scholarly journals Intravenous Methadone for Severe Cancer Pain: A Presentation of 10 Cases

ISRN Pain ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
D. Lossignol ◽  
I. Libert ◽  
B. Michel ◽  
C. Rousseau ◽  
M. Obiols-Portis
Keyword(s):  
Cancer Pain ◽  
Pain Syndrome ◽  
Oral Formulation ◽  
Opioid Agonist ◽  
Refractory Pain ◽  
Day Range ◽  
Starting Dose ◽  
Reduction Of Pain ◽  
Few Data ◽  
Strong Opioids

Purpose. Methadone, a synthetic opioid agonist, is an effective alternative to strong opioids (morphine, hydromorphone, oxycodone, and buprenorphine) and is widely available as an oral formulation. Few data have been published so far on the use of intravenous (i.v.) methadone for the management of severe or refractory cancer pain. Methods. We followed 10 consecutives cancer patients with severe pain, treated with IV methadone. All had advanced disease and had already received strong opioids, some in association with ketamine. Pain was assessed at T0, T24 hours, and at the end of the treatment. Results. All patients benefited from the switch to IV methadone with a reduction of pain on VAS after 24 hours (median: 4/10; range 0–5) until the end of the treatment (all cases <3/10). The median starting dose was 100 mg/day (range 20–400) and the final dose remained stable with a median of 100 mg/day (range 27–700). The median duration of IV methadone was 11 days (range 2–59). No cardiac toxicity had been observed. Conclusions. IV methadone is an effective pain relieving alternative for the treatment of severe cancer pain, especially in refractory pain syndrome. Moreover, we did not observe any toxicity (neurological or cardiac) or any other major side effects and the treatment was overall well tolerated. More extensive comparative studies should be planned.

Evaluation of the Japanese opioid conversion ratio for switching to methadone for cancer pain control.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 196-196
Author(s):  
Yoshinobu Matsuda ◽  
Sachiko Okayama ◽  
Yoshito Yoshikawa ◽  
Yoshio Kobayashi
Keyword(s):  
Cancer Pain ◽  
Oral Morphine ◽  
Conversion Ratio ◽  
Dose Titration ◽  
Rapid Progression ◽  
Methadone Dose ◽  
Opioid Dose ◽  
Refractory Pain ◽  
Starting Dose ◽  
Oral Morphine Equivalent

196 Background: In Japan, oral administration of methadone was approved for patients with cancer pain in March 2013. As methadone exhibits complex pharmacokinetics with individual differences and rare but serious adverse effects, methadone is only prescribed as a fourth-line drug by cancer pain specialists, who must start methadone according to the following table and must not increase methadone dose within 7 days. Aims: To assess the validity of the Japanese opioid conversion ratio. Methods: The clinical characteristics of 60 patients who were prescribed oral methadone between April 2013 and March 2016 were analyzed. Results: The switch from other opioids to methadone was initiated due to refractory pain in the stop-and-go switching. According to the table in Japan, the starting dose of methadone ranged from 15-45mg/day, depending on the previous opioid dose. Fifty cases (11 outpatients, 39 inpatients) were successfully switched to methadone; although 10 cases subsequently exhibited rapid progression of illness and failed due to oral difficulty during the course of dose titration. At the outset, the average oral morphine equivalent daily dose before methadone administration was 155mg (range, 40-660mg) and the starting methadone dose was 10 mg in 2 cases (extremely old age and multi-drug taking), 15 mg in 35 cases, 30 mg in 11 cases and 45 mg in 2 cases. Upon completion of the dose titration according to the Japanese definition, the methadone dose was the same as the starting dose in 21 cases, and was decreased or increased from the starting dose in 5 and 24 cases, respectively. Conclusions: TheJapanese opioid conversion ratio might be better corrected in the near future. For example, it is good to be able to start with 10mg or 20 mg because minute changes might lead the performance of low dose titration in some cases. It should be possible to increase the dose of methadone after 3 or 4 days from the later change based upon the pain severity. [Table: see text]

Pain Biomarkers in Cancer: An Overview

2020 ◽  
Vol 26 ◽  
Author(s):  
Fabrizio Calapai ◽  
Epifanio Mondello ◽  
Carmen Mannucci ◽  
Emanuela Elisa Sorbara ◽  
Sebastiano Gangemi ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Bone Cancer ◽  
Common Symptom ◽  
Scientific Databases ◽  
Reactive Protein ◽  
Cancer Breast ◽  
Oncologic Patients ◽  
Few Data ◽  
Analgesic Response ◽  
Pro Inflammatory Cytokines

Background: Pain is a common symptom in oncologic patients and its management is generally guided by pain individually perceived by patients and expressed through self-reported scales. However, the utility of these tools is limited because strongly dependent on patients’ opinions. For this reason, more objective instruments are desirable. Objective: In this overview scientific articles indicating potential markers to be used for pain management in cancer were collected and discussed. Methods: research was performed on principal electronic scientific databases by using the words “pain”, “cancer”, “markers” as “biomarkers” as the main keywords, and findings describing potential biomarkers for the management of cancer pain were reported. Results: Studies on pain markers not specific for cancer typology (inflammatory, genetic, markers predicting response to analgesic drugs, neuroimaging markers) and pain markers for specific types of cancer (bone cancer, breast cancer, lung cancer, head and neck cancer, prostate cancer, cancer in pediatrics) are presented and commented. Conclusion: This overview supports the view of the involvement of inflammatory mediators in the mechanisms underlying cancer pain. Up today only a few data from research on markers can help in the management of pain, except for pro-inflammatory cytokines and other inflammatory indexes such as C-reactive protein (CRP). However, biomarkers are a promising strategy useful to predict pain intensity and to purchase objective quantification of analgesic response in guiding decisions on individual-tailored treatments in cancer patients.

Interventions for myofascial pain syndrome in cancer pain

2019 ◽  
Vol 13 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Athmaja Thottungal ◽  
Pranab Kumar ◽  
Arun Bhaskar
Keyword(s):  
Cancer Pain ◽  
Myofascial Pain ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome

scholarly journals The use of fentanyl in pain management in head and neck cancer patients: a narrative review

2017 ◽  
Vol 12 (3) ◽  
pp. 155-162 ◽  
Author(s):  
Raffaele Giusti ◽  
Paolo Bossi ◽  
Marco Mazzotta ◽  
Marco Filetti ◽  
Daniela Iacono ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Head And Neck ◽  
Relative Effectiveness ◽  
Malignant Tumours ◽  
Exclusion Criteria ◽  
Search Terms ◽  
Strong Opioids ◽  
Cross Reference

Background: Head and neck (H&N) cancers account for about 5% of all malignant tumours. Pain is one of the most feared consequences of H&N neoplasms and is experienced by up to 80% of patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing. Nevertheless, pain is still often underestimated and undertreated. Objectives: The role of opioids in cancer pain has been well established but evidences about the role and the relative effectiveness of opioids such as fentanyl in the context of H&N cancer pain remains unclear. Methods: A literature review based on the guidance of the Centre for Reviews and Dissemination was conducted. An iterative approach was used starting with an electronic search in the MEDLINE database. The search terms ((‘Neoplasms’[Mesh]) AND ‘Head and Neck Neoplasms’[Mesh]) AND ‘Fentanyl’[Mesh] were used. Results: A total of 18 publications were found by the first performed search on PubMed. Other publications concordant with our aim were found by cross-reference. Considering inclusion and exclusion criteria for our review, eight papers resulted eligible for analysis. Conclusion: Fentanyl transdermal therapeutic system (TTS) seems to be an important option, thanks to the way of administration, the good safety and tolerability profiles to control baseline pain. For breakthrough cancer pain (BTcP), several formulations of transmucosal fentanyl are available. All the formulations seem to be active and safety but we lack head-to-head studies of fentanyl versus other strong opioids, as well as with different formulation of fentanyl, particularly for BTcP where H&N cancer population is very poorly represented.

scholarly journals Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

2017 ◽  
Vol 7 (2) ◽  
pp. 68-79 ◽  
Author(s):  
Bruno Camporeze ◽  
Renata Faria Simm ◽  
Iracema Araújo Estevão ◽  
Luis Roberto Mathias Junior ◽  
Paulo Henrique Pires de Aguiar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Cost Effective ◽  
Medical Conditions ◽  
Reduction Of Pain ◽  
Bibliographic Search

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS).

scholarly journals The experience with repetitive peripheral magnetic stimulation in subjects with lumbosacral radiculopathy

2020 ◽  
Vol 10 (2) ◽  
pp. 31-38
Author(s):  
V. N. Blokhina ◽  
M. M. Kopachka ◽  
E. M. Troshina ◽  
D. S. Kanshin ◽  
S. G. Nikolaev
Keyword(s):  
Functional Status ◽  
Magnetic Stimulation ◽  
Randomized Study ◽  
Pain Syndrome ◽  
Duration Of Treatment ◽  
Traditional Treatment ◽  
Lumbosacral Radiculopathy ◽  
Significant Difference ◽  
Reduction Of Pain ◽  
Inflammatory Drugs

Introduction. Lumbosacral radiculopathy is а leading cause of long-term disability. Taking into a consideration the duration of treatment radiculopathy, the risk of developing adverse reactions when taking analgesics, non-steroidal anti-inflammatory drugs, the physiotherapeutic method — repetitive peripheral magnetic stimulation may become a promising method of therapy.Aim of the study. Assessment of the effectiveness of the complex treatment for patients with lumbosacral radiculopathy using the course of the repetitive peripheral magnetic stimulation.Materials and methods. Forty patients with lumbosacral radiculopathy were enrolled in the open non-randomized study, were divided into 2 parallel groups. The patients of the 1st group received a course of traditional treatment and a course of the repetitive peripheral magnetic stimulation. The patients of the 2nd group were treated with the traditional treatment without the course of the stimulation. A magnetic stimulator MagPro (Magventure, Denmark) was used for repetitive peripheral magnetic stimulation.Results. A significant difference (p <0.001) was registered regarding the reduction of pain syndrome and the improvement of the functional status after treatment in both groups. 14 (70 %) patients of the first group achieved a pain visual analogue scale relief by 50 % after 10 repetitive peripheral magnetic stimulation sessions, while 6 (30 %) patients did this after 15 repetitive peripheral magnetic stimulation sessions. We did not observed a statistically significant differences (p >0.05) in pain syndrome, functional status, anxiety level at the end of follow-up between the groups.Conclusion. We did not receive the benefits of the repetitive peripheral magnetic stimulation course in comparison with a traditional treatment of a lumbosacral radiculopathy. Further placebo-controlled studies to study the effect of repetitive peripheral magnetic stimulation on pain and anxiety in patients with back pain and radiculopathy are required.

Pain

2016 ◽  
pp. 75-90
Author(s):  
Konstantin V. Slavin
Keyword(s):  
Dorsal Root ◽  
Pain Syndrome ◽  
Board Examination ◽  
Entry Zone ◽  
The Core ◽  
Root Entry Zone ◽  
Refractory Pain ◽  
Pain Syndromes ◽  
Pain Pump ◽  
Neurosurgical Education

Historically, surgery for pain has been a large part of general neurosurgical practice. A variety of destructive and decompressive interventions have been developed over the years, and a number of comprehensive textbooks have summarized neurosurgical involvement with management of all kinds of medically refractory pain syndromes. It is included in the core neurosurgical education curriculum and is an integral part of neurosurgical knowledge that is tested during the Oral Board Examination. Not surprisingly, cases involving complex pain conditions that require neurosurgical interventions routinely show up during examinations, and it is expected that examinees are comfortable performing these interventions and able to discuss indications, surgical details, outcomes, and complications. Cases include trigeminal neuralgia, plexopathy, cordotomy versus morphine pain pump for cancer pain, dorsal root entry zone myelotomy for brachial plexus avulsion, and complex regional pain syndrome.

Targin - efficacy and safety of therapy following conversion from earlier opioid in patients with cancer pain. Observational study report

Ból ◽  
2016 ◽  
Vol 17 (3) ◽  
pp. 11-18
Author(s):  
Elwira Góraj
Keyword(s):  
Observational Study ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Analgesic Efficacy ◽  
Previous Treatment ◽  
Tolerability Profile ◽  
Efficacy And Safety ◽  
Average Pain Intensity ◽  
Average Pain ◽  
Strong Opioids

The aim of the study was evaluation of the efficacy, safety and compliance of the treatment with combination of oxycodone / naloxone (Targin) after the rotation from weak or strong opioid in a multicenter, open, prospective, observational study. Research group consisted of adult patients with chronic, severe cancer pain with presents of symptoms of Opioid Induced Constipation (OIC) associated with the previous treatment were enrolled into the rotation to oxycodone /naloxone (Targin). The study consisted of 4 visits in total, the observation was scheduled for 3 months. The following data were collected: daily dose of oxycodone / naloxone, pain intensity (NRS), adverse effects, number of omitted doses (compliance). After completion of all four visits an assessment of the efficacy and safety of the Targin treatment was made. A reduction in pain intensity (NRS) from baseline of 5.2 (average pain intensity at V1) to 2.1 (average pain intensity for V4) was observed. In sub-groups selected according to previous pain therapy, a reduction in pain intensity out of 5,0 (average pain intensity for V1 in patients treated earlier with strong opioids) to 2.1 (V4) and 5.7 (average pain intensity for V1 in patients treated earlier with weak opioids) to 2.1 (V4). The proportion of patients who did not require laxatives decreased from visit to visit. Patients who received Targin monotherapy after the rotation showed a greater compliance than patients who, in addition to Targin, also were prescribed with another opioid. In the group of patients who completed all four visits, efficacy was assessed as very good or good in 91.7% cases, similarly in 95.8% cases tolerability was evaluated as very good or good. Concluding, rotation to Targin from both, the weak and strong opioids, resulted in a very good and good pain control with reduction in the frequency and severity of OIC. The final result could be multifactorial, but we can confirm the good analgesic efficacy and favorable tolerability profile of Targin with significant reduction of OIC symptoms.

Efficacy of selective agonist V2 vasopressin receptor, 1-dezamino-8-D-arginine-vasopressin, in the treatment of pain in patients with degenerative-dystrophic diseases of the spine

2016 ◽  
Vol 14 (3) ◽  
pp. 58-65
Author(s):  
Svetlana G. Belokoskova ◽  
Sergei G. Tsikunov
Keyword(s):  
Arginine Vasopressin ◽  
Vertebral Column ◽  
Depressive Disorders ◽  
Pain Syndrome ◽  
Control Group ◽  
Reduction Of Pain ◽  
Therapy Of Pain ◽  
V2 Vasopressin Receptor ◽  
Leading Symptom ◽  
The Impact

Pain is the leading symptom with degenerative-dystrophic diseases of the vertebral column. Now for the treatment of vertebral pain using pharmacological and non-pharmacological treatments. However, in some cases, the application of these techniques is contraindicated or ineffective. In this regard, relevant search for new methods of therapy of pain syndrome. It is known that arginine-vasopressin (AVP), along with the hormonal effects shows properties of neuromodulator. The experiment shows that AVP showed analgetic properties. AVP reduced the severity of pain in patients with renal colic, with migraine, pains due to cancer [24, 36, 37]. There is not data on the impact of AVP on vertebrogenic pain syndrome. In this context, the aim of the research was to assess the effectiveness of the agonist V2-receptors, 1-dezamino-8-D-arginine-vasopressin, DDAVP, in correction of pain syndrome in patients with degenerative-dystrophic diseases of the vertebral column. Treatment received 23 patients. DDAVP is injected intranasal drip in a daily dose of 1•10 -7 g. The control group consisted of 10 patients with vertebral pain who received traditional therapy. Therapeutic effect of DDAVP was in 87 % of cases. Pain decreased after 2.5-3 hours from the beginning of treatment in patients with moderate and mild pain. Along with reduction of pain regressed fatigue-depressive disorders. Thus, it was shown that the DDAVP was effective and safe in the treatment of vertebral pain.

Efficacy of oral ketamine against opioid-refractory cancer pain due to bone metastases: Four case reports.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 161-161
Author(s):  
Takeshi Hagihara
Keyword(s):  
Adverse Effects ◽  
Oral Administration ◽  
Cancer Pain ◽  
Bone Metastases ◽  
Case Reports ◽  
Nmda Receptor Antagonist ◽  
World Health ◽  
Oral Ketamine ◽  
Refractory Pain ◽  
Patient Consent

161 Background: The use of oral ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is reported to be effective against opioid-refractory cancer pain. Only a few studies have been performed worldwide so far, and in Japan we have more difficulty evaluating it, as the insurance doesn’t cover the application of ketamine to the tumor pain unlike in some other countries. Here we present the successful treatment of four patients with severe cancer-related pain due to bone metastases, by oral administration of ketamine. Methods: Inclusion criteria were cancer pain refractory to standard opiates. After institutional approval and informed patient consent were obtained, the treatment started with 40mg/day of oral ketamine. The ketamine regimen was adjusted individually based on analgesia and any adverse effects. Results: Self-reported pain significantly improved. In addition, serious adverse effects such as nightmares were not observed. In one case, epidural anesthesia became unnecessary. In another case, base and rescue opiates regimen can decreased. Conclusions: Ketamine is considered one of the World Health Organization essential drugs for the management of refractory pain. By oral administration of ketamine the quality of life can be improved, so we consider that further studies should be performed.

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