Grid-climbing Behaviour as a Pain Measure for Cancer-induced Bone Pain and Neuropathic Pain

In the management of pain associated with serious illness, ‘adjuvant analgesics’ usually are administered in concert with opioid therapy in an effort to improve outcomes when an opioid does not provide satisfactory relief with tolerable side effects. They may be divided into categories, including multipurpose drugs, and drugs used selectively for neuropathic pain, bone pain, pain due to bowel obstruction, or musculoskeletal pain. These drugs are selected for a trial based on limited data available and clinical experience; sequential trials may be undertaken when pain is refractory. Multipurpose drugs may be considered for any type of pain. The most useful include corticosteroids and analgesic antidepressants. For neuropathic pain, conventional first-line agents are gabapentinoids, analgesic antidepressants, and corticosteroids. Corticosteroids and bisphosphonates, are used commonly for bone pain. The indications and dosing strategies for these drugs are evolving as scientific evidence and clinical experience accumulate.

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Ketamine for acute and subacute pain in opioid-tolerant patients

Journal of Opioid Management ◽

10.5055/jom.2008.0023 ◽

2018 ◽

Vol 4 (3) ◽

pp. 173 ◽

Cited By ~ 21

Author(s):

Shoshana Chazan, RN ◽

Margaret P. Ekstein, MD ◽

Nissim Marouani, MD ◽

Avi A. Weinbroum, MD

Keyword(s):

Neuropathic Pain ◽

Epidural Analgesia ◽

Severe Pain ◽

Bone Pain ◽

Phantom Pain ◽

Chronic Ischemia ◽

Central Neuropathic Pain ◽

Pain Syndromes ◽

Metastatic Bone Pain ◽

New Onset

Prolonged acute pain, especially that of oncologic neurological origin, is at times difficult to control; it is seldom entirely alleviated by opioids. We report eight patients with severe pain, three of whom suffered from new onset oncologic metastatic bone pain, others had previous pain syndromes and presented with exacerbation of pain. Pain was associated with hyperalgesia and allodynia phenomena in two patients and with phantom pain in a third one. Tolerance to opioids had developed, and high IV doses of morphine, meperidine or fentanyl, and patient-controlled intravenous and epidural analgesia were insufficient. Several patients became dependent on opioids and could not be weaned from assisted ventilation.Pain was controlled with decreasing adjunct doses of ketamine. Within 5-10 days of ketamine and opioid protocols, pain was controlled and after an additional 5-7 days, ketamine could be stopped and pain controlled on oral regimens compatible with outpatient care.Ketamine is an efficient adjuvant analgesic for intractable severe pain, caused by metastasis, trauma, chronic ischemia, or central neuropathic pain. It is effective even when mega doses of IV, epidural, or oral opioids prove ineffective and when signs of tolerance have developed.

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Complex Regional Pain Syndrome (CRPS/RSD) and Neuropathic Pain: Role of Intravenous Bisphosphonates as Analgesics

The Scientific World JOURNAL ◽

10.1100/tsw.2008.33 ◽

2008 ◽

Vol 8 ◽

pp. 229-236 ◽

Cited By ~ 19

Author(s):

Jennifer Yanow ◽

Marco Pappagallo ◽

Letha Pillai

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Animal Models ◽

Complex Regional Pain Syndrome ◽

Bone Pain ◽

Treatment Options ◽

Pain Syndrome ◽

Pain Pathways ◽

Intravenous Bisphosphonates

Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS) types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology remains elusive and whose available treatment options remain few. While an exact animal model for CRPS doesn't yet exist, there are several animal models of neuropathic pain that develop behaviors of hypersensitivity, one of the hallmark signs of neuropathic pain in humans.Bisphosphonates have been used for pathologic conditions associated with abnormal bone metabolism, such as osteoporosis, Paget’s disease and cancer-related bone pain for many years. More recently, results of clinical trials have indicated the potential role of bisphosphonates in the treatment of CRPS/RSD.In this paper we will review the preclinical studies regarding the use of bisphosphonates as analgesics in animal models of neuropathic pain, and also summarize the clinical trials that have been done to date. We will give an overview of bisphosphonate pharmacology and discuss several potential mechanisms by which bisphosphonates may be analgesic in CRPS/RSD and bone pain of noncancer origin.

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Adjuvants

10.1093/med/9780198745457.003.0007 ◽

2016 ◽

Author(s):

Richard D.W. Hain ◽

Satbir Singh Jassal

Keyword(s):

Neuropathic Pain ◽

Bone Pain ◽

Muscle Spasm ◽

Evidence Based ◽

Pain Syndromes ◽

Selection Of

An adjuvant is not analgesic but is capable of relieving pain in certain specific pain situations. Selection of an appropriate adjuvant is a key element of a rational and evidence-based approach to management of pain in children. It depends on the diagnosis of the type of pain, considered in this chapter in relation to the selection of a suitable adjuvant, based on recognizing the nature of the pain to be treated. Adjuvants for specific types of pain, including neuropathic pain, bone pain, muscle spasm, and cerebral irritation, and pain syndromes are discussed in detail, with information provided on symptoms and management.

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Neuropathic Pain Features in Patients With Bone Metastases Referred for Palliative Radiotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.6559 ◽

2010 ◽

Vol 28 (33) ◽

pp. 4892-4897 ◽

Cited By ~ 43

Author(s):

Marc Kerba ◽

Jackson S.Y. Wu ◽

Qiuli Duan ◽

Neil A. Hagen ◽

Michael I. Bennett

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Bone Metastases ◽

Bone Pain ◽

Oral Morphine ◽

Comprehensive Cancer Center ◽

Life Questionnaire ◽

Eortc Qlq C30 ◽

Eortc Qlq

Purpose To estimate the prevalence of pain with neuropathic features among patients with metastatic bone pain and to assess differences between patients with and without neuropathic features by pain severity, functional interference, and quality-of-life (QOL) measures. Patients and Methods A prospective cross-sectional survey of consecutive patients with symptomatic bone metastases was conducted between December 2006 and March 2008 at a comprehensive cancer center. Patients completed the Brief Pain Inventory (BPI), the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30). Statistical associations between pain with neuropathic features and other measures were explored. Results Ninety-eight patients were enrolled. Seventeen percent of patients (95% CI, 10% to 24%) had positive S-LANSS scores suggesting pain with neuropathic features. Mean worst pain and mean interference scores were 7.2 (standard deviation [SD], 2.0) and 5.8 (SD, 2.5), respectively. EORTC QLQ-C30 global QOL, function, and symptom scores were 42 (SD, 24), 52 (SD, 20), and 46 (SD, 17), respectively. Patients with neuropathic features had a higher BPI worst pain score than patients without neuropathic features (8.3 v 7.0, respectively; P = .016). Corticosteroid use, oral morphine equivalent dosing, and site of bone pain were not associated with neuropathic features. Conclusion Some patients with bone metastases manifest bone pain with distinguishable neuropathic features, and these patients reported greater pain intensity. Additional work is required to validate the S-LANSS against clinical criteria for neuropathic pain in this context and to explore the unmet pain management needs in this population.

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