The Association Between Analgesic Treatment Beliefs and Electronically Monitored Adherence for Cancer Pain

e19350 Background: Opioids have been the cornerstone of analgesic treatment for severe chronic pain. OIC is the most commonly reported adverse effect associated with opioids, and compromises patient satisfaction and adherence to analgesic treatment and also quality of life. Naloxegol is a PEGylated derivative of the µ-opioid receptor antagonist naloxone indicated for the treatment of opioid-induced constipation (OIC) in adult patients who have had an inadequate response to laxatives. This real-world (RW) study (NCT03638440) aims to evaluate safety and efficacy of Naloxegol in patients with cancer pain diagnosed with OIC. Methods: This is a single-arm, multinational, prospective, RW observational study in adult subjects receiving treatment with opioids for at least 4 weeks, diagnosed with OIC that receive naloxegol in routine clinical practice. This study will recruit patients from 25 European hospitals. Data for efficacy are collected through the patient's diary during a 4-week period. Results: One hundred fifty-two patients, median age 66 years, 54% women, have been included in this analysis. Main cancer locations were lung (26%), breast (21%), prostate (10%), pancreas (9%) and head and neck (9%), and 67% had metastasis, mainly in bone (37%). Most frequent opioid treatments were fentanyl (29%), oxycodone (22%), and morphine (15%). Most frequent previous laxatives were osmotic (61%) and stimulant (27%) laxatives. Over 109 patients with at least one BFI score available after baseline, change in BFI score was ≥12 points in 61% of patients and 33% had BFI score <30 points after 4 weeks of treatment. There were statistically significant differences between baseline and final visit in BFI overall score as well as in the score of each of the three questions. Most common adverse reactions to naloxegol were abdominal pain (7.9%), diarrhea (2.6%), flatulence (1.3%) and nausea (1.3%), most of them grade 1-2. Eight patients had adverse reactions leading to study discontinuation: abdominal pain (5), diarrhea (2), intestinal perforation (1) and fatigue (1). Only one patient died due to an adverse reaction: intestinal perforation. Conclusions: Preliminary results show a promising efficacy of naloxegol in this RW treatment study. Toxicity profile was as expected. RW evidence seems to be a useful methodology to assess the real-life use of naloxegol and its efficacy in cancer patients.

Download Full-text

Standards for monitoring quality of analgesic treatment of postoperative pain and cancer pain

Pain ◽

10.1016/0304-3959(90)92778-o ◽

1990 ◽

Vol 41 ◽

pp. S331

Author(s):

M.B. Maz ◽

M. Donovan ◽

R.K. Portenoy ◽

C.S. Cleeland ◽

M.A. Simmonds ◽

...

Keyword(s):

Postoperative Pain ◽

Cancer Pain ◽

Analgesic Treatment ◽

Monitoring Quality

Download Full-text

Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial

Journal of Clinical Oncology ◽

10.1200/jco.2003.09.011 ◽

2003 ◽

Vol 21 (22) ◽

pp. 4120-4126 ◽

Cited By ~ 242

Author(s):

David Alimi ◽

Carole Rubino ◽

Evelyne Pichard-Léandri ◽

Sabine Fermand-Brulé ◽

Marie-Laure Dubreuil-Lemaire ◽

...

Keyword(s):

Cancer Pain ◽

Pain Intensity ◽

Cancer Patients ◽

Controlled Trial ◽

Auricular Acupuncture ◽

Analgesic Treatment ◽

Analgesic Drugs ◽

The Difference ◽

Absolute Decrease ◽

Therapy Treatment

Purpose: During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients.Patients and Methods: Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS.Results: The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P < .0001).Conclusion: The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment.

Download Full-text

Interns’ Attitudes on Cancer Pain and Its Management

Songklanagarind Medical Journal ◽

10.31584/smj.2017.35.3.735 ◽

2017 ◽

Vol 35 (3) ◽

pp. 255

Author(s):

Sasikaan Nimmaanrat ◽

Chatchai Prechawai ◽

Maliwan Oofuvong

Keyword(s):

Cancer Pain ◽

Clinical Judgment ◽

Low Dose ◽

Morphine Injection ◽

Negative Attitudes ◽

Opioid Prescription ◽

Analgesic Treatment ◽

Pain Medications ◽

To Receive ◽

Pain Patients

Objective: This study was designed to evaluate interns’ attitudes in terms of cancer pain and its management, including opioid prescription.Material and Method: Questionnaires consisting of 2 parts (attitudes toward cancer pain and its management as well as attitudes toward opioid prescription), were completed by 125 out of 165 interns (75.8%).Result: The majority of them thought that maximum analgesic treatment should be commenced when patients’ life expectancy was not more than 1 year (76.0%). They rated the patients’ requirement for pain medications as average (73.6%) and supposed that the demand for higher analgesic doses indicating increased pain level (60.8%). Almost seventy percent would cautiously regulate the dosage and frequency of opioids to avoid tolerance and addiction. Two thirds did not agree to provide too low dose of opioid to prevent tolerance. Over 80.0% did not agree that they should inform patients, as well as their relatives, that opioids were bad, nor did they reassure them that trying to bear pain may be a better alternative. Over half would discourage patients who were willing to stand the pain and refused to receive a morphine injection. None strongly agreed not to prescribe opioids due to a fear of respiratory depression.Conclusion: Although the minority of the participated interns had negative attitudes towards cancer pain and its management, these negative attitudes may influence their clinical judgment and practice, which lead to inadequate pain management being provided to cancer pain patients, who are in need for optimal pain relief.

Download Full-text

Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

Current Medical Research and Opinion ◽

10.1185/03007995.2013.792247 ◽

2013 ◽

Vol 29 (6) ◽

pp. 667-671 ◽

Cited By ~ 18

Author(s):

Sebastiano Mercadante ◽

Alessandro Valle ◽

Giampiero Porzio ◽

Federica Aielli ◽

Claudio Adile ◽

...

Keyword(s):

Cancer Pain ◽

Clinical Studies ◽

Breakthrough Pain ◽

Analgesic Treatment ◽

Preliminary Study

Download Full-text

Patient and physician satisfaction with analgesic treatment in Southeast Asia (SEA): Findings from the analgesic treatment for cancer pain in Southeast Asia (ACE) study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21698 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21698-e21698

Author(s):

Hanlim Moon ◽

Dang Huy Quoc Thinh ◽

Wimonrat Sriraj ◽

Marzida Binti Mansor ◽

Kian Hian Tan ◽

...

Keyword(s):

Southeast Asia ◽

Cancer Pain ◽

Sleep Disturbance ◽

Pain Intensity ◽

Pain Control ◽

Oral Morphine ◽

Physician Satisfaction ◽

Analgesic Treatment ◽

Ace Study ◽

Pain Status

e21698 Background: Adequate dosing of analgesics is important for optimum cancer pain control & quality of life (QoL). To understand current attitudes toward analgesic treatment for cancer pain in SEA, the ACE study explored patient & physician satisfaction with pain control in 6 SEA countries. Methods: This cross-sectional observational study included 465 adult outpatients prescribed analgesics for cancer pain for ≥1 month in Indonesia, Malaysia, Philippines, Singapore, Thailand, & Vietnam. Pain intensity, sleep disturbance, QoL, satisfaction with pain control, & physicians’ assessment of adequacy of analgesics were recorded via questionnaires. Current analgesic doses prescribed were extracted from medical records. Results: Most patients (84%) had stage 3 or 4 cancer. While 91% were prescribed opioids, mean reported pain intensity was 4.1 (0/no pain, 10/worst possible pain) & most had problems with sleep (55%) & QoL (problems with pain/discomfort [82%], usual activities [66%] & anxiety/depression [56%]). 60% of patients were satisfied with their pain control status & 30% found it acceptable. Physicians more often reported dissatisfaction with patients’ pain control status compared with patients (21% vs 10%). Patient-physician concordance in satisfaction with pain control was low (weighted Kappa 0.36; 95% CI 0.30-0.43). More than 1 in 4 physicians (29%) assessed prescribed analgesics to be “inadequate” for pain control. Median daily dose prescribed in oral morphine equivalents was 30 mg for both morphine & tramadol. Of the SEA countries included, prescribed doses of opioids were generally lower in Indonesia & higher in Vietnam. Conclusions: The results highlight the complexity of managing cancer pain in SEA. Despite unrelieved pain, sleep disturbance & QoL issues, many patients still reported satisfaction with pain control. Notably, physicians expressed dissatisfaction more frequently than patients. These findings suggest a need for all-round pain status assessment (including pain intensity, sleep disturbance, QoL) & improved patient-physician communication about analgesic treatment expectations, pain control & adverse effects.

Download Full-text

Patient and Physician Satisfaction with Analgesic Treatment: Findings from the Analgesic Treatment for Cancer Pain in Southeast Asia (ACE) Study

Pain Research and Management ◽

10.1155/2018/2193710 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Dang Huy Quoc Thinh ◽

Wimonrat Sriraj ◽

Marzida Mansor ◽

Kian Hian Tan ◽

Cosphiadi Irawan ◽

...

Keyword(s):

Cancer Pain ◽

Pain Intensity ◽

Pain Control ◽

Weighted Kappa ◽

Physician Satisfaction ◽

Cross Sectional ◽

Analgesic Treatment ◽

Ace Study ◽

Pain Patients

Aim. The aim of this study was to examine patients’ and physicians’ satisfaction, and concordance of patient-physician satisfaction with patients’ pain control status. Methods. This cross-sectional observational study involved 465 adults prescribed analgesics for cancer-related pain from 22 sites across Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam. Pain intensity, pain control satisfaction, and adequacy of analgesics for pain control were documented using questionnaires. Results. Most patients (84.4%) had stage III or IV cancer. On a scale of 0 (no pain) to 10 (worse pain), patients’ mean worst pain intensity over 24 hours was 4.76 (SD 2.47). More physicians (19.0%) than patients (8.0%) reported dissatisfaction with patient’s pain control. Concordance of patient-physician satisfaction was low (weighted kappa 0.36; 95% CI 0.03–0.24). Most physicians (71.2%) found analgesics to be adequate for pain control. Patients’ and physicians’ satisfaction with pain control and physician-assessed analgesic adequacy were significantly different across countries (P<0.001 for all). Conclusions. Despite pain-related problems with sleep and quality of life, patients were generally satisfied with their pain control status. Interestingly, physicians were more likely to be dissatisfied with patients’ pain control. Enhanced patient-physician communication, physicians’ proactivity in managing opioid-induced adverse effects, and accessibility of analgesics have been identified to be crucial for successful cancer pain management. This study was registered at ClinicalTrials.gov (identifier NCT02664987).

Download Full-text

Preference for Analgesic Treatment for Cancer Pain Among African Americans

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2006.10.019 ◽

2007 ◽

Vol 34 (2) ◽

pp. 136-147 ◽

Cited By ~ 26

Author(s):

Salimah H. Meghani ◽

Anne Keane

Keyword(s):

African Americans ◽

Cancer Pain ◽

Analgesic Treatment

Download Full-text

Analgesic Effect of a 5% Lidocaine Patch in Patients With Opioid Treatment-Resistant Neuropathic Cancer Pain

10.21203/rs.3.rs-564703/v1 ◽

2021 ◽

Author(s):

Jui-hung Tsai ◽

I-Ting Liu ◽

Pei-Fang Su ◽

Ying-Tzu Huang ◽

Ge-Lin Chiu ◽

...

Keyword(s):

Neuropathic Pain ◽

Pain Relief ◽

Cancer Pain ◽

Pain Intensity ◽

Cancer Patients ◽

Transdermal Patch ◽

Analgesic Treatment ◽

Opioid Treatment ◽

Significant Difference

Abstract PurposeLimited efficacy has been observed when using morphine to treat neuropathic pain. Lidocaine patches reduce neuropathic pain in post-herpetic neuralgia, but their benefits for cancer-related neuropathic pain remain unclear. This study aimed to demonstrate a useful treatment for cancer-related neuropathic pain. The primary endpoint was pain intensity evaluated by the visual analog scale (VAS). The secondary endpoints were the pain relief score and the quality of analgesic treatment. MethodsWe assessed the efficacy and safety of lidocaine patches in patients experiencing neuropathic cancer pain. Terminal cancer patients with opioid treatment resistance participated in the 3-day study. ResultsThe results showed a statistically significant difference in the median VAS over three days (Kruskal-Wallis test, P<0.0001). The median VAS pain intensity from Day 1 to Day 3 was 4.0 with 95% C.I. (3.3, 5.0), 3.0 (2.5, 3.5) and 2.5 (2.0, 3.0), respectively. The difference between the median VAS pain intensities of any two days was statistically significant (Wilcoxon signed-rank test, P < 0.0001). There was no statistically significant difference in the pain relief score or the quality of analgesic treatment. ConclusionIn this study, the 5% lidocaine transdermal patch reduced the VAS pain intensity in neuropathic cancer patients with morphine resistance. The transdermal patch is generally useful and well-tolerated.

Download Full-text