Repeated subcutaneous esketamine administration for depressive symptoms and pain relief in a terminally ill cancer patient: A case report

2020 ◽  
Vol 34 (6) ◽  
pp. 822-825
Author(s):  
Matheus Ghossain Barbosa ◽  
Rodrigo Simonini Delfino ◽  
Luciana Maria Sarin ◽  
Andrea Parolin Jackowski
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Vital Signs ◽  
Subcutaneous Administration ◽  
Antidepressant Effect ◽  
Abdominal Tumor ◽  
Case Presentation ◽  
Research Problems

Background: Depressive disorders are common among cancer patients. Ketamine can quickly relieve depression, and its subcutaneous administration appears to be as effective as and probably safer than its standard intravenous administration. Herein, we report a case verifying the antidepressant effect of a subcutaneous esketamine formulation. Case presentation: A 65-year-old male with metastatic abdominal tumor reported sadness, weight loss, fatigue, hopelessness, insomnia, inattention, and reduced motivation. His scores on the visual analogical scale for pain and Montgomery–Asberg depression rating scale were 8/10 and 30/60, respectively. Possible courses of action: Monoaminergic antidepressants are effective, but their response is slow for end-of-life care. Formulation of a plan: Esketamine was preferred because it possibly contributes to pain relief. It can repeatedly be infused intravenously, but was subcutaneously administered twice a week for safety reasons. Outcome: The patient showed continuous mood improvement, achieving depression remission on day 7. Pain relief was observed but without stability. His vital signs remained stable, and he remained calm, without major complaints. Lessons from the case: Repeated subcutaneous esketamine injections are possibly safe and effective in pain and depression relief in palliative care cancer patients. View on research problems, objectives, or questions generated by the case: Placebo-controlled studies with similar cases are needed to establish efficacy and safety.

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

scholarly journals Differentiated approach and indications for optimization of agomelatine therapy for endogenous depression

2019 ◽  
Vol 11 (2) ◽  
pp. 71-77
Author(s):  
L. I. Abramova ◽  
G. P. Panteleeva ◽  
I. Yu. Nikiforova ◽  
T. E. Novozhenova
Keyword(s):  
Depressive Disorders ◽  
Rating Scales ◽  
Rating Scale ◽  
Treatment Cycle ◽  
Endogenous Depression ◽  
Good Effect ◽  
Antidepressant Effect ◽  
Antidepressive Effect ◽  
Wide Range ◽  
Days Of Therapy

Objective: to develop and justify differentiated indications for the use of agomelatine (valdoxan) to treat the typological variants of endogenous depressions with varying severity on the basis of an analysis of its therapeutic efficacy.Patients and methods. An open prospective study was conducted using the clinical, psychopathological, and psychometric rating scales: the Hamilton Depression Rating Scale (HAMD-21); Udvalg for Kliniske Undersњgelser Scale (UKU); the Snaith-Hamilton Pleasure Scale (SHAPS) for assessing anhedonic disorders, and statistical methods. Examinations were made in 56 patients (mean age, 34.9 years) with moderate and severe endogenous depression within affective psychosis (n=42) and shift-like schizophrenia (n=14) (ICD-10 items F31.3–4; F32.1–2, and F33.1–2). The patients received a cycle treatment with agomelatine (valdoxan) 25–50 mg once a day in the evening for 4–8 weeks. The patients' status was evaluated over time on fixed days from a reduction in the mean total score (MTS) of the respective scales as insignificant (less than 19% reduction in disorders), moderate (20–49%), good (50–69%), and excellent (70% or more) effects. The effect of agomelatine was analyzed in two patient groups. The specific features of the antidepressive effect and its dynamics in the presence of endogenous depressions of different typologies (melancholic, anxious, and adynamic depressions) were studied in Group 1 (n=26); the effect of agomelatine on anhedonic endogenous depressions and manifestations of anhedonia in different mental activity areas (interests, social activity, emotional engagement and eating/drinking) was investigated in Group 2 (n=30).Results and discussion. There was a good tolerance and a high antidepressant activity of agomelatine during its treatment cycle for moderate and severe endogenous depressions. A significant improvement (an 84.4% reduction in HAMD-21 MTS) was noted in patients at 3 and 4 weeks of the treatment cycle and consistently persisted at a subsequent follow-up. Agomelatine showed a good effect (a 50% or more reduction in HAMD-21 MTS) just at 14 days of therapy. The drug was observed to have a balanced antidepressant effect, significant thymoleptic, stimulant, anxiolytic, and antianhedonic activities (reductions in the MTS of depressive disorders by 90.83, 84.9, 82.39, and 78.9%, respectively).Conclusion. The universal spectrum of the antidepressive effect of agomelatine, its good tolerability, high efficacy, and rapid improvement makes it the drug of choice in treating a wide range of psychopathological endogenous depressions: melancholic, apatho-adynamic, anxious, and anhedonic ones.

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 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.

Acute and Chronic Depressive Disorders in Head and Neck Cancer Patients

2020 ◽  
pp. 27-33
Author(s):  
Leonid Bardenshtein ◽  
Valeriy Leontiev ◽  
Aleksey Drobyshev ◽  
Aleksandr Tsimbalistov ◽  
Nikolay Malginov ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Depressive Disorders ◽  
Clinical Symptoms ◽  
Depression Prevalence ◽  
Patient Category ◽  
Antipsychotic Drug Treatment ◽  
Timely Administration

The review focuses on depressive disorders in cancer patients. The article summarizes the findings of domestic and foreign studies on depression prevalence, clinical symptoms and treatment in head and neck cancer patients. Early detection of affective disorder and timely administration of antipsychotic drug treatment is shown to be important for this patient category.

scholarly journals Preanesthetic severe postural hypotension following 5-aminolevulinic acid pretreatment in patients for photodynamic diagnosis-assisted urological surgery

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Tohru Shiratori ◽  
Kunihisa Hotta ◽  
Masaaki Satoh ◽  
Chiaki Kiuchi ◽  
Noriyuki Ogawa ◽  
...  
Keyword(s):  
Postural Hypotension ◽  
Aminolevulinic Acid ◽  
Vital Signs ◽  
Photodynamic Diagnosis ◽  
Careful Monitoring ◽  
High Concentration ◽  
Acid Pretreatment ◽  
Case Presentation ◽  
Severe Hypotension ◽  
Prolonged Hypotension

Abstract Background 5-Aminolevulinic acid (5-ALA) is utilized for photodynamic diagnosis-assisted (PDD) surgery. However, it has been associated with vasodilation, hence, occasional hypotension. Case presentation We encountered two patients who had severe postural hypotension following 5-ALA pretreatment prior to an operation. They were scheduled for urological PDD surgery, but upon standing to walk to the operation room, they felt sick because of severe hypotension. One of them underwent the surgery after recovery, but the other surgery was canceled due to a prolonged hypotension that lasted for more than a day. Conclusions Severe postural hypotension may develop as a result of the high concentration of porphyrin precursors, which may affect the nervous system. Severe postural hypotension may be due to 5-ALA-induced autonomic dysfunction as well as vasodilative action of 5-ALA. These observations suggest that in addition to the careful monitoring of patients’ vital signs, standing should be avoided following 5-ALA pretreatment.

scholarly journals Preliminary Pharmacogenetic Study to Explore Putative Dopaminergic Mechanisms of Antidepressant Action

2021 ◽  
Vol 11 (8) ◽  
pp. 731
Author(s):  
Taichi Ochi ◽  
Natalya M. Vyalova ◽  
Innokentiy S. Losenkov ◽  
Diana Z. Paderina ◽  
Ivan V. Pozhidaev ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Sufficient Evidence ◽  
Therapeutic Effects ◽  
Pharmacogenetic Study ◽  
Dopaminergic Mechanisms ◽  
Major Depressive Disorders ◽  
Related Proteins ◽  
Antidepressant Action

Background: There is sufficient evidence that interference of dopaminergic neurotransmission contributes to the therapeutic effects of antidepressants in unipolar and bipolar depression. Methods: Hamilton depression rating scale (HAMD 17) scores of 163 at least moderately ill patients with major depressive disorders were used to establish treatment response. HAMD 17 score status was measured before initiation, after two weeks, and after four weeks of treatment with various antidepressants. The possible association between response and genotype in a total of 14 variants of dopamine neurotransmission-related proteins was investigated. Results: DRD4 rs11246226 CA heterozygous patients were found with a greater improvement of HAMD 17 score when compared to homozygous C patients during 0–2 weeks and 0–4 weeks. Patients with MAOB rs1799836 heterozygous GA and homozygous A also demonstrated improved scores during 2–4 weeks and 0–4 weeks. Conclusions: The results are preliminary due to the limited population size and the small number of variants. Further research into the involvement of habenular dopamine D4 receptors in the antidepressant response is desirable.

scholarly journals A Prospective Multicentre Study to Evaluate the Efficacy and Tolerability of Osmotic Release Oral System (Oros®) Hydromorphone in Opioid-Naive Cancer Patients: Results of the Korean South West Oncology Group Study

2015 ◽  
Vol 20 (6) ◽  
pp. 293-299 ◽  
Author(s):  
Eun-Kee Song ◽  
Hyunjeong Shim ◽  
Hye-Suk Han ◽  
DerSheng Sun ◽  
Soon-Il Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Pain Control ◽  
Intensity Difference ◽  
Front Line ◽  
Long Acting

BACKGROUND: Osmotic release oral system (OROS®) hydromorphone is a potent, long-acting opioid analgesic, effective and safe for controlling cancer pain in patients who have received other strong opioids. To date, few studies have examined the efficacy of hydromorphone for pain relief in opioid-naive cancer patients.OBJECTIVES: A prospective, open-label, multicentre trial was conducted to determine the efficacy and tolerability of OROS hydromorphone as a single and front-line opioid therapy for patients experiencing moderate to severe cancer pain.METHODS: OROS hydromorphone was administered to patients who had not previously received strong, long-acting opioids. The baseline evaluation (visit 1) was followed by two evaluations (visits 2 and 3) performed two and 14 weeks later, respectively. The starting dose of OROS hydromorphone was 4 mg/day and was increased every two days when pain control was insufficient. Immediate-release hydromorphone was the only accepted alternative strong opioid for relief of breakthrough pain. The efficacy, safety and tolerability of OROS hydromorphone, including the effects on quality of life, and patients’ and investigators’ global impressions on pain relief were evaluated. The primary end point was pain intensity difference (PID) at visit 2 relative to visit 1 (expressed as %PID).RESULTS: A total of 107 patients were enrolled in the present study. An improvement in pain intensity of >50% (≥50% PID) was observed in 51.0% of the full analysis set and 58.6% of the per-protocol set. The mean pain score, measured using a numerical rating scale, was significantly reduced after two weeks of treatment, and most adverse events were manageable. Quality of life also improved, and >70% of patients and investigators were satisfied with the treatment.CONCLUSIONS: OROS hydromorphone provided effective pain relief and improved quality of life in opioid-naive cancer patients. As a single and front-line treatment, OROS hydromorphone delivered rapid pain control.

scholarly journals Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takeshi Ueda ◽  
Tetsuya Tanaka ◽  
Takashi Yokoyama ◽  
Tomomi Sadamitsu ◽  
Suzuka Harada ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Abdominal Cavity ◽  
Vital Signs ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Case Presentation ◽  
Free Air ◽  
Spontaneous Pneumoperitoneum ◽  
Upper Abdominal ◽  
Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

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