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BACKGROUND: The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. OBJECTIVE: This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. METHODS: This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. RESULTS: The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. CONCLUSIONS: This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. TRIAL REGISTRATION: PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55792.
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Neoplasias da Mama , Metanálise como Assunto , Manejo da Dor , Revisões Sistemáticas como Assunto , Humanos , Feminino , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Manejo da Dor/métodos , Auriculoterapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Percutaneous lateral cervical cordotomy (PLCC) is a treatment option for predominantly nociceptive pain of oncological origin that is refractory to conservative methods, with unilateral distribution, particularly in the lower trunk or lower limbs of patients with a life expectancy of less than one year. OBJECTIVE: The aim of this study was to assess the analgesic efficacy and opioid utilization alteration in patients undergoing PLCC. METHODS: We retrospectively collected data from patients undergoing PLCC between 2011 and 2021 at the AC Camargo Cancer Center in São Paulo, Brazil. RESULTS: Sixty-three patients and their respective surgical outcomes were analyzed. The mean preoperative pain intensity, as assessed by the mean numerical rating scale (NRS), was 8.4 (range: 4-10), while postoperatively, it decreased to 0.78 (range: 0-8). Lower postoperative NRS scores were observed for pain in the lower limbs and abdomen compared to the lower thorax. The mean preoperative oral morphine equivalent (OME) consumption was 231.0 mg (range: 30.0-1015.2). At 30 days postoperative, the mean consumption of OME was 120.2 mg (range: 0.0-705.0). Twelve months after surgery, the average consumption of OME was 98.3 mg (range: 0.0-396.0). CONCLUSION: PLCC is a valuable therapeutic intervention for patients experiencing cancer pain that is unresponsive to conservative treatments. The anticipated analgesic outcomes are generally favorable, particularly in cases where the pain is localized unilaterally in the abdomen or lower body segments.
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Analgésicos Opioides , Dor do Câncer , Cordotomia , Medição da Dor , Humanos , Masculino , Analgésicos Opioides/uso terapêutico , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Dor do Câncer/tratamento farmacológico , Cordotomia/métodos , Adulto , Dor Pós-Operatória/tratamento farmacológico , Manejo da Dor/métodos , Neoplasias/complicações , Neoplasias/cirurgia , Brasil , Idoso de 80 Anos ou maisRESUMO
Introduction: Brazil is a developing and an Upper Middle Income, categorized by the World Bank. Therefore, it is a country that needs a special vision for children with oncological diseases who require Pediatric Palliative Care. This study aimed to understand the specificities of services that provide oncology services in comparison to those that do not provide oncological care. Methods: This is a descriptive, cross-sectional, and online survey study. A questionnaire was created by a multidisciplinary group of leaders from the Brazilian Pediatric Palliative Care Network and then the survey was distributed using a snowball strategy. Results: Of the 90 services that answered the questionnaire, 40 (44.4%) attended oncologic patients. The Southeast represented most of the services (57.57%), followed by the Northeast, with 18.89% (17 services), the South with 12.22% (11 services), and the Center West with 8.89% (8 services). No differences were observed in access to opioid prescriptions between the services. It was observed that those services that attended oncologic patients had a tendency to dedicate more time to Pediatric Palliative Care. Discussion: The distribution of services that cover oncology and those that do not, are similar in the different regions of Brazil. In Brazil, there are difficulties in accessing opioids in pediatrics: access to opioid prescriptions without differences revealed that even pediatric oncologists might have difficulty with this prescription, and this should improve. It is concluded that education in Pediatric Palliative Care is the key to improvements in the area.
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OBJECTIVE: This study aimed to explore the effect of narrative nursing on improving the negative emotions, sleep quality, and quality of life of patients with moderate to severe cancer pain. METHODS: A total of 80 patients with moderate to severe cancer pain who had been hospitalized in the lymphoma oncology department in our hospital from March 2019 to September 2021 were selected as the study subjects and randomly divided into the conventional nursing and narrative nursing groups, with 40 cases in each group. A conventional nursing intervention was conducted for one group, and narrative nursing was provided for the second group in addition to the conventional nursing. The anxiety and depression, sleep quality, quality of life, and satisfaction with pain management of the patients in the two groups were compared before and after the intervention. RESULTS: In the narrative nursing group, the self-rating anxiety scale and self-rating depression scale scores were significantly lower than those in the conventional nursing group after the intervention (P < 0.05). The scores for sleep quality, sleep duration, sleep efficiency, and daytime dysfunction and the total Pittsburgh Sleep Quality Index scores were significantly lower in the narrative nursing group compared with the conventional care group (P < 0.05). The scores for the physical function, living ability, social adaptation, and psychological status items in the Quality of Life Questionnaire Core 30 were significantly higher in the narrative nursing group than in the conventional care group (P < 0.05). The patients' satisfaction with pain management was higher in the narrative nursing group than in the conventional care group (P < 0.05). CONCLUSION: Narrative nursing can alleviate the negative emotions of anxiety and depression in patients with moderate to severe cancer pain and improve their sleep quality, quality of life, and pain management satisfaction.
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Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.
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Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.
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Anestésicos Locais , Lidocaína , Síndromes da Dor Miofascial , Neoplasias , Cuidados Paliativos , Humanos , Lidocaína/uso terapêutico , Lidocaína/administração & dosagem , Masculino , Feminino , Cuidados Paliativos/métodos , Pessoa de Meia-Idade , Idoso , Síndromes da Dor Miofascial/tratamento farmacológico , Síndromes da Dor Miofascial/terapia , Método Simples-Cego , Anestésicos Locais/uso terapêutico , Anestésicos Locais/administração & dosagem , Neoplasias/complicações , Medição da Dor , Brasil , Dor do Câncer/tratamento farmacológico , Dor do Câncer/terapia , Idoso de 80 Anos ou maisRESUMO
One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.
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Analgesia Epidural , Analgésicos Opioides , Dor do Câncer , Neoplasias Gastrointestinais , Morfina , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Administração Oral , Analgesia Epidural/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/complicações , Morfina/administração & dosagem , Morfina/uso terapêutico , Morfina/efeitos adversos , Resultado do TratamentoRESUMO
Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancerassociated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.
El cáncer de páncreas se puede presentar con dolor abdominal intenso, siendo necesario el uso de analgésicos a largo plazo en muchos de los pacientes. Sin embargo, estos medicamentos pueden tener efectos adversos que finalmente reducen la calidad de vida de los pacientes. La neurólisis del plexo celíaco guiada por ecoendoscopia es un procedimiento que controla el dolor asociado a este tipo de neoplasia y consiste en inyectar un agente neurolítico en o alrededor del plexo celíaco. Presentamos tres casos en los cuales se realizan diferentes técnicas de abordaje terapéutico.
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INTRODUCTION: Pain is the second most frequent symptom reported in patients with cancer among the main reasons for consultation. The incorporation of educational modalities in pain intervention processes has been suggested. This study aims to examine the efficacy of neuroscience pain education (PNE) in relation to pain, biopsychosocial variables and functional capacity in comparison with conventional treatment. It is hypothesised that an intervention based on PNE achieves better outcomes than conventional management, in terms of pain, biopsychosocial variables and functional capacity in adults with oncological pain. METHODS AND ANALYSIS: This will be a single-blind, controlled clinical trial in which two groups will be compared using changes in pain as the primary measure. The first group will receive conventional treatment in addition to PNE, and participants will undergo an intervention of nine sessions (one session per week, for a total of 9 weeks), each lasting 30-40 min. Specifically, these sessions will teach biophysiological elements using metaphors that allow the adoption of these concepts related to pain. The second group will receive conventional treatment (pharmacological treatment). For this study, a sample size calculation was made based on the background, where 80 adults with oncological pain were required. An initial evaluation will be made to establish the baseline characteristics, and then, according to the randomisation, the assignment to the PNE group or the control group will be made and the two groups will be summoned again. Ten weeks later, for the intervention evaluation, the statistical analysis plan will be established by protocol and by intention-to-treat. ETHICS AND DISSEMINATION: This protocol complies with all ethical considerations. The authors commit to presenting the study's results. This study was approved by the ethics committees of the Universidad Santiago de Cali, Clínica de Occidente/Angiografía de Occidente. The authors commit to presenting the study's results. TRIAL REGISTRATION NUMBER: NCT05581784.
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Dor do Câncer , Neoplasias , Humanos , Adulto , Dor do Câncer/terapia , Método Simples-Cego , Dor , Resultado do Tratamento , Neoplasias/complicações , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL). OBJECTIVE: The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit. METHODS: This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL. RESULTS: A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001). CONCLUSION: Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.
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ABSTRACT BACKGROUND AND OBJECTIVES: Cannabinoids, such as delta-9-tetrahydrocannabinol and cannabidiol, have several therapeutic properties that may be useful in medicine. The objective of this study was to analyze the impact of cannabinoid use on pain control, quality of life and opioid-sparing in patients with advanced cancer. CONTENTS: A systematic review of the evidence for the use of cannabinoids in patients with advanced cancer was conducted on 1) Pain control; 2) Quality of life; and 3) Opioid-sparing effect. PubMed, Web of Science and Cochrane databases were searched for articles, written in English, published between January 1, 2011, and December 31, 2022, with the filters "randomized controlled trials" and "clinical trials". Using oral formulations of cannabinoids was accepted as "intervention" and placebo as "control". Risk of bias analysis was performed with Cochrane's RoB 2 and ROBINS-I tools. This review followed the 2020 PRISMA- statement. Ten studies were included, with 1169 participants, most with moderate risk of bias. The studies were from Australia (n=4), Canada (n=1), Israel (n=1), Mexico (n=1), The United Kingdom (n=1); two were multinationals. Eight were randomized, placebo-controlled trials; two were non-randomized studies. The most used formulation was nabiximols oral spray. Cannabinoids provide a clinical improvement in pain control. Evidence of improved quality of life with cannabinoids is inconclusive. Cannabinoids do not affect the daily dose of opioids in refractory cancer pain. Cannabinoid use cannot be said to have an opioid-sparing effect. CONCLUSION: It is necessary to expand research on the prescription of cannabinoids in individuals with cancer and other progressive diseases, with several comorbidities and multiple medications, in different health contexts.
RESUMO JUSTIFICATIVA E OBJETIVOS: Os canabinoides, como o delta-9-tetrahidrocanabinol e o canabidiol, possuem propriedades terapêuticas que podem ser úteis em pacientes oncológicos. O objetivo deste estudo foi avaliar o impacto do uso de canabinoides no controle da dor, na melhoria da qualidade de vida, e no efeito poupador de opioides em pacientes com câncer avançado. CONTEÚDO: Realizou-se uma revisão sistemática sobre a evidência da utilização de canabinoides em pacientes com câncer avançado, relativamente a: 1) Controle da dor; 2) Qualidade de vida; e 3) Efeito poupador de opioides. Foram buscados artigos na Pubmed, Web of Science e Cochrane, em inglês, publicados entre 2011 e 2022, com os filtros "randomized controlled trials" e "clinical trials". Aceitaram-se como "intervenção" qualquer uso de formulações orais de canabinoides e como "controle" o uso de placebo. Fez-se análise de viés com as ferramentas da Cochrane RoB 2 e ROBINS-I. Seguiu-se a Declaração PRISMA 2020. Foram incluídos 10 estudos, com 1169 participantes, a maioria com risco moderado de viés. Os estudos provinham de Austrália (n=4), Canadá (n=1), Israel (n=1), México (n=1), Reino Unido (n=1); dois eram multinacionais. Oito eram ensaios randomizados controlados com placebo; dois eram não randomizados. A formulação mais usada foi spray bucal de nabiximóis. Os canabinoides proporcionam uma melhoria clínica do controle da dor. A evidência da melhoria da qualidade de vida com canabinoides é inconclusiva. Os canabinoides não afetam a dose diária de opioides na dor oncológica refratária. Não se pode afirmar que o uso de canabinoides tem um efeito poupador de opioides. CONCLUSÃO: É necessário incrementar a investigação sobre a prescrição de canabinoides em indivíduos com câncer e outras doenças progressivas, com comorbilidades e polimedicação, em diferentes contextos de saúde.
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Pain is one of the most prevalent and difficult to manage symptoms in cancer patients, and conventional drugs present a range of adverse reactions. The development of ß-cyclodextrins (ß-CD) complexes has been used to avoid physicochemical and pharmacological limitations due to the lipophilicity of compounds such as p-Cymene (PC), a monoterpene with antinociceptive effects. Our aim was to obtain, characterize, and measure the effect of the complex of p-cymene and ß-cyclodextrin (PC/ß-CD) in a cancer pain model. Initially, molecular docking was performed to predict the viability of complex formation. Afterward, PC/ß-CD was obtained by slurry complexation, characterized by HPLC and NMR. Finally, PC/ß-CD was tested in a Sarcoma 180 (S180)-induced pain model. Molecular docking indicated that the occurrence of interaction between PC and ß-CD is favorable. PC/ß-CD showed complexation efficiency of 82.61%, and NMR demonstrated PC complexation in the ß-CD cavity. In the S180 cancer pain model, PC/ß-CD significantly reduced the mechanical hyperalgesia, spontaneous nociception, and nociception induced by non-noxious palpation at the doses tested (p < 0.05) when compared to vehicle differently from free PC (p > 0.05). Therefore, the complexation of PC in ß-CD was shown to improve the pharmacological effect of the drug as well as reducing the required dose.
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Dor do Câncer , Ciclodextrinas , Neoplasias , beta-Ciclodextrinas , Humanos , Camundongos , Animais , Simulação de Acoplamento Molecular , beta-Ciclodextrinas/química , Dor/tratamento farmacológico , Dor/etiologia , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Analgésicos/química , SolubilidadeRESUMO
Fatigue is a reversible change in biological, physical and psychic functions, resulting from the imbalance of the organism. In patients with head and neck cancer (HNC), fatigue has been cited as one of the most frequent symptoms, especially in individuals with metastasis. It can significantly limit daily activities in order to be considered as a chronic condition, in particular, when associated with painful symptoms. The objective of this studt was to report the occurrence of fatigue and pain in patients with HNC. This was a series of prospective clinical cases describing the clinical history of four patients with HNC submitted to radio chemotherapeutic treatment, users of a public oncology service. To assess the degree of fatigue, the Brief Fatigue Inventory questionnaire was applied at five different moments during the antineoplastic treatment and pain analysis, an analog pain scale was used. The analysis of the questionnaires showed that fatigue was a frequent complaint and intensified with the advance of antineoplastic therapy. Its occurrence was also related to the difficulty performing daily activities. Painful symptomatology has been reported by patients to varying degrees. The occurrence of fatigue and pain in patients with HNC presents variability due to the individual's own experience, reflected by their socioeconomic and cultural context and their personal perception of the illness process.(AU)
A fadiga é uma alteração reversível das funções biológicas, físicas e psíquicas, proveniente do desequilíbrio do organismo. Em pacientes com câncer de cabeça e pescoço (CCP), a fadiga tem sido citada como um dos sintomas mais frequentes, principalmente em indivíduos com metástase. Pode limitar de forma significativa as atividades diárias, de modo a ser considerada uma condição crônica, em especial, quando associada à sintomatologia dolorosa. Este trabalho objetiva relatar a ocorrência de fadiga e dor em pacientes com CCP. Tratou-se de uma série de casos clínicos, de caráter prospectivo, que descreve a história clínica de quatro pacientes com CCP submetidos ao tratamento radioquimioterápico, usuários de um serviço de oncologia público. Para avaliação do grau de fadiga, foi aplicado o questionário Brief Fatigue Inventory em cinco momentos distintos, durante o tratamento antineoplásico e para a análise da dor, foi utilizada uma escala analógica de dor. A análise dos questionários demonstrou que a fadiga foi uma queixa frequente e se intensificou com o avanço da terapia antineoplásica. Sua ocorrência também esteve relacionada à dificuldade de execução de atividades cotidianas. A sintomatologia dolorosa foi relatada pelos pacientes em diferentes graus. A ocorrência de fadiga e dor em pacientes com CCP apresenta variabilidade em razão da experiência vivida pelo próprio indivíduo refletida pelo seu contexto socioeconômico e cultural e a sua percepção pessoal acerca do processo de adoecimento.(AU)
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Cancer diagnosis is increasing rapidly worldwide and pain is a common feature reported by cancer patients. Therapeutical approach on cancer pain is complex where less invasive methods with little side effects have been sought. The aim of this study was to compare transcutaneous electrical nerve stimulation (TENS) and interferential current (IC) therapies effects on cancer pain. Double blind study with 81 cancer pain patients. Subjects were set up into two groups: one treated with TENS VIF (n=42) and other with IC (n=39). Age, gender, duration of pain, tumor site and histology, medications, treatments, Karnofsky score and clinical state were evaluated. Pain was measured by EMADOR and McGill scores. Electroanalgesia was performed for 30 minutes, the equipments used were Neurodyn III Ibramed® and Neurovector generation 2000 Ibramed®. Electrodes were placed where there was higher intensity of pain according to what was shown by the patient through EMADOR, and each one got only one electrotherapy session. Pain intensity was significantly reduced in both groups (p<0.001) soon after and until 6th hour post electrotherapy. IC group had better results at 4th, 5th (p<0.001) and 6th hour (p=0.022). McGill score in TENS VIF group was significant until 4th hour and in the IC group was highly significant in all evaluated times (p<0.001). Analgesic effect of TENS VIF and IC electrotherapy was clinically effective, however, IC did cause better results regarding analgesia duration.(AU)
O diagnóstico de câncer está aumentando rapidamente em todo o mundo e a dor é uma característica comum relatada por pacientes com câncer. A abordagem terapêutica da dor oncológica é complexa onde métodos menos invasivos e com poucos efeitos colaterais têm sido buscados. O objetivo deste estudo foi comparar os efeitos das terapias de estimulação elétrica nervosa transcutânea (TENS) e corrente interferencial (IC) na dor oncológica. Estudo duplo-cego com 81 pacientes com dor oncológica. Os indivíduos foram divididos em dois grupos: um tratado com TENS VIF (n=42) e outro com IC (n=39). Idade, sexo, duração da dor, local do tumor e histologia, medicamentos, tratamentos, pontuação de Karnofsky e estado clínico foram avaliados. A dor foi mensurada pelos escores EMADOR e McGill. A eletroanalgesia foi realizada por 30 minutos, os equipamentos utilizados foram Neurodyn III Ibramed® e Neurovector geração 2000 Ibramed®. Os eletrodos foram colocados onde havia maior intensidade de dor de acordo com o apresentado pelo paciente através da EMADOR. A intensidade da dor foi significativamente reduzida em ambos os grupos (p<0,001) logo após e até a 6ª hora pós-eletroterapia. O grupo CI teve melhores resultados na 4ª, 5ª (p<0,001) e 6ª hora (p=0,022). O escore de McGill no grupo TENS VIF foi significativo até a 4ª hora e no grupo IC foi altamente significativo em todos os tempos avaliados (p<0,001). O efeito analgésico da TENS VIF e da eletroterapia com IC foi clinicamente eficaz, porém a IC trouxe melhores resultados quanto à duração da analgesia.(AU)
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BACKGROUND: The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures. METHODS: This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov-Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome. RESULTS: We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%). CONCLUSIONS: Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.
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Background: Ecuador is facing increasing health-related suffering due to cancer; however, the distributed opioid analgesic in the country is below the global average. Aim: This study explores the access to cancer pain management (CPM) from the healthcare professionals' perspective in a middle-income country. Methods: Thirty problem-centered interviews with healthcare providers were conducted in six cancer facilities and were analyzed thematically. Results: Limited and unequal access to opioid analgesics was reported. Structural weaknesses of the healthcare system restrain access for the poorest, at the primary care level, and for people living in remote areas. The lack of education among the healthcare personnel, patients, and society was identified as the main barrier. Conclusion: Access barriers were interrelated; therefore multisectoral strategies must be considered to improve access to CPM.
The number of patients with cancer in Ecuador is growing. It is known that people with a cancer diagnosis often experience severe pain, which requires opioid analgesics. In this study, we explore the opinion of healthcare providers regarding access to opioid analgesics to alleviate cancer pain in Ecuador. We interviewed 30 healthcare professionals working at six cancer centers in different cities, who deal daily with patients with a cancer diagnosis. We found that it is difficult for cancer patients in the country to access adequate pain therapy and this generates avoidable severe health-related suffering. The structure of the healthcare system makes it difficult to be supplied with the medication they need. That is worst for the country's poor and people in rural areas. The main problem is the lack of knowledge on the subject among health workers, patients and society. We conclude that the obstacles in providing patients access to cancer pain relief lie in different areas, including the healthcare system, the healthcare professionals and the patients and society, all of which are interrelated. All areas must work together to improve the situation.
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Neoplasias , Manejo da Dor , Humanos , Equador , Pessoal de Saúde , Analgésicos Opioides/uso terapêutico , Neoplasias/complicaçõesRESUMO
CONTEXT: Pain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime. OBJECTIVES: To assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids. METHODS: In this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients' perception of improved pain control. RESULTS: Among 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation [SD]) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval (CI) [-0.49; 1.32]; P = 0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24; 26.1]; P = 0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (P = 0.81). CONCLUSION: Among patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.
Assuntos
Dor Aguda , Analgésicos não Narcóticos , Dor do Câncer , Neoplasias , Humanos , Acetaminofen/uso terapêutico , Analgésicos Opioides/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Dor do Câncer/complicações , Morfina/uso terapêutico , Dor Aguda/tratamento farmacológico , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Método Duplo-Cego , Dor Pós-OperatóriaRESUMO
Difficult visceral cancer pain is defined as pain that does not improve with conventional non-pharmacological and pharmacological strategies, including opioids and adjuvants, and occurs in up to 15% of patients with cancer. In oncological practice, we must be prepared to establish strategies for dealing with such complex cases. Different analgesic strategies have been described in the literature, including managing refractory pain through palliative sedation; however, this might become a dilemma from a clinical and bioethical point of view in end-of-life situations. We present the case of a young male patient with moderately differentiated intestinal-type adenocarcinoma of the left colon, with intra-abdominal sepsis, and for whom despite the multimodal treatment for difficult visceral cancer pain, the pain was refractory leading to palliative sedation. Difficult visceral cancer pain is a pathology that affects the quality of life of patients and is a challenge for pain specialists, for both pharmacological and non-pharmacological management.
RESUMO
BACKGROUND: The underlying mechanism of chronic pain involves the plasticity in synaptic receptors and neurotransmitters. This study aimed to investigate potential roles of Neuroligins (NLs) within the spinal dorsal horn of rats in a newly established Bone Cancer Pain (BCP) model. The objective was to explore the mechanism of neuroligin involved in the occurrence and development of bone cancer pain. METHODS: Using our rat BCP model, we assessed pain hypersensitivity over time. Quantitative real-time polymerase chain reaction and Western blot analysis were performed to investigate NL expression, and NLs were overexpressed in the rat spinal cord using lentiviral vectors. Immunofluorescence staining and whole-cell patch-clamp recordings were deployed to investigate the role of NLs in the development of BCP. RESULTS: We observed reduced expression levels of NL1 and NL2, but not of NL3, within the rat spinal cord, which were found to be associated with and essential for the development of BCP in our model. Accordingly, NL1 or NL2 overexpression in the spinal cord alleviated mechanical hypersensitivity of rats. Electrophysiological experiments indicated that NL1 and NL2 are involved in BCP via regulating γ-aminobutyric acid-ergic interneuronal synapses and the activity of glutamatergic interneuronal synapses, respectively. CONCLUSIONS: Our observations unravel the role of NLs in cancer-related chronic pain and further suggest that inhibitory mechanisms are central features of BCP in the spinal dorsal horn. These results provide a new perspective and basis for subsequent studies elucidating the onset and progression of BCP.
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RESUMEN INTRODUCCIÓN El uso medicinal del cannabis en pacientes oncológicos se ha popularizado en los últimos años. Para poder brindar asesoramiento que redunde en un uso más eficaz y seguro, es necesario conocer la experiencia y expectativas de los usuarios. El objetivo fue conocer los motivos y la experiencia del uso medicinal de cannabis en adultos con enfermedades oncológicas en San Carlos de Bariloche (Río Negro). MÉTODOS Se realizó un estudio basado en una encuesta en línea autoadministrada sobre uso de cannabis, tiempo y motivo de uso, grado de satisfacción, asesoramiento profesional, vía de administración y efectos adversos. RESULTADOS Participaron 201 pacientes. Un 19% utilizaba cannabis, y el 31% lo había utilizado antes. La principal forma de uso fue el aceite. Los principales motivos fueron tratar el dolor, dormir mejor y sentirse mejor. Las experiencias fueron satisfactorias o muy satisfactorias para más del 50%, y las más favorables fueron para tratar el dolor, mejorar el ánimo, tolerar la quimioterapia y dormir mejor. Entre las razones para dejar de usarlo se mencionó falta de utilidad, efectos adversos, dudas sobre dosis, tiempo de uso y calidad del producto adquirido. Menos del 50% de los pacientes habían recibido asesoramiento profesional sobre uso de cannabis. DISCUSIÓN El 50% de los participantes utilizó cannabis. Este relevamiento ofrece un diagnóstico útil para promover políticas que reflejen las necesidades frente al uso de cannabis.
ABSTRACT INTRODUCTION The medicinal use of cannabis in cancer patients has become popular in recent years. In order to provide advice that results in a more effective and safe use, it is necessary to know the experience and expectations of users. The objective was to know the reasons and experience of the medicinal use of cannabis in adults with oncological diseases in San Carlos de Bariloche (Río Negro province). METHODS The study was based on a self-administered online survey on cannabis use, time and reason for use, degree of satisfaction, professional advice, route of administration and adverse effects. RESULTS A total of 201 patients participated, of which 19% used cannabis and 31% had previously used it. The main form of use was oil. The main reasons for use were to treat pain, sleep better and feel better. The experiences were satisfactory or very satisfactory for more than 50%, and the most favorable ones were to treat pain, improve mood, tolerate chemotherapy, and sleep better. Lack of usefulness, adverse effects, doubts about the dose, time of use and quality of the product purchased were mentioned among the reasons for the decision to stop using it. Less than 50% of the patients had received professional advice on the use of cannabis. DISCUSSION Half of the participants used cannabis. This survey provides a useful diagnosis to foster policies that reflect the needs regarding the use of cannabis.