological states. This field is referred to as epigenomics, and it is defined as epigenetic changes (ie, DNA methylation, histone modifications and regulation by noncoding RNAs such as microRNAs on a genomic scale rather than a single gene. Epigenetics modulate the structure of the chromatin, thereby affecting the transcription of genes in the genome. Different studies have already identified changes in epigenetic modifications in a few genes in specific pathways in cancers. Based on these epigenetic changes, drugs against different types of tumors were developed, which mainly target epimutations in the genome. Examples include DNA methylation inhibitors, histone modification inhibitors, and small molecules that target chromatin-remodeling proteins. However, these drugs are not specific, and side effects are a major problem; therefore, new DNA sequencing technologies combined with epigenomic tools have the potential to identify novel biomarkers and better molecular targets to treat cancers. The purpose of this review is to discuss current and emerging epigenomic tools and to address how these new technologies may impact the future of cancer management.Keywords: genomics, epigenomics, epigenetics, DNA methylation, histone modifications, new technologies, cancer management

  5. Cancer Pain Control for Advanced Cancer Patients by Using Autonomic Nerve Pharmacopuncture

    Directory of Open Access Journals (Sweden)

    Hwi-joong Kang

    2014-09-01

    Full Text Available Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12 ─ 20 mL injection of each patient’s dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain.

  6. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain.

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents - morphine and ziconotide - are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal

  7. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a “critical mass” intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients’ needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations

  8. Radiation-induced mucositis pain in laryngeal cancer

    International Nuclear Information System (INIS)

    Radiation therapy in those with head and neck malignancies often triggers painful mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). To better understand how radiation-induced pain develops over time, we studied the numerical rating scale (NRS 0-5) pain scores from 32 persons undergoing radiation therapy of 60-72 Gy for newly diagnosed laryngeal cancer. The degree of mucositis was evaluated using Common Terminology Criteria for Adverse Events version3.0 (CTCAE v3.0). We divided the 32 into a conventional fractionation (CF) group of 14 and a hyperfractionation (HF) group of 18, and further divided laryngeal cancer into a small-field group of 23 and a large-field group of 9. The mucositis pain course was similar in CF and HF, but mucositis pain was severer in the HF group, which also required more NSAIDs. Those in the large-field group had severer pain and mucositis and required more NSAIDs than those in the small-field group. We therefore concluded that small/large-field radiation therapy, rather fractionation type, was related to the incidence of radiation-induced mucositis pain. (author)

  9. Omega-Conotoxins as Experimental Tools and Therapeutics in Pain Management

    Directory of Open Access Journals (Sweden)

    Heidi E. Hannon

    2013-03-01

    Full Text Available Neuropathic pain afflicts a large percentage of the global population. This form of chronic, intractable pain arises when the peripheral or central nervous systems are damaged, either directly by lesion or indirectly through disease. The comorbidity of neuropathic pain with other diseases, including diabetes, cancer, and AIDS, contributes to a complex pathogenesis and symptom profile. Because most patients present with neuropathic pain refractory to current first-line therapeutics, pharmaceuticals with greater efficacy in pain management are highly desired. In this review we discuss the growing application of ω-conotoxins, small peptides isolated from Conus species, in the management of neuropathic pain. These toxins are synthesized by predatory cone snails as a component of paralytic venoms. The potency and selectivity with which ω-conotoxins inhibit their molecular targets, voltage-gated Ca2+ channels, is advantageous in the treatment of neuropathic pain states, in which Ca2+ channel activity is characteristically aberrant. Although ω-conotoxins demonstrate analgesic efficacy in animal models of neuropathic pain and in human clinical trials, there remains a critical need to improve the convenience of peptide drug delivery methods, and reduce the number and severity of adverse effects associated with ω-conotoxin-based therapies.

  10. Recent Advances in Postoperative Pain Management

    OpenAIRE

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

    Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensiti...

  11. Assessment and management of pain in infants

    OpenAIRE

    Mathew, P.; Mathew, J.

    2003-01-01

    Infants, including newborn babies, experience pain similarly and probably more intensely than older children and adults. They are also at risk of adverse long term effects on behaviour and development, through inadequate attention towards pain relief in early life. However, the issue of analgesia in young babies has been largely neglected in most clinical settings, despite subjecting them to painful diagnostic and therapeutic procedures. Several therapeutic and preventive strategies, includin...

  12. Psychological therapies for the management of chronic pain

    OpenAIRE

    Sturgeon JA

    2014-01-01

    John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy fo...

  13. Pain in cancer. An outcome research project to evaluate the epidemiology, the quality and the effects of pain treatment in cancer patients

    Directory of Open Access Journals (Sweden)

    Nicora Mariaflavia

    2006-02-01

    Full Text Available Abstract Background Management of pain related to advanced or metastatic cancer, although the availability of several pharmacological and non-pharmacological interventions and the existence of well-known guidelines and protocols, is often difficult and inadequate. Evidence of the relative effectiveness of current options for treating cancer pain from comparative randomized studies is scanty. Methods In the context of a wider project, a multicenter, open label, prospective Outcome Research study will be launched in Italy in 2006 to investigate the epidemiology of cancer pain and of its treatments, the quality of analgesic-drug therapy and the effectiveness of alternative analgesic strategies in a large, prospective, unselected cohort of cancer patients using the state-of-the art of patient-reported-outcomes. About 100 Italian centers will recruit 2500 patients with advanced/progressive/metastatic cancer with pain (related to the cancer disease requiring analgesic treatments. Each center is expected to recruit 25 consecutive and eligible patients during the study inception period. Approximately two months will be allowed for subject recruitment and enrollment. Subject evaluation and follow-up will be for 3 months. The effect on outcomes of various therapeutic analgesic options administered by physicians, given the observational approach where patients are not assigned at random to different treatments, will be compared using the propensity score approach, allowing the adjustment for treatment selection bias. Later, after the launch of the observational study and on the basis of results, in specific subsamples of patients and in select centers of the network, a Randomized Controlled Trial will be carried out to formally compare the efficacy of alternative analgesic strategies, with particular emphasis on oral morphine (as comparator and buprenorphine patch (as experimental arm. Results from the outcome (cohort and experimental (Randomized

  14. Reliability and Validity of the Korean Cancer Pain Assessment Tool (KCPAT)

    OpenAIRE

    Kim, Jeong A; Choi, Youn Seon; Lee, Juneyoung; Park, Jeanno; Lee, Myung Ah; Yeom, Chang Hwan; Jang, Se Kwon; Yoon, Duck Mi; Kim, Jun Suk

    2005-01-01

    The Korean Cancer Pain Assessment Tool (KCPAT), which was developed in 2003, consists of questions concerning the location of pain, the nature of pain, the present pain intensity, the symptoms associated with the pain, and psychosocial/spiritual pain assessments. This study was carried out to evaluate the reliability and validity of the KCPAT. A stratified, proportional-quota, clustered, systematic sampling procedure was used. The study population (903 cancer patients) was 1% of the target po...

  15. Evaluation and Management of SCI-Associated Pain.

    Science.gov (United States)

    Saulino, Michael; Averna, Justin F

    2016-09-01

    Traumatic spinal cord injury (SCI) is a devastating neurological condition. Treatment of SCI-related pain is challenging for the treating physician, as normal neural pathways are disrupted. Patients with SCI consistently rate pain as one of the most difficult problems associated with their injury. SCI-related pain can be refractory and complete relief is often not possible. The multidimensional nature of SCI-related pain affects the neural system including autonomic nervous system deregulation and can alter metabolic and biochemical processes throughout the body. Co-morbid psychological illnesses such as depression and adjustment disorder are seen in a significant percentage of patients. Despite a better understanding of the underlying pain mechanisms and advances in procedural, pharmacologic, and non-pharmacologic therapies, treatment of pain after SCI remains elusive. This manuscript reviews the current evidence-based evaluation and management of the SCI patient with the overarching goal of providing appropriate and effective management of their pain. In particular, additional well-designed studies are needed to help elucidate effective treatments for SCI-related neuropathic pain in an effort to help provide these patients with better management of their pain and improve their quality of life. PMID:27474095

  16. Study of Patient Pain Management after Heart Surgery

    Directory of Open Access Journals (Sweden)

    Mohammadreza Sattari

    2013-08-01

    Full Text Available Purpose: To investigate postoperative pain control and analgesic use after heart surgery. Methods: 120 patients undergone heart surgery, randomly entered the study. Each patient was asked to score his pain intensity on visual analog scale (VAS at four different occasions. Results: 120 patients aged 59 year-old; including 81 male were enrolled in the study. 69.2% had coronary artery disease and 16.7% had heart-valve problem. Main types of surgeries were coronary artery bypass surgery (70.5% and valve repairement (23%. Duration of ICU stay was 4.78±2.7 days and duration of intubations was 17.38 ± 36.46 hours. Pre-surgery pain relief was administrated to 42% of the subjects and morphine and promethazine was the main pre-surgery analgesia medication. Post surgery analgesic included morphine (injection, petidine (injection and NSAIDS (oral or rectal. According to VAS, mean pain level, 1 and 4 hours after extubation, and before and one hour after transferring to wards was 5.05±2.5, 4.09±2.0, 3.52±1.8, 2.36±1.89, respectively. Although the level of pain reported was mostly moderate, 80% were reported satisfaction with their post-surgery pain management. Conclusion: A closer pain management control is needed for patients after heart surgery. Introduction of newer pain management techniques, medications and dosages could reduce the pain and suffering.

  17. Randomized trial of opioids versus tricyclic antidepressants for radiation-induced mucositis pain in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ehrnrooth, E.; Grau, C.; Zachariae, R.; Andersen, Joern [Aarhus Univ. Hospital (Denmark). Dept. of Oncology

    2001-11-01

    Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant (TC), commonly used in the treatment of neuropathic pain, with the effect of opioids on radiation-induced mucositis pain. Forty-three patients receiving 66-68 Gy external radiation according to the DAHANCA guidelines (the Danish Head and Neck Cancer Study Group) were randomized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics. Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm. Pain was evaluated weekly using a VAS scale and the McGill Pain Questionnaire. The degree of mucositis and the degree of depression were measured at the same time intervals. Twenty-two patients entered the opioid arm and 21 the TC arm. Two patients in each arm were non-evaluable. VAS pain scores were significantly reduced in the opioid treatment arm one week after randomization (p=0.01). Eight patients in the TC arm were managed with TC alone, but for 11 patients it was necessary to add morphine. The 20 evaluable patients in the morphine arm required no additional treatment. There were no significant differences in side effects between the two groups. Higher pain scores in the TC arm, but not in the opioid arm, were significantly correlated with higher BDI scores. Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone. This might be useful in patients with relative counter-indications to opioid treatment.

  18. Randomized trial of opioids versus tricyclic antidepressants for radiation-induced mucositis pain in head and neck cancer

    International Nuclear Information System (INIS)

    Patients who receive radiotherapy for head and neck cancer are likely to develop painful mucositis. The pain is characterized by a burning or stinging sensation similar to neuropathic pain sensations. The purpose of the present study was to compare the analgesic effect of a tricyclic antidepressant (TC), commonly used in the treatment of neuropathic pain, with the effect of opioids on radiation-induced mucositis pain. Forty-three patients receiving 66-68 Gy external radiation according to the DAHANCA guidelines (the Danish Head and Neck Cancer Study Group) were randomized to either morphine or TC when mucositis pain was insufficiently managed with weak analgesics. Patients with insufficient pain control in either treatment arm received supplementary medication from the opposite treatment arm. Pain was evaluated weekly using a VAS scale and the McGill Pain Questionnaire. The degree of mucositis and the degree of depression were measured at the same time intervals. Twenty-two patients entered the opioid arm and 21 the TC arm. Two patients in each arm were non-evaluable. VAS pain scores were significantly reduced in the opioid treatment arm one week after randomization (p=0.01). Eight patients in the TC arm were managed with TC alone, but for 11 patients it was necessary to add morphine. The 20 evaluable patients in the morphine arm required no additional treatment. There were no significant differences in side effects between the two groups. Higher pain scores in the TC arm, but not in the opioid arm, were significantly correlated with higher BDI scores. Some head and neck cancer patients with radiation-induced nucositis pain may have sufficient pain control on TC alone. This might be useful in patients with relative counter-indications to opioid treatment

  19. Knowledge Toward Cancer Pain and the Use of Opioid Analgesics Among Medical Students in their Integrated Clinical Clerkship

    Directory of Open Access Journals (Sweden)

    Maria Fidelis C. Manalo

    2008-01-01

    Full Text Available Introduction: Among the focal issues of barriers to pain management include the physicians’ lack of knowledge about cancer pain and negative attitudes towards opioids. Many physicians and educators attribute this, at least in part, to limited exposure to pain and palliative care education during medical school.Aim: The researcher investigated the medical students’ knowledge about cancer pain and the use of opioid analgesics.Methods: The subjects were a sample of 50 students of the University of the Philippines College of Medicine in their integrated clinical clerkship year. Descriptive statistics (frequencies, means, standard deviation, rating scales were used to determine mean knowledge score and level of confidence with opioid use. The study also identified specific areas where students exhibited good or poor knowledge of opioids.Results: Approximately sixty-nine (69% of the study respondents mentioned that pain management was given to them during their Anesthesiology lectures while a few recalled that they had these lectures during their Family Medicine rotation in Supportive, Palliative and Hospice Care. More than a third (35% of the respondents admitted to not being confident with morphine use at present. The top three reasons cited as limitations in choice of opioids for cancer pain include fear of addiction, lack of adequate knowledge and experience and fear of side effects and complications. Out of a maximum of 13 correct answers, the mean knowledge score of the medical students was 6.6 ± 2.9. Less than 16% of the respondents had adequate knowledge on cancer pain and opioid use.Conclusions: The results show that basic knowledge of the role of opioids in cancer pain management among medical students in their integrated clinical clerkship year at the University of the Philippines is poor. The findings imply a need to look into making revisions in the medical curriculum to include a training program that will enable all students to

  20. Managing low back pain second edition

    International Nuclear Information System (INIS)

    This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment

  1. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China*

    Institute of Scientific and Technical Information of China (English)

    Yi Zhu; Bin Su; Ning Li; Hongzhu Jin

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospit-als in Nanjing, China between February 2007 and January 2012. Al patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8%of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebel opontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par-ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative re-lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

  2. The Cognitive-Behavioral Management of Pain: Neurophysiological Relevancies.

    Science.gov (United States)

    Stone, Christopher I.

    Traditional medical interventions for the management of pain have consisted largely of either pharmacological treatments or surgery to interrupt the involved neural pathways. The results of these procedures have been largely unsatisfactory because of debilitating side effects and recurrence of pain. Investigations of a host of psychological…

  3. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Saulino M

    2014-11-01

    Full Text Available Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been

  4. 硫酸吗啡控释片直肠、阴道给药治疗女性癌痛的疗效%Therapeutie Effects of Rectal and Vaginal Administration of Morphine Sulfate in Female Cancer Pain Management

    Institute of Scientific and Technical Information of China (English)

    沈惠琴; 胡祎; 刘忆菁; 龚晓桃

    2011-01-01

    目的 比较硫酸吗啡控释片(商品名:美施康定)直肠、阴道给药治疗女性癌痛的临床疗效.方法 将入选的97例口服给药困难的女性癌痛患者按随机数字表法分成两组,直肠给药组48例,阴道给药组49例,两组均给予硫酸吗啡控释片,1次/12 h,并在用药过程中根据疼痛缓解程度调整剂量;5 d后比较两组镇痛效果、不良反应发生率、硫酸吗啡控释片用量以及治疗前后生活质量评分变化情况.结果 硫酸吗啡控释片直肠、阴道给药治疗中重度癌痛女性总有效率分别为93 8%和91 7%,组间比较差异无统计学意义(P>0.05);两组生活质量治疗后均有提高,差异有统计学意义,但组间比较差异无统计学意义(P>0.05);阴道给药组便秘发生率较直肠给药组明显降低,硫酸吗啡控释片用量少(P<0.05).结论 对于各种原因所致不能口服或直肠给药的女性癌痛患者,阴道给药是一种安全、有效、简便的给药途径.%Objective To compare the clinical efficacy of rectal and vaginal administration of morphine sulfate in female cancer pain management.Methods Ninety-seven female patients with difficulty in oral administration of morphine sulfate were randomized into rectal administration group(n=48) and vaginal administration group(n=49).The patients in the two groups were treated by vaginal administration or rectum administration per 12 hour.The dose was adjusted according to pain relief levels during medication.After five days' treatment, comparisons were conducted on the efficacy, the incidence of adverse reactions,the dosage of morphine sulfate controlled-release tablets and the scores of quality of life(QOL) before and after surgery.Results The total efficacy rate of rectum administration and vaginal administration for moderate-severe female cancer pain were 93.8 % and 91.7 % respectively,with no significant difference between two groups(P>0.05).The quality of life was significantly

  5. [Transfer managment of postoperative acute pain therapy to outpatient aftercare].

    Science.gov (United States)

    Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

    2014-10-01

    The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. PMID:24452431

  6. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence.

    Science.gov (United States)

    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

  7. Surgical management of intramedullary cavernous angiomas and analysis pain relief

    Directory of Open Access Journals (Sweden)

    Huang Si Qing

    2014-01-01

    Full Text Available Objective: The objective of this study was to conduct a retrospective analysis of the clinical characteristics of 20 individuals with intramedullary cavernous angiomas (ICA presented with serious pain complaints. This study was to investigate the efficacy of short- and long-term pain relief following surgical resection. Materials and Methods: Between 2006 and 2012, 55 patients with ICA were surgically managed in our institution. Of these 20 (36.4% patients presented with serious pain as a unique clinical feature. Numerical pain scores (NPS: 0-10 were used to assess the patients′ pain levels preoperatively, as well as at 1 month and 1 year postoperatively. All the patients had magnetic resonance imaging (MRI preoperatively and during follow-up. IBM SPSS Statistics 19.0 was used to analysis the outcomes. Results: Of the 20 patients with ICA, 9 (45% required cervical and 11 (55% thoracic surgery. Seven (35% patients presented with radicular pain and 13 (65% presented with central pain. Pain improved from a total mean preoperative score of 8.60 to total mean score of 2.95 (P < 0.01 at one month and 3.35 (P < 0.01 at one year post-surgery. However, the pain symptoms completely disappeared in the long-term follow-up only in three (15% patients. Five (25% patients reported new pain symptoms with no lesion reoccurrence postoperatively. Conclusion: Pain is the common complaint in patients with ICA. Surgery is effective in providing short- and long-term pain relief. However, long-term follow-up measures on postoperative pain levels show that the pain does recur in the months following surgery.

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

    OpenAIRE

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

    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), i...

  9. Education On Prehospital Pain Management: A Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Scott C. French

    2013-03-01

    Full Text Available Introduction: The most common reason patients seek medical attention is pain. However,there may be significant delays in initiating prehospital pain therapy. In a 2001 qualityimprovement (QI study, we demonstrated improvement in paramedic knowledge,perceptions, and management of pain. This follow-up study examines the impact of thisQI program, repeated educational intervention (EI, and effectiveness of a new painmanagement standard operating procedure.Methods: 176 paramedics from 10 urban and suburban fire departments and two privateambulance services participated in a 3-hour EI. A survey was performed prior to the EI andrepeated one month after the EI. We reviewed emergency medical services (EMS runs withpain complaints prior to the EI and one month after the EI. Follow-up results were comparedto our prior study. We performed data analysis using descriptive statistics and chi-square tests.Results: The authors reviewed 352 surveys and 438 EMS runs with pain complaints. Usingthe same survey questions, even before the EI, 2007 paramedics demonstrated significantimprovement in the knowledge (18.2%; 95% CI 8.9%, 27.9%, perceptions (9.2%; 95% CI6.5%, 11.9%, and management of pain (13.8%; 95% CI 11.3%, 16.2% compared to 2001.Following EI in 2007, there were no significant improvements in the baseline knowledge (0%;95% CI 5.3%, 5.3% but significant improvements in the perceptions of pain principles (6.4%;95% CI 3.9%, 9.0% and the management of pain (14.7%; 95% CI 11.4%, 18.0%.Conclusion: In this follow up study, paramedics’ baseline knowledge, perceptions, andmanagement of pain have all improved from 6 years ago. Following a repeat educationalintervention, paramedics further improved their field management of pain suggestingparamedics will still benefit from both initial and also ongoing continuing education on thetopic of pain management.

  10. Psychological therapies for the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-04-01

    Full Text Available John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed. Keywords: pain management, multidisciplinary pain treatment, psychological therapy

  11. Diffusion of pain management research into nursing practice.

    Science.gov (United States)

    Dooks, P

    2001-04-01

    The promotion of evidence based practice is a challenge within nursing. Pain management is a prime example of this practice research gap. There is solid evidence for 20 years to promote positive change in our methods of pain management, yet outdated approaches are still amazingly evident. Even among oncology nurses, who place a high value on promoting patient comfort, there is a lack of evidence-based pain management. Rogers' Diffusion of Innovation Theory provides an interesting framework for examining the issues and possible solutions to this complex problem. Rogers' theory examines how changes diffuse through a social system over time and also exposes some of the barriers and facilitators to this process. The theory looks at adopters, the nature of the innovation, the social system, and communication patterns. Identifying the barriers of the past will help nursing to overcome these same barriers and increase the adoption of evidence-based pain management approaches in the future. PMID:11318267

  12. Living with Fibromyalgia, Drugs Approved to Manage Pain

    Science.gov (United States)

    ... Consumers Home For Consumers Consumer Updates Living with Fibromyalgia, Drugs Approved to Manage Pain Share Tweet Linkedin ... syndrome, and depression. back to top What Causes Fibromyalgia? Scientists believe that the condition may be due ...

  13. Management of patients with neck pain

    OpenAIRE

    E. A. Chechet; V. A. Parfenov

    2016-01-01

    Neck pain (cervicalgia) occupies one of the leading places among the reasons for outpatient visits, 75% of people have experienced neck pain at least once in their lives. In most cases, neck pain regresses; however, it recurs in almost one half of patients. The paper gives data on the risk factors, mechanisms, course, and prognosis of cervicalgia. It discusses the issues of differential diagnosis, examination, and approaches to treating this condition in these patients. Nonsteroidal anti-infl...

  14. Integrated Approach for Pain Management in Parkinson Disease.

    Science.gov (United States)

    Geroin, Christian; Gandolfi, Marialuisa; Bruno, Veronica; Smania, Nicola; Tinazzi, Michele

    2016-04-01

    Pain, one of the most frequent nonmotor symptoms of Parkinson disease (PD), is recognized as an important component of the illness that adversely affects patient quality of life. The aims of this review are to summarize the current knowledge on the clinical assessment and to provide a detailed overview of the evidence-based pharmacologic and nonpharmacologic approaches to treating pain. Results of a literature search include studies investigating pain/sensory abnormalities in PD. The effects of levodopa administration, deep brain stimulation (DBS), pallidotomy, spinal cord stimulation, rehabilitation, and complementary/alternative medicine are reviewed critically. PD patients have altered pain and sensory thresholds; levodopa and DBS improve pain and change sensory abnormalities toward normal levels through antinociceptive and/or modulatory effects that remain unknown. A wide range of nonpharmacologic approaches require further investigation. A multidisciplinary approach is fundamental in managing pain syndromes in PD. PMID:26879763

  15. 24例癌痛会诊病例疼痛缓解及不良反应转归的分析%Analysis of pain management and opioid -related adverse drug reaction of 24 cancer pain patients for pharmacist consultation

    Institute of Scientific and Technical Information of China (English)

    任振宇; 曲昂; 李金娜; 郭福新; 刘晓光; 马力文; 王俊杰; 赵荣生; 刘芳; 王墨培; 姜玉良; 田素青; 张煜

    2016-01-01

    目的:评价药师会诊前后癌痛病例的疼痛控制及药物相关不良反应的改善情况。方法对24例癌痛会诊患者在会诊前和会诊后1周内对过去24 h疼痛评分、24 h内爆发痛次数和评分,以及便秘、恶心呕吐、尿潴留等药物相关不良反应的转归情况进行评估和对比分析。结果与会诊前相比,会诊后1周疼痛控制总体情况显著改善:24 h 疼痛评分显著降低[(5.87±0.46) vs (3.17±0.33),P<0.05)],24 h内爆发痛次数和评分显著降低[(3.09±0.27) vs (0.94±0.21),P<0.05;(7.01±0.51)vs(2.63±0.57),P<0.05]。阿片类镇痛药物相关的便秘和恶心呕吐显著好转( P<0.05)。结论临床药师会诊有助于改善难治性癌痛治疗效果。%Objective To investigate the effects of pharmacist consulta-tion on cancer pain management.Methods Assess and analysis the pain NRS score during the past 24 h, breakthrough pain scores and times during the past 24 h, and opioid -related adverse drug reactions inclu-ding constipation , nausea , vomiting and urinary retention pre -and post-consultation.Results Compared with pre -consultation , pain during past 24 h [ ( 5.87 ±0.46 ) vs ( 3.17 ±0.33 ) , P<0.05 ) ] and break-through pain [ ( 3.09 ± 0.27 ) vs ( 0.94 ± 0.21 ) , P <0.05;(7.01 ±0.51 ) vs (2.63 ±0.57), P<0.05)] improved significantly after pharmacist consultation.Opioid -related adverse drug reactions including constipation, nausea, vomiting was also improved.Conclusion Pharmacist consultation significantly improves the management of cancer pain .

  16. ORAL OPIOIDS IN THE TREATMENT OF CANCER PAIN

    NARCIS (Netherlands)

    ZYLICZ, Z; TWYCROSS, RG

    1991-01-01

    Persistent severe cancer pain should be treated with opioid drugs, principally morphine. It can be administered orally, rectally and parenterally. Morphine is metabolised in the liver mainly to glucuronides, of which morphine-6-glucuronide is a powerful analgesic. Oral morphine should be administere

  17. Painful os Acromiale: Conservative Management in a Young Swimmer Athlete

    OpenAIRE

    Frizziero, Antonio; Benedetti, Maria G.; Creta, Domenico; Moio, Antonio; Galletti, Stefano; Maffulli, Nicola

    2012-01-01

    An os acromiale (OA) arises from a fusion failure of the anterior acromial apophysis. This case report presents the successful management of a painful OA associated to rotator cuff impingement in a competitive swimmer, based on ultrasonographic diagnosis and conservative management. Rest from sport activity, oral anti-inflammatory drugs and previous attempt of treatment of shoulder pain were ineffective. After two months of conservative treatment consisting of avoidance of swimming, local ant...

  18. Opioid therapy in non-cancer chronic pain patients: Trends and efficacy in different types of pain, patients age and gender

    Directory of Open Access Journals (Sweden)

    Yasin S AlMakadma

    2013-01-01

    Full Text Available Background: In both developing and developed countries, chronic pain remains a real issue and a true disease that affects up to 42% of the population in some areas. Opioids are widely used for the management of chronic pain with variations in prescribing practices, indications and observed efficacy. Aim: to analyze trends in opioids prescribing and patient response in chronic non-cancer pain conditions. Methods: Retrospective study of 1500 casenotes of patients suffering variable non-cancer chronic pain conditions. Detailed review of those cases who were managed using opioids. Statistical analysis using "SOFA" software set. Results: The prevalence of opioids prescribing in patients suffering this condition was thus around 35% (n=526. Women older than 50 years were more likely than men to have a chronic pain condition and to be given opioid therapy for 1 year or more. Opioid efficacy on neuropathic and mixed types of pain was found to be significant with relatively low rate of drop-out and limited side-effects that are not life threatening. Overall, patients stopped or changed their opioid medication due to inefficacy in only 12.7% of cases. Conclusions: The simple fact of having pain is itself a source of self-reported disability regardless of the actual physiological or pathological mechanism. Policy makers should be aware of the huge impact of chronic pain disease and of its serious effects on social and economical well-being. In developing countries, chronic pain could represent a real challenge for all parties. Multimodal management, including opioids, appears crucial for the approach of this disease.

  19. Determinants of nurses' knowledge gap on pain management in Ghana.

    Science.gov (United States)

    Aziato, Lydia; Adejumo, Oluyinka

    2014-03-01

    There are concerns about adequacy of nurses' knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses' inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses' inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required. PMID:24011564

  20. Hypnosis: an alternative in pain management for nurse practitioners.

    Science.gov (United States)

    Hrezo, R J

    1998-12-01

    Hypnosis and the trance phenomenon is an age-old tool for the treatment of a variety of conditions, including pain. Medically accepted for over 50 years as a legitimate therapy, research continues into its mechanisms and actions. In this article, its origins, history, theoretical basis, and various uses are discussed. Case presentations from the author are provided, showing its use for a variety of pain management scenarios. Sample hypnotic scripts allow the reader to better visualize the applicability of hypnotic suggestion to general inductions and pain management. References are provided for individuals seeking further information and/or training in hypnosis. PMID:10214224

  1. Breakthrough cancer pain – still a challenge

    OpenAIRE

    Margarit, César

    2012-01-01

    Cesar Margarit,1 Joaquim Juliá,2 Rafael López,3 Antonio Anton,4 Yolanda Escobar,5 Ana Casas,6 Juan Jesús Cruz,7 Rafael Galvez,8 Ana Mañas,9 Francisco Zaragozá101Pain Unit, Alicante University General Hospital, Alicante, Spain; 2Department of Integral Support-Palliative Care, Catalan Institute of Oncology (ICO), Germans Trias i Pujol University Hospital, Badalona, Spain; 3Department of Clinical Oncology, University Hospital Complex, Santia...

  2. Neonatal pain management: still in search for the Holy Grail.

    Science.gov (United States)

    Allegaert, Karel; van den Anker, John N

    2016-07-01

    Inadequate pain management but also inappropriate use of analgesics in early infancy has negative effects on neurodevelopmental outcome. As a consequence, neonatal pain management is still in search for the Holy Grail. At best, effective pain management is based on prevention, assessment, and treatment followed by a re-assessment of the pain to determine if additional treatment is still necessary. Unfortunately, epidemiological observations suggest that neonates are undergoing painful procedures very frequently, unveiling the need for effective preventive, non-pharmacological strategies. In addition, assessment is still based on validated, multimodal, but subjective pain assessment tools. Finally, in neonatal intensive care units, there is a shift in clinical practices (e.g., shorter intubation and ventilation), and this necessitates the development and validation of new pharmacological treatment modalities. To illustrate this, a shift in the use of opioids to paracetamol has occurred and short-acting agents (remifentanil, propofol) are more commonly administered to neonates. In addition to these new modalities and as part of a more advanced approach of the developmental pharmacology of analgesics, pharmacogenetics also emerged as a tool for precision medicine in neonates. To assure further improvement of neonatal pain management the integration of pharmacogenetics with the usual covariates like weight, age and/or disease characteristics is needed. PMID:27087155

  3. Managing a chronic pain patient in the perioperative period.

    Science.gov (United States)

    Kopf, Andreas

    2013-12-01

    The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303836

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

    Science.gov (United States)

    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

  5. Biphalin preferentially recruits peripheral opioid receptors to facilitate analgesia in a mouse model of cancer pain - A comparison with morphine.

    Science.gov (United States)

    Lesniak, Anna; Bochynska-Czyz, Marta; Sacharczuk, Mariusz; Benhye, Sandor; Misicka, Aleksandra; Bujalska-Zadrozny, Magdalena; Lipkowski, Andrzej W

    2016-06-30

    The search for new drugs for cancer pain management has been a long-standing goal in basic and clinical research. Classical opioid drugs exert their primary antinociceptive effect upon activating opioid receptors located in the central nervous system. A substantial body of evidence points to the relevance of peripheral opioid receptors as potential targets for cancer pain treatment. Peptides showing limited blood-brain-barrier permeability promote peripheral analgesia in many pain models. In the present study we examined the peripheral and central analgesic effect of intravenously administered biphalin - a dimeric opioid peptide in a mouse skin cancer pain model, developed by an intraplantar inoculation of B16F0 melanoma cells. The effect of biphalin was compared with morphine - a golden standard in cancer pain management. Biphalin produced profound, dose-dependent and naloxone sensitive spinal analgesia. Additionally, the effect in the tumor-bearing paw was largely mediated by peripheral opioid receptors, as it was readily attenuated by the blood-brain-barrier-restricted opioid receptor antagonist - naloxone methiodide. On the contrary, morphine facilitated its analgesic effect primarily by activating spinal opioid receptors. Both drugs induced tolerance in B16F0 - implanted paws after chronic treatment, however biphalin as opposed to morphine, showed little decrease in its activity at the spinal level. Our results indicate that biphalin may be considered a future alternative drug in cancer pain treatment due to an enhanced local analgesic activity as well as lower tolerance liability compared with morphine. PMID:27094782

  6. A new transmucosal drug delivery system for patients with breakthrough cancer pain: the fentanyl effervescent buccal tablet

    Directory of Open Access Journals (Sweden)

    Enno Freye

    2008-12-01

    Full Text Available Enno FreyeCenter of Ambulatory Pain Medicine, Neuss-Uedesheim, GermanyAbstract: Breakthrough pain, a transitory severe pain with the background of otherwise controlled persistent pain has a prevalence between 52% and 67% in outpatients with cancer. Medications for such sudden-onset pain require non-invasive delivery of a potent and short-acting opioid for rapid pain relief. Although oral transmucosal delivery of fentanyl citrate (OTFC has been shown to provide better pain relief than a typical oral opioid administration such as morphine sulfate immediate release (MSIR in the management of breakthrough pain in patients with cancer-related pain, newer delivery systems offer a potential for further enhancement of pain relief. The fentanyl effervescent buccal tablet (FBT formulation employs a novel drug delivery system that relies on an effervescence reaction to improve buccal fentanyl absorption. Using the effervescence reaction results in the production and dissipation of carbon dioxide with a dynamic shift in pH as the tablet dissolves. The induced low pH favors dissolution of fentanyl citrate in saliva (higher water solubility. The subsequent increase in pH thereafter favors the buccal absorption of non-ionized fentanyl across the buccal mucosa. Such a pH “pumping” mechanism increases the permeation of fentanyl into and through the buccal to the vascular system from where the agent is transported to the specific opioid receptor sites in the CNS. Compared with OTFC, data in healthy volunteers show that the effervescence reaction employed in FBT increases the total amount and the speed of absorption of fentanyl being absorbed. Compared with OTFC there is an increase in peak fentanyl blood concentrations, and an enhancement of the amount of buccal delivery of fentanyl. Such favorable data are underlined by the results of clinical studies where the FBT technology was studied in patients with breakthrough pain in chronic malignant pathologies

  7. The assessment and management of pain in the demented and non-demented elderly patient

    Directory of Open Access Journals (Sweden)

    D C Andrade

    2011-01-01

    Full Text Available Persistent pain is a frequent health problem in the elderly. Its prevalence ranges from 45% to 80%. Chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. The presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. Alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. Many patients have language deficits and thus cannot properly describe its characteristics. In more advanced cases, it becomes even difficult to determine whether pain is present or not. Therefore, the evaluation of these patients should be performed in a systematic way. There are three ways to measure the presence of pain: by direct questioning (self-report, by direct behavioral observation and by interviews with caregivers or informants. In recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. Some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. The next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contra-indications against some drug classes. A multiprofessional approach is the rule in the management of these patients.

  8. Investigation and analysis of oncologists' knowledge of morphine usage in cancer pain treatment

    Directory of Open Access Journals (Sweden)

    Liu W

    2014-05-01

    also identified major impediment factors on clinical use of morphine.Results: Among the 127 respondents, morphine controlled-release tablets were the most popular drug chosen to treat severe cancer pain (76 respondents, 35.8%. Participants who reported having received training in cancer pain management and drug use demonstrated a significantly higher mean score of basic knowledge compared with their untrained peers (11.51±2.60 versus 9.28±3.68, t=2.48, P=0.022. The top four barriers to widespread clinical use of morphine for cancer pain were 1 insufficient analgesia administration training for medical personnel, 2 poor patient compliance, 3 drug side effects, and 4 concerns surrounding drug addiction.Conclusion: The oncologists in the People's Republic of China simultaneously lack comprehensive knowledge and harbor misconceptions with regard to cancer pain treatment and morphine's clinical application. Creating professional training initiatives for oncologists is necessary to enhance their awareness and expertise in morphine use for cancer pain treatment.Keywords: pain management, training, clinical application

  9. The Challenges of Perioperative Pain Management in Total Joint Arthroplasty.

    Science.gov (United States)

    Scuderi, Giles R

    2015-10-01

    Despite advances in the understanding of postoperative pain, approximately 80% of surgical patients still experience a meaningful level of pain, which can result in unnecessary stress and suffering; compromise the patient's progress, recovery, and outcome; and lead to poor function and the development of chronic pain. In arthroplasty patients, the goals of pain management include improving comfort and satisfaction, enabling patients to ambulate and move their joints soon after surgery, and, where appropriate, reducing the hospital length of stay. Opioid medications have been used for many years as the mainstay of pain management. These drugs, however, are associated with a range of adverse effects and complications, which can lead to increased hospital length of stay or readmission. Furthermore, as-needed administration of opioids allows for the repeated return of pain after the operation as each dose wears off. A balanced multimodal approach that combines different anesthetic and analgesic modalities in a rational way to target the distinct pain pathways, rather than relying predominantly on opioid drugs, is essential for effective control of postoperative pain, avoiding the risk of opioid-related adverse events and complications, reducing length of stay, and improving longterm outcomes. PMID:26447428

  10. Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?

    Science.gov (United States)

    McGeary, Cindy A; McGeary, Donald D; Moreno, Jose; Gatchel, Robert J

    2016-01-01

    Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD)), especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT) trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS) pain rating), disability (Oswestry Disability Index; Million Visual Analog Scale), and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores) in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed. PMID:27417626

  11. Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?

    Directory of Open Access Journals (Sweden)

    Cindy A. McGeary

    2016-06-01

    Full Text Available Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD, especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS pain rating, disability (Oswestry Disability Index; Million Visual Analog Scale, and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.

  12. Opioids Switching with Transdermal Systems in Chronic Cancer Pain

    Directory of Open Access Journals (Sweden)

    Barbarisi M

    2009-05-01

    Full Text Available Abstract Background Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy Objective To assess the efficacy and tolerability of an alternative transdermally applied (TDS opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. Methods A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks Results Pain relief as assessed by VAS, PPI, and PRI significantly improved (p Conclusion Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.

  13. Mechanisms and clinical management of pain

    Directory of Open Access Journals (Sweden)

    Patrick Raymond Nicolas Andre Ghislain Stump

    2012-01-01

    Full Text Available Pain is an unpleasant, sensitive and emotional experience associated with or described in terms of tissue lesion, and may be acute or chronic. It may also be classified as nociceptive, neuropathic or psychogenic. Nociceptive pain involves the transformation of environmental stimuli into action potentials carried to the central nervous system, where they are modulated and integrated up to final interpretation in the cerebral cortex. Neuropathic pain may arise as a consequence of the direct lesion of axons, or of an increase in the production of neurotrophic factors. Chronic pain is always associated with anxiety and some degree of depression. Drug therapy should be selected according to its efficacy; nonetheless, the professional should also consider the tolerability and adverse effects that may occur, for example, in elderly individuals. It is necessary to emphasize the safety-considering the possibility of drug interactions-and define the posology to promote better adherence. However, the treatment of neuropathic pain should not be limited to the use of analgesic drugs, which are just one among several options enabling patients to participate in bio-psycho-social rehabilitation programs.

  14. The clinical psychologist and the management of inpatient pain: a small case series

    Directory of Open Access Journals (Sweden)

    Childs SR

    2014-12-01

    Full Text Available Susan R Childs,1,* Emma M Casely,2,* Bianca M Kuehler,1 Stephen Ward,1 Charlotte L Halmshaw,1 Sarah E Thomas,1 Ian D Goodall,1 Carsten Bantel1,3 1Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, 2Anaesthetic Department, Hillingdon Hospital, Uxbridge, 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK *These authors contributed equally to this manuscript Abstract: Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients’ pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize

  15. Interpersonal Responses and Pain Management Within the US Military.

    Science.gov (United States)

    McGeary, Cindy A; Blount, Tabatha H; Peterson, Alan L; Gatchel, Robert J; Hale, Willie J; McGeary, Donald D

    2016-06-01

    Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345-356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited

  16. Epigenomics in cancer management

    International Nuclear Information System (INIS)

    The identification of all epigenetic modifications implicated in gene expression is the next step for a better understanding of human biology in both normal and pathological states. This field is referred to as epigenomics, and it is defined as epigenetic changes (ie, DNA methylation, histone modifications and regulation by noncoding RNAs such as microRNAs) on a genomic scale rather than a single gene. Epigenetics modulate the structure of the chromatin, thereby affecting the transcription of genes in the genome. Different studies have already identified changes in epigenetic modifications in a few genes in specific pathways in cancers. Based on these epigenetic changes, drugs against different types of tumors were developed, which mainly target epimutations in the genome. Examples include DNA methylation inhibitors, histone modification inhibitors, and small molecules that target chromatin-remodeling proteins. However, these drugs are not specific, and side effects are a major problem; therefore, new DNA sequencing technologies combined with epigenomic tools have the potential to identify novel biomarkers and better molecular targets to treat cancers. The purpose of this review is to discuss current and emerging epigenomic tools and to address how these new technologies may impact the future of cancer management

  17. Advances in cancer pain from bone metastasis

    OpenAIRE

    Zhu XC; JL Zhang; Ge CT; Yu YY; Wang P; Yuan TF; Fu CY

    2015-01-01

    Xiao-Cui Zhu,1 Jia-Li Zhang,1 Chen-Tao Ge,1 Yuan-Yang Yu,1 Pan Wang,1 Ti-Fei Yuan,2 Cai-Yun Fu1,31College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, 2School of Psychology, Nanjing Normal University, Nanjing, 3Institute for Cell-Based Drug Development of Zhejiang Province, Hangzhou, People’s Republic of ChinaAbstract: With the technological advances in cancer diagnosis and treatment, the survival rates for patients with cancer are prolonged. The issue of figuring out h...

  18. Transient Receptor Potential Channel and Interleukin-17A Involvement in LTTL Gel Inhibition of Bone Cancer Pain in a Rat Model.

    Science.gov (United States)

    Wang, Juyong; Zhang, Ruixin; Dong, Changsheng; Jiao, Lijing; Xu, Ling; Liu, Jiyong; Wang, Zhengtao; Lao, Lixing

    2015-07-01

    Cancer pain management is a challenge for which Chinese herbal medicine might be useful. To study the spinal mechanisms of the Chinese medicated gel Long-Teng-Tong-Luo (LTTL), a 7-herb compound, on bone cancer pain, a bone cancer pain model was made by inoculating the tibias of female rats with Walker 256 cells. LTTL gel or inert gel, 0.5 g/cm(2)/d, was applied to the skin of tumor-bearing tibias for 21 days beginning a day after the inoculation. Mechanical threshold and paw withdrawal latency to thermal stimulation was measured. Transient receptor potential (TRP) cation channels in lumbar dorsal root ganglia (DRG) were immunostained and counted, and lumbar spinal cord interleukin-17A (IL-17A) was measured with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. TRP antagonists and interleukin (IL)-17A antibodies were intrathecally administered to determine their effects on bone cancer pain. The gel significantly (P cancer-induced mechanical allodynia and thermal hyperalgesia and inhibited cancer-enhanced expression of IL-17A in spinal astrocytes and the TRP subfamily members V1, A1, and V4 in lumbar DRG. Intrathecal TRP antagonists at 10 µg significantly (P cancer pain. IL-17A antibodies inhibited cancer pain, suggesting that IL-17A promotes such pain. The data show that LTTL gel inhibits cancer pain, and this might be accounted for by the decrease in expression of DRG TRP channels and spinal astrocyte IL-17A. PMID:26100378

  19. Management of pain in pre-hospital settings.

    Science.gov (United States)

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings. PMID:26050779

  20. Dry needling for the management of thoracic spine pain.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  1. The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey.

    Science.gov (United States)

    McCarberg, Bill H; Nicholson, Bruce D; Todd, Knox H; Palmer, Trish; Penles, Leslie

    2008-01-01

    Pain is one of the most common medical complaints, but despite its prevalence, many individuals still suffer with unrelieved or undertreated pain. This marketing research survey was designed to determine the physical, psychological, and economic impact pain has on the lives of individuals suffering with pain and to identify the unmet needs of patients who have taken opioid medications to treat their pain. In addition, the survey sought to address the challenges physicians face when treating patients with pain. Pain sufferers were recruited through e-mail invitation to an Internet survey; 173,854 invitations were sent out, 22,018 people responded (12.7%), and 606 met the criteria for inclusion in the survey as pain sufferers. Of these, 359 people had moderate to moderately severe chronic pain and 247 people had moderate to moderately severe acute pain. Additionally, physicians currently treating pain were recruited through e-mail and postal mail invitations and 492 met eligibility criteria: 241 specialists (orthopedic or general surgeons, pain specialists or anesthesiologists), 125 primary care, and 126 emergency medicine physicians. Results of this survey supported what many physicians observe in their practice and hear from their patients, that pain has a negative impact on daily activities in the majority of pain sufferers. Many chronic pain sufferers reported that pain had deleterious effects on their mental health, employment status, sleep, and personal relationships. The impact of pain on patient quality of life and the unmet needs in pain management were recognized by the majority of physicians surveyed, with inadequate pain control, end-of-dose pain, and side effects associated with increased dosing reported as negative factors influencing their choice of pain medication. In conclusion, effective communication between physicians and patients is encouraged to not only improve overall pain management but also to establish shared treatment goals with functional

  2. Metastasic bone pain management with radioactive isotopes

    International Nuclear Information System (INIS)

    Pain is the commonest clinical manifestation of bone metastases. Its treatment is palliative in nature, and consists of chemotherapy, radiotherapy, hormone therapy, di phosphonates, and drug therapy (i. e., opiates). Radioactive isotopes represent an appealing alternative to conventional treatment modalities. Among the different types of isotopes, wide clinical experience with 153 Sm has been obtained in this laboratory. In the present study, 94 patients (mean age = 65 years), who had been diagnosed of having breast, prostate and other malignant tumors, were evaluated. These patients were treated with 37 MBq/Kg 153 Sm-EDTMP. All of them complained of bone pain and had scintigraphic evidence of metastatic bone dissemination. Treatment efficacy was evaluated both objectively and subjectively. Eighty-five per cent (85%) of the patients reported pain relief, and analgesia was reduced by 55%. Twenty-two per cent (22%) had a complete response. Bone marrow toxicity was not a concern, with mild transient hematologic derangements in 30% of the patients. It was concluded that 153 Sm-EDTMP results in relief or cessation of metastatic bone pain in a majority of patients.(author)

  3. Management of insomnia in patients with chronic pain conditions.

    Science.gov (United States)

    Stiefel, Frederic; Stagno, Daniele

    2004-01-01

    The management of insomnia in patients experiencing chronic pain requires careful evaluation, good diagnostic skills, familiarity with cognitive-behavioural interventions and a sound knowledge of pharmacological treatments. Sleep disorders are characterised by a circular interrelationship with chronic pain such that pain leads to sleep disorders and sleep disorders increase the perception of pain. Sleep disorders in individuals with chronic pain remain under-reported, under-diagnosed and under-treated, which may lead--together with the individual's emotional, cognitive and behavioural maladaptive responses--to the frequent development of chronic sleep disorders. The moderately positive relationship between pain severity and sleep complaints, and the specificity of pain-related arousal and mediating variables such as depression, illustrate that insomnia in relation to chronic pain is multifaceted and poorly understood. This may explain the limited success of the available treatments. This article discusses the evaluation of patients with chronic pain and insomnia and the available pharmacological and nonpharmacological interventions to manage the sleep disorder. Non-pharmacological interventions should not be considered as single interventions, but in association with one another. Some non-pharmacological interventions especially the cognitive and behavioural approaches, can be easily implemented in general practice (e.g. stimulus control, sleep restriction, imagery training and progressive muscle relaxation). Hypnotics are routinely prescribed in the medically ill, regardless of their adverse effects; however, their long-term efficacy is not supported by robust evidence. Antidepressants provide an interesting alternative to hypnotics, since they can improve pain perception as well as sleep disorders in selected patients. Sedative antipsychotics can be considered for sleep disturbances in those patients exhibiting psychotic features, or for those with

  4. Managing cancer pain at the end of life with multiple strong opioids: a population-based retrospective cohort study in primary care.

    Directory of Open Access Journals (Sweden)

    Wei Gao

    Full Text Available BACKGROUND: End-of-life cancer patients commonly receive more than one type of strong opioid. The three-step analgesic ladder framework of the World Health Organisation (WHO provides no guidance on multiple opioid prescribing and there is little epidemiological data available to inform practice. This study aims to investigate the time trend of such cases and the associated factors. METHODS: Strong opioid prescribing in the last three months of life of cancer patients were extracted from the General Practice Research Database (GPRD. The outcome variable was the number of different types of prescribed non-rescue doses of opioids (1 vs 2-4, referred to as a complex case. Associated factors were evaluated using prevalence ratios (PR derived from multivariate log-binomial model, adjusting for clustering effects and potential confounding variables. RESULTS: Overall, 26.4% (95% CI: 25.6-27.1% of 13,427 cancer patients (lung 41.7%, colorectal 19.1%, breast 18.6%, prostate 15.5%, head and neck 5.0% were complex cases. Complex cases increased steadily over the study period (1.02% annually, 95%CI: 0.42-1.61%, p = 0.048 but with a small dip (7.5% reduction, 95%CI: -0.03 to 17.8% around the period of the Shipman case, a British primary care doctor who murdered his patients with opioids. The dip significantly affected the correlation of the complex cases with persistent increasing background opioid prescribing (weighted correlation coefficients pre-, post-Shipman periods: 0.98(95%CI: 0.67-1.00, p = 0.011; 0.14 (95%CI: -0.85 to 0.91, p = 0.85. Multivariate adjusted analysis showed that the complex cases were predominantly associated with year of death (PRs vs 2000: 1.05-1.65, not other demographic and clinical factors except colorectal cancer (PR vs lung cancer: 1.24, 95%CI: 1.12-1.37. CONCLUSION: These findings suggest that prescribing behaviour, rather than patient factors, plays an important role in multiple opioid prescribing at the end of life

  5. Hypnosis and its place in modern pain management - review article.

    Science.gov (United States)

    Amadasun, F E

    2007-09-01

    This is an evidence-based review of the efficacy of hypnosis in pain management. Hypnosis is as old as mankind. It is reported in the Ebers Papyrus in ancient Egyptian cures. It went into decline in the Middle Ages with the rise of Christianity, being erroneously associated with witchcraft. There was resurgence of interest in the 19th century. In the early 1950s, the British Medical Association endorsed the teaching of hypnosis in all medical schools. The literature is replete with anecdotal and controlled studies of the efficacy of hypnotherapy in pain management. Not much is found of the effectiveness in acute pain conditions. Nevertheless, in spite of some methodological flaws in many reports, there seems to be sufficient clinical evidence of sufficient quality, to conclude that hypnosis has demonstrable efficacy in the treatment of chronic pain. PMID:17767210

  6. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  7. An improved behavioural assay demonstrates that ultrasound vocalizations constitute a reliable indicator of chronic cancer pain and neuropathic pain

    Directory of Open Access Journals (Sweden)

    Selvaraj Deepitha

    2010-03-01

    Full Text Available Abstract Background On-going pain is one of the most debilitating symptoms associated with a variety of chronic pain disorders. An understanding of mechanisms underlying on-going pain, i.e. stimulus-independent pain has been hampered so far by a lack of behavioural parameters which enable studying it in experimental animals. Ultrasound vocalizations (USVs have been proposed to correlate with pain evoked by an acute activation of nociceptors. However, literature on the utility of USVs as an indicator of chronic pain is very controversial. A majority of these inconsistencies arise from parameters confounding behavioural experiments, which include novelty, fear and stress due to restrain, amongst others. Results We have developed an improved assay which overcomes these confounding factors and enables studying USVs in freely moving mice repetitively over several weeks. Using this improved assay, we report here that USVs increase significantly in mice with bone metastases-induced cancer pain or neuropathic pain for several weeks, in comparison to sham-treated mice. Importantly, analgesic drugs which are known to alleviate tumour pain or neuropathic pain in human patients significantly reduce USVs as well as mechanical allodynia in corresponding mouse models. Conclusions We show that studying USVs and mechanical allodynia in the same cohort of mice enables comparing the temporal progression of on-going pain (i.e. stimulus-independent pain and stimulus-evoked pain in these clinically highly-relevant forms of chronic pain.

  8. Pain Management in Four-Limb Amputation: A Case Report.

    Science.gov (United States)

    Warner, Nafisseh S; Warner, Matthew A; Moeschler, Susan M; Hoelzer, Bryan C

    2015-09-01

    Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation. PMID:26011696

  9. Duloxetine in the management of chronic musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Smith EJ

    2012-06-01

    Full Text Available Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor

  10. Role of the radiologist in the management of pain

    International Nuclear Information System (INIS)

    Radiologists are taking an expanding role in the management of pain. The procedures most commonly used at our institution are facet blocks, peripheral nerve blocks, peripheral nerve ablations, ganglion ablations, chemoinfusions, chemoembolizations, and embolizations alone. CT is used for the facet, ganglion, and peripheral nerve procedures. The techniques for these procedures will be stressed, as meticulous technique is imperative. The radiologist must work closely with the attending clinician to determine both the neurologic level and to monitor therapy. The University of South Florida pain team flow sheet and pain evaluation method is presented

  11. CE: Appropriate Use of Opioids in Managing Chronic Pain.

    Science.gov (United States)

    Denenberg, Risa; Curtiss, Carol P

    2016-07-01

    : Over the past two decades, the use of opioids to manage chronic pain has increased substantially, primarily in response to the recognized functional, emotional, and financial burden associated with chronic pain. Within this same period, unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal. PMID:27294667

  12. Treatment of painful bony metastasis of prostatic cancer by Samarium 153 (Quadramet)

    International Nuclear Information System (INIS)

    Full text: SUMMARY. Introduction: Despite of the progress realized in the treatment of prostatic cancer, the appearance of bony metastasis had limited considerably the life expectancy. In that case, pain is the most important symptom to consider because of its most frequency and the most difficult to manage. Its management needs a multidisciplinary approach with the objective of improving patients' life quality. Aim: The objective of the study was to evaluate the interest of metabolic radiotherapy to 153Samarium-EDTMP, for the pain treatment of bony metastasis of prostatic cancer. Material and method: This was a multicentric study where data were collected retrospectively lasting 40 months. The study was conducted in three departments of nuclear medicine: Institute Salah Azaiez, the center 'CERU', and military hospital of Tunis. Forty five patients with painful bony metastasis of prostatic cancer had been enrolled in the study. Efficacy and factors influencing treatment response had been assessed as well as toxicity and the cause of failures. Results: Positive response was obtained in 92.1% of cases and response was completed in 36.5% of cases. Results obtained after multiple administrations of treatment, showed that the cures could be repeated and could have results comparable to the first cure. The efficacy of our treatment is at least equivalent to the one obtained by the other methods of treatment, with very rare adverse events. The only toxicity was a hematological disorder that is usually moderated and reversible as well with complete recovery in around 8 weeks. Conclusion: Our results supported the efficacy of 'Samarium 153-EDTMP' in the management of painful bony metastasis of prostatic cancer. (author)

  13. Pediatric pain: prevalence, assessment, and management in a teaching hospital

    OpenAIRE

    M.B.M. Linhares; F.N.P. Doca; Martinez, F.E.; A.P.P. Carlotti; R.G.M. Cassiano; Pfeifer, L.I.; Funayama, C.A.; L.R.G. Rossi; Finley, G.A.

    2012-01-01

    The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h prece...

  14. American Society for Pain Management Nursing Position Statement: Prescribing and Administering Opioid Doses Based Solely on Pain Intensity.

    Science.gov (United States)

    Pasero, Chris; Quinlan-Colwell, Ann; Rae, Diana; Broglio, Kathleen; Drew, Debra

    2016-06-01

    The foundation of safe and effective pain management is an individualized, comprehensive pain assessment, which includes, but is not limited to, determining the intensity of pain if the patient is able to report it. An unforeseen consequence of the widespread use of pain intensity rating scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity. Many factors in addition to pain intensity influence opioid requirements, and there is no research showing that a specific opioid dose will relieve pain of a specific intensity in all patients. The American Society for Pain Management Nursing (ASPMN) holds the position that the practice of prescribing doses of opioid analgesics based solely on a patient's pain intensity should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to untoward patient outcomes. PMID:27108082

  15. Mindfulness, functioning and catastrophizing after multidisciplinary pain management for chronic low back pain.

    Science.gov (United States)

    Cassidy, Emma Louise; Atherton, Rachel Jane; Robertson, Noelle; Walsh, David Andrew; Gillett, Raphael

    2012-03-01

    We examined mindfulness in people with chronic low back pain who were attending a multidisciplinary pain management programme. Participants completed questionnaires at baseline (n=116) and after a 3-month cognitive-behaviourally informed multidisciplinary intervention (n=87). Self-reported mindfulness was measured before and after the intervention, and relationships were explored between mindfulness, disability, affect and pain catastrophizing. Mindfulness increased following participation in the intervention, and greater mindfulness was predictive of lower levels of disability, anxiety, depression and catastrophizing, even when pain severity was controlled. Mediator analyses suggested that the relationship between mindfulness and disability was mediated by catastrophizing. It is possible that cognitive-behavioural interventions and processes can affect both catastrophizing and mindfulness. PMID:22240149

  16. 75 FR 6208 - Proposed Collection; Comment Request; Web Based Training for Pain Management Providers

    Science.gov (United States)

    2010-02-08

    ... for Pain Management Providers SUMMARY: Under the provisions of Section 3507(a)(1)(D) of the Paperwork... Collection Title: Web Based Training for Pain Management Providers. Type of Information Collection Request... Based Training for Pain Management Providers, via the Web site PainAndAddictionTreatment.com ,...

  17. Perioperative pain management in hip arthroscopy; what options are there?

    Science.gov (United States)

    Bech, N H; Hulst, A H; Spuijbroek, J A; van Leuken, L L A; Haverkamp, D

    2016-08-01

    Hip arthroscopy is a fast growing orthopedic field of expertise. As in any field of surgery adequate postoperative pain management regimes are of utmost importance. The purpose of this review is to provide an overview of current knowledge on anesthetic options for perioperative pain management for hip arthroscopy. We searched the Pubmed/Medline and Embase database for literature and included 10 studies for our analysis. Because of the variety of pain scales and different ways of measured pain no meta-analysis could be performed and a descriptive review is performed. There are several types of pain regimens that can mostly be divided in two groups: local anesthetics and nerve blocks. Included studies show a rather large variation in reported visual analogue scale scores, post anesthesia care unit admission time and opioid usage. There are several anesthetic options available for hip arthroscopy. Different studies use different dosages, anesthetic regimens and different protocols; this partly explains the differences between studies with similar techniques. Peripheral nerve blocks seems promising but regarding current literature no clear recommendation can be made about what the best perioperative pain management option is, an overview of all reported techniques is given. PMID:27583156

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

    OpenAIRE

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

    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 (severi...

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

    Science.gov (United States)

    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

  20. Sensory function and pain in a population of patients treated for breast cancer

    DEFF Research Database (Denmark)

    Vilholm, O J; Cold, S; Rasmussen, Lars;

    2009-01-01

    BACKGROUND: Chronic pain is often reported after surgery for breast cancer. This study examined pain and sensory abnormalities in women following breast cancer surgery. METHODS: Sensory tests were carried out on the operated and contra-lateral side in 55 women with chronic pain after breast cance...

  1. PAIN MANAGEMENT IN CIRCUMCISION: A COMPARATIVE STUDY

    OpenAIRE

    Dr.Khalid Mahmood; Dr. Zahid Mahmood Nagra; Dr.Muhammad Akram Malik; Prof.Sajid Hameed; Dr.Rana Liaqat Ali

    2010-01-01

    Objective: To assess the effectiveness and safety of interventions of reducing pain at neonatal circumcision.Study Design: Quasi-experimental designPlace and Duration of Study: Departments of Pediatric Surgery and Plastic Surgery, Allied Hospital, Madina TeachingHospital, Faisal Hospital, Abdullah Medical Complex, Jail Road, Faisalabad from June 2005 to July 2010.Methodology: Neonates presenting for circumcision during the first month of life were included in the study. A total of 102neonates...

  2. Clinical Decision Making in Renal Pain Management

    OpenAIRE

    Aganovic, Damir; Prcic, Alen; Kulovac, Benjamin; Hadziosmanovic, Osman

    2012-01-01

    Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., whi...

  3. Options for perioperative pain management in neurosurgery

    OpenAIRE

    Vadivelu, Nalini

    2016-01-01

    Nalini Vadivelu,1 Alice M Kai,2 Daniel Tran,1 Gopal Kodumudi,3 Aron Legler,1 Eugenia Ayrian,4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3California Northstate University College of Medicine, Elk Grove, 4Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA Abstract: Moderate-to-severe pain following neurosurgery is common but often does not get attention and is...

  4. Developments in managing severe chronic pain: role of oxycodone–naloxone extended release

    Directory of Open Access Journals (Sweden)

    Fanelli G

    2015-07-01

    Full Text Available Guido Fanelli,1 Andrea Fanelli2 1Anesthesia and Intensive Care Unit, University of Parma, Parma, 2Anesthesia and Intensive Care Unit, Policlinico S Orsola-Malpighi, Bologna, Italy Abstract: Chronic pain is a highly disabling condition, which can significantly reduce patients’ quality of life. Prevalence of moderate and severe chronic pain is high in the general population, and it increases significantly in patients with advanced cancer and older than 65 years. Guidelines for the management of chronic pain recommend opioids for the treatment of moderate-to-severe pain in patients whose pain is not responsive to initial therapies with paracetamol and/or nonsteroidal anti-inflammatory drugs. Despite their analgesic efficacy being well recognized, adverse events can affect daily functioning and patient quality of life. Opioid-induced constipation (OIC occurs in 40% of opioid-treated patients. Laxatives are the most common drugs used to prevent and treat OIC. Laxatives do not address the underlying mechanisms of OIC; for this reason, they are not really effective in OIC treatment. Naloxone is an opioid receptor antagonist with low systemic bioavailability. When administered orally, naloxone antagonizes the opioid receptors in the gut wall, while its extensive first-pass hepatic metabolism ensures the lack of antagonist influence on the central-mediated analgesic effect of the opioids. A prolonged-release formulation consisting of oxycodone and naloxone in a 2:1 ratio was developed trying to reduce the incidence of OIC maintaining the analgesic effect compared with use of the sole oxycodone. This review includes evidence related to use of oxycodone and naloxone in the long-term management of chronic non-cancer pain and OIC. Keywords: chronic pain, opioid-induced constipation, opioids, oxycodone–naloxone

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

    OpenAIRE

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

    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 acu...

  6. Abdominal pain as initial presentation of lung cancer

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  8. Application of evidence - based thinking in pain management of senile cancer patients%循证思想在老年癌症患者疼痛控制中的应用

    Institute of Scientific and Technical Information of China (English)

    刘荣荣; 汪丽芳

    2011-01-01

    目的 探讨应用循证思想对老年癌症患者疼痛控制的效果.方法 运用循证思想对59例癌症晚期伴疼痛的老年患者进行护理,通过疼痛评估,制订并使用合理的健康教育、心理干预和药物治疗.结果 在实施循证护理后患者的疼痛程度和生活质量均比实施前改善(P<0.05).结论 运用循证护理理论指导临床护理可减轻癌症患者的疼痛感,提高其生活质量,进而提高护理质量.%Objective To explore the effects of evidence - based thinking applied in pain control of senile cancer patients. Methods A total of 59 cases of elderly cancer patients received pain control nursing based on the evidence - based thinking. The measures included evaluating the pain ,planning and implementing proper health education, psychological intervention and medication. Results After the intervention, the level of pain was lower and the level of life quality was higher than before. The differences were statistically significant ( P < 0.05 ). Conclusion The clinical nursing under the guidance of evidence - based nursing is effective to reduce patients'pain and increase their quality of life,so as to improve the quality of nursing.

  9. Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course

    OpenAIRE

    Carnes, D; Homer, K; Underwood, M; Pincus, T.; Rahman, A; Taylor, S J C

    2013-01-01

    Objective: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. Design: We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories we...

  10. Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes.

    Science.gov (United States)

    Vaismoradi, Mojtaba; Skär, Lisa; Söderberg, Siv; Bondas, Terese E

    2016-01-01

    Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of "identity of pain," "recognition of pain," and "response to pain." The metaphor of "normalizing suffering" was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society-among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain-must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain. PMID:27173102

  11. Gonyautoxins: First evidence in pain management in total knee arthroplasty.

    Science.gov (United States)

    Hinzpeter, Jaime; Barrientos, Cristián; Zamorano, Álvaro; Martinez, Álvaro; Palet, Miguel; Wulf, Rodrigo; Barahona, Maximiliano; Sepúlveda, Joaquín M; Guerra, Matias; Bustamante, Tamara; Del Campo, Miguel; Tapia, Eric; Lagos, Nestor

    2016-09-01

    Improvements in pain management techniques in the last decade have had a major impact on the practice of total knee arthroplasty (TKA). Gonyautoxin are phycotoxins, whose molecular mechanism of action is a reversible block of the voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of Gonyautoxin infiltration, as a long acting pain blocker in TKA. Fifteen patients received a total dose of 40 μg of Gonyautoxin during the TKA operation. Postoperatively, all patients were given a standard painkiller protocol: 100 mg of intravenous ketoprofen and 1000 mg of oral acetaminophen every 8 hours for 3 days. The Visual Analog Scale (VAS) pain score and range of motion were recorded 12, 36, and 60 hours post-surgery. All patients reported pain of 2 or less on the VAS 12 and 36 hours post-surgery. Moreover, all scored were less than 4 at 60 hours post-surgery. All patients achieved full knee extension at all times. No side effects or adverse reactions to Gonyautoxin were detected in the follow-up period. The median hospital stay was 3 days. For the first time, this study has shown the effect of blocking the neuronal transmission of pain by locally infiltrating Gonyautoxin during TKA. All patients successfully responded to the pain control. The Gonyautoxin infiltration was safe and effective, and patients experienced pain relief without the use of opioids. PMID:27317871

  12. Role of calcitonin in management of musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Lars Arendt-Nielsen

    2009-12-01

    Full Text Available Calcitonin was discovered more than 40 years ago and the scientific community continues to debate the primary and secondary pharmacological actions of calcitonin. Presently calcitonin is accepted by agencies only for treatment of osteoporosis, but many studies have indicated an effect on pain in many different experimental settings both pre-clinically and clinically. The effects of calcitonin on clinical pain conditions have received increasing attention in the past decades, although a consensus on mode of action and potential indications still has to be reached. Several key advances in the pain field may enable a deeper understanding of the putative analgesic effects of calcitonin. Most studies have focused on the effect of calcitonin on musculoskeletal pain problems. Ample lines of independent evidence suggest that calcitonin exerts putative analgesic effects. Well-designed clinical trials, particularly in the field of musculoskeletal pain, are needed to validate fragmented evidence of analgesic actions. This in combination with advanced mechanism-based pain assessment tools can provide new insight into the role of calcitonin, alone or in combination with other compounds, in management of pain.

  13. Effects of palma reflexology massage and music therapy on cancer pain management%足底按摩加音乐疗法对癌痛干预的研究

    Institute of Scientific and Technical Information of China (English)

    曹娟妹; 田利; 黄丽艳; 周群英; 李惠玲

    2011-01-01

    目的 应用足底反射区按摩、音乐疗法缓解癌症患者的疼痛,提高其生活质量.方法 将60例癌痛患者随机分为实验组和对照组各30例,分别采用足底反射区按摩加音乐疗法和单纯的足底反射区按摩进行干预治疗,观察比较两组患者的干预效果.结果 两组患者的疼痛情况均有不同程度的缓解,但两组患者的疼痛缓解情况无统计学差异(P>0.05).结论 足底反射区按摩对癌痛具有一定的缓解作用,音乐疗法在癌症患者疼痛干预中效果甚微,音乐疗法在癌痛干预中的应用还有待于进一步的研究.%Objective To investigate the therapeutic effect of palma reflexology massage and music therapy on the treatment of cancer pain and improvement of the life quality. Methods Sixty patients admitted were randomly divided into 2 groups: group Ⅰ palma reflexology massage plus music therapy; group Ⅱ palma reflexology massage. Results Pain alleviation was observed in both groups. However, the curative effects didn't show significant difference between this two groups ( P >0.05). Conclusion Palma reflexology massage proves to be an effective strategy against cancer pain. While the abirritation of music therapy was indeterminate. The application of music therapy in cancer pain treatment still needs more investigation.

  14. Present-day challenges and future solutions in postoperative pain management: results from PainForum 2014.

    Science.gov (United States)

    Kuusniemi, Kristiina; Pöyhiä, Reino

    2016-01-01

    This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People's Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS), which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen) and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change. PMID:26893579

  15. Morphine as first medication for treatment of cancer pain

    Directory of Open Access Journals (Sweden)

    Beatriz C. Nunes

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: the medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder. METHOD: sixty patients without opioid therapy, with >18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months. RESULTS: the groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p = 0.0088, drowsiness (p = 0.0005, constipation (p = 0.0071 and dizziness (p = 0.0376 in the second visit and drowsiness (p = 0.05 in the third. CONCLUSIONS: the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.

  16. Evidence-based pharmacological management of chronic neuropathic pain

    Directory of Open Access Journals (Sweden)

    Zarrin Ansari

    2013-06-01

    Full Text Available Neuropathic pain (NP is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP, post-herpetic neuralgia (PHN, trigeminal neuralgia, HIV- associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline, selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine, calcium channel alpha 2 - delta ligands (pregabalin, gabapentin, carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient’s age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and

  17. A descriptive study of older adults with persistent pain: Use and perceived effectiveness of pain management strategies [ISRCTN11899548

    Directory of Open Access Journals (Sweden)

    Ersek Mary

    2005-11-01

    Full Text Available Abstract Background Persistent pain is a common, often debilitating, problem in older adults; however, few studies have focused on the experiences of older adults in managing their pain. The objective of this study was to describe the use and perceived effectiveness of pain management strategies in a sample of older adults and to explore the associations of these variables with demographic and psychosocial characteristics. Methods Adults ≥ 65 years old and living in retirement facilities who reported persistent pain (N = 235, mean age = 82 years, 84% female, 94% white completed measures of demographics, pain, depression, self-efficacy for managing pain, and a Pain Management Strategies Survey. Participants identified current and previous-year use of 42 pain management strategies and rated helpfulness of each on a 5-point scale. Results Acetaminophen, regular exercise, prayer, and heat and cold were the most frequently used pain management strategies (61%, 58%, 53%, and 48%, respectively. Strategies used by >25% of the sample that were rated moderately or more helpful (i.e., >2 on a 0 to 4 scale were prayer [mean (SD = 2.9 (0.9], opioids [2.6 (0.8], regular exercise [2.5 (1.0], heat/cold [2.5 (1.0], nonsteroidal anti-inflammatory drugs [2.4 (1.0], and acetaminophen [2.3 (1.0]. Young-old (65–74 years study participants reported use of more strategies than did old-old (85+ years participants (p = .03. Perceived helpfulness of strategy use was significantly associated with pain intensity (r = -.14, p Conclusion On average, older adults view the strategies they use for persistent pain as only moderately helpful. The associations between perceived helpfulness and self-efficacy and depression suggest avenues of pain management that are focused less on specific treatments and more on how persons with persistent pain think about their pain.

  18. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  19. Current Studies of Acupuncture in Cancer-Induced Bone Pain Animal Models

    OpenAIRE

    Hee Kyoung Ryu; Yong-Hyeon Baek; Yeon-Cheol Park; Byung-Kwan Seo

    2014-01-01

    Acupuncture is generally accepted as a safe and harmless treatment option for alleviating pain. To explore the pain mechanism, numerous animal models have been developed to simulate specific human pain conditions, including cancer-induced bone pain (CIBP). In this study, we analyzed the current research methodology of acupuncture for the treatment of CIBP. We electronically searched the PubMed database for animal studies published from 2000 onward using these search terms: (bone cancer OR can...

  20. Management of chronic pain in the elderly: focus on transdermal buprenorphine

    Directory of Open Access Journals (Sweden)

    Nalini Vadivelu

    2008-09-01

    Full Text Available Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration have opened up new treatment options to meet this challenge. The transdermal buprenorphine matrix allows for slow release of buprenorphine and damage does not produce dose dumping. In addition the long-acting analgesic property and relative safety profile makes it a suitable choice for the treatment of chronic pain in the elderly. Its safe use in the presence of renal failure makes it an attractive choice for older individuals. Recent scientific studies have shown no evidence of a ceiling dose of analgesia in man but only a ceiling effect for respiratory depression, increasing its safety profile. It appears that transdermal buprenorphine can be used in clinical practice safely and efficaciously for treating chronic pain in the elderly.Keywords: transdermal buprenorphine, chronic pain, elderly

  1. Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes

    Science.gov (United States)

    Vaismoradi, Mojtaba; Skär, Lisa; Söderberg, Siv; Bondas, Terese E.

    2016-01-01

    Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model using three themes of “identity of pain,” “recognition of pain,” and “response to pain.” The metaphor of “normalizing suffering” was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society—among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain—must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain. PMID:27173102

  2. Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes

    Directory of Open Access Journals (Sweden)

    Mojtaba Vaismoradi

    2016-05-01

    Full Text Available Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people that stems from pain demands knowledge improvement through an integration of international knowledge. This study aimed to integrate current international findings and strengthen the understanding of older people's experiences of and perspectives on pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare's interpretative meta-ethnography approach was conducted. Empirical research papers from journals were collected from various databases. The search process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each in Iceland, Norway, the UK, and Australia. The older people's experiences of pain as well as perspectives on pain management from all involved (older people, their family members, and healthcare staff were integrated into a theoretical model using three themes of “identity of pain,” “recognition of pain,” and “response to pain.” The metaphor of “normalizing suffering” was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society's common attitude that pain is unavoidable and therefore acceptable in old age in society—among older people themselves as well as those who are responsible for reporting, acknowledging, and relieving pain—must change. The article emphasizes that pain as a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition, healthcare staff require sufficient training to take a person-centered approach towards assessment and management of pain that considers all elements of pain.

  3. Present-day challenges and future solutions in postoperative pain management: results from PainForum 2014

    Directory of Open Access Journals (Sweden)

    Kuusniemi K

    2016-02-01

    Full Text Available Kristiina Kuusniemi,1 Reino Pöyhiä2,3 1Department of Anaesthesiology, Turku University, Turku, Finland; 2Department of Anaesthesiology, University of Helsinki, Helsinki, Finland; 3Department of Palliative Medicine and Oncology, University of Turku, Turku, Finland Abstract: This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People's Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS, which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change. Keywords

  4. Post traumatic painful shoulder – a delayed clinical feature of upper lobe lung cancer in a 74 year-old male. - case report -

    OpenAIRE

    Oana-Cristina Arghir; Mihaela Trenchea; Mădălina Iliescu; Galie, N; Camelia Ciobotaru

    2014-01-01

    A 74 year old Caucasian man, presents with a 6 week history of right sided chest pain including traumatic related painful right shoulder. Shoulder minor contusion was diagnosed and partial managed by symptomatic treatment associated to rehabilitation. The pain was initially eased with nonsteroidal anti-inflammatory drug (NSAID) use and finally changed worsening. He has evidence of moderate COPD on spirometry and has been commenced on inhalers. An invasive primitive adenocarcinoma lung cancer ...

  5. Qualitative interview study of patients', ambulance practitioners' and emergency department clinicians' perceptions of prehospital pain management

    OpenAIRE

    Mohammad, Iqbal; Spaight, P. A.; Siriwardena, Niro

    2010-01-01

    Introduction Pre-hospital pain management is increasingly important with most patients (80%) presenting to UK ambulance services in pain and 20% of patients reporting inadequate pain relief. Improving prehospital pain management is important for service quality. Our aim was to investigate perceptions of pain management from patients, ambulance and emergency care staff. Methods Qualitative data were gathered through focus group (5) and interviews (28). Participants were purposively ...

  6. A Triage Approach to Managing a Two Year Wait-List in a Chronic Pain Program

    Directory of Open Access Journals (Sweden)

    Alexander J Clark

    2005-01-01

    Full Text Available OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.

  7. Intrathecal Ziconotide and Morphine for Pain Relief: A Case Series of Eight Patients with Refractory Cancer Pain, Including Five Cases of Neuropathic Pain

    OpenAIRE

    de la Calle Gil, Ana Bella; Peña Vergara, Isaac; Cormane Bornacelly, María Auxiliadora; Pajuelo Gallego, Antonio

    2015-01-01

    Introduction Studies have shown that, at low doses and with careful titration, combination therapy with intrathecal ziconotide and morphine results in rapid control of opioid-refractory cancer pain. However, there is a lack of published data regarding the efficacy and safety of intrathecal ziconotide specifically for the treatment of neuropathic cancer pain. Case series Case reports of ziconotide intrathecal infusion in eight patients (age 45–71 years; 75% male) with chronic, uncontrolled can...

  8. Efficacy of rapid-onset oral fentanyl formulations vs. oral morphine for cancer-related breakthrough pain: a meta-analysis of comparative trials

    OpenAIRE

    Jandhyala, R; Fullarton, JR; Bennett, MI

    2013-01-01

    Context: Breakthrough cancer pain (BTcP) is widely recognized as a clinically significant complication of chronic cancer pain. With most BTcP episodes peaking in intensity within a few minutes and lasting for approximately 30 minutes, speed of onset is crucial for effective pain management. Although the last decade has seen the development of a number of rapid-onset fentanyl preparations, BTcP is still typically managed by supplemental or rescue doses of the patient's around-the-clock medicat...

  9. Intrathecal combination of ziconotide and morphine for refractory cancer pain: a rapidly acting and effective choice.

    Science.gov (United States)

    Alicino, Ilaria; Giglio, Mariateresa; Manca, Fabio; Bruno, Francesco; Puntillo, Filomena

    2012-01-01

    Ziconotide is a nonopioid intrathecal analgesic drug used to manage moderate to severe chronic pain. The aim of this work is to assess the safety and efficacy of intrathecal (IT) combination of ziconotide and morphine in malignant pain refractory to high doses of oral opioids. Patients with malignant pain refractory to high oral opioids doses with a mean visual analogue scale of pain intensity (VASPI) score of ≥ 70 mm were enrolled. An IT combination therapy was administered: Ziconotide was started at a dose of 2.4 μg/day, followed by increases of 1.2 μg/day at intervals of at least 7 days, and an initial IT daily dose of morphine was calculated based on its oral daily dose. Percentage change in VASPI scores from baseline was calculated at 2 days, at 7 days, and weekly until the first 28 days. The mean percentage change of VASPI score from baseline was used for efficacy assessment. Safety was monitored based on adverse events and routine laboratory values. Twenty patients were enrolled, with a mean daily VASPI score at rest of 90±7. All had a disseminated cancer with bone metastases involving the spine. The percentage changes in VASPI mean scores from baseline to 2 days, 7 days, and 28 days were 39±13% (95% confidence interval [CI]=13.61-64.49, Pziconotide and morphine allows safe and rapid control of oral opioid-refractory malignant pain. PMID:22082570

  10. Analgesic efficacy of ketoprofen in postpartum, general surgery, and chronic cancer pain.

    Science.gov (United States)

    Sunshine, A; Olson, N Z

    1988-12-01

    This article summarizes the results of five single-dose clinical studies of three pain models: postpartum, postoperative, and chronic cancer pain. The efficacy of ketoprofen (in varying doses from 25 to 225 mg) was compared with one of the following standards: aspirin (650 mg), codeine (90 mg), acetaminophen (650 mg) plus codeine (60 mg), and parenteral morphine (5 mg and 10 mg). The results indicate that ketoprofen in doses as low as 25 mg has analgesic properties significantly superior to those of placebo. For the treatment of postpartum pain, ketoprofen was significantly more effective than aspirin 650 mg but not significantly different from codeine 90 mg. Ketoprofen doses of 50 mg and 150 mg also provided analgesia superior to that with acetaminophen 650 mg plus codeine 60 mg for the management of moderate to severe postoperative pain. Moreover, oral doses of ketoprofen (75 and 225 mg) provided analgesia similar to that obtained with 5 and 10 mg parenteral doses of morphine. Adverse effects related to ketoprofen were relatively minor and infrequent. Ketoprofen was recently approved for use as an analgesic for treatment of mild to moderate pain in total daily doses up to 300 mg; the recommended initial dose is 25 to 50 mg every 6 to 8 hours as necessary. PMID:3072358

  11. Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments

    OpenAIRE

    Sarantopoulos, Constantine D.

    2007-01-01

    Cancer related pain may be due to the malignant disease itself, or subsequent to treatments, such as surgery, chemotherapy or radiation therapy. The pathophysiology of pain due to cancer may be complex and include a variety of nociceptive, inflammatory, and neuropathic mechanisms. Despite modern advances in pharmacotherapy, cancer pain remains overall under-treated in a world-wide scale, and a main reason is lack of understanding of its pertinent pathophysiology and basic pharmacology. Re...

  12. Pain Management: A Practical Approach to Nursing Education.

    Science.gov (United States)

    Wacker, Margaret S.; Pawasauskas, Joyce

    2002-01-01

    Nine brief onsite educational sessions of 10-20 minutes each trained nurses in pain management techniques. Participants recognized the value of brief presentations, but wanted more time to learn the material. The content was made available on disk for further study. (SK)

  13. Use of analgesic drugs for pain management in sheep.

    Science.gov (United States)

    Lizarraga, I; Chambers, J P

    2012-03-01

    Awareness of pain and its effects is increasing within the veterinary profession, but pain management in food animals has been neglected. Sheep seldom receive analgesics despite various conditions, husbandry practice and experimental procedures being known to be painful, e.g. footrot, mastitis, vaginal prolapse, castration, vasectomy, penis deviation, and laparoscopy. The evidence supporting use of analgesic drugs in this species is reviewed here. Opioid agonists are of dubious efficacy and are short acting. α₂-agonists such as xylazine are good, short-lived analgesics, but induce hypoxaemia. Non-steroidal anti-inflammatory drugs (NSAID) such as ketoprofen provide long-lasting analgesia, but not as marked as that from α₂-agonists; they should be more widely used for inflammatory pain. Local anaesthetics reliably block pain signals, but may also induce motor blockade. Balanced analgesia using more than one class of drug, such as an α₂ agonist (e.g. medetomidine) and N-methyl-D-aspartate antagonist (e.g. ketamine), with the combination selected for the circumstances, probably provides the best analgesia for severe pain. It should be noted that there are no approved analgesic drugs for use in sheep and therefore the use of such drugs in this species has to be off-label. This information may be useful to veterinary practitioners, biomedical researchers, and regulators in animal welfare to develop rational analgesic regimens which ultimately may improve the health and welfare of sheep in both farming and experimental conditions. PMID:22352925

  14. Hypnosis for pain management in the older adult.

    Science.gov (United States)

    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

  15. The management of right iliac fossa pain - is timing everything?

    LENUS (Irish Health Repository)

    McCartan, D P

    2012-01-31

    BACKGROUND: Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. METHODS: Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. RESULTS: Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. CONCLUSION: The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.

  16. The place of oxycodone/naloxone in chronic pain management

    OpenAIRE

    Leppert, Wojciech

    2013-01-01

    Opioid analgesics are usually effective in the management of severe chronic pain. However, symptoms of opioid-induced bowel dysfunction (OIBD) are common during opioid therapy. Opioid-induced bowel dysfunction is often unsuccessfully managed due to limited effectiveness and numerous adverse effects of traditional laxatives. Newer treatment possibilities directed at the pathomechanism of OIBD comprise combined prolonged-release oxycodone with prolonged-release naloxone (oxycodone/naloxone) tab...

  17. Duloxetine in the management of diabetic peripheral neuropathic pain

    OpenAIRE

    Boomershine, Chad

    2011-01-01

    Michelle J Ormseth, Beth A Sholz, Chad S BoomershineDivision of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USAAbstract: Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no tr...

  18. Postoperative pain management after supratentorial craniotomy.

    Science.gov (United States)

    Verchère, Eric; Grenier, Bruno; Mesli, Abdelghani; Siao, Daniel; Sesay, Mussa; Maurette, Pierre

    2002-04-01

    The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. One hour before the end of surgery, all patients received 30 mg/kg propacetamol intravenously then 30 mg/kg every 6 hours. Patients in the PT group received 1.5 mg/kg tramadol 1 hour before the end of surgery. For patients in the PN group, 0.15 mg/kg nalbuphine was injected after discontinuation of remifentanil, because of its mu-antagonist effect. Postoperative pain was assessed in the fully awake patient after extubation (hour 0) and at 1, 2, 4, 8, and 24 hours using a visual analog scale (VAS). Additional tramadol (1.5 mg/kg) or 0.15 mg/kg nalbuphine was administered when the VAS score was > or = 30 mm. Analgesia was compared using the Mantha and Kaplan-Meier methods. Adverse effects of the drugs were also measured. The three groups were similar with respect to the total dose of remifentanil received (0.27 +/- 0.1 mircog/kg/min). In all patients, extubation was obtained within 6 +/- 3 minutes after remifentanil administration. Postoperative analgesia was ineffective in the P group; therefore, inclusions in this group were stopped after the eighth patient. Postoperative analgesia was effective in the two remaining groups because VAS scores were similar, except at hour 1, when nalbuphine was more effective (P = .001). Nevertheless, acquiring such a result demanded significantly more tramadol than nalbuphine (P < .05). More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P < .06). In conclusion, pain after supratentorial neurosurgery must be taken into account

  19. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  20. Optimising postoperative pain management in the ambulatory patient.

    Science.gov (United States)

    Shang, Allan B; Gan, Tong J

    2003-01-01

    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  1. History of Pain Research and Management in Canada

    Directory of Open Access Journals (Sweden)

    Harold Merskey

    1998-01-01

    Full Text Available Scattered accounts of the treatment of pain by aboriginal Canadians are found in the journals of the early explorers and missionaries. French and English settlers brought with them the remedies of their home countries. The growth of medicine through the 18th and 19th centuries, particularly in Europe, was mirrored in the practice and treatment methods of Canadians and Americans. In the 19th century, while Americans learned about causalgia and the pain of wounds, Canadian insurrections were much less devastating than the United States Civil War. By the end of that century, a Canadian professor working in the United States, Sir William Osler, was responsible for a standard textbook of medicine with a variety of treatments for painful illnesses. Yet pain did not figure in the index of that book. The modern period in pain research and management can probably be dated to the 20 years before the founding of the International Association for the Study of Pain. Pride of place belongs to The management of pain by John Bonica, published in Philadelphia in 1953 and based upon his work in Tacoma and Seattle. Ideas about pain were evolving in Canada in the 1950s with Donald Hebb, Professor of Psychology at McGill University in Montreal, corresponding with the leading American neurophysiologist, George H Bishop. Hebb's pupil Ronald Melzack engaged in studies of early experiences in relation to pain and, joining with Patrick Wall at Massachusetts Institute of Technology, published the 1965 paper in Science that revolutionized thinking. Partly because of this early start with prominent figures and partly because of its social system in the organization of medicine, Canada became a centre for a number of aspects of pain research and management, ranging from pain clinics in Halifax, Kingston and Saskatoon - which were among the earliest to advance treatment of pain - to studying the effects of implanted electrodes for neurosurgery. Work in Toronto by Moldofsky

  2. The effect of postoperative pain management program on improving nurses' knowledge and attitudes toward pain.

    Science.gov (United States)

    Abdalrahim, Maysoon S; Majali, Sawsan A; Stomberg, Margareta Warrén; Bergbom, Ingegerd

    2011-07-01

    Effective postoperative pain treatment is an essential component to good quality of care. The purpose of this study was to explore nurses' knowledge of and attitudes toward pain in surgical wards before and after implementation of a postoperative management program at a university hospital in Jordan. The program consisted of an education program for nurses, and its effect was evaluated by using a pre- and post-intervention design. Sixty five registered nurses were asked to respond to a 21 items questionnaire, and a total of 240 patients' records were audited. After implementation of the program, the mean scores for all the questionnaire items were found to increase to 75%, with an average of 16/21 for the correct answers. There was a statistically significant difference (p nurses' responses in the pre-intervention phase and their responses in the post-intervention phase for most of the questionnaire items. Also, there was a statistically significant improvement in the documentation of patients' care in 85% of the audited patients' records. It was recommended to introduce an acute pain services (APS) using a well established and safe pain management routines to increase the quality of care. PMID:21186139

  3. Opioid Prescribing Laws and Emergency Department Guidelines for Chronic Non-Cancer Pain in Washington State.

    Science.gov (United States)

    Skaer, Tracy L; Nwude, Azuka C

    2016-06-01

    Rising mortality rates, increased opioid prescription abuse, and a perceived need to provide practitioners with structured guidance in opioid prescribing have prompted the Washington State Legislature to establish new legal standards of practice regarding chronic non-cancer pain management. Clinicians are required to conduct a detailed physical examination and health history prior to treatment. Risk assessments for abuse and detailed periodic reviews of treatment are required at least every 6 months. Those considered "high risk" or who have significant psychiatric comorbidities will be required to sign and follow a written agreement or pain contract, obtain their pain prescriptions from a single provider, and submit to biological drug screening. Unless an exemption exists, patients prescribed > 120 mg of morphine-equivalents daily, considered severe pain nonresponders, necessitating dosage escalation, diagnosed with multifaceted mental health-related comorbidities, demonstrating diagnostic ambiguity, and/or requiring significant treatment individualization are referred to a pain specialist. Episodic care settings should refrain from supplying opioids to chronic pain patients whenever possible. The ER is for Emergencies coalition instituted the Seven Best Practices program throughout the state to reduce unnecessary visits, coordinate prescribing practice, reduce Medicaid expenditures, and improve overall patient care. The state reported approximately $33.65 million in savings in 2013 through the use of these practices and converting Medicaid participants from fee-for-service to managed care plans. Similar legislation to complement clinical practice guidelines is expected to be enacted in other states. It is vital that practitioners comprehend the new guidelines and make appropriate adjustments in their opioid prescribing habits. PMID:26369588

  4. Current concepts in management of pain in children in the emergency department.

    Science.gov (United States)

    Krauss, Baruch S; Calligaris, Lorenzo; Green, Steven M; Barbi, Egidio

    2016-01-01

    Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and assessment of pain in infants and children and discuss the manifestations of pain in children with chronic illness, recurrent pain syndromes, and cognitive impairment, including the difficulties of pain management in these patients. Non-pharmacological interventions, as adjuncts to pharmacological management for acute anxiety and pain, are described by age and development. We discuss the pharmacological management of acute pain and anxiety, reviewing invasive and non-invasive routes of administration, pharmacology, and adverse effects. PMID:26095580

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

    Directory of Open Access Journals (Sweden)

    Daniel T Barratt

    Full Text Available 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.

  6. Trends in Clinically Significant Pain Prevalence Among Hospitalized Cancer Patients at an Academic Hospital in Taiwan

    Science.gov (United States)

    Wang, Wei-Yun; Ho, Shung-Tai; Wu, Shang-Liang; Chu, Chi-Ming; Sung, Chun-Sung; Wang, Kwua-Yun; Liang, Chun-Yu

    2016-01-01

    cancer patients. However, based on these positive findings, we can provide feedback to nurses, physicians, and pharmacists to empower them to be more committed to pain management. PMID:26735526

  7. Pain Management among Hospitalized Cancer Patients and its Impact on the Quality of Life%住院癌症患者的疼痛控制状况及疼痛对生活质量影响的调查

    Institute of Scientific and Technical Information of China (English)

    秦亚辉; 卢玉林

    2014-01-01

    目的:调查住院肿瘤患者的疼痛控制情况,以及癌痛对肿瘤患者生活质量的影响,为癌痛护理实施提供依据。方法:对376例住院肿瘤患者进行了调查,调查采用癌痛患者疼痛调查表,其中包括疼痛部位调查,24 h疼痛的轻重程度调查,使用止疼药物的调查,24 h受疼痛影响的程度。结果:本组患者目前的癌痛评分(NRS评分)平均为(4.10±2.48)分;有过疼痛的患者为371例(98.67%),既往使用口服药物止痛208例(89.27%);使用过非药物止痛疗法的患者有189例(50.27%)。生活质量在24 h受疼痛影响的程度,影响最大的是日常生活(6.51±2.43)分,影响最小的是睡眠(3.46±2.62)分。结论:疼痛对癌症患者的生活质量产生影响,住院患者癌痛控制效果有待加强。%Objective: To investigate the status of pain management and pain influence on the quality of life of hospitalized tumor patients, so as to provide a basis for the implementation of cancer pain treatment. Methods:376 cases hospitalized tumor patients were investigated by using pain questionnaire, including pain part investigation, lowest the degree of pain within 24 hours, the use of pain medications survey, and the effects degrees of pain within 24 hours. Results: The scores of pain at present in this group of patients (NRS score) was (4.10 ± 2.48);371 cases (98.67%) patients have a history of pain, and 208 cases (89.27%) took oral analgesic drugs;189 cases (50.27%) patients used of non-drug therapy before. The quality of life affected by pain within 24 hours, the biggest effect was (6.51 ± 2.43) scores for daily life, the smallest effect was (3.46 ±2.62) scores for sleep. Conclusion:The pain affects the quality of life of cancer patients;cancer pain control of patients remains to be improved.

  8. Procedure-specific pain management and outcome strategies

    DEFF Research Database (Denmark)

    Joshi, Girish P; Schug, Stephan A; Kehlet, Henrik

    2014-01-01

    recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. The procedure-specific evidence is supplemented with data from other similar surgical procedures and clinical practices to balance benefits and risks of each analgesic technique. There......Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical...

  9. Ziconotide in severe, drug-resistant cancer pain. preliminary experience

    OpenAIRE

    Angelo Lavano

    2008-01-01

    The Author reports the case of ziconotide intrathecal treatment in three terminal cancer patients, with nociceptive and neuropathic pain, unresponsive to the treatment with intrathecal opioid and adjuvant drugs. An external pump for continuous subarachnoid infusion was implanted to the three patients. The initial dose was 2,4 mcg/die, with increments of 1,2 mcg/die every three days till the maximum dose of 4,8 mcg/die in two patients (survival 61 and 45 days) and 7,2 mcg/die in a pat...

  10. Management of vulvar cancers

    NARCIS (Netherlands)

    de Hullu, J. A.; van der Avoort, I. A. M.; Oonk, M. H. M.; van der Zee, A. G. J.

    2006-01-01

    Aim The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage squamous cell cancer. However, the morbidity is impressive, leading to more individualized treatment. The aim of this review is to give an o

  11. Management of vulvar cancers.

    NARCIS (Netherlands)

    Hullu, J.A. de; Avoort, I.A.M. van der; Oonk, M.H.; Zee, A.G. van der

    2006-01-01

    AIM: The radical surgical approach in the treatment of vulvar cancer patients has led to a favorable prognosis for the majority of the patients with early stage squamous cell cancer. However, the morbidity is impressive, leading to more individualized treatment. The aim of this review is to give an

  12. Chronic pain management in the active-duty military

    Science.gov (United States)

    Jamison, David; Cohen, Steven P.

    2012-06-01

    As in the general population, chronic pain is a prevalent and burdensome affliction in active-duty military personnel. Painful conditions in military members can be categorized broadly in terms of whether they arise directly from combat injuries (gunshot, fragmentation wound, blast impact) or whether they result from non-combat injuries (sprains, herniated discs, motor vehicle accidents). Both combat-related and non-combat-related causes of pain can further be classified as either acute or chronic. Here we discuss the state of pain management as it relates to the military population in both deployed and non-deployed settings. The term non-battle injury (NBI) is commonly used to refer to those conditions not directly associated with the combat actions of war. In the history of warfare, NBI have far outstripped battle-related injuries in terms not only of morbidity, but also mortality. It was not until improvements in health care and field medicine were applied in World War I that battle-related deaths finally outnumbered those attributed to disease and pestilence. However, NBI have been the leading cause of morbidity and hospital admission in every major conflict since the Korean War. Pain remains a leading cause of presentation to military medical facilities, both in and out of theater. The absence of pain services is associated with a low return-to-duty rate among the deployed population. The most common pain complaints involve the low-back and neck, and studies have suggested that earlier treatment is associated with more significant improvement and a higher return to duty rate. It is recognized that military medicine is often at the forefront of medical innovation, and that many fields of medicine have reaped benefit from the conduct of war.

  13. The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study

    OpenAIRE

    Horan Sheila; Kelly Valerie; O'Keeffe Declan; Power Camillus K; Blake Catherine; Cunningham Jennifer M; Spencer Orla; Fullen Brona M

    2011-01-01

    Abstract Background Reduced sleep quality is a common complaint among patients with chronic pain, with 50-80% of patients reporting sleep disturbance. Improvements in pain and quality of life measures have been achieved using a multidisciplinary cognitive behavioural therapy pain management programme (CBT-PMP) that aims to recondition attitudes to pain, and improve patients' self-management of their condition. Despite its high prevalence in patients with chronic pain, there is very limited ob...

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

    Directory of Open Access Journals (Sweden)

    Karim Welaya

    2016-04-01

    Full Text Available 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.

  15. Effect of sex in the MRMT-1 model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Al-Dihaissy, Tamara; Mezzanotte, Laura;

    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...

  16. Phytotherapy for pain relief.

    Science.gov (United States)

    Zareba, Grazyna

    2009-06-01

    Pain is considered the third most common healthcare problem disabling more individuals than heart disease and cancer together. Although pharmacological pain management offers a significant relief in several pain-related diseases, many patients turn to its supplementation with complementary and alternative medicine. Botanicals used in pain therapy can contribute to restoring the quality of life to a patient and may effect and enhance conventional pain management. Herbal analgesic use in several pain-related diseases such as rheumatologic diseases, back pain, cancer, diabetic peripheral neuropathy and migraine will be discussed. In addition, this review describes botanicals with known analgesic activity for which randomized, placebo-controlled, double-blind trials assessing their efficacy in different pain-related diseases have been published and which have been recently evaluated in many systematic reviews with well-described methodology. PMID:19649334

  17. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    Science.gov (United States)

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  18. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS and interactive voice response (IVR

    Directory of Open Access Journals (Sweden)

    te Boveldt Nienke

    2011-12-01

    Full Text Available Abstract Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR, has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR: NTR2739

  19. Quality indicators in postoperative pain management: a validation study.

    Science.gov (United States)

    Idvall, E; Hamrin, E; Sjöström, B; Unosson, M

    2001-01-01

    Quality indicators in postoperative pain management: a validation study. In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care. PMID:12453175

  20. Guidance on the management of pain in older people.

    Science.gov (United States)

    Abdulla, Aza; Adams, Nicola; Bone, Margaret; Elliott, Alison M; Gaffin, Jean; Jones, Derek; Knaggs, Roger; Martin, Denis; Sampson, Liz; Schofield, Pat

    2013-03-01

    This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided

  1. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, Rikke Rie; Nielsen, Christian K.; Nasser, Arafat;

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... with and without astrocyte activation (BALB/cJ or C3H mice inoculated with 4T1 mammary cancer cells or NCTC 2472 osteosarcoma cells, respectively), suggesting that astrocytic P2X7 receptors play a negligible role in bone cancer pain. The results support the hypothesis that bone cancer pain is a...

  2. Conversing Rate from Morphine to Continuous Infusion of Fentanyl in Patients Suffering Cancer Pain

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain. Methods: A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003. Pain intensity, adverse reactions, and satisfaction index of patients were evaluated. Results: The pain intensity was stable in 17 patients indicating good pain-control within 1 week after conversion and unstable in 3 patients after conversion suggesting poor pain-control. Fentanyl injection could alleviate side effects and increase the satisfaction index of patients. Conclusion: The equipotent ratio for ratio less than 72:1 was proposed to get stable pain-relieving effect. But the equipotent ratio for conversion of morphine to continuous infusion of fentanyl could not be determined. We must consider the morphine dose before the confirmation of the conversing rate.

  3. Pain in long-term breast cancer survivors: The role of body mass index, physical activity, and sedentary behavior

    OpenAIRE

    Forsythe, Laura P; Alfano, Catherine M.; George, Stephanie M.; McTiernan, Anne; Baumgartner, Kathy B.; Bernstein, Leslie; Ballard-Barbash, Rachel

    2012-01-01

    Although pain is common among post-treatment breast cancer survivors, studies that are longitudinal, identify a case definition of clinically meaningful pain, or examine factors contributing to pain in survivors are limited. This study describes longitudinal patterns of pain in long-term breast cancer survivors, evaluating associations of body mass index [BMI], physical activity, sedentary behavior with mean pain severity and above-average pain. Women newly diagnosed with stages 0–IIIA breast...

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

    Science.gov (United States)

    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)

  5. Improving radionuclide therapy in prostate cancer patients with metastatic bone pain

    NARCIS (Netherlands)

    Lam, M.G.E.H.

    2009-01-01

    Bone seeking radiopharmaceuticals are indicated in cancer patients with multiple painful skeletal metastases. The majority of these patients are hormone-refractory prostate cancer patients in an advanced stage of their disease. Bone seeking radiopharmaceuticals relieve pain and improve the patients

  6. Pain Management: Knowledge and Attitudes of Senior Nursing Students and Practicing Registered Nurses

    Science.gov (United States)

    Messmer, Sherry

    2009-01-01

    Despite scientific advances in pain management, inadequate pain relief in hospitalized patients continues to be an on-going phenomenon. Although nurses do not prescribe medication for pain, the decision to administer pharmacological or other interventions for pain relief is part of nursing practice. Nurses play a critical role in the relief of…

  7. Managing childhood fever and pain – the comfort loop

    Directory of Open Access Journals (Sweden)

    Clinch Jacqui

    2007-08-01

    Full Text Available Abstract Parents can transmit their anxiety to their child, and just as children can pick up on parental anxiety, they can also respond to a parent's ability to stay calm in stressful situations. Therefore, when treating children, it is important to address parental anxiety and to improve their understanding of their child's ailment. Parental understanding and management of both pain and fever – common occurrences in childhood – is of utmost importance, not just in terms of children's health and welfare, but also in terms of reducing the economic burden of unnecessary visits to paediatric emergency departments. Allaying parental anxiety reduces the child's anxiety and creates a positive feedback loop, which ultimately affects both the child and parent. In this review, the integral role of parental perception of the child's condition and the efficacy of treatment in the management of childhood fever and pain will be discussed.

  8. Controversies in the management of tongue base cancer.

    LENUS (Irish Health Repository)

    O'Neill, J P

    2012-01-31

    BACKGROUND: Tongue base cancer is one of the most lethal head and neck cancers. There is considerable controversy in the management of this disease with wide variation of opinion within the literature. METHODS: We discuss the presentation, diagnostic and therapeutic strategies which exist in the literature. Articles were reviewed from 1970 to 2007 within the Medline, Pubmed and Cochrane libraries. CONCLUSIONS: Smokers with a history of persistent unilateral neck pain, even in the absence of clinical signs warrant MRI neck imaging. Tongue base cancer organ preservation therapeutic strategies, radiation and concomitant platinum based chemotherapy, currently optimise oncologic and quality of life outcomes.

  9. Obamacare 2012: prognosis unclear for interventional pain management.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2012-01-01

    The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. While proponents argue that ObamaCare will provide insurance for almost everyone, with an improvement in the quality of and reduction in the cost of health care,, opponents criticize it as being a massive bureaucracy laden with penalties and taxes, that will ultimately eliminate personal medicine and individual practices. Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional pain management is unclear. The damage sustained to interventional pain management and the majority of medicine practices is irreparable. ObamaCare may provide insurance for all, but with cuts in Medicare to fund Obamacare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training. PMID:22996858

  10. Stomatitis-Related Pain in Women with Breast Cancer Undergoing Autologous Hematopoietic Stem Cell Transplant

    OpenAIRE

    Fall-Dickson, Jane M.; Mock, Victoria; Berk, Ronald A.; Grimm, Patricia M.; Davidson, Nancy; Gaston-Johansson, Fannie

    2008-01-01

    The purpose of this cross-sectional, correlational study was to describe stomatitis-related pain in women with breast cancer undergoing autologous hematopoietic stem cell transplant. Hypotheses tested were that significant, positive relationships would exist between oral pain and stomatitis, state anxiety, depression, and alteration in swallowing. Stomatitis, sensory dimension of oral pain, and state anxiety were hypothesized to most accurately predict oral pain overall intensity. Thirty-two ...

  11. Perioperative pain management in hip and knee replacement surgery.

    Science.gov (United States)

    Barrington, John W; Halaszynski, Thomas M; Sinatra, Raymond S; Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty, For The

    2014-04-01

    Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps. The benefits of multimodal regimens that include a combination of agents acting synergistically have been established unequivocally, and many analgesic and anesthetic agents are now available, as well as treatment options that differ according to route of administration. It is therefore possible to individualize treatment based on the type of procedure and patient need. One exciting advance that offers effective, safe, and efficient analgesia for many kinds of surgical procedures is the introduction of an extended-release local anesthetic (liposomal bupivacaine) for infiltration. This new option, which can be administered directly into the knee or hip by an orthopedic surgeon, is an example of the changing paradigm in perioperative analgesia, where commitment, communication, and coordination across all members of the clinical care team- including the surgeon, anesthesiologist, pharmacist, physical therapist, and nursing staff-are fundamental elements of an improved standard of care. An Expert Working Group on Anesthesia and Orthopaedics: Critical Issues in Hip and Knee Replacement Arthroplasty (April 13, 2013; Dallas, Texas) evaluated current approaches to perioperative pain management and proposed new regimens to help achieve optimal outcomes in these

  12. An open-label, 1-year extension study of the long-term safety and efficacy of once-daily OROS® hydromorphone in patients with chronic cancer pain

    Directory of Open Access Journals (Sweden)

    Tuca Alberto

    2009-09-01

    Full Text Available Abstract Background Opioid analgesics have proven efficacy in the short-term management of chronic cancer pain, but data on their long-term use is more limited. OROS® hydromorphone is a controlled-release formulation of oral hydromorphone that may be particularly well suited to long-term management of chronic cancer pain because it provides stable plasma concentrations and consistent analgesia with convenient once-daily dosing. The objective of this study (DO-118X was to characterise the pain control achieved with long-term repeated dosing of OROS® hydromorphone in patients with chronic cancer pain. Methods In this multicentre, phase III, open-label, single treatment, 1-year extension study, OROS® hydromorphone was administered to 68 patients with moderate-to-severe chronic cancer pain, who had successfully completed a short-term equivalence study, and whose pain was controlled with a stable dose of medication (≥ 8 mg OROS® hydromorphone or equivalent controlled-release morphine. Patients were started on the dose of OROS® hydromorphone equivalent to the opioid dose on which they achieved dose-stable pain control in the equivalence study; dose adjustments were made as necessary and breakthrough pain medication was permitted. Efficacy was assessed with the Brief Pain Inventory (BPI and patient and investigator global evaluations of treatment effectiveness. No formal statistical analysis was done. Results The mean (standard deviation duration of exposure to study medication was 139 (129.9 days and the mean (standard deviation average daily consumption of OROS® hydromorphone was 43.7 (28.14 mg/day. All scores were maintained at a mild to moderate severity throughout the study; however, BPI scores for pain at its worst, pain at its least, pain on average, pain right now, and pain relief were slightly worsened at end point compared with baseline. Mean BPI pain interference with daily activities and patient and investigator global evaluation

  13. Contemporary Management of Bladder Cancer

    Science.gov (United States)

    Bell, David; Fradet, Yves

    1991-01-01

    Bladder cancer is currently the fifth most common cancer in Western society, and its incidence appears to be increasing. Important advances have recently occurred in both diagnostic and therapeutic approaches to bladder neoplasms. Presentation is not unique, and physician awareness is important to identify patients who are at risk for bladder neoplasia and consequently require further investigation. A diagnostic approach and contemporary management are discussed. ImagesFigure 1Figure 4 PMID:21229043

  14. Procedural and postoperative pain management in children : experiences, assessments and possibilities to reduce pain, distress and anxiety

    OpenAIRE

    Nilsson, Stefan

    2010-01-01

    Introduction Children’s visits to hospital are often connected with painfulexaminations and treatments. If these situations are associated withunsuccessful alleviation of pain, the children may develop distress, anxiety and even pain sensitization. Effective pain management including pharmacological treatment and coping methods that support the children when undergoing examinations or treatments could reduce these harmful effects. Distraction methods such as serious games and music medicine a...

  15. The role of physical therapy in craniofacial pain disorders: an adjunct to dental pain management.

    Science.gov (United States)

    Heinrich, S

    1991-01-01

    Treatment of craniofacial pain disorders is often complicated by diverse factors such as acute or chronic trauma and persistent postural changes. In addition, emotional issues and life stress often cloud the recovery process. Physical therapists, with their diverse knowledge base and highly competent treatment skills, can be quite effective in assisting dentists and physicians with management of the many difficult upper quarter and craniofacial pain syndromes. This article reviews the role of myofascial and craniosacral dysfunction, as well as the function of posture, tension, and stress in the development of these syndromes. Additionally, it provides a comprehensive overview of the many evaluative techniques and treatment options that can be provided by today's physical therapists. PMID:1843484

  16. Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program

    OpenAIRE

    Logan, Deirdre E; Conroy, Caitlin; Sieberg, Christine B.; Simons, Laura E.

    2012-01-01

    The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents...

  17. Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

    Directory of Open Access Journals (Sweden)

    Sizakele L.T. Khoza

    2014-10-01

    Full Text Available Background: Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice.Objective: This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals.Method: A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng.Results: The response rate was 35.33% (n = 53, most respondents being professional nurses (88.68%; n = 47 working in neonatal intensive care units (80.77%; n = 42; 24 (45.28% had less than 5 years’ and 29 respondents 6 or more years’ working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p < 0.05 was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64% reported that there were no pain management guidelines in the neonatal wards in which they worked.Conclusion: The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates. 

  18. A new transmucosal drug delivery system for patients with breakthrough cancer pain: the fentanyl effervescent buccal tablet

    OpenAIRE

    Enno Freye

    2008-01-01

    Enno FreyeCenter of Ambulatory Pain Medicine, Neuss-Uedesheim, GermanyAbstract: Breakthrough pain, a transitory severe pain with the background of otherwise controlled persistent pain has a prevalence between 52% and 67% in outpatients with cancer. Medications for such sudden-onset pain require non-invasive delivery of a potent and short-acting opioid for rapid pain relief. Although oral transmucosal delivery of fentanyl citrate (OTFC) has been shown to provide better pain relief than a typic...

  19. Laser Acupuncture for Postoperative Pain Management in Cats

    Directory of Open Access Journals (Sweden)

    Virgínia I. Marques

    2015-01-01

    Full Text Available The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM ketamine (5 mg kg−1, midazolam (0.5 mg kg−1, and tramadol (2 mg kg−1. Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. Anaesthesia was induced using intravenous propofol (4 mg kg−1 and maintained with isoflurane. Postoperative analgesia was evaluated by a blinded assessor for 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Pain Scale. Rescue analgesia was provided with IM tramadol (2 mg kg−1, and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1 IM, single dose was administered. Data were analyzed using t-tests, the Mann-Whitney test, and the Friedman test (P<0.05. The pain scores did not differ between groups. However, postoperative supplemental analgesia was required by significantly more cats in the Control (5/10 compared with the Laser group (1/10 (P=0.038. Laser acupuncture reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy.

  20. How Can We Make the Pain Go Away? Public Policies to Manage Pain at the End of Life

    Science.gov (United States)

    Imhof, Sara; Kaskie, Brian

    2008-01-01

    The continued undertreatment of pain at the end of life is a substantive public health problem that has not been resolved through increased public awareness, the issuance of clinical guidance for providers, or expanded organizational commitments. In this forum, we illuminate the role of public policies in promoting pain management. We review…

  1. Duloxetine in the management of diabetic peripheral neuropathic pain.

    Science.gov (United States)

    Ormseth, Michelle J; Scholz, Beth A; Boomershine, Chad S

    2011-01-01

    Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients. PMID:21845034

  2. Duloxetine in the management of diabetic peripheral neuropathic pain

    Science.gov (United States)

    Ormseth, Michelle J; Scholz, Beth A; Boomershine, Chad S

    2011-01-01

    Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients. PMID:21845034

  3. Lysine-Specific Demethylase 1 in Breast Cancer Cells Contributes to the Production of Endogenous Formaldehyde in the Metastatic Bone Cancer Pain Model of Rats

    OpenAIRE

    Jia Liu; Feng-Yu Liu; Zhi-Qian Tong; Zhi-Hua Li; Wen Chen; Wen-Hong Luo; Hui Li; Hong-Jun Luo; Yan Tang; Jun-Min Tang; Jie Cai; Fei-Fei Liao; You Wan

    2013-01-01

    BACKGROUND: Bone cancer pain seriously affects the quality of life of cancer patients. Our previous study found that endogenous formaldehyde was produced by cancer cells metastasized into bone marrows and played an important role in bone cancer pain. However, the mechanism of production of this endogenous formaldehyde by metastatic cancer cells was unknown in bone cancer pain rats. Lysine-specific demethylase 1 (LSD1) is one of the major enzymes catalyzing the production of formaldehyde. The ...

  4. 11th Annual NIH Pain Consortium Symposium on Advances in Pain Research | Division of Cancer Prevention

    Science.gov (United States)

    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?” |

  5. Further Effort is Needed to Improve Management of Chronic Pain in Primary Care. Results from the Arkys Project.

    Science.gov (United States)

    Piccinocchi, Gaetano; Piccinocchi, Roberto

    2016-04-26

    Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs) in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years) had mostly chronic non-cancer pain (87.7%). In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%). Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%). NSAID prescription decreased (12.8%), while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation. PMID:27478585

  6. Further effort is needed to improve management of chronic pain in primary care. Results from the Arkys project

    Directory of Open Access Journals (Sweden)

    Gaetano Piccinocchi

    2016-06-01

    Full Text Available Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years had mostly chronic non-cancer pain (87.7%. In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%. Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%. NSAID prescription decreased (12.8%, while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.

  7. Duloxetine in the management of diabetic peripheral neuropathic pain

    Directory of Open Access Journals (Sweden)

    Boomershine CS

    2011-07-01

    Full Text Available Michelle J Ormseth, Beth A Sholz, Chad S BoomershineDivision of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USAAbstract: Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients.Keywords: duloxetine, diabetic peripheral neuropathic pain, review, treatment

  8. [Management of laryngeal cancers].

    Science.gov (United States)

    Brunin, F; Rodriguez, J; Cougniot-Lescure, S; Point, D; Jaulerry, C; Brugère, J

    1995-04-01

    With 5,000 cases yearly, laryngeal carcinomas account in France for the third of squamous cell cancers of the upper digestive and respiratory tract. The crude survival rate is 50% at 5 years. Carcinomas of vocal cords are often diagnosed as early stages if dysphonia leads the patients to the ENT specialist within 2 weeks. Cure of the primary is achieved in 90% of the early stages by radiotherapy with narrow fields or partial surgery, with a 80% 5 years survival rate. Advanced tumors are often treated by total laryngectomy and postoperative radiotherapy. Supra-glottic cancers (epiglottis) are more serious. Unilateral dysphagia or upper cervical neck node often delay early diagnosis. A total laryngectomy is the commonest treatment. The 5 years survival rate of 40% is due to local and/or regional failures and metachronous cancers in head and neck, and radiotherapy remains the two major treatments. Primary prevention is based upon suppression of tobacco and reduction of alcoholic consumption, secondary prevention on resection of leucoplakia and close follow-up of patients with chronic laryngitis. PMID:7761753

  9. Therapeutic Management of Colon Cancer

    Directory of Open Access Journals (Sweden)

    Ana-Maria Todosi

    2014-09-01

    Full Text Available Colorectal cancer is a major public health problem worldwide, and a major cause of mortality and morbidity. Correct pretherapeutic staging has the role of guiding the management of colon cancer patients. The diagnosis is guided by the clinical symptoms. Chemotherapy is an important part of colon cancer treatment. Chemotherapy regimens are adapted to tumor stage and patient status and have various side effects and variable survival outcomes. International guidelines recommend different treatments depending on the presence or absence of metastases. The primary goal of treatment in nonmetastatic colon cancer is surgical removal of the tumor which could be the first step of the complex therapy or preceded by neoadjuvant therapy, depending on pretherapeutic staging. In resectable nonmetastatic tumors the preferred surgical procedure is colectomy with en bloc removal of regional lymph nodes. The extent of colectomy should be based on tumor location. The management of metastatic colon cancer also targets the therapeutic approach of the metastatic disease. Therapy is standardized and applied according to tumor stage. Surveillance has a major role in therapeutic success, reason why a time schedule and a protocol adapted to the primary lesion are essential. The goal of implementing the recommendations of international guidelines for the treatment of colon cancer is to provide a uniform treatment for this disease in view of improving overall survival of patients.

  10. Ziconotide in severe, drug-resistant cancer pain. preliminary experience

    Directory of Open Access Journals (Sweden)

    Angelo Lavano

    2008-12-01

    Full Text Available The Author reports the case of ziconotide intrathecal treatment in three terminal cancer patients, with nociceptive and neuropathic pain, unresponsive to the treatment with intrathecal opioid and adjuvant drugs. An external pump for continuous subarachnoid infusion was implanted to the three patients. The initial dose was 2,4 mcg/die, with increments of 1,2 mcg/die every three days till the maximum dose of 4,8 mcg/die in two patients (survival 61 and 45 days and 7,2 mcg/die in a patient (survival 52 days. VAS reduction was 50% in the fi rst patient, of 57% in the second one and 70% in the third one. In one case, at the dose of 4,8 mcg/die, the treatment was associated with important collateral effects, that requested the temporary suspension of the drug.

  11. Enhanced excitability of small dorsal root ganglion neurons in rats with bone cancer pain

    OpenAIRE

    Zheng Qin; Fang Dong; Cai Jie; Wan You; Han Ji-Sheng; Xing Guo-Gang

    2012-01-01

    Abstract Background Primary and metastatic cancers that affect bone are frequently associated with severe and intractable pain. The mechanisms underlying the development of bone cancer pain are largely unknown. The aim of this study was to determine whether enhanced excitability of primary sensory neurons contributed to peripheral sensitization and tumor-induced hyperalgesia during cancer condition. In this study, using techniques of whole-cell patch-clamp recording associated with immunofluo...

  12. Current management of oral cancer

    Institute of Scientific and Technical Information of China (English)

    Robert Ord

    2008-01-01

    @@ This presentation will summarize some of the current areas of interest in the management of oral cancer. The presentation will be divided into a brief review of epidemiology and diagnosis, with a more extensive discussion regarding the controversial areas in surgery and a review of the adjuvant roles of radiation and chemotherapy.

  13. Evaluation and Management of Patients with Noncardiac Chest Pain

    Directory of Open Access Journals (Sweden)

    C. Shekhar

    2008-01-01

    Full Text Available Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. This review covers the assessment and management of this challenging condition, which includes a combination of education, reassurance, and pharmacotherapy. For the more refractory cases, behavioral treatments, such as cognitive behavioral therapy or hypnotherapy, may have to be considered.

  14. Evidence-based postoperative pain management after laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Bonnet, F; Kehlet, H

    2013-01-01

    undergoing laparoscopic colorectal surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. The efficacy and adverse effects of the analgesic techniques was assessed. The recommendations were based on procedure-specific evidence from a systematic review and supplementary......Aim  The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery. Method  Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults...... transferable evidence from other relevant procedures. Results  Of the 170 randomized studies identified, 12 studies were included. Overall, all approaches including ketorolac, methylprednisolone, intraperitoneal instillation of ropivacaine, intravenous lidocaine infusion, intrathecal morphine and epidural...

  15. Study on Tongkuaixiao Babu Plaster(痛块消巴布剂)in Treating Cancer Pain

    Institute of Scientific and Technical Information of China (English)

    万冬桂; 李佩文

    2004-01-01

    Objective: To explore the efficacy of Tongkuaixiao Babu plaster (痛块消巴剂, TKXBBP)in treating cancer pain. Methods: In the clinical observation, sixty-five patients with moderate or severe cancer pain were randomly divided into two groups: 32 in the treated group (TKXBBP group) and 33 in the control group (Bucinnazine group). The therapeutic effects in relieving pain, improving quality of life (QOL),and the rate of satisfaction the patients felt of the two groups were compared respectively. Results: TKXBBP was effective in treating cancer pain. There wasn't any statistically significant difference in total effective rate (P>0.05), but the statistical difference was significant in obvious remission rate (P<0.05) between the treated and control group, and the effect on serious pain shown in the treated group was better than that of the control group (P<0.05). The difference in the initiation time of relieving cancer pain was insignificant (P>0.05), while in the remission period, the treated group showed its treatment was obviously superior to that of the control group (P<0.05). TKXBBP showed better effect in the improvement of QOL (P<0.05)and satisfaction rate, with significant difference between the treated and the control groups (P<0.01). Conclusion: TKXBBP's effect in treating cancer pain was obvious, its application was safe and convenient. It was shown that the external treatment with this kind of Chinese medicine had great advantage in treating cancer pain.

  16. Pain in hospitalized children: A prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital

    OpenAIRE

    Taylor, Elsa M; Kristina Boyer; Campbell, Fiona A

    2008-01-01

    BACKGROUND: Pain is under-recognised and undertreated. Although standards now exist for pain management, it is not known if this has improved care of hospitalized children.OBJECTIVES: To benchmark pain prevalence, pain intensity, pain assessment documentation and pharmacological treatment of pain. The aim was to highlight areas of good practice, identify areas for improvement and inform development of hospital standards, education, future audits and the research agenda.METHODS: The present pr...

  17. Influence of sex differences on the progression of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Appel, Camilla;

    2013-01-01

    on the progression of cancer-induced bone pain. Materials and Methods: 4T1-luc2 mammary cancer cells were introduced into the femoral cavity of female and male BALB/cJ mice. Bioluminescence tumor signal, pain-related behavior and bone degradation were monitored for 14 days. Results: Female mice demonstrated...... a significantly greater bioluminescence signal on day 2 compared to male mice and, in addition, a significant earlier onset of pain-related behavior was observed in the females. No sex difference was observed for bone degradation. Finally, a strong correlation between pain-related behavior and bone degradation...

  18. Clinical Trials Management | Division of Cancer Prevention

    Science.gov (United States)

    Information for researchers about developing, reporting, and managing NCI-funded cancer prevention clinical trials. Protocol Information Office The central clearinghouse for clinical trials management within the Division of Cancer Prevention.Read more about the Protocol Information Office. | Information for researchers about developing, reporting, and managing NCI-funded cancer prevention clinical trials.

  19. Pain in Pancreatic Cancer: Does Drug Treatment Still Play a Role?

    Directory of Open Access Journals (Sweden)

    Ilaria Uomo

    2011-09-01

    Full Text Available Disabling pain together with cachexia is the most important symptom in patients with pancreatic cancer. Abdominal pain is a common debilitating symptom quickly leading to deterioration of the quality of life and performance status [1]. Although only 30-40% of patients report moderate to severe pain at the time of diagnosis, more than 80-90% of them with advanced disease experience severe pain before death [2]. Pain is generally transmitted through the celiac plexus which harbors sympathetic fibers carrying nociceptive information from the pancreas and surrounding organs. More infrequently, pain results from pancreatic duct obstruction and associated pancreatitis; this type of pain usually appears after meals, thus increasing the continuous pain related to the infiltration of the peripancreatic nervous plexus [3].

  20. Nurses' willingness to manage the pain of specific groups of patients.

    Science.gov (United States)

    Brockopp, Dorothy Y; Ryan, Patty; Warden, Sherry

    Effective pain management remains a challenge for the nursing profession. While nurses' knowledge of appropriate pain strategies has improved considerably, additional research needs to be conducted into the influence of factors other than knowledge on the management of pain. This study examined the willingness of nurses (n = 157) and nursing students (n = 265) to spend time and energy managing the pain of different groups of patients, when told that all patients had the same degree of pain. The willingness of nurses to spend time and energy in managing patients' pain was used as a proxy for preconceived notions relative to particular groups of patients. A pattern emerged that suggested that nurses' and nursing students' willingness to spend time and energy managing patients' pain in influenced by their perceptions of different groups of patients. PMID:12743487

  1. Concepts of rehabilitation for the management of low back pain.

    Science.gov (United States)

    Waddell, Gordon; Burton, A Kim

    2005-08-01

    This chapter develops rehabilitation principles for the clinical and occupational management of non-specific low back pain (LBP). Rehabilitation has traditionally been a secondary intervention, which focused on permanent impairment, but this is inappropriate for LBP. Most patients with LBP do not have any irremediable impairment and long-term incapacity is not inevitable: given the right care, support and opportunity, most should be able to return to work. Rehabilitation should then address obstacles to recovery and barriers to (return to) work. Rehabilitation should not be a separate, second stage after 'treatment' is complete: rehabilitation principles should be integral to clinical and occupational management. It should be possible to reduce sickness absence and long-term incapacity due to LBP by at least 30-50%, but this will require a fundamental shift in management culture. PMID:15949782

  2. Differential activation of spinal cord glial cells in murine models of neuropathic and cancer pain

    DEFF Research Database (Denmark)

    Hald, Andreas; Nedergaard, S; Hansen, RR;

    2009-01-01

    of spinal cord glial activation in three different murine pain models to investigate if microglial activation is a general prerequisite for astrocyte activation in pain models. We found that two different types of cancer induced pain resulted in severe spinal astrogliosis without activation of microglia......Activation of spinal cord microglia and astrocytes is a common phenomenon in nerve injury pain models and is thought to exacerbate pain perception. Following a nerve injury, a transient increase in the presence of microglia takes place while the increased numbers of astrocytes stay elevated...

  3. Cost-effectiveness evaluations of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2011-06-01

    Full Text Available Introduction and objective: ziconotide is the first-in-class drug of selective N-type voltage-sensitive calcium-channel blockers used to control severe chronic pain. The present study is developed in order to analyze clinical and economical outcomes of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice.Methods: costs and effects of ziconotide are compared with those of traditional neuromodulation with morphine and adjuvant drugs, administered by intrathecal infusion.Effectiveness and resources consumption data were retrospectively collected in 22 patients with severe complex cancer pain followed by one Italian centre from the day of port implantation to drop-out , due to death or consent withdrawal. 11 patients received morphine regimens and the other 11 were treated with ziconotide. The evaluation of the number of days with controlled pain (i.e., with an at least 30% reduction on the Numeric Rating Scale-Pain Intensity, NRSPI is the primary outcome of the analysis. The evaluated consumed health resources include drugs, visits, port maintenance, and pump recharge and amortization. Current Italian prices, real practice acquisition and remuneration costs borne by the third payer are applied.Results: patients receiving ziconotide lived significantly more days with controlled pain (78% vs 40%; p < 0.05. Average weekly cost is about 232 € for ziconotide and 120 € for morphine; the main driver being the pharmaceutical cost (respectively 81% and 65% of the total. Higher ziconotide acquisition costs are partially offset by minor expenses for adjuvant therapies, as ziconotide-treated patients on average receive a lower number of drugs than those receiving a traditional regimen. The incremental cost for one further day with controlled pain resulted of 42,30 €.Conclusions: ziconotide permits effective treatment of extremely difficult-to-manage pain, with a mild increment of cost, as compared to

  4. Children with medically unexplained pain symptoms: Categorization and effective management

    Directory of Open Access Journals (Sweden)

    Sharmishtha S Deshpande

    2011-01-01

    Full Text Available Context: Medically unexplained pain symptoms are common in children, and their incidence is on the rise. There is often a lack of clearly articulated pathophysiology in these patients. There is need to improve understanding about varied causes and presentations of these patients which would generate further insight in management of these patients. Documentation and detailed assessment of such children in Indian setting is not seen in literature. Materials and Methods: A series of 17 cases, 10 boys and 7 girls referred from pediatrics department is discussed, so as to categorize them in three different subgroups for management. Result and Discussion: Although there were often no overt anxiety or depressive features, some psychosocial stress which was mostly unnoticed by the child, the parents and the doctor, preceded such a pain. It was often an academic stress, familial separation or parental psychiatric illness. They were at times not able to verbalize their distress, which was revealed with the help of Children′s Apperception Test (C.A.T.. They mainly had anxieties about loss of love or disapproval by parents and also fear of harm or injury. They used defence mechanisms like denial, reaction formation and repression, which were ineffective in handling the overwhelming anxiety. Most of these children had either above average or borderline intelligence. Somatic expression of emotional needs and fears in these children was managed effectively by supportive therapy and antidepressant drugs.

  5. Diagnostic value of 18F-FDG PET/CT for cancer pain of peripheral nerves

    OpenAIRE

    Fang, Lei; Jian-ping AN; Hui ZHAO; Xu, Xiao-Hong; Jun-feng MAO; Li, Yun; Dai, Wei

    2013-01-01

    Objective To observe the characteristics of cancer pain of the peripheral nerves on 18F-FDG PET/CT images, and explore the diagnostic value of 18F-FDG PET/CT for cancer pain of the peripheral nerves. Methods Imaging data of 18F-FDG PET/CT of 10 patients with cancer pain of the peripheral nerves confirmed by histopathology or long-term follow-up were analyzed retrospectively. The similarities and differences in PET/CT manifestations between the diseased side peripheral nerves and contralateral...

  6. Laser Acupuncture for Postoperative Pain Management in Cats

    Science.gov (United States)

    Marques, Virgínia I.; Cassu, Renata N.; Nascimento, Felipe F.; Tavares, Rafaela C. P.; Crociolli, Giulliane C.; Guilhen, Rafael C.; Nicácio, Gabriel M.

    2015-01-01

    The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1), and tramadol (2 mg kg−1). Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. Anaesthesia was induced using intravenous propofol (4 mg kg−1) and maintained with isoflurane. Postoperative analgesia was evaluated by a blinded assessor for 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Pain Scale. Rescue analgesia was provided with IM tramadol (2 mg kg−1), and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1 IM, single dose) was administered. Data were analyzed using t-tests, the Mann-Whitney test, and the Friedman test (P cats in the Control (5/10) compared with the Laser group (1/10) (P = 0.038). Laser acupuncture reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy. PMID:26170879

  7. The assessment and management of pain in an orthopaedic out-patient setting: A case study.

    Science.gov (United States)

    Hall, Gillian; Gregory, Julie

    2016-08-01

    The management of pain is an important aspect of an orthopaedic nurse's role. The aim of this paper is to use an individual case study to demonstrate the role of an out-patient orthopaedic nurse in the identification, assessment and management of pain. This paper describes how pain was identified and managed for a patient in the orthopaedic outpatient department, highlighting that pain and its management are not isolated to the in-patient setting. The case study illustrates the importance of recognising pain and taking into account the numerous factors that can influence pain perception. The assessment of an individual patient's pain led to obtaining help from the Acute Pain Team which led to improvement in the patient's pain management and quality of life. The nursing team reflected and discussed the issues identified by this case study which led to changes in practice being introduced. This has resulted in an increased knowledge of and confidence in pain management within the nursing team and development and improvement of pain management practice within the orthopaedic out-patient department. PMID:26711709

  8. Management of patients with acute nonspecific low back pain

    Directory of Open Access Journals (Sweden)

    A. I. Isaikin

    2015-01-01

    Full Text Available The paper describes an observation of a female patient with acute non-specific low back pain (LBP. It gives current recommendations for the treatment of acute LBP and evaluates the clinical efficiency of these methods. The management of patients with acute nonspecific LBP encompasses: 1 correct information about the nature and prognosis of the disease; 2 recommendations for daily activities; 3 a short-term rational therapy with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs, and/or myorelaxants. The role of NSAIDs, ketorol in particular, in treating patients with acute nonspecific LBP is discussed.

  9. Laser Acupuncture for Postoperative Pain Management in Cats

    OpenAIRE

    Virgínia I. Marques; Cassu, Renata N.; Nascimento, Felipe F.; Tavares, Rafaela C. P.; Crociolli, Giulliane C.; Guilhen, Rafael C.; Gabriel M. Nicácio

    2015-01-01

    The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1), and tramadol (2 mg kg−1). Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. An...

  10. Development and implementation of a telehealth-enhanced intervention for pain and symptom management.

    Science.gov (United States)

    Eaton, Linda H; Gordon, Debra B; Wyant, Sheryl; Theodore, Brian R; Meins, Alexa R; Rue, Tessa; Towle, Cara; Tauben, David; Doorenbos, Ardith Z

    2014-07-01

    Managing chronic pain effectively is often challenging for health care providers and patients. Telehealth technologies can bridge geographic distance and improve patients' quality of care in communities where access to pain specialists has previously been unavailable. This paper describes the development and evaluation of a telehealth intervention (TelePain) designed to address the need for pain specialist consultation regarding pain and symptom management issues in non-academic medical centers. We describe the theoretical foundation and development of a multifaceted intervention using a cluster randomized clinical trial design. Health care providers and their patients with chronic pain are enrolled in the study. Patient participants receive the intervention (report of symptoms and receipt of a pain graph) weekly for 8 weeks and are contacted at 12 weeks for completion of post-intervention follow-up measures. Their providers attend TelePain sessions which involve a didactic presentation on an evidence-based topic related to pain management followed by patient case presentations and discussion by community clinicians. Symptom management recommendations for each patient case are made by a panel of pain specialists representing internal medicine, addiction medicine, rehabilitation medicine, anesthesiology, psychiatry, and nursing. The outcomes assessed in this randomized trial focus on pain intensity, pain's interference on function and sleep, and anxiety, depression, and cost-effectiveness. Some of the challenges and lessons that we have learned early in implementing the TelePain intervention are also reported. PMID:24846620

  11. Managing the acute painful episode in sickle cell disease

    Directory of Open Access Journals (Sweden)

    B. Kaya

    2011-12-01

    Full Text Available Sickle cell pain is a complex but frequently experienced symptom. Acute painful events in children can be managed effectively in the community with appropriate support and education. If hospital management is required, rapid access to a consistent, reliable and safe analgesic pathway is recommended to ensure a good standard of care. Use of oral opiates in addition to short acting easily administrable forms of analgesia and strict adherence to protocoled monitoring will enable the acute event to be well managed and the negative pain experience minimised. An important part of the outpatient evaluation is determining the impact pain events are having on the child’s quality of life. Addressing psycho-social aspects, defining and modifying precipitating factors, if any are identified, and having a holistic approach to pain management is helpful. Education and use of self-management techniques can also be productive. Use of sickle modifying interventions such as hydroxycarbamide therapy or transfusion therapy can have a significant impact on reducing the severity and frequency of the acute pain event. 镰状细胞疼痛是一种复杂的常发症。 通过适当的支助和教育,儿童急性疼痛症可以得到有效抑制。 如果需要在医院进行护理,患者应尽快寻求持续可靠且安全的止痛方式,确保良好的护理。 除采取作用短、管理方便的止痛治疗和遵守监测协议之外,患者还需口服鸦片剂,这样,急性症状可以得到良好的抑制,还可尽量减轻疼痛感。 诊断门诊病人一个重要的部分就是确定疼痛症对患儿生活质量产生的影响。 问询生理社会方面问题,确定和修改诱发因子(如有),并整体分析可行的疼痛护理方法。 教育和使用个人护理法也很有效果。 采用镰状细胞修改干预法,例如羟基尿素疗法或输液疗法,对减轻急性疼痛症和减少发作频率有着显著效果。

  12. Validation of the University of California San Francisco Oral Cancer Pain Questionnaire

    OpenAIRE

    Kolokythas, Antonia; Connelly, S. Thaddeus; Schmidt, Brian L.

    2007-01-01

    The aim of this paper was to validate the published UCSF Oral Cancer Pain Questionnaire. To test for validity of the questionnaire 16 oral cancer patients completed the 8-item questionnaire immediately prior to and following treatment (surgical resection) of their oral cancer. For all 8 questions the difference between mean preoperative and mean postoperative responses were statistically significant (p

  13. Management of oromandibular cancers

    International Nuclear Information System (INIS)

    Objective: To emphasize the role and importance of multidisciplinary approach in the management of oral cavity can- involving the mandible. Subjects and Methods: A total of 63 patients who had biopsy-proven oromandibular tumors, after thorough assessment/ staging in Joint Head and Neck Oncology Clinic, underwent resection and reconstruction for malignant oral cavity tumors involving the mandible were included in the study. All the resected tumor specimen were sent for histopathology. All the post-resection defects were properly classified and reconstructed by the plastic surgery team. Post-operatively, all the patients underwent adjuvant full dose radiotherapy at the Department of Radiation Oncology. Complications were recorded and managed accordingly. At one year follow-up all the available patients were assessed for functional and aesthetic restoration and recurrences. Results: Out of 63 patients there were 40 males and 23 females (ratio 1.7 : 1) with an average age of 50 years. Tumor-free resection margins could be achieved in 56 patients. In 88% cases tumor was a Squamous cell carcinoma Radical neck dissections were carried on in 27 patients. Radial forearm free flap was used in 27 patients, pectorals major myocutaneous flap in 19, free fibula osteocutaneous flap in 10, rectus-abdominis myocutaneous free flap Implant was used in 3 patients to reconstruct the post-resection defects. There was only one total flap loss and 3 partial flap losses. Implant exposure was encountered in 4 instances with 3 major and 5 minor fistulae. At one year follow-up 56 patients were available. Thirty-seven patients had intelligible speech, 15 patients were taking normal diet in 33 patients there was a satisfactory mandibular contour restoration. Seven patients had recurrences, 2 were raceable and 5 patients had died by that time. Conclusion: A multidisciplinary collaboration is the key to effectively manage this group of extremely debilitating malignancies. (author)

  14. Spinal neuronal correlates of tapentadol analgesia in cancer pain: A back-translational approach

    DEFF Research Database (Denmark)

    Falk, Sarah; Patel, Ryan; Heegaard, Anne-Marie;

    2015-01-01

    Background Pain is a common and highly debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of multiple mechanisms including both inflammatory and neuropathic processes and also some unique changes. S...... to the mechanistic understanding of cancer-induced bone pain and support the sparse clinical data indicating a possible use of the drug as a therapeutic alternative for cancer patients with metastatic pain complication.......Background Pain is a common and highly debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of multiple mechanisms including both inflammatory and neuropathic processes and also some unique changes....... Strong opioids are a mainstay of treatments but side effects are problematic and can compromise optimal pain control. Tapentadol is a novel dual-action drug, both stimulating inhibitory μ-opioid receptors (MOR) and mediating noradrenaline reuptake inhibition (NRI) leading to activation of the inhibitory...

  15. P2X7 receptor-mediated analgesia in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; D. Schwab, Samantha; Frøsig-Jørgensen, Majbrit;

    2015-01-01

    Pain is a common and debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of molecular events, including mechanisms observed in inflammatory and neuropathic pain states, but also changes unique for...... cancer-induced bone pain. The P2X7 receptor (P2X7R) is involved in a variety of cellular functions and has been linked to both inflammatory and neuropathic pain. Here we study the analgesic potential of P2X7 receptor antagonism in a rat model of cancer-induced bone pain. In cancer-bearing animals, the P2....... The results suggest that the P2X7R is involved in the mechanisms of cancer-induced bone pain, and that P2X7R antagonism might be a useful analgesic target. No effect was observed in sham or naïve animals, indicating that the P2X7R-mediated effect is state-dependent, and might therefore be an...

  16. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

    Directory of Open Access Journals (Sweden)

    Turner Barbara J

    2011-07-01

    Full Text Available Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96% employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods

  17. The effect of breakthrough pain on heart and lung function during the cancer pain treatment in palliative care

    Directory of Open Access Journals (Sweden)

    Samir Husić

    2011-09-01

    Full Text Available Introduction: The aim of the research was to determine the effect of breakthrough pain (BTP on heart and lung function in patients whose cancer pain had been treated with strong opiates.Methods: A prospective study was conducted on 80 patients who were treated in recumbent patients’ hospice of Palliative Care Centre (hospice University Clinical Centre Tuzla. The effect of pain breakthrough onheart function was monitored by blood pressure and pulse measuring outside. The effect on respiratory function was monitored by measuring the respiration number with SpO2 and pCO2 and pO2 capillary blood valuesoutside, during and after relieving pain breakthrough.Results: Mean value for Karnofsky score for patients upon admission was 47.13 ± 11.05 and on discharge 51.25 ± 11.73. The total number of pain breakthroughs for patients within the 10 days of the treatment was1396. During the pain breakthrough the mean of systolic pressure was 133.1 mmHg and it was statistically significantly higher than the mean of systolic pressure measured after BTP relief with oral morphine. Themean of diastolic pressure measured outside of pain breakthrough was 75.9 mmHg and after the BTP relief it was 72.9 mmHg. The mean pulse outside of pain breakthrough was 92.7 heartbeats per minute and afterthe BTP relief 8 9.1 heartbeats per minute.Conclusion: Pain breakthrough leads to pulse acceleration, increased systolic and diastolic blood pressure and it also affects respiratory function by accelerating the respiration

  18. Long-term administration of high doses of transdermal buprenorphine in cancer patients with severe neuropathic pain

    Science.gov (United States)

    Leppert, Wojciech; Kowalski, Grzegorz

    2015-01-01

    Background Buprenorphine is often administered by the transdermal route (transdermal buprenorphine [TB]) in cancer patients with severe neuropathic pain. However, high doses of TB of 140 µg/h are rarely used. Patients and methods Three cancer patients with severe neuropathic Numeric Rating Scale (NRS) pain scores of 8–10 who were successfully treated with high doses of TB up to 140 µg/h along with other opioids and adjuvant analgesics. Results TB was administered for a long period of follow-up (9 months to 4 years, including 34–261 days of treatment with the dose of 140 µg/h), which allowed achievement of satisfactory analgesia (NRS 3–5) and good treatment tolerance. In all three patients, TB dose was gradually titrated from 35 to 140 µg/h, and all patients used morphine at least for some time for breakthrough and background pain management along with adjuvant analgesics. Two patients continued the treatment with TB until the end of life, and one patient is still receiving the treatment. Conclusion TB at doses of up to 140 µg/h in cancer patients with severe neuropathic pain seems to be effective and safe in combination with other opioids and with adjuvant analgesics, and may significantly improve patients’ quality of life. Clinical studies may explore higher than maximal 140 µg/h TB doses recommended by a manufacturer, and also in combination with other opioids and adjuvant analgesics. PMID:26675083

  19. Unnatural birth? : medical pain management technology and the naturalness of birth

    OpenAIRE

    2008-01-01

    The aim of this thesis is to explore how medical pain management technology affects the concept of natural birth.The relationship between medical pain management technology and natural birth is discussed in a structural framework in which medicalization, risk, and identity are acknowledged as important issues within the current childbirth paradigm. The analysis is based on thirteen in-depth interviews with Norwegian midwives and mothers on their perceptions of medical pain management technolo...

  20. Ziconotide in the treatment of cancer patients with a severe pain : a retrospective study

    OpenAIRE

    Gianpiero Patrucco; Roberto Bellini

    2012-01-01

    Cancer patients with complex and severe pain were treated with intrathecal continuous infusion of ziconotide according to a protocol implemented by the “SOS of Pain Therapy of Casale Monferrato (ASL - AL) S. Spirito Hospital”. Analgesic efficacy of intrathecal ziconotide treatments was compared with efficacy of treatments with intrathecal morphine and adjuvants using several indicators and choosing as primary outcome the reduction of NRSPI (Numeric Rating Scale Pain Intensity). The res...