Methadone and neuropathic cancer pain subcomponents: a prospective cohort pilot study

2021 ◽  
pp. bmjspcare-2021-003220
Author(s):  
Audrey Fawoubo ◽  
Élise Perceau-Chambard ◽  
Murielle Ruer ◽  
Marilene Filbet ◽  
Colombe Tricou ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Prospective Cohort ◽  
Analogue Scale ◽  
Nociceptive Pain ◽  
Pain Symptom ◽  
Refractory Pain ◽  
Observational Prospective Cohort Study

Forty per cent of cancer pain associate neuropathic and nociceptive pain simultaneously, and refractory pain affects 15% of cancer pain. Methadone is an effective opioid in treating nociceptive pain and could have an effect on neuropathic pain. Uncertainty remains on its effects on the different subcomponents of neuropathic pain.ObjectivesTo identify which subcomponents of neuropathic cancer pain are addressed using methadone.MethodsAn observational prospective cohort study of palliative care inpatients after rotation for refractory neuropathic cancer pain. Pain intensity was assessed weekly for 28 days, using a Visual Analogue Scale (VAS) and the Neuropathic Pain Symptom Inventory (NPSI).ResultsForty-eight patients were included and 17 completed the 28 days follow-up. VAS pain rating decreased by at least 20 mm in 47% of patients and the pain intensity was significantly lower at day 28 with 53% of patients with a VAS inferior to 4 (p<0.001). The pressure/squeezing component (NPSI score) decreased by more than 2 points in 50% of patients.A linear regression showed allodynia and pressure/squeezing were responsible for the largest part of the overall alleviation of pain (p=0.01).ConclusionsMethadone could significantly improve neuropathic pain through a targeted effect of allodynia and its pressure/squeezing component.

scholarly journals Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Rie Ishikawa ◽  
Masako Iseki ◽  
Rie Koga ◽  
Eiichi Inada
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Pain Intensity ◽  
Visual Analog Scale ◽  
Analog Scale ◽  
Paindetect Questionnaire ◽  
Relationship Of ◽  
The Relationship ◽  
Over Time

Postherpetic itch (PHI), or herpes zoster itch, is an intractable and poorly understood disease. We targeted 94 herpes zoster patients to investigate their pain and itch intensities at three separate stages of the condition (acute, subacute, and chronic). We used painDETECT questionnaire (PDQ) scores to investigate the correlation between PHI and neuropathic pain. Seventy-six patients were able to complete follow-up surveys. The prevalence of PHI was 47/76 (62%), 28/76 (37%), and 34/76 (45%) at the acute, subacute, and chronic stages, respectively. PHI manifestation times and patterns varied. We investigated the relationship of PHI with neuropathic pain using the visual analog scale (VAS), which is a measure of pain intensity, and the PDQ, which is a questionnaire used to evaluate the elements of neuropathic pain. The VAS and PDQ scores did not differ significantly between PHI-positive and PHI-negative patients. A large neuropathic component was not found for herpes zoster itch, suggesting that neuropathic pain treatments may not able to adequately control the itch. Accordingly, we suggest that a more PHI-focused therapy is required to address this condition.

Amitriptyline in Neuropathic Cancer Pain in Patients on Morphine Therapy: A Randomized Placebo-controlled, Double-blind Crossover Study

2002 ◽  
Vol 88 (3) ◽  
pp. 239-242 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Edoardo Arcuri ◽  
Walter Tirelli ◽  
Patrizia Villari ◽  
Alessandra Casuccio
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Double Blind ◽  
Blind Crossover Study ◽  
Double Blind Crossover Study

Aims and Background Amitriptyline is the most common analgesic adjuvant used in cancer patients with neuropathic pain, even though no specific studies have demonstrated a benefit. A randomized placebo-controlled, double-blind crossover study was designed to evidence the effects of amitriptyline in patients with neuropathic cancer pain. Methods Sixteen advanced cancer patients with neuropathic pain on systemic morphine therapy, no longer receiving oncologic treatment, presenting moderate pain (about 4 or more, but less than 7, on a numerical scale of 0-10) in the last week, and given a stable morphine dose in the last 2 days were admitted to the study. During the first week of study, patients were administered 25 mg of amitriptyline or equivalent drops of placebo at night for 3 days and 50 mg for the following 4 days. Doses for patients aged more than 65 years were 15 mg (first 3 days) and 30 mg (3 days after). After a week, a crossover took place for the second week, with the other treatment at an inverse sequence. Opioid consumption, pain intensity, symptoms and adverse effects, mood, sleep, patient's preference, quality of life before starting the study, the first week after and the second week after were recorded. Results No significant benefits in analgesia were found in the global pain intensity of the previous week of treatment, the least pain intensity or the pain evaluated just after a week of treatment, at the moment of the visit, when amitriptyline was compared with placebo. A significant difference was evidenced for the worst pain (P < 0.035). No differences in opioid doses during the period of study were found. Drowsiness, confusion and dry mouth were significantly more intense with amitriptyline than with placebo (P < 0.036, 0.003, and 0.034, respectively). There were no substantial differences between the two treatments in Spitzer's quality of life score and for each item. No differences in patients' preference for the two treatment periods were found. The analgesic effects of amitriptyline were slight and associated with adverse effects. Conclusions In light of the results obtained in the study, the extensive use of the drug for cancer pain should be questioned.

scholarly journals Study protocol for resolution of organ injury in acute pancreatitis (RESORP): an observational prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040200
Author(s):  
Ahmed E Sherif ◽  
Rory McFadyen ◽  
Julia Boyd ◽  
Chiara Ventre ◽  
Margaret Glenwright ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Acute Pancreatitis ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Observational Prospective Cohort Study ◽  
New Onset

IntroductionSurvivors of acute pancreatitis (AP) have shorter overall survival and increased incidence of new-onset cardiovascular, respiratory, liver and renal disease, diabetes mellitus and cancer compared with the general population, but the mechanisms that explain this are yet to be elucidated. Our aim is to characterise the precise nature and extent of organ dysfunction following an episode of AP.Methods and analysisThis is an observational prospective cohort study in a single centre comprising a University hospital with an acute and emergency receiving unit and clinical research facility. Participants will be adult patient admitted with AP. Participants will undergo assessment at recruitment, 3 months and 3 years. At each time point, multiple biochemical and/or physiological assessments to measure cardiovascular, respiratory, liver, renal and cognitive function, diabetes mellitus and quality of life. Recruitment was from 30 November 2017 to 31 May 2020; last follow-up measurements is due on 31 May 2023. The primary outcome measure is the incidence of new-onset type 3c diabetes mellitus during follow-up. Secondary outcome measures include: quality of life analyses (SF-36, Gastrointestinal Quality of Life Index); montreal cognitive assessment; organ system physiological performance; multiomics predictors of AP severity, detection of premature cellular senescence. In a nested cohort within the main cohort, individuals may also consent to multiparameter MRI scan, echocardiography, pulmonary function testing, cardiopulmonary exercise testing and pulse-wave analysis.Ethics and disseminationThis study has received the following approvals: UK IRAS Number 178615; South-east Scotland Research Ethics Committee number 16/SS/0065. Results will be made available to AP survivors, caregivers, funders and other researchers. Publications will be open-access.Trial registration numbersClinicalTrials.gov Registry (NCT03342716) and ISRCTN50581876; Pre-results.

scholarly journals Pain in the Emergency Department with One-Week Follow-Up of Pain Resolution

2005 ◽  
Vol 10 (2) ◽  
pp. 67-70 ◽  
Author(s):  
C Celeste Johnston ◽  
Anita J Gagnon ◽  
Carolyn J Pepler ◽  
Patricia Bourgault
Keyword(s):  
Emergency Department ◽  
Visual Analogue Scale ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Analogue Scale ◽  
Attitudes And Beliefs ◽  
Post Discharge ◽  
Residual Pain ◽  
Normal Functions

OBJECTIVES: To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post-discharge, and the postdischarge treatment of pain.METHODS: Patients (n=871) admitted to two urban, university-affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self-reported, and chart reviews of the assessment, immediate treatment and follow-up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585).RESULTS: Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One-quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities.CONCLUSIONS: More than one-third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.

scholarly journals Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study

10.2196/17894 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17894 ◽  
Author(s):  
Zixin Wang ◽  
Xue Yang ◽  
Phoenix K H Mo ◽  
Yuan Fang ◽  
Tsun Kwan Mary Ip ◽  
...  
Keyword(s):  
Social Media ◽  
Cohort Study ◽  
Social Networking ◽  
Prospective Cohort ◽  
Telephone Survey ◽  
Anal Intercourse ◽  
Observational Prospective Cohort Study ◽  
Male Sex ◽  
Sex With Men

Background Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population. Objective This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period. Methods Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted. Results At Month 6, 6.9% (28/407) and 4.4% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU (β=.04; B=.002, 95% CI 0.001-0.01). Conclusions Social media and gay social networking apps may be a major source of influence on MSM’s perceptions and actual behaviors related to SDU.

scholarly journals The structure, nature and intensity of painin various forms of external genital endometriosis

2016 ◽  
Vol 65 (2) ◽  
pp. 24-30 ◽  
Author(s):  
Tatiana O Efimenko
Keyword(s):  
Neuropathic Pain ◽  
Pain Intensity ◽  
Nociceptive Pain ◽  
Visual Analogue Scale Pain ◽  
Ovarian Cysts ◽  
Microsoft Excel ◽  
Analogue Scale Pain ◽  
Severe Degree ◽  
Relationship Of ◽  
The Relationship

Background. The study of the relationship of severity of endometriosis, localization and intensity of pelvic pain is a significant scientific interest. Aim of the study was to determine the structure of pain in women with external genital endometriosis (EGE) varying forms of distribution. Materials and methods. 124 patients were examined. Degree exam proliferation was assessed by endoscopy. Recovered: superficial endometriosis; endometrioid ovarian cysts; infiltrative forms of endometriosis; combined forms of endometriosis. Pain intensity was determined in accordance with a 10-point visual-analogue scale. Pain Detect scale was used to determine the nature of the pain. Statistical analysis of the material was carried out using the Microsoft Excel 2013 (Microsoft Corp., USA) applications and Stastistica 10.0 for Windows. Results. Light degree of pain intensity in patients with superficial forms EGE (92.11 %, 35 cases) is 21 times higher than that in patients with infiltrative forms (4.35 %, 1 case). Severe degree of pain intensity and with the same frequency is found at infiltrative (56.52 %, 13 cases), combined forms of endometriosis (57.14 %, 8 cases) and in patients with bilateral endometrioid cysts (47.37 %, 9 cases). Nociceptive pain is typical for patients with superficial forms EGE (73.68 %, 28 cases). Neuropathic pain occurs 4.5 times more frequently in patients with infiltrative (86.96 %, 20 cases) and combined forms of endometriosis (92.86 %, 13 cases). Conclusions. Light degree of pain intensity corresponds to the surface form of endometriosis, moderate and severe degree of pain equally common in infiltrative forms and endometrioid ovarian cysts, severe degree of intensity of the most common in infiltrative endometriosis and associated forms. By the nature of pain in superficial forms of endometriosis is dominated by complaints typical for nociceptive pain, neuropathic pain is more common in infiltrative endometriosis and associated forms.

A randomized controlled trial of cognitive behavioral therapy compared with diabetes education for diabetic peripheral neuropathic pain

2020 ◽  
pp. 135910532096226
Author(s):  
Diana M Higgins ◽  
Alicia A Heapy ◽  
Eugenia Buta ◽  
Kathryn M LaChappelle ◽  
Kristin L Serowik ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Intensity ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Diabetes Education ◽  
Peripheral Neuropathic Pain ◽  
Mental Health Functioning ◽  
Randomized Controlled ◽  
Health Functioning

A randomized controlled trial compared cognitive behavioral therapy (CBT) and diabetes education (ED) as an adjunctive treatment for diabetic peripheral neuropathic pain (DPNP). We examined change from baseline to 12- and 36-week follow-up in overall pain intensity (NRS), neuropathic pain intensity/quality, pain interference, and mental health functioning, among others. Although CBT participants demonstrated improvement in pain intensity NRS, there were no between-condition differences at either follow-up. CBT reduced neuropathic pain intensity at 12-weeks more than ED. At 36-weeks, CBT was superior to ED for improving pain interference and mental health functioning. Results provide evidence of benefit of CBT for DPNP. ClinicalTrials.gov Identifier: NCT00830011

The routine use of the Edmonton Classification System for Cancer Pain in an outpatient supportive care center

2014 ◽  
Vol 13 (5) ◽  
pp. 1185-1192 ◽  
Author(s):  
Joseph Arthur ◽  
Sriram Yennurajalingam ◽  
Linh Nguyen ◽  
Kimberson Tanco ◽  
Gary Chisholm ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Psychological Distress ◽  
Clinical Practice ◽  
Supportive Care ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Classification System ◽  
Comprehensive Cancer Center ◽  
Outpatient Supportive Care ◽  
Median Pain

AbstractObjective:There is no standardized and universally accepted pain classification system for the assessment and management of cancer pain in both clinical practice and research studies. The Edmonton Classification System for Cancer Pain (ECS–CP) is an assessment tool that has demonstrated value in assessing pain characteristics and response. The purpose of our study was to determine the relationship between negative ECS–CP features and some pain-related variables like pain intensity and opioid use. We also explored whether the number of negative ECS–CP features was associated with higher pain intensity.Method:The electronic charts of 100 patients at an outpatient supportive care clinic in a comprehensive cancer center were reviewed for variables like patient characteristics, initial ECS–CP assessment, morphine equivalent daily dose (MEDD), opioid rotation, Edmonton Symptom Assessment Score (ESAS), and use of adjuvant analgesics.Results:Some 91 of the 100 charts were eligible for analysis. The most common primary cancer type was gastrointestinal (22.1%). The median pain intensity was 6, and the median MEDD was 45 mg. Neuropathic pain was associated with higher median pain intensity (7 vs. 5, p = 0.007) and median MEDD requirement (83 vs. 30, p = 0.013). Psychological distress was associated with higher median pain intensity (7 vs. 5, p = 0.042). Incident pain was also associated with a trend toward higher pain intensity (6 vs. 5, p = 0.06). A higher number of negative ECS–CP features was associated with higher pain intensity (p = 0.01).Significance of Results:The ECS–CP was successfully completed in the majority of patients, demonstrating its utility in routine clinical practice. Neuropathic pain and psychological distress were associated with higher pain intensity. Also, neuropathic pain was associated with a higher MEDD. A higher sum of negative ECS–CP features was associated with higher pain intensity. Further studies will be needed to verify and explore these observations.

scholarly journals Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Zixin Wang ◽  
Xue Yang ◽  
Phoenix K H Mo ◽  
Yuan Fang ◽  
Tsun Kwan Mary Ip ◽  
...  
Keyword(s):  
Social Media ◽  
Cohort Study ◽  
Social Networking ◽  
Prospective Cohort ◽  
Telephone Survey ◽  
Anal Intercourse ◽  
Observational Prospective Cohort Study ◽  
Male Sex ◽  
Sex With Men

BACKGROUND Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population. OBJECTIVE This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period. METHODS Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted. RESULTS At Month 6, 6.9% (28/407) and 4.4% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU (β=.04; B=.002, 95% CI 0.001-0.01). CONCLUSIONS Social media and gay social networking apps may be a major source of influence on MSM’s perceptions and actual behaviors related to SDU.

scholarly journals Neurological complications of breast cancer: study protocol of a prospective cohort study

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006301 ◽  
Author(s):  
Susana Pereira ◽  
Filipa Fontes ◽  
Teresa Sonin ◽  
Teresa Dias ◽  
Maria Fragoso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Neuropathic Pain ◽  
Cohort Study ◽  
Peripheral Neuropathy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Neurological Complications

IntroductionThe improvement in breast cancer survival rates, along with the expected overdiagnosis and overtreatment associated with breast cancer screening, requires a comprehensive assessment of its burden. Neurological complications can have a devastating impact on these patients; neuropathic pain and chemotherapy-induced peripheral neuropathy are among the most frequently reported. This project aims to understand the burden of neurological complications of breast cancer treatment in Northern Portugal, and their role as mediator of the impact of the treatment in different dimensions of the patients’ quality of life.Methods and analysisA prospective cohort study was designed to include 500 patients with breast cancer, to be followed for 3 years. The patients were recruited at the Portuguese Oncology Institute of Porto and evaluations were planned at different stages: pretreatment, after surgery, after chemotherapy (whenever applicable) and at 1 and 3 years after enrolment. Patients diagnosed with neuropathic pain or chemotherapy-induced peripheral neuropathy (subcohorts), were also evaluated at the moment of confirmation of clinical diagnosis of the neurological complication and 6 months later. In each of the follow-up periods, a neurological examination has been performed by a neurologist. Data were collected on sociodemographic and clinical characteristics, quality of life, sleep quality, and anxiety and depression. Between January and December 2012, we recruited and conducted the baseline evaluation of 506 participants. The end of the follow-up period is scheduled for December 2015.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Portuguese Oncology Institute of Porto and all patients provided written informed consent. All study procedures were developed in order to assure data protection and confidentiality. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.

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