Effects of Massage on Pain Intensity, Analgesics and Quality of Life in Patients with Cancer Pain:

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.

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Pain management

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0064 ◽

2020 ◽

pp. 629-633

Author(s):

Marie Fallon

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Pain Relief ◽

Adverse Effects ◽

Cancer Pain ◽

Daily Functioning ◽

Opioid Analgesia ◽

Patients With Cancer ◽

Good Pain Relief

Pain occurs in more than 50% of patients with advanced disease, interferes with daily functioning and quality of life, and is very often undertreated. Patients can find it difficult to articulate the character of their pains, but it is important to determine whether it is somatic, neuropathic, or visceral since this has important implications for management. For most patients with cancer pain, a three-step approach combining simple or opioid analgesia (depending on severity) along with an adjuvant analgesic (depending on cause) will result in good pain relief, but the challenge is to achieve good pain relief without unacceptable adverse effects.

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Application of quality control circle in the treatment of moderate cancer pain in inpatients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz214 ◽

2020 ◽

Vol 50 (5) ◽

pp. 581-585

Author(s):

Yehuan Liu ◽

Beibei Lin

Keyword(s):

Quality Of Life ◽

Quality Control ◽

Cancer Pain ◽

Pain Control ◽

Management Tool ◽

Control Group ◽

Observation Group ◽

Patients With Cancer ◽

Significant Difference

Abstract Context Pain is one of the most common and intolerable symptoms in cancer patients. But cancer pain control is still negative in China. Objectives This paper explores the application of quality control circle in the treatment of cancer pain in inpatients to improve the quality of life of patients with cancer pain. Method Established a quality control circle group to analyze the current status of cancer pain control in inpatients with moderate cancer pain, set goals, formulate corresponding countermeasures and implement and review them in stages. The plan-do-check-act method was cyclically applied. The Brief Pain Inventory was used to evaluate the cancer pain status of patients with cancer pain hospitalized before (January to April 2016) and after (September to December 2016) the implementation of quality control circle activities. Results The pain control effect of the observation group was significantly better than that of the control group. The mean (standard deviation) of pain severity and pain interference in the observation group were significantly lower than those in the control group (6.21 [2.86] vs 4.31 [2.25], 10.54 [4.10] vs 7.25 [3.77]). There was significant difference after the implementation of quality control circle (P < 0.01). Conclusion Quality control circle activities are used to manage patients with cancer pain, to improve the situation of pain control and to improve the quality of life of patients. This management tool and method is worthy of clinical promotion and application.

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Amitriptyline in Neuropathic Cancer Pain in Patients on Morphine Therapy: A Randomized Placebo-controlled, Double-blind Crossover Study

Tumori Journal ◽

10.1177/030089160208800310 ◽

2002 ◽

Vol 88 (3) ◽

pp. 239-242 ◽

Cited By ~ 69

Author(s):

Sebastiano Mercadante ◽

Edoardo Arcuri ◽

Walter Tirelli ◽

Patrizia Villari ◽

Alessandra Casuccio

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Adverse Effects ◽

Cancer Pain ◽

Pain Intensity ◽

Cancer Patients ◽

Double Blind ◽

Blind Crossover Study ◽

Double Blind Crossover Study

Aims and Background Amitriptyline is the most common analgesic adjuvant used in cancer patients with neuropathic pain, even though no specific studies have demonstrated a benefit. A randomized placebo-controlled, double-blind crossover study was designed to evidence the effects of amitriptyline in patients with neuropathic cancer pain. Methods Sixteen advanced cancer patients with neuropathic pain on systemic morphine therapy, no longer receiving oncologic treatment, presenting moderate pain (about 4 or more, but less than 7, on a numerical scale of 0-10) in the last week, and given a stable morphine dose in the last 2 days were admitted to the study. During the first week of study, patients were administered 25 mg of amitriptyline or equivalent drops of placebo at night for 3 days and 50 mg for the following 4 days. Doses for patients aged more than 65 years were 15 mg (first 3 days) and 30 mg (3 days after). After a week, a crossover took place for the second week, with the other treatment at an inverse sequence. Opioid consumption, pain intensity, symptoms and adverse effects, mood, sleep, patient's preference, quality of life before starting the study, the first week after and the second week after were recorded. Results No significant benefits in analgesia were found in the global pain intensity of the previous week of treatment, the least pain intensity or the pain evaluated just after a week of treatment, at the moment of the visit, when amitriptyline was compared with placebo. A significant difference was evidenced for the worst pain (P < 0.035). No differences in opioid doses during the period of study were found. Drowsiness, confusion and dry mouth were significantly more intense with amitriptyline than with placebo (P < 0.036, 0.003, and 0.034, respectively). There were no substantial differences between the two treatments in Spitzer's quality of life score and for each item. No differences in patients' preference for the two treatment periods were found. The analgesic effects of amitriptyline were slight and associated with adverse effects. Conclusions In light of the results obtained in the study, the extensive use of the drug for cancer pain should be questioned.

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Use of morphine in cancer pain management and quality of life in patients with cancer: An international point of view.

Ensho ◽

10.2492/jsir1981.19.81 ◽

1999 ◽

Vol 19 (2) ◽

pp. 81-84

Author(s):

Fumikazu Takeda

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Cancer Pain ◽

Point Of View ◽

Cancer Pain Management ◽

Patients With Cancer

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Quality of Life in Community-Dwelling Chinese American Patients with Cancer Pain

Journal of Immigrant and Minority Health ◽

10.1007/s10903-016-0392-4 ◽

2016 ◽

Vol 19 (6) ◽

pp. 1442-1448 ◽

Cited By ~ 5

Author(s):

Malcolm Barrett ◽

Alice Chu ◽

Jack Chen ◽

Kin Yui Lam ◽

Russell Portenoy ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Pain ◽

Chinese American ◽

Community Dwelling ◽

Patients With Cancer

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Sleep quality with WHO Step III opioid use for cancer pain

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001399 ◽

2018 ◽

Vol 9 (3) ◽

pp. 307-315 ◽

Cited By ~ 4

Author(s):

Gunnhild Jakobsen ◽

Morten Engstrøm ◽

Peter Fayers ◽

Marianne J Hjermstad ◽

Stein Kaasa ◽

...

Keyword(s):

Quality Of Life ◽

Sleep Quality ◽

Cancer Pain ◽

Advanced Cancer ◽

Poor Sleep ◽

Global Score ◽

Patients With Cancer ◽

Emotional Function ◽

Financial Difficulties

ObjectiveSleep is often disturbed in patients with advanced cancer. There is limited knowledge about sleep in patients with cancer treated with strong opioids. This study examines sleep quality in patients with advanced cancer who are treated with a WHO Step III opioid for pain.MethodsAn international, multicentre, cross-sectional study with 604 adult patients with cancer pain using WHO Step III opioids. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) global score (range; 0–21; score >5 indicates poor sleep). PSQI includes sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction. Pain and quality of life were assessed by Brief Pain Inventory and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core30.ResultsThe median age was 62 years, 42% were female, mean Karnofsky performance score (KPS) was 62.5 (±14.2) and mean oral daily morphine equivalent dose was 303 mg/24 hours (±543.8 mg). The mean PSQI global score was 8.8 (±4.2) (range 0–20). Seventy-eight per cent were poor sleepers. All PSQI components were affected, and 44% reported trouble sleeping caused by pain. In the multiple regression model, predictors of PSQI global scores were pain intensity, emotional function, constipation, financial difficulties and KPS (adjusted R2=0.21).ConclusionThe majority (78%) of these patients with cancer treated with Step III opioids experienced poor sleep quality. Pain intensity, emotional function, constipation, financial difficulties and KPS predicted poor PSQI global scores. The clinical implication is that healthcare personnel should routinely assess and treat sleep disturbance in patients with advanced cancer disease.

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Opioid-induced constipation in patients with cancer pain in Japan (OIC-J study): a post hoc subgroup analysis of patients with lung cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa186 ◽

2020 ◽

Author(s):

Hisao Imai ◽

Soichi Fumita ◽

Toshiyuki Harada ◽

Toshio Noriyuki ◽

Makio Gamoh ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Cancer Pain ◽

Diagnostic Criteria ◽

Bowel Function ◽

Early Management ◽

Patients With Cancer ◽

Bowel Movements ◽

Post Hoc

Abstract Objective To evaluate the opioid-induced constipation burden in the subgroup of patients with lung cancer who participated in the observational Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J) study. Methods The prospective, observational study, OIC-J, included 212 patients with various tumour types, 33% of whom had lung cancer. The incidence of opioid-induced constipation was evaluated using several diagnostic criteria, as well as the physician’s diagnosis and patient’s subjective assessment. Following initiation of opioids, patients recorded details of bowel movements (i.e. date/time, Bristol Stool Scale form, sensations of incomplete evacuation or anorectal obstruction/blockage and degree of straining) in a diary for 2 weeks. Relationships between patient characteristics and opioid-induced constipation onset and effects of opioid-induced constipation on quality of life were explored. Results In total, 69 patients were included in this post hoc analysis. The incidence of opioid-induced constipation varied (39.1–59.1%) depending on which diagnostic criteria was used. Diagnostic criteria that included a quality component or a patient’s feeling of bowel movement as an evaluation item (i.e. Rome IV, physician’s diagnosis, Bowel Function Index, patient’s assessment) showed higher incidences of opioid-induced constipation than recording the number of spontaneous bowel movements alone. Opioid-induced constipation occurred rapidly after initiating opioids and had a significant impact on Patient Assessment of Constipation Symptoms total score (P = 0.0031). Patient baseline characteristics did not appear to be predictive of opioid-induced constipation onset. Conclusions In patients with lung cancer, opioid-induced constipation can occur quickly after initiating opioids and can negatively impact quality of life. Early management of opioid-induced constipation, with a focus on quality-of-life improvement and patient’s assessments of bowel movements, is important for these patients.

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