Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Opioids May be Appropriate for Chronic Pain

2020 ◽  
Vol 48 (2) ◽  
pp. 241-248 ◽  
Author(s):  
Paul J. Christo
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Treatment Option ◽  
Severe Pain ◽  
Opioid Therapy ◽  
Therapeutic Options ◽  
Opioid Epidemic ◽  
Pain Care

Patients living with chronic pain require appropriate access to opioid therapy along with improved access to pain care and additional therapeutic options. It's both medically reasonable and ethical to consider opioid therapy as a treatment option in the management of chronic, non-cancer pain for a subset of patients with severe pain that is unresponsive to other therapies (e.g., injections, other medications, integrative strategies), negatively impacts function or quality of life, and will likely outweigh the potential harms. This paper will examine opioid therapy in the setting of the opioid epidemic, why critics feel that the CDC guideline has resulted in harsh consequences for patients and their physicians, and the rationale for opioid therapy as a means of providing ethical and compassionate pain care.

scholarly journals Patient Experiences With Integrated Pain Care: A Qualitative Evaluation of One VA’s Biopsychosocial Approach to Chronic Pain Treatment and Opioid Safety

2019 ◽  
Vol 8 ◽  
pp. 216495611983884 ◽  
Author(s):  
Natalie Purcell ◽  
Kara Zamora ◽  
Carolyn Gibson ◽  
Jennifer Tighe ◽  
Jamie Chang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Treatment ◽  
Wide Spectrum ◽  
Qualitative Evaluation ◽  
Patient Experiences ◽  
Limited Effectiveness ◽  
Care Models ◽  
Pain Care

Background Mounting concern about the risks and limited effectiveness of opioid therapy for chronic pain has spurred the implementation of novel integrated biopsychosocial pain care models in health-care systems like the Department of Veterans Affairs (VA). However, little is known about patient experiences with these new care models. Objective We conducted a qualitative study to examine patient experiences with a pain care model currently being disseminated at the VA: interdisciplinary, integrated pain teams (IPTs) embedded in primary care. Method We interviewed 41 veterans who received care from VA’s first IPT to learn how working with the team impacted their pain care and quality of life. We asked about their overall experience with IPT, what worked and did not work for them, and what changes they would recommend to improve IPT care. Results The interviews revealed a wide spectrum of patient experiences and varying perspectives on the extent to which the new model improved their pain and quality of life. Thematic analysis shed light on factors impacting patients’ experiences, including pretreatment goals and expectations as well as attitudes toward opioids and nonpharmacological treatments. Conclusion We discuss the implications of our findings for national efforts to implement biopsychosocial pain care, and we offer recommendations to promote patient-centered implementation.

Obstructive sleep apnea is common in patients with high-impact chronic pain – an exploratory study from an interdisciplinary pain center

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Dennis Boye Larsen ◽  
Laila Bendix ◽  
Karin Abeler ◽  
Kristian Kjær Petersen ◽  
Michael Sprehn ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Clinical Utility ◽  
Pain Treatment ◽  
Objective Assessment ◽  
High Impact ◽  
Sleep Monitoring ◽  
Predictive Values ◽  
Clinical Pain ◽  
Obstructive Sleep

Abstract Objectives Sleep disturbances are increasingly recognized as a major part of chronic pain pathology. Obstructive sleep apnea (OSA) is a common occurrence in patients with chronic pain attending specialized pain clinics, yet its prevalence remains unclear. Using screening tools such as the Berlin and STOP-BANG questionnaires may aid in early identification of OSA and improve clinical care. This study i) examined the frequency of OSA based on objective sleep monitoring in patients with high-impact chronic pain, ii) explored potential differences in self-reported pain and sleep characteristics between patients with and without OSA, and iii) tested the agreement between OSA classification based on objective assessment and two OSA screening questionnaires. Methods A consecutive cohort of 90 patients (71 women and 19 men; mean age: 47.1 ± 11.0 years) referred for interdisciplinary pain treatment, underwent one night of sleep monitoring using portable respiratory polygraphy (RP), and suspected OSA was confirmed with polysomnography (PSG). Self-reported data on clinical pain (severity, pain drawings and health-related quality of life), sleep characteristics (sleep quality insomnia, sleepiness), and risk of OSA (Berlin and STOP-BANG questionnaires) were collected the day before RP assessment. Results Forty-six (51.1%) patients were classified with OSA according to RP and verified with PSG. Twenty-eight patients (31.1%) had moderate or severe OSA (apnea-hypopnea index [AHI] >15). Patients with OSA reported lower sleep quality compared with patients without OSA. Scores on pain severity, disability, quality of life, insomnia and sleepiness were comparable between patients with and without OSA. Sensitivity and specificity were 78.6 and 45.2% respectively for the Berlin questionnaire, and 71.4 and 58.1% respectively for the STOP-BANG questionnaire. The agreement for both questionnaires with objective assessment was poor-to-fair. Both questionnaires had acceptable negative predictive values but low positive predictive values reducing the clinical utility to identify patients with low OSA-risk in this sample. Conclusions The current study demonstrates a high prevalence of OSA in patients with high-impact chronic pain referred to specialized pain treatment, however the clinical pain profiles were similar in patients with and without OSA. The Berlin and STOP-BANG questionnaires have poor specificity and low-to-fair agreement with RP/PSG questioning their clinical utility in identifying OSA in this sample.

scholarly journals The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 113
Author(s):  
Mo Chen ◽  
Tejal Patel ◽  
Feng Chang
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Family Health ◽  
Primary Care Settings ◽  
Pain Intervention ◽  
Family Health Team ◽  
The Impact

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

scholarly journals Wikipedia: A Medical Student Educational Project to Edit Wikipedia in Preparation for Practicing Evidence-Based Pain Medicine

2020 ◽  
Vol 7 ◽  
pp. 238212052095969
Author(s):  
Diana Kantarovich ◽  
Hanna B Vollbrecht ◽  
Sebastian A Cruz ◽  
Hector Castillo ◽  
Cody S Lee ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Students ◽  
Evidence Based Medicine ◽  
Medical Information ◽  
Medical Curriculum ◽  
Evidence Based ◽  
Online Information ◽  
Pain Medicine ◽  
Based Medicine

Objective: Wikipedia is commonly used to acquire information about various medical conditions such as chronic pain. Ideally, better online pain management content could reduce the burden of opioid use disorders. Our goal was to improve the quality of the content available on Wikipedia to make it more accurate and applicable to medical students and the general public while training medical students to practice evidence-based medicine and critically assess their sources of information. Methods: An elective class in Neuroscience, Pain, and Opioids composed of 10 medical students met biweekly to discuss landmark and practice-changing research articles in the fields of acute pain, chronic pain, and opioid management. The professor chose Wikipedia articles relevant to this course. Three independent viewers analyzed the quality of citations, anecdotal medical content, and content value for both patients and medical professionals. As part of their coursework, students then edited the Wikipedia articles. Results: Although some of the Wikipedia pain topic content (6.7% ± 2.0) was anecdotal, financially biased, or inconsistent with Western Medical Practice content, overall articles included primarily high-quality citations (85.6% ± 3.1). On a 0-5 Likert scale, students felt content would be moderately helpful for both medical students/professionals (3.4 ± 0.2) and laypersons (3.5 ± 0.2). Editing and adding citations was feasible, but novel material was often reverted. Conclusion: A significant amount of pain medicine content was relevant and amenable to student editing. Therefore, future use of this tactic could provide a unique opportunity to integrate evidence-based medicine into the medical curriculum and have a direct impact on the widely available medical information. Future refinement in the editorial process may also further improve online information.

Israel

2018 ◽  
Author(s):  
Elon Eisenberg ◽  
Silviu Brill
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
End Of Life ◽  
Acute Pain ◽  
Later Life ◽  
Recent Innovation ◽  
History Of ◽  
Prevalence Of Pain ◽  
Pain Care

Israel is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.

France

2018 ◽  
Author(s):  
Didier Bouhassira ◽  
Nadine Attal
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
End Of Life ◽  
Acute Pain ◽  
Later Life ◽  
Recent Innovation ◽  
History Of ◽  
Prevalence Of Pain ◽  
Pain Care

France is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.

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