Ketamine Use and Opioid-Tolerant Cancer Patients

2018 ◽  
Author(s):  
Fardin Yousefshahi ◽  
Giuliano Michelagnoli ◽  
Juan Francisco Asenjo
Keyword(s):  
Cancer Pain ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Pain Treatment ◽  
Small Sample ◽  
World Health ◽  
Chronic Cancer Pain ◽  
Small Sample Sizes ◽  
Health Organization ◽  
Intravenous Ketamine

Pain occurs in up to 70% of cancer patients and it can be challenging to manage. The standard for analgesic therapy is the World Health Organization ladder; however, up to 25% of patients don’t reach a level of comfort using this approach. Ketamine has been recognized as an excellent adjuvant for cancer pain treatment, especially when other analgesics have failed. Some randomized clinical trials have confirmed ketamine’s efficacy in refractory cancer pain, but most had small sample sizes and low power. Some publications have confirmed the beneficial effect of oral, intranasal, subcutaneous, or intravenous ketamine in treatment of refractory chronic cancer pain, while others are less conclusive. While ketamine is rapidly gaining ground as an adjuvant in treating pain in patients with cancers refractory to conventional therapy and/or patients with opioid tolerance, care should be taken to identify patients with ketamine contraindications in order to offer the greatest benefit with the lowest risk of side effects.

scholarly journals Empirical evidence for robust personality-gaming disorder associations from a large-scale international investigation applying the APA and WHO frameworks

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261380
Author(s):  
Christian Montag ◽  
Christopher Kannen ◽  
Bruno Schivinski ◽  
Halley M. Pontes
Keyword(s):  
Large Scale ◽  
International Classification Of Diseases ◽  
Small Sample ◽  
World Health ◽  
Medical Attention ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Diagnostic Framework ◽  
Small Sample Sizes ◽  
Health Organization

Disordered gaming has gained increased medical attention and was recently included in the eleventh International Classification of Diseases (ICD-11) by the World Health Organization (WHO) after its earlier inclusion in the Diagnostic and Statistical Manual of Mental Disorders (fifth revision) (DSM-5) as an emerging disorder by the American Psychiatric Association (APA). Although many studies have investigated associations between personality and disordered gaming, no previous research compared the differential associations between personality and disordered gaming with time spent gaming. Due to the novelty of the WHO diagnostic framework for disordered gaming, previous research focused mainly on the associations between personality and disordered gaming in relation to the APA framework. Beyond that, these studies are generally limited by small sample sizes and/or the lack of cross-cultural emphasis due to single-country sampling. To address these limitations, the present study aimed to investigate the associations between personality and gaming behavior in a large and culturally heterogeneous sample (N = 50,925) of individuals from 150 countries. The results obtained suggested that low conscientiousness and high neuroticism were robustly associated with disordered gaming across both the APA and WHO frameworks. Interestingly, personality associations with weekly time spent gaming were smaller. The findings of the present study suggest that personality is of higher importance to predict disordered gaming compared to weekly time spent gaming.

scholarly journals The possibilities of using xenon therapy in patients with severe cancer pain

2020 ◽  
pp. 265-270
Author(s):  
R. R. Sarmanayeva ◽  
G. R. Abuzarova ◽  
N. M. Bychkova ◽  
V. E. Khoronenko ◽  
S. V. Kuznetcov
Keyword(s):  
Side Effects ◽  
Cancer Pain ◽  
Opioid Analgesics ◽  
World Health ◽  
Nmda Receptor Antagonists ◽  
Chronic Cancer Pain ◽  
The Russian Federation ◽  
Health Organization ◽  
Stepwise Scheme ◽  
Mechanisms Of Analgesia

In accordance with the clinical recommendations of the World Health Organization and the Ministry of Health of the Russian Federation, the main analgesics for the treatment of chronic cancer pain are non-opioid and opioid analgesics, given stepwise in combination with co-analgesics and adjuvant drugs. As a rule, this stepwise scheme of painkilling is effective in most cases. However, 20-30% of patients cannot achieve an acceptable level of pain relief despite the use of these analgesics in combination. Is there another way to help such patients? Interventional methods of analgesia are an option, yet not all patients agree to invasive methods due to the possible side effects and unavailability of these methods. In these cases other mechanisms of analgesia are required, such as NMDA receptor antagonists, which reduce opioid tolerance and hyperalgesia. Still not all the drugs of this group can be applied in our practice. Analgesic properties of nitrous oxide can only be found in high anesthetic doses. Another option is metadon, but it is forbidden and cannot be used in our country. Still one more option is ketamine, which has severe side effects. In our clinical practice we decided to use xenon, which has NMDA inhibition effects. Its analgesic effect and safety have been confirmed in numerous studies. This publication aims to demonstrate a successful clinical case when we used xenon and oxygen inhalations course for the treatment of a severe cancer pain with a patient who had been taking morphine by mouth.

scholarly journals Intradermal Acupuncture Along with Analgesics for Pain Control in Advanced Cancer Cases: A Pilot, Randomized, Patient-Assessor-Blinded, Controlled Trial

2018 ◽  
Vol 17 (4) ◽  
pp. 1137-1143 ◽  
Author(s):  
Kyungsuk Kim ◽  
Sanghun Lee
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
World Health Organization ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
World Health ◽  
Advanced Cancer Patients ◽  
Health Organization ◽  
Intradermal Acupuncture

Purpose: Ninety percent of patients with advanced cancer have moderate to severe pain, and up to 70% of patients with cancer pain do not receive adequate pain relief. This randomized controlled clinical trial was designed to determine the feasibility and evaluate the effects and safety of intradermal acupuncture (IA) in patients who were being administered analgesics for cancer pain. Methods: Advanced cancer patients experiencing pain were randomly assigned to IA or sham IA treatment for 3 weeks (15 patients for each group), wherein the CV12, bilateral ST25, LI4, LR3, PC06, and Ashi points were selected and stimulated. Follow-up evaluations were conducted 3 weeks after the end of treatments. The grade and dosage of analgesics for cancer pain, pain intensity, quality of life, and safety were assessed. Results: Twenty-seven patients (90%) completed 6-week trial, and no serious adverse events were associated with either IA or sham IA procedures except the transient side effect such as fatigue. Nine patients in the IA group (64.3%) and 5 in the sham IA group (38.5%) responded to the 3-week intervention. These patients were mostly in the nonopioid and the weak opioid levels of the World Health Organization analgesic ladder. Self-reported pain declined by −1.54 ± 1.45 and −1.15 ± 1.57 in the IA and sham IA groups, respectively, with improved quality of life reported. Conclusions: IA treatment appears feasible and safe for advanced cancer patients. It might reduce analgesic usage in the early World Health Organization analgesic ladder stage cancer patient, though it could not show significant outcome differences due to design limitation of sham IA.

Clinical outcomes of cancer patients with COVID-19: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18600-e18600
Author(s):  
Maryam Alasfour ◽  
Salman Alawadi ◽  
Malak AlMojel ◽  
Philippos Apolinario Costa ◽  
Priscila Barreto Coelho ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Small Sample ◽  
Prediction Intervals ◽  
Invasive Ventilation ◽  
Newcastle Ottawa Scale ◽  
Small Sample Sizes ◽  
Meta Analyses

e18600 Background: Patients with coronavirus disease 2019 (COVID-19) and cancer have worse clinical outcomes compared to those without cancer. Primary studies have examined this population, but most had small sample sizes and conflicting results. Prior meta-analyses exclude most US and European data or only examine mortality. The present meta-analysis evaluates the prevalence of several clinical outcomes in cancer patients with COVID-19, including new emerging data from Europe and the US. Methods: A systematic search of PubMED, medRxiv, JMIR and Embase by two independent investigators included peer-reviewed papers and preprints up to July 8, 2020. The primary outcome was mortality. Other outcomes were ICU and non-ICU admission, mild, moderate and severe complications, ARDS, invasive ventilation, stable, and clinically improved rates. Study quality was assessed through the Newcastle–Ottawa scale. Random effects model was used to derive prevalence rates, their 95% confidence intervals (CI) and 95% prediction intervals (PI). Results: Thirty-four studies (N = 4,371) were included in the analysis. The mortality prevalence rate was 25.2% (95% CI: 21.1–29.7; 95% PI: 9.8-51.1; I 2 = 85.4), with 11.9% ICU admissions (95% CI: 9.2-15.4; 95% PI: 4.3-28.9; I 2= 77.8) and 25.2% clinically stable (95% CI: 21.1-29.7; 95% PI: 9.8-51.1; I 2 = 85.4). Furthermore, 42.5% developed severe complications (95% CI: 30.4-55.7; 95% PI: 8.2-85.9; I 2 = 94.3), with 22.7% developing ARDS (95% CI: 15.4-32.2; 95% PI: 5.8-58.6; I 2 = 82.4), and 11.3% needing invasive ventilation (95% CI: 6.7-18.4; 95% PI: 2.3-41.1; I 2 = 79.8). Post-follow up, 49% clinically improved (95% CI: 35.6-62.6; 95% PI: 9.8-89.4; I 2 = 92.5). All outcomes had large I 2 , suggesting high levels of heterogeneity among studies, and wide PIs indicating high variability within outcomes. Despite this variability, the mortality rate in cancer patients with COVID-19, even at the lower end of the PI (9.8%), is higher than the 2% mortality rate of the non-cancer with COVID-19 population, but not as high as what other meta-analyses conclude, which is around 25%. Conclusions: Patients with cancer who develop COVID-19 have a higher probability of mortality compared to the general population with COVID-19, but possibly not as high as previous studies have shown. A large proportion of them developed severe complications, but a larger proportion recovered. Prevalence of mortality and other outcomes published in prior meta-analyses did not report prediction intervals, which compromises the clinical utilization of such results.

scholarly journals Transdermal buprenorphine in cancer pain and palliative care

2006 ◽  
Vol 20 (8_suppl) ◽  
pp. 25-30
Author(s):  
Reinhard Sittl
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Rescue Therapy ◽  
The Elderly ◽  
World Health ◽  
Prolonged Treatment ◽  
Postmarketing Surveillance ◽  
Efficacy And Safety ◽  
Good Tolerability

Transdermal buprenorphine has been assessed as a therapy for chronic cancer and non-cancer pain in both clinical and postmarketing surveillance studies. Data from 239 patients who had participated in a follow-up study of up to six years have shown efficacy and safety, and good tolerability over prolonged treatment periods with a marked stability of doses. From the cancer pain population (134 patients), 20% stayed on transdermal buprenorphine until the end of their lives. Postmarketing surveillance study data from 13 179 patients, including 3690 cancer patients assessed during a 10-week observation period, showed that 81% of patients achieved good/very good pain relief with transdermal buprenorphine. Furthermore, 49.6% of patients did not require any analgesic comedication or rescue therapy, a point that is particularly important in the elderly population. Results from the Spanish Pain Society on transdermal buprenorphine in chronic non-cancer, neuropathic and cancer-related pain, and on switching from morphine, also confirmed its beneficial efficacy and safety, and showed that buprenorphine does not antagonize pain relief, or cause withdrawal when combined with full μ-agonists. The effectiveness of buprenorphine is further supported by evidence of its pronounced anti-hyperalgesic effect in a human pain model, which may be a factor in explaining the efficacy of buprenorphine in neuropathic pain. When switching of opioids is indicated to improve pain relief or reduce adverse events, equipotency dosage ratios are important. The equipotency ratio for morphine to buprenorphine, previously established as 75:1, is now being questioned as new data from a retrospective cohort study were published indicating a ratio of 100:1. Moreover, transdermal buprenorphine has superior safety in respect to respiratory depression, immunological and renal effects compared with standard World Health Organization step III opioids, which makes it highly suitable for treating moderate-to-severe pain also in cancer patients, a per se vulnerable patient population requiring a sensible selection of potent analgesics.

scholarly journals The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter?

2020 ◽  
Vol 7 (1) ◽  
pp. 14-21
Author(s):  
Alexander von Glinski ◽  
Emre Yilmaz ◽  
Ryan Goodmanson ◽  
Clifford Pierre ◽  
Sven Frieler ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Arthroscopy ◽  
Randomized Clinical Trials ◽  
Technical Note ◽  
Small Sample ◽  
Level Of Evidence ◽  
Thomson Reuters ◽  
Treatment Indications ◽  
Small Sample Sizes ◽  
The Impact

Abstract The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.

Nutritional intervention for ADHD

2018 ◽  
Author(s):  
Jan K. Buitelaar ◽  
Nanda Rommelse ◽  
Verena Ly ◽  
Julia J. Rucklidge
Keyword(s):  
Fatty Acids ◽  
Clinical Relevance ◽  
Randomized Clinical Trials ◽  
Nutritional Intervention ◽  
Evidence Base ◽  
Small Sample ◽  
Omega 3 ◽  
Dietary Interventions ◽  
Small Sample Sizes ◽  
Sampling Procedures

This chapter discusses four dietary interventions (exclusion of artificial colours and preservatives; restrictive elimination diets/oligoantigenic diets; supplementation with omega-3 fatty acids; and supplementation with micronutrients) and their clinical relevance for ADHD. The evidence base for exclusion of artificial colours and preservatives has many gaps. Effectiveness of the elimination phase of elimination diets has been demonstrated in several randomized clinical trials and about one-third of the children with ADHD show an excellent response. Data on maintenance of effect in the longer term, however, are lacking. Supplementation of free fatty acids was associated with a small but reliable reduction of ADHD symptoms, but the clinical relevance is unclear. The trials using a broad spectrum of micronutrients show promise but suffered from small sample sizes, lack of controls, varied sampling procedures and inclusion criteria, and multiple assessment methods, and need confirmation.

scholarly journals SARS-CoV-2 Infection and Cardioncology: From Cardiometabolic Risk Factors to Outcomes in Cancer Patients

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3316
Author(s):  
Vincenzo Quagliariello ◽  
Annamaria Bonelli ◽  
Antonietta Caronna ◽  
Gabriele Conforti ◽  
Martina Iovine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
World Health ◽  
Fulminant Myocarditis ◽  
Cardiac Events ◽  
Risk Of Death ◽  
Cardiovascular Side Effects ◽  
Viral Illness ◽  
Health Organization ◽  
Gastro Intestinal Tract

The coronavirus disease-2019 (COVID-19) is a highly transmissible viral illness caused by SARS-CoV-2, which has been defined by the World Health Organization as a pandemic, considering its remarkable transmission speed worldwide. SARS-CoV-2 interacts with angiotensin-converting enzyme 2 and TMPRSS2, which is a serine protease both expressed in lungs, the gastro-intestinal tract, and cardiac myocytes. Patients with COVID-19 experienced adverse cardiac events (hypertension, venous thromboembolism, arrhythmia, myocardial injury, fulminant myocarditis), and patients with previous cardiovascular disease have a higher risk of death. Cancer patients are extremely vulnerable with a high risk of viral infection and more negative prognosis than healthy people, and the magnitude of effects depends on the type of cancer, recent chemotherapy, radiotherapy, or surgery and other concomitant comorbidities (diabetes, cardiovascular diseases, metabolic syndrome). Patients with active cancer or those treated with cardiotoxic therapies may have heart damages exacerbated by SARS-CoV-2 infection than non-cancer patients. We highlight the cardiovascular side effects of COVID-19 focusing on the main outcomes in cancer patients in updated perspective and retrospective studies. We focus on the main cardio-metabolic risk factors in non-cancer and cancer patients and provide recommendations aimed to reduce cardiovascular events, morbidity, and mortality.

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