scholarly journals Transdermal buprenorphine in cancer pain and palliative care

2006 ◽  
Vol 20 (8_suppl) ◽  
pp. 25-30
Author(s):  
Reinhard Sittl
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Rescue Therapy ◽  
The Elderly ◽  
World Health ◽  
Prolonged Treatment ◽  
Postmarketing Surveillance ◽  
Efficacy And Safety ◽  
Good Tolerability

Transdermal buprenorphine has been assessed as a therapy for chronic cancer and non-cancer pain in both clinical and postmarketing surveillance studies. Data from 239 patients who had participated in a follow-up study of up to six years have shown efficacy and safety, and good tolerability over prolonged treatment periods with a marked stability of doses. From the cancer pain population (134 patients), 20% stayed on transdermal buprenorphine until the end of their lives. Postmarketing surveillance study data from 13 179 patients, including 3690 cancer patients assessed during a 10-week observation period, showed that 81% of patients achieved good/very good pain relief with transdermal buprenorphine. Furthermore, 49.6% of patients did not require any analgesic comedication or rescue therapy, a point that is particularly important in the elderly population. Results from the Spanish Pain Society on transdermal buprenorphine in chronic non-cancer, neuropathic and cancer-related pain, and on switching from morphine, also confirmed its beneficial efficacy and safety, and showed that buprenorphine does not antagonize pain relief, or cause withdrawal when combined with full μ-agonists. The effectiveness of buprenorphine is further supported by evidence of its pronounced anti-hyperalgesic effect in a human pain model, which may be a factor in explaining the efficacy of buprenorphine in neuropathic pain. When switching of opioids is indicated to improve pain relief or reduce adverse events, equipotency dosage ratios are important. The equipotency ratio for morphine to buprenorphine, previously established as 75:1, is now being questioned as new data from a retrospective cohort study were published indicating a ratio of 100:1. Moreover, transdermal buprenorphine has superior safety in respect to respiratory depression, immunological and renal effects compared with standard World Health Organization step III opioids, which makes it highly suitable for treating moderate-to-severe pain also in cancer patients, a per se vulnerable patient population requiring a sensible selection of potent analgesics.

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.

An Open-Label, Analgesic Efficacy and Safety of Pituitary Radiosurgery for Patients With Opioid-Refractory Pain: Study Protocol for a Randomized Controlled Trial

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 146-153 ◽  
Author(s):  
Pierre-Yves Borius ◽  
Stéphanie Ranque Garnier ◽  
Karine Baumstarck ◽  
Frédéric Castinetti ◽  
Anne Donnet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Cancer Pain ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Standards Of Care ◽  
Control Group ◽  
Efficacy And Safety ◽  
Open Label

Abstract BACKGROUND Hypophysectomy performed by craniotomy or percutaneous techniques leads to complete pain relief in more than 70% to 80% of cases for opioid refractory cancer pain. Radiosurgery could be an interesting alternative approach to reduce complications. OBJECTIVE To assess the analgesic efficacy compared with standard of care is the primary goal. The secondary objectives are to assess ophthalmic and endocrine tolerance, drug consumption, quality of life, and mechanisms of analgesic action. METHODS The trial is multicenter, randomized, prospective, and open-label with 2 parallel groups. This concerns patients in palliative care suffering from nociceptive or mixed cancer pain, refractory to standard opioid therapy. Participants will be randomly assigned to the control group receiving standards of care for pain according to recommendations, or to the experimental group receiving a pituitary GammaKnife (Elekta, Stockholm, Sweden) radiosurgery (160 Gy delivered in pituitary gland) associated with standards of care. Evaluation assessments will be taken at baseline, day0, day4, day7, day14, day28, day45, month3, and month6. EXPECTED OUTCOMES We could expect pain improvement in 70% to 90% of cases at day4. In addition we will assess the safety of pituitary radiosurgery in a vulnerable population. The secondary endpoints could show decay of opioid consumption, good patient satisfaction, and improvement of the quality of life. DISCUSSION The design of this study is potentially the most appropriate to demonstrate the efficacy and safety of radiosurgery for this new indication. New recommendations could be obtained in order to improve pain relief and quality of life.

A single-arm, prospective, multicenter study on the efficacy and safety of low-dose transdermal fentanyl patch in opioid-naive patients with moderate to severe cancer pain.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24149-e24149
Author(s):  
Yong Liu ◽  
Qing Li ◽  
Yang Yu ◽  
Jie Jun Wang ◽  
Han Ping Shi
Keyword(s):  
Quality Of Life ◽  
Cognitive Function ◽  
Pain Relief ◽  
Cancer Pain ◽  
Adverse Reactions ◽  
Low Dose ◽  
Response Rate ◽  
Mainland China ◽  
Efficacy And Safety

e24149 Background: The efficacy and safety of low-dose fentanyl transdermal patch (TDF) in the treatment of opioid-naive patients with moderate-to-severe cancer pain has no tyet been confirmed. There are little international studies, and none in mainland China. The aim of this study was to explore the effect and tolerability of low dose of TDF in opioid-naive patients with Chinese moderate-to-severe cancer pain, and evaluate the influence on quality of life and cognitive function. Methods: A prospective, single-arm, non-randomized, open-label, multicenter trial was conducted with 285 opioid-naivepatients with moderate-to-severe cancer pain in 14 tertiary hospitals in mainland China. The initial analgesic dose of TDF was 12.5 µg/h, pain assessment (pain score, pain relief and pain response rate) was performed every 3 days for a total of 9 cycles.Adverse reactions and events were monitored over 24 days. In the meantime, quality of life and cognitive function of patient were evaluated with EORTC QLQ-C30 and MMSE. Results: 285 patients with 267(92.00%) completed the trial were enrolled. The average age was 60 (range 28-87) and the average effective therapeutic dose was 6.3±6.08mg.The total pain relief rate was 98.12% (mean pain score ±SD, 5.7±0.89 vs 3.9±1.28; P < 0.001). The efficacy of low-dose TDF on pain relief was consistent in groups separated by gender (p < 0.001), age (p < 0.001), types of cancer (p < 0.001), and baseline pain intensity (p < 0.001). There were 79 patients (29.59%) in the low-dose subgroup, and the pain response rate of the low-dose subgroup was better than other dose groups within one week (p = 0.0018).The adverse effects were mild. The most common adverse reactions are constipation 7.87%, followed by nausea 11.24%, vomiting 4.12%, drowsiness 1.87% and urine retention 1.5%.There was no difference in the incidence of adverse reactions between the low-dose subgroup and the other groups (p > 0.05). Meanwhile, TDF improved the quality of life of patients with moderate-to-severe cancer pain (mean± SD: 46.44±16.96 vs. 67.04±18.02;p < 0.05), without impairing cognitive function(mean ±SD, 29.13±1.54 vs. 28.98±1.99; p > 0.05). Conclusions: Low-dose TDF is effective for opioid-naive patients with moderate-to-severe cancer pain. Adverse reactions are mild and the quality of life of patients is improvedwith little losson cognitive function. Further randomized controlled studies are warranted to investigate the value of low-dose TDF in the treatment of opioid intolerant cancer pain. Clinical trial information: ChiCTR-ONC-17014080 .

scholarly journals Quadratus Lumborum Block for Back Pain Related to Pancreatic Cancer – A Report of Two Cases

2018 ◽  
pp. 197-203
Author(s):  
Uri Hochberg
Keyword(s):  
Pancreatic Cancer ◽  
Back Pain ◽  
Pain Management ◽  
Pain Relief ◽  
Cancer Pain ◽  
Myofascial Pain ◽  
Celiac Plexus ◽  
World Health ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum

Pancreatic cancer is often accompanied by severe pain. Patients typically experience upper abdominal and/or thoracolumbar back pain. For those cases failing to respond to standard medical management, as suggested by the World Health Organization, interventions designated at interruption of the sympathetic axis (such as neurolysis of the celiac plexus or splanchnic nerves) have been shown to be efficacious. Other than axial drug delivery, there are few interventional alternatives in patients with pancreatic cancerrelated pain. There is little knowledge regarding the therapeutic effects of treating peripheral somatic soft tissue among oncological patients. Here we report on 2 such patients, whose back pain improved following a quadratus lumborum block. Two patients diagnosed with pancreatic cancer presented with severe back pain. The pain pattern and patients’ physical exams were compatible with myofascial pain arising from the quadratus lumborum muscle, possibly irritated by the abdominal tumor. Advanced pain management, including long- and short-acting opioids and adjuvants, as well as celiac plexus neurolytic block, failed to provide satisfactory pain relief. Given the apparent muscular origin of the pain, a bilateral ultrasound-guided quadratus lumborum block was performed. Four weeks post procedure, the 2 patients reported substantial pain relief supported by reduced consumption of pain medication and improved functional status. No adverse events or complications were observed in either case. In the patients described here, quadratus lumborum block proved to be safe and efficacious in alleviating back pain related to pancreatic cancer. In our opinion, clinicians should be aware of the possible contribution of a myofascial component to pain in pancreatic cancer and in cancer-related pain in general. Key words: Quadratus lumborum block, cancer pain, pancreatic cancer, pain control, myofascial pain syndrome, interventional pain management

Ketamine Use and Opioid-Tolerant Cancer Patients

2018 ◽  
Author(s):  
Fardin Yousefshahi ◽  
Giuliano Michelagnoli ◽  
Juan Francisco Asenjo
Keyword(s):  
Cancer Pain ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Pain Treatment ◽  
Small Sample ◽  
World Health ◽  
Chronic Cancer Pain ◽  
Small Sample Sizes ◽  
Health Organization ◽  
Intravenous Ketamine

Pain occurs in up to 70% of cancer patients and it can be challenging to manage. The standard for analgesic therapy is the World Health Organization ladder; however, up to 25% of patients don’t reach a level of comfort using this approach. Ketamine has been recognized as an excellent adjuvant for cancer pain treatment, especially when other analgesics have failed. Some randomized clinical trials have confirmed ketamine’s efficacy in refractory cancer pain, but most had small sample sizes and low power. Some publications have confirmed the beneficial effect of oral, intranasal, subcutaneous, or intravenous ketamine in treatment of refractory chronic cancer pain, while others are less conclusive. While ketamine is rapidly gaining ground as an adjuvant in treating pain in patients with cancers refractory to conventional therapy and/or patients with opioid tolerance, care should be taken to identify patients with ketamine contraindications in order to offer the greatest benefit with the lowest risk of side effects.

A Review of the Effects of Guided Imagery on Cancer Patients with Pain

2010 ◽  
Vol 15 (2) ◽  
pp. 98-107 ◽  
Author(s):  
Kelly King
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Guided Imagery ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Alternative Measures ◽  
Keywords Cancer ◽  
Body Techniques

Over half of the patients diagnosed with cancer suffer from pain. Often, analgesic medications do not completely relieve the pain and alternative measures are sought out for relief. Mind—body techniques such as guided imagery (GI) have been thought to be helpful and used as an adjuvant to pain relief. This article evaluates and summarizes studies performed from 2001 to 2008, which investigated the use of GI for relief of cancer pain. Electronic databases were searched with the keywords cancer pain, visualization, and guided imagery, for any studies utilizing GI with an outcome measure of pain. Five studies included pain as either a primary or a secondary outcome measure. In three of those, pain intensity and pain-related distress decreased in the GI intervention versus control. There is inconsistency in the methodological qualities of these trials and further research is necessary to provide better evidence for the use of GI in cancer pain.

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