scholarly journals Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain

2019 ◽  
Vol 49 (11) ◽  
pp. 1061-1064
Author(s):  
Nobuhisa Nakajima
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Advanced Cancer Patients ◽  
Morphine Group ◽  
Time Required

Abstract Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

Facilitation of accurate and effective radiation therapy using fentanyl pectin nasal spray (FPNS) to reduce incidental breakthrough pain due to procedure positioning

2016 ◽  
Vol 11 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Isabel Prieto ◽  
José Pardo ◽  
Javier Luna ◽  
Juan P. Marin ◽  
Jesús Olivera ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Pharmacoeconomic Analysis ◽  
Opioid Analgesic ◽  
Oral Morphine ◽  
Average Dose ◽  
Advanced Cancer Patients

AbstractPurposeTo provide effective and accurate radiotherapy (RT) for advanced cancer patients who experience breakthrough pain (BP) due to positioning manoeuvres, through the use of FPNS. Secondary endpoints were the dose and time required to achieve a 50% numeric rating scale (NRS) reduction and conduction of a pharmacoeconomic analysis.Patients and methodsTwenty-seven advanced cancer patients with moderate-severe BP associated with routine radiotherapy procedures and manoeuvres were selected to receive FPNS. Most patients (20/27) had bone metastases. The patients showed a low Karnovsky performance status (mean 54%; range: 30–80). BP intensity was scored with the NRS before and after the procedures that triggered it. All patients were already receiving opioid baseline treatment at a total dose equivalent to 40–160 mg oral morphine. Before the procedure, BP was treated with 100-400 μg of FPNS. Data related to tolerance, pain relief, onset of the relief and efficient dose to allow RT to proceed were collected.Results In 26 patients the BP score was reduced by at least 50% as determined in 15.5 min (range 8-35 min) after fentanyl pectin intranasal administration, and pain relief started after 7 min (range 3–15 min); p <0.05 in both cases. The duration of pain reduction facilitated the proceeding of RT. The Mean NRS score before the procedure was 9 (95%CI: 8.6–9.4) and decreased during procedure to 3 (95%CI: 2.5–3.8). The average dose of FPNS for most patients was 100-200 to achieve pain control, except in three patients who required progressive doses of up to 300–400 μg. After receiving 300 μg, one patient dropped out of the study due to severe adverse effects (nausea). Seven patients reported minor undesirable effects related to FPNS administration.Conclusions and implicationsCertain necessary RT procedures in advanced cancer patients can cause severe BP episodes. A simple, safe, fast acting and strong analgesic is needed. FPNS is a rapidly absorbed opioid analgesic with a pain relief profile that would be particularly well suited for this patient population. By reducing BP, the drug enables the completion of necessary RT procedures without needless patient discomfort. When BP is attenuated, Department productivity is maintained and unnecessary delays are avoided. Further studies and clinical trials are needed to assess therapeutic FPNS dosages with a view to defining efficacy in the correct clinical context.

High-flow oxygen (HFO) and bilevel positive airway pressure (BiPAP) for refractory dyspnea in patients with advanced cancer: A randomized controlled trial.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9611-9611
Author(s):  
David Hui ◽  
Margarita Morgado ◽  
Gary B. Chisholm ◽  
Laura Withers ◽  
Quan Nguyen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Rating Scale ◽  
Rank Test ◽  
Randomized Controlled ◽  
Bilevel Positive Airway Pressure ◽  
High Flow Oxygen ◽  
Before And After ◽  
Physiologic Parameters

9611 Background: Dyspnea is one of the most common and distressing symptoms in cancer patients. Few treatments are evidence based because research in this area is difficult. The role of HFO and BiPAP in the palliation of severe refractory dyspnea has not been well characterized.We examined the changes in dyspnea, physiologic parameters and adverse effects in patients receiving HFO and BiPAP. Methods: In this phase II “pick the winner” randomized trial, we assigned hospitalized advanced cancer patients with refractory dyspnea to either HFO or BiPAP for 2 hours. We assessed dyspnea with the numeric rating scale (NRS) and modified Borg scale (MBS) before and after intervention. We also documented the vital signs, transcutaneous carbon dioxide and adverse effects. We used the sign rank test to compare before and after each intervention, and the Wilcoxon rank sum test to compare between arms with intention-to-treat analysis. Results: Thirty patients were enrolled (1:1 ratio) and 23 (77%) completed the assigned intervention. The median baseline dyspnea NRS was 7/10 (Q1-Q3 5-8), despite being on supplemental oxygen and opioids. Both HFO and BiPAP were associated with significant improvement in dyspnea after 2 h, with no differences detected between arms (Table). We observed prolonged dyspnea relief in 6 patients 1 h after completion of the study intervention. HFO improved oxygen saturation. No adverse effects were observed. Conclusions: HFO and BiPAP alleviated dyspnea, improved physiologic parameters and were safe. Our results justify larger randomized controlled trials to confirm these findings. Clinical trial information: NCT01518140. [Table: see text]

Does oncologist productivity impact goals of care discussions?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21675-e21675
Author(s):  
Sofya Pintova ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Natalia Egorova ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Skills Training ◽  
Study Patient ◽  
Advanced Cancer Patients ◽  
High Quality ◽  
Goals Of Care ◽  
Imaging Results ◽  
Time Required ◽  
The Impact

e21675 Background: Oncologists are pressed to care for higher volumes of advanced cancer patients. Interviews with oncologists revealed their concern that goals of care (GoC) discussions take time. We studied the impact of oncologists’ productivity on their conduct of meaningful GOC discussions with patients. Methods: At academic, municipal and rural hospitals, we recruited & randomized solid tumor oncologists & their newly diagnosed advanced cancer patients with <2 year prognosis to participate in a RCT testing a coaching model of communication skills training. All oncologists were encouraged to have GoC discussions at the visit after imaging to restage. Patients are surveyed after that post-imaging visit. We define GoC discussions as patient report that their doctor talked about preferences for cancer treatment and clarified things most important to them given their illness. We measure quality of GoC discussions by patients’ rating. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient post-imaging. Results: We enrolled 22/25 oncologists (88%); to date 77 patients completed surveys. Productivity did not vary significantly by hospital though oncologists generated greater wRVUs at the municipal hospital (p=0.2203). Overall, 36% of patients report having a high quality GoC discussion. There was no significant relationship between level of productivity and conduct of high quality GoC discussion. Multivariate model controlling for hospital and intervention found no relationship between productivity and conduct of high quality GoC discussion. Conclusions: Despite concerns about the time required to conduct GoC discussions, we found that productivity did not affect oncologists’ ability to conduct high quality GoC discussions nor did conduct of a GoC reduce productivity. The prevalence of high quality GoC discussions was low. [Table: see text]

scholarly journals Opioid-induced or pain relief-reduced symptoms in advanced cancer patients?

2006 ◽  
Vol 10 (2) ◽  
pp. 153-153 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Patrizia Villari ◽  
Patrizia Ferrera ◽  
Alessandra Casuccio
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

scholarly journals A Case Report of Abdominal Pain Relief in a Patient with Metastatic Colorectal Cancer Treated with Korean Medicine

2021 ◽  
Vol 42 (4) ◽  
pp. 687-694
Author(s):  
Mi-jung Yoon ◽  
Na-yeon Kim ◽  
Hong-sik Choi ◽  
Seung-mo Kim ◽  
Kyung-soon Kim
Keyword(s):  
Colorectal Cancer ◽  
Abdominal Pain ◽  
Case Report ◽  
Pain Relief ◽  
Herbal Medicine ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Korean Medicine ◽  
Numeric Rating

Objectives: The aim of this case report is to present abdominal pain relief in a patient diagnosed with colorectal cancer with several organ metastases.Methods: The patient was treated with herbal medicine, acupuncture, and moxibustion. The effect of the treatment was measured by a numeric rating scale (NRS).Results: The NRS of the patient’s abdominal pain was reduced after Korean medicine treatment.Conclusions: This case report suggests that Korean medicine may be effective for treating abdominal pain in cancer patients. However, additional study is needed to confirm interactions between Korean medicine and the control of abdominal pain.

scholarly journals Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Chang Sun ◽  
Yu-Tong Wang ◽  
Yu-Jie Dai ◽  
Zhi-Hui Liu ◽  
Jing Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Short Form ◽  
Intrathecal Morphine ◽  
Prospective Trial ◽  
Depression Scale ◽  
Thoracic Vertebrae ◽  
Advanced Cancer Patients ◽  
Refractory Pain

Background: The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients. Methods: This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level. Conclusion: The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

Development of the Opioid Self-Management Scale for Advanced Cancer Patients and Examination of its Validity and Reliability

2021 ◽  
Author(s):  
Shiori Yoshida ◽  
Fumiko Sato ◽  
Keita Tagami ◽  
Rie Sasaki ◽  
Chikako Takahashi ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Goodness Of Fit ◽  
Intraclass Correlation ◽  
Self Management ◽  
Equation Modeling ◽  
Validity And Reliability ◽  
Advanced Cancer Patients ◽  
Fit Index

Abstract Background: Approximately 60% of outpatients with advanced cancer experience pain, and self-management with opioids according to lifestyle is important for appropriate pain relief. To date, there are no studies that clearly describe the concept of opioid self-management or that have assessed the factors involved, such as improving self-management abilities. This study developed the Opioid Self-Management Scale for Advanced Cancer Patients (OSSA), and examined its validity and reliability.Methods: The scale was developed in three phases. In phase 1 the scale content was validated. In phase 2 surface validity was examined. The surface validity was examined using a draft scale that extracted qualitatively and deductively. Phase 3 validated and verified the reliability of the OSSA. The validity and reliability were examined using a factor analysis and re-testing.Results: The OSSA consists of 33 items on six subscales. The structural equation modeling was such that the χ2 value was 709.8 (p<.001, df = 467), goodness-of-fit index 0.78, adjusted goodness-of-fit index 0.73, root mean squares of approximation 0.063, and comparative fit index 0.92. Cronbach’s α was 0.93. The intraclass correlation coefficient was 0.59–0.90. The coefficient was -0.21 (p<0.05) for the total OSSA score and “Average pain over 24 hours,” and 0.26 (p<0.01) for “Rate of pain relief over 24 hours.”Conclusion: We determined that the OSSA had tolerable validity and reliability, and the results indicated that a higher self-management ability leads to greater pain relief. The OSSA scales can be considered effective for use in research. A shortened version of the OSSA is required for realistic and practical clinical use.

scholarly journals Opioid-induced or pain relief-reduced symptoms in advanced cancer patients?

Acute Pain ◽  
2006 ◽  
Vol 8 (3) ◽  
pp. 133
Author(s):  
S. Mercadante ◽  
P. Villari ◽  
P. Ferrera ◽  
A. Casuccio
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients
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