scholarly journals The McGill University Health Centre Cancer Pain Clinic: A Retrospective Analysis of an Interdisciplinary Approach to Cancer Pain Management

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jordi Perez ◽  
Sara Olivier ◽  
Emmanouil Rampakakis ◽  
Manuel Borod ◽  
Yoram Shir
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Retrospective Analysis ◽  
Health Centre ◽  
Interdisciplinary Approach ◽  
Pain Clinic ◽  
Initial Assessment ◽  
Cancer Pain Management ◽  
Edmonton Symptom Assessment Scale ◽  
Mcgill University

Context. The McGill University Health Center (MUHC) Cancer Pain Clinic offers an interdisciplinary approach to cancer pain management for patients. The core team includes a nurse clinician specialist in oncology and palliative care, a palliativist, an anaesthetist, and a radiation oncologist. This tailored approach includes pharmacological and nonpharmacological therapies offered concurrently in an interdisciplinary fashion.Objectives. Description of the interdisciplinary MUHC cancer pain approach and analysis of treatments and outcomes.Methods. A retrospective analysis of new outpatients completing two subsequent visits (baseline and follow-ups: FU1, FU2) was conducted. Variables included (a) symptom severity measured by the Edmonton Symptom Assessment Scale, (b) pain and disability measured with the Brief Pain Inventory, and (c) analgesic plan implementation including pharmacological and nonpharmacological therapies.Results. 71 charts were reviewed. Significant pain relief was achieved consistently at FU1and FU2. The average pain severity decreased by 2 points between initial assessment and FU2. More than half (53%) of patients responded with a pain reduction greater than 30%. Severity of other symptoms (i.e., fatigue, nausea, depression, and anxiety) and disability also decreased significantly at FU2. The total consumption of opioids remained stable; however, the consumption of short acting preparations decreased by 52% whereas the prescription of nonopioid agents increased. Beyond drug management, 60% of patients received other analgesic therapies, being the most common interventional pain procedures and psychosocial approaches.Conclusion. The MUHC interdisciplinary approach to cancer pain management provides meaningful relief of pain and other cancer-related symptoms and decreases patients’ disability.

The McGill University Health Centre interdisciplinary approach to cancer pain management: Description of treatments and outcomes.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 190-190
Author(s):  
Sara Olivier ◽  
Jordi Perez ◽  
Yoram Shir ◽  
Manuel Borod ◽  
Rosemary O'Grady
Keyword(s):  
Cancer Pain ◽  
Symptom Management ◽  
Health Centre ◽  
Interdisciplinary Approach ◽  
Palliative Radiotherapy ◽  
Interdisciplinary Teams ◽  
Pain Clinic ◽  
Symptom Improvement ◽  
Opioid Prescription ◽  
Edmonton Symptom Assessment Scale

190 Background: Cancer-related symptom management is best achieved by interdisciplinary teams. In 2011, the MUHC launched an interdisciplinary Cancer Pain Clinic including palliative care, anesthesia, radiation oncology and nursing with rapid access to physiotherapy, occupational therapy and psychosocial oncology. Methods: We retrospectively analysed all new outpatients completing two subsequent visits since March 2013. Variables included a) symptom severity with the Edmonton Symptom Assessment Scale (ESAS), b) pain with the Brief Pain Inventory (BPI) and c) treatment including medication (type, formulation, dose of opioids) of non-pharmacological approaches. Results: 71 patients were analysed. Symptom management: Severity of pain and other five symptoms decreased significantly at V2 or V3 (Table). Pain significantly decreased in all four BPI categories. One third of patients had ≥50% pain relief at V2 or V3. Number of severe pain cases decreased (45% at V1 to 18% at V3) in parallel to an increase of mild pain cases (11% at V1, 41% at V3). Treatments: Acetaminophen, anticonvulsants and NSAIDs were the most common non-opioid drugs. Opioid prescription remained constant at an 80% yet the ratio between short acting (SA) and long acting (LA) changed at V3 compared to V1 (V1: SA/LA=76/44; V3: SA/LA=48/58) and the morphine equivalent daily doses decreased (V1: 100±194 mg, V2: 84±158mg and V3: 65±80mg). Among non-pharmacological methods, 28% of patients received interventional procedures, 18% psychotherapy and 12% palliative radiotherapy. Conclusions: We believe that the pain and other symptom improvement observed after three visits along with a lower opioid consumption is a result of the interdisciplinary approach offered. [Table: see text]

scholarly journals The Effectiveness of Cancer Pain Management in a Tertiary Hospital Outpatient Pain Clinic in Thailand: A Prospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Suratsawadee Wangnamthip ◽  
Skaorat Panchoowong ◽  
Carolina Donado ◽  
Kimberly Lobo ◽  
Pimporn Phankhongsap ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pain Management ◽  
Side Effects ◽  
Cancer Pain ◽  
Multidisciplinary Approach ◽  
Assessment System ◽  
Pain Clinic ◽  
Cancer Pain Management ◽  
Pain Care ◽  
Analgesic Use

Context. In a previous retrospective study, cancer pain management was effective in 47.5% of a cohort assessed after 3 months in a pain clinic at Siriraj Hospital. New guidelines were established, including a multidisciplinary approach, availability of pain interventions, and palliative care referral. Objectives. The objective was to examine the effectiveness of the updated approach. Methods. With IRB approval, outpatients with cancer were enrolled from January to December 2018. Assessments were recorded at baseline and three consecutive visits (BL, FU1, FU2, and FU3), including Numerical Rating Scale (NRS), the Brief Pain Inventory (BPI), the Edmonton Symptom Assessment System (ESAS), side effects, and analgesic use. The primary outcome was a favorable response, defined as an NRS decrease more than 30% or NRS <4. Secondary outcomes included trends over time in BPI, ESAS, side effects, and analgesic use. Pain response predictors at FU3 were analyzed using logistic regression. Results. Among 150 patients, 72 (48%) completed follow-ups. Of these, 61% achieved a favorable response at FU3. Pain interference diminished at all visits relative to baseline ( p < 0.05 ). Median morphine equivalent daily dosage (MEDD) at BL was 20 mg/day, with a statistically significant, but clinically modest increase to 26.4 mg/day at FU3. Radiation therapy during pain care was a predictor of pain responders. Conclusion. The current Siriraj multidisciplinary approach provided effective relief of pain and stabilization of other cancer-related symptoms. Radiation therapy during pain care can be used to predict pain outcomes. Ongoing improvement domains were identified and considered in the context of cultural, economic, and geographic factors.

Pharmacogenetic (PGx) guided cancer pain management in an oncology palliative medicine (PM) clinic.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 117-117
Author(s):  
Jai Narendra Patel ◽  
Danielle Boselli ◽  
James Thomas Symanowski ◽  
Stephanie Wodarski ◽  
ShRhonda Turner ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Pilot Trial ◽  
Final Visit ◽  
Buccal Swab ◽  
Nucleotide Polymorphisms ◽  
Cancer Pain Management ◽  
Improvement Rate ◽  
Edmonton Symptom Assessment Scale ◽  
Pain Improvement

117 Background: About 30% of cancer patients presenting with pain have symptomatic improvement using conventional strategies within one month. PGx may help personalize opioid selection and improve cancer pain management. Methods: This is a pragmatic pilot trial investigating the feasibility and application of PGx testing to improve pain management in adults with uncontrolled cancer pain referred to an oncology PM clinic. PM providers assessed patients using Edmonton Symptom Assessment Scale at baseline and opioid therapy was initiated or modified. A buccal swab was obtained for genotyping single nucleotide polymorphisms in: COMT, CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, and OPRM1. The first assessment occurred within one week of baseline and a second within another week if intervention was required. PGx results were available before the first assessment and utilized, if applicable, throughout the one-month study period. Pain improvement rate (≥ 2-point reduction on a 0-10 scale) from baseline to final visit, was compared to historical control data by a one-sided exact binomial test of proportions. Results: Of 75 undergoing PGx testing, 52 were evaluable for the primary endpoint (54% female, 81% white, 17% black, median age 63, 75% stage 3 or 4 disease, median personalized pain goal 3 [0-6]). 56% had pain improvement compared to 30% in historical controls (p < 0.001). At final assessment, 35% met their personalized pain goal. Of 26 (50%) requiring opioid adjustments, 18 (69%) had an actionable genotype with a 61% pain improvement rate. The two most common genes for opioid adjustment were CYP2D6 (16/18; 89%) and COMT (8/18; 44%). The most common PGx-guided modification involved switching from a CYP2D6-metabolized drug (hydrocodone, oxycodone, tramadol) to a non-CYP2D6-metabolized drug (fentanyl, hydromorphone, methadone, morphine). Conclusions: PGx implementation in an oncology PM clinic was feasible and improved pain management. Half of those requiring opioid adjustments had an actionable genotype, with the largest impact from CYP2D6 polymorphisms. Future studies should focus on preemptive PGx testing to guide initial drug selection and confirm clinical utility in a randomized trial. Clinical trial information: NCT02542397.

scholarly journals Retrospective Analysis Based on Clinical Experience of Tapentadol in Cancer Pain Management

2016 ◽  
Vol 11 (1) ◽  
pp. 306-310
Author(s):  
Tomoe Fukunaga ◽  
Tatsuo Kamikawa ◽  
Masahiro Senta ◽  
Shinichi Ishikawa
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Retrospective Analysis ◽  
Clinical Experience ◽  
Cancer Pain Management

Cancer pain management

2014 ◽  
Vol 155 (3) ◽  
pp. 93-99
Author(s):  
Péter Heigl
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Relief ◽  
Life Expectancy ◽  
Cancer Pain ◽  
Cancer Pain Management ◽  
Medical Activity ◽  
Short Summary ◽  
Adequate Quality

Pain is a significant and alarming symptom of cancer seriously affecting the activity and quality of life of patients. Recent research proved that inadequate analgesia shortens life expectancy. Therefore, pain relief is not only a possibility but a professional, ethical and moral commitment to relieve patients from suffering, as well as ensure their adequate quality of life and human dignity. Proper pain relief can be achieved with medical therapy in most of the cases and the pharmacological alternatives are available in Hungary. Yet medical activity regarding pain relief is far from the desired. This paper gives a short summary of the guidelines on medical pain management focusing particularly on the use of opioids. Orv. Hetil., 2014, 155(3), 93–99.

Sign in / Sign up

Export Citation Format

Share Document