Impact of Cannabis Use on Least Pain Scores Among African American and White Patients with Cancer Pain: A Moderation Analysis

BACKGROUND Pain ratings reported by patients with cancer continue to increase, and numerous computer and phone apps for managing cancer-related pain have been developed recently; however, whether these apps effectively alleviate patients’ pain remains unknown. OBJECTIVE This study aimed to comprehensively evaluate the role of mobile apps in the management of cancer pain. METHODS Literature on the use of apps for cancer pain management and interventions, published before August 2019, was retrieved from the following databases: MEDLINE, Embase, Cochrane, CINAHL, Scopus, and PsycINFO. The effects of apps on cancer pain were evaluated using RevMan5.3 software, and the rates of adverse drug reactions were analyzed using the R Statistical Software Package 3.5.3. RESULTS A total of 13 studies were selected for the analysis: 5 randomized controlled trials (RCTs), 4 before-after studies, 2 single-arm trials, 1 prospective cohort study, and 1 prospective descriptive study. The 5 RCTs reported data for 487 patients (240 patients in the intervention group and 247 patients in the control group), and the remaining studies reported data for 428 patients. We conducted a meta-analysis of the RCTs. According to the meta-analysis, apps can significantly reduce pain scores (mean difference [MD]=–0.50, 95% CI –0.94 to –0.07, I2=62%, P=.02). We then used apps that have an instant messaging module for subgroup analysis; these apps significantly reduced patients’ pain scores (MD=–0.67, 95% CI –1.06 to –0.28, I2=57%, P<.01). Patients using apps without an instant messaging module did not see a reduction in the pain score (MD=0.30, 95% CI –1.31 to 1.92, I2=70%, P=.71). Overall, patients were highly satisfied with using apps. Other outcomes, such as pain catastrophizing or quality of life, demonstrated greater improvement in patients using apps with instant messaging modules compared with patients not using an app. CONCLUSIONS The use of apps with instant messaging modules is associated with reduced pain scores in patients with cancer-related pain, and patient acceptance of these apps is high. Apps without instant messaging modules are associated with relatively higher pain scores. The presence of an instant messaging module may be a key factor affecting the effect of an app on cancer pain.

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African Americans With Cancer Pain Are More Likely to Receive an Analgesic With Toxic Metabolite Despite Clinical Risks: A Mediation Analysis Study

Journal of Clinical Oncology ◽

10.1200/jco.2013.54.7992 ◽

2014 ◽

Vol 32 (25) ◽

pp. 2773-2779 ◽

Cited By ~ 28

Author(s):

Salimah H. Meghani ◽

Youjeong Kang ◽

Jesse Chittams ◽

Erin McMenamin ◽

Jun J. Mao ◽

...

Keyword(s):

African American ◽

Adverse Effects ◽

Cancer Pain ◽

Strong Predictor ◽

Private Insurance ◽

Toxic Metabolite ◽

Opioid Prescription ◽

Insurance Type ◽

To Receive ◽

White Patients

Purpose Renal impairment is highly prevalent among patients with cancer, and many patients have undiagnosed chronic kidney disease (CKD) from underlying disease, treatment, or both. African American individuals have disproportionate risk factors (diabetes, hypertension) predisposing them to CKD. We investigated whether African American patients are more likely than white patients to receive morphine with 3- and 6-glucuronide metabolites, which are known to be neurotoxic and accumulate in CKD; whether insurance type mediates the relationship between race and the prescriber's opioid selection; and whether the chosen opioid has a resultant negative effect according to race. Patients and Methods Patients (N = 182) were recruited from oncology clinics within the University of Pennsylvania Health System. Inclusion was based on self-identified African American or white race, age older than 18 years, and the presence of cancer-related pain plus a prescription for morphine or oxycodone. Kidney function was estimated using the abbreviated Modification of Diet in Renal Disease formula. Results Patients with CKD who received morphine reported a greater severity of analgesic-related adverse effects than patients with CKD who received oxycodone (P = .010). Controlling for health insurance type, African American patients had 71% lower odds of receiving a prescription of oxycodone than white patients (P < .001). Limiting analysis to those with CKD, the effect of private insurance became insignificant. However, race still remained a significant predictor of the prescribed opioid selection. Race was a strong predictor of adverse effect severity in the presence of CKD, and the type of opioid selection partially mediated this relationship. Conclusion Reducing racial disparities in the type of opioid prescription and understanding mechanisms of disproportionate opioid-related adverse effects in African American patients might decrease the clinical disparities in cancer pain outcomes.

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Modifiable pathways from pain to functional status: Confirmatory baseline results from a randomised trial of African American patients with cancer pain

European Journal of Cancer Care ◽

10.1111/ecc.12994 ◽

2019 ◽

pp. e12994 ◽

Cited By ~ 2

Author(s):

April Hazard Vallerand ◽

Thomas N. Templin ◽

Susan M. Hasenau ◽

Angelika Maly

Keyword(s):

African American ◽

Cancer Pain ◽

Functional Status ◽

Randomised Trial ◽

Patients With Cancer

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Disparities Between Black and White Patients with Cancer Pain: The Effect of Perception of Control over Pain

Pain Medicine ◽

10.1111/j.1526-4637.2005.05038.x ◽

2005 ◽

Vol 6 (3) ◽

pp. 242-250 ◽

Cited By ~ 43

Author(s):

April Hazard Vallerand ◽

Susan Hasenau ◽

Thomas Templin ◽

Deborah Collins-Bohler

Keyword(s):

Cancer Pain ◽

Black And White ◽

Patients With Cancer ◽

Perception Of Control ◽

White Patients

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Benefits of Mobile Apps for Cancer Pain Management: Systematic Review

JMIR mhealth and uhealth ◽

10.2196/17055 ◽

2020 ◽

Vol 8 (1) ◽

pp. e17055 ◽

Cited By ~ 2

Author(s):

Caiyun Zheng ◽

Xu Chen ◽

Lizhu Weng ◽

Ling Guo ◽

Haiting Xu ◽

...

Keyword(s):

Pain Management ◽

Cancer Pain ◽

Instant Messaging ◽

Mobile Apps ◽

Meta Analysis ◽

Control Group ◽

Cancer Pain Management ◽

Patients With Cancer ◽

Pain Scores ◽

Reported Data

Background Pain ratings reported by patients with cancer continue to increase, and numerous computer and phone apps for managing cancer-related pain have been developed recently; however, whether these apps effectively alleviate patients’ pain remains unknown. Objective This study aimed to comprehensively evaluate the role of mobile apps in the management of cancer pain. Methods Literature on the use of apps for cancer pain management and interventions, published before August 2019, was retrieved from the following databases: MEDLINE, Embase, Cochrane, CINAHL, Scopus, and PsycINFO. The effects of apps on cancer pain were evaluated using RevMan5.3 software, and the rates of adverse drug reactions were analyzed using the R Statistical Software Package 3.5.3. Results A total of 13 studies were selected for the analysis: 5 randomized controlled trials (RCTs), 4 before-after studies, 2 single-arm trials, 1 prospective cohort study, and 1 prospective descriptive study. The 5 RCTs reported data for 487 patients (240 patients in the intervention group and 247 patients in the control group), and the remaining studies reported data for 428 patients. We conducted a meta-analysis of the RCTs. According to the meta-analysis, apps can significantly reduce pain scores (mean difference [MD]=–0.50, 95% CI –0.94 to –0.07, I2=62%, P=.02). We then used apps that have an instant messaging module for subgroup analysis; these apps significantly reduced patients’ pain scores (MD=–0.67, 95% CI –1.06 to –0.28, I2=57%, P<.01). Patients using apps without an instant messaging module did not see a reduction in the pain score (MD=0.30, 95% CI –1.31 to 1.92, I2=70%, P=.71). Overall, patients were highly satisfied with using apps. Other outcomes, such as pain catastrophizing or quality of life, demonstrated greater improvement in patients using apps with instant messaging modules compared with patients not using an app. Conclusions The use of apps with instant messaging modules is associated with reduced pain scores in patients with cancer-related pain, and patient acceptance of these apps is high. Apps without instant messaging modules are associated with relatively higher pain scores. The presence of an instant messaging module may be a key factor affecting the effect of an app on cancer pain.

Download Full-text