Breakthrough Pain in Patients with Lung Cancer. A Secondary Analysis of IOPS MS Study

Aim: To characterize breakthrough cancer pain (BTcP) in patients with lung cancer. Methods: This was a secondary analysis of multicenter study of patients with BTcP. Background pain intensity and opioid dose were recorded. The number of BTcP episodes, their intensity, predictability, onset, duration and interference with daily activities were collected. Opioids used for BTcP, the mean time to meaningful pain relief after taking medication, satisfaction and adverse effects were assessed. Results: 1087 patients with lung cancer were examined. In comparison with other tumors, patients with lung cancer showed: higher background pain intensity (p = 0.006), lower opioid doses (p = 0.005), higher intensity of BTcP (p = 0.005), movement (79.5%) and cough (8.2%), as principal triggers for predictable BTcP (p < 0.009), larger BTcP interference with daily activity (p = 0.0001), higher use of adjuvants (p = 0.0001). No relevant differences in the other parameters examined were found. Conclusion: Patients with lung cancer have their own peculiarities, including higher basal and BTcP pain intensity and the use of more adjuvant drugs for background pain. The most frequent triggers for predictable BTcP are movement and cough. Future studies should be performed to analyze the prevalence of BTcP in patients with different lung cancers as well as the optimal management strategy for background pain and BTcP.

Download Full-text

The use of intravenous morphine for breakthrough pain in terminal cancer patients admitted to hospice center.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20621 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20621-e20621

Author(s):

Ik-Joo Chung ◽

Sang-Hee Cho ◽

Jun-Eul Hwang ◽

Jae-Sook Ahn ◽

Won-young Choi ◽

...

Keyword(s):

Adverse Effects ◽

Pain Intensity ◽

Breakthrough Pain ◽

Terminal Cancer ◽

Care Clinic ◽

Opioid Dose ◽

Study Results ◽

Intravenous Morphine ◽

The Mean ◽

Moderate Nausea

e20621 Background: The adequate opioid dose to be administered for breakthrough pain(BTP) is still controversial. Dosing recommendations are based on patient’s(pts) total daily opioid dose. Intravenous morphine(IV-M) has been found to be effective and safe for the management of BTP. However, physicians are often reluctant in using large doses of IV-M because of the possible adverse events in terminal cancer pts. The aim of this study was to evaluate whether pts were treated appropriately for their BTP in hospice setting. Methods: A total of 94 consecutive terminal cancer pts who were admitted in the Hospice and Palliative Care Clinic at Jeonnam Regional Cancer Center from June 2012 to Nov 2012 were analyzed in this study. Results: In total, 1,213 BTP events treated by IV-M were recorded and the mean number of events per pts was 13.6 (95% confidence interval (CI) 10.5-15.4). The mean dose of IV-M was 13.9mg (95% CI 12.5-14.5mg, range 3-90mg) and was equivalent to 7.1% of the total daily opioid dose. For each episode, pain intensity and opioid-related symptoms were recorded at the base (T0) and within 30 minutes after (T1). Pain intensity decreased from a mean of 5.1(on a 0-10 numeric scale) at base to 1.8 at T1. A decrease in pain of more than 30%, 50% and 70% was observed in 1179 (97.2%), 958 (78.9%) and 460 (37.9%) BTP events, respectively. In 21 episodes, no changes in pain intensity were observed and a further dose of IV-M was given. Doses of more than 10mg, 30mg and 50mg of IV-M were given for 456 (37.6%), 200 (16.5%) and 104(8.6%). No differences in age, sex and pain location were found. Adverse effects were uncommon, moderate nausea/vomiting in 32 episodes, drowsiness in 15 episodes, and confusion in one episode. Conclusions: In the current study, IV-M was safe and effective for almost all episodes of BTP. This study shows that IV-M did not result in life-threatening adverse effects in terminal cancer pts, including older pts and those requiring relatively large doses.

Download Full-text

Adrenal metastases: clinical manifestations and surgical outcomes

Cancer Urology ◽

10.17650/1726-9776-2018-14-2-79-87 ◽

2018 ◽

Vol 14 (2) ◽

pp. 79-87 ◽

Cited By ~ 1

Author(s):

V. R. Latypov ◽

O. S. Popov ◽

V. N. Latypova ◽

M. Yu. Grishchenko

Keyword(s):

Lung Cancer ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Tumor Size ◽

Renal Cell ◽

Clinical Manifestations ◽

Adrenal Metastasis ◽

Adrenal Metastases ◽

The Mean ◽

Mean Time

Background. The adrenal glands are one of the most common sites of metastases in malignant disease, particularly lung cancer. The frequency of adrenal metastasis in patients with breast cancer and lung cancer reaches 39 and 35 % respectively.Materials and methods. A total of 156 patients with adrenal tumors underwent surgical treatment in the Siberian State Medical University between December 1998 and July 2017. The study included 16 (10.2 %) patients (9 males and 7 females) with adrenal metastases. The mean age of study participants was 57.6 years (range: 44–73 years).Results. By the moment of surgery, the mean metastatic adrenal tumor size was 4.9 ± 3.0 cm (range: 1.0–10.2 cm). Thirteen out of 16 patients had adrenal metastases from renal cell carcinoma, one patient – from colon cancer, one patient – from lung cancer, and one patient – from breast cancer. Nine patients had left-sided adrenal metastases, whereas six patients had right-sided adrenal metastases. Synchronous adrenal metastasis was detected in two cases: one patient had adrenal metastasis at the side of the renal tumor; the other one had bilateral renal cell carcinoma with both adrenal glands affected.We identified three main variants of the disease course according to prevailing clinical manifestations of adrenal metastasis: no manifestations, pain syndrome, and arterial hypertension.Seven participants had no clinical manifestations; of them, 6 patients had renal cell carcinoma, whereas 1 patient had breast cancer. The mean time between surgical removal of the primary tumor and detection of adrenal metastases was 24.1 months; the mean tumor size was 4.5 cm.Pain syndrome was observed in 5 patients. In three of them, adrenal metastases derived from renal cell carcinoma, in one patient – from lung cancer, and in one patient – from colon cancer. The mean time between removal of the primary tumor and detection of adrenal metastases was 19.8 months; the mean tumor size was 5.4 cm.Arterial hypertension was diagnosed in four patients. The mean time between removal of the primary tumor and identification of adrenal metastases was 27.3 months; the mean tumor size was 4.1 cm. The five-year overall survival rate in operated patient was 47.8 %.Conclusion. Regular examinations of patients after surgical treatment of malignant tumors are needed to detect adrenal metastases; surgery can extend the patient’s life. can extend the patient’s life.

Download Full-text

Intrathecal Analgesia Via a Percutaneous Port For the Management of Movement-Evoked Breakthrough Cancer Pain of Refractory Lower Extremity Cancer Pain: A Retrospective Review and Commentary

10.21203/rs.3.rs-885466/v1 ◽

2021 ◽

Author(s):

Liang Zhou ◽

Zhenggang Guo

Keyword(s):

Lower Extremity ◽

Cancer Pain ◽

Pain Intensity ◽

Breakthrough Pain ◽

Infusion Therapy ◽

The Mean ◽

Intractable Cancer Pain ◽

Time To Onset ◽

Morphine Equivalent ◽

Intrathecal Analgesia

Abstract Background and Objectives: Intrathecal analgesia (ITA) is a trusty treatment option for refractory and intractable cancer pain. However, there is still no general consensus on the analgesic effect of movement-evoked breakthrough pain (MEBTP) in the ITA setting. This study examined the effect of patient-controlled intrathecal analgesia (PCIA) on analgesic efficacy, emphasizing movement evoked breakthrough pain (MEBTP) in patients with refractory lower extremity cancer pain. Methods: A retrospective chart review included all patients with refractory lower extremity cancer pain who received Intrathecal morphine infusion therapy via percutaneous port (IMITPP) at our hospital between January 2017 and December 2020. Data on the numerical pain rating scales (NRS) scores, opioid doses, and complications were collected from medical records prior to IMITPP and at a one-month postimplant visit.Results: A total of 16 patients were included in the study group. Mean SRPI (spontaneous resting pain intensity) decreased from 8.75 pre- IMITPP to 3.75 post- IMITPP, (P < 0.001); mean MEPI (movement-evoked breakthrough pain intensity) fell from 8.83 pre- IMITPP to 4.25 post- IMITPP (P < 0.001); mean daily morphine equivalent dosing decreased from 360 mg/d to 48mg/d (P< 0.001); mean daily morphine equivalent dosing for MEBTP decreased from 87 mg/d to 6 mg/d (P< 0.001). Both total and breakthrough dosing of conventional opioid medications significantly decreased following the initiation of ITT with PCIA. The mean perceived time to onset with conventional movement evoked breakthrough medications was 38 minutes, and the mean perceived time to onset with PCIA was 8 minutes (P < 0.001). Conclusions: IMITPP was associated with improved pain control in patients with refractory lower extremity cancer pain. Compared with conventional MEBTP medication, appropriate PCIA provided superior analgesia and a much faster onset of action.

Download Full-text

Remission from Depression among Adults with Arthritis: A 12-Year Followup of a Population-Based Study

Depression Research and Treatment ◽

10.1155/2014/828965 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Esme Fuller-Thomson ◽

Marla Battiston ◽

Tahany M. Gadalla ◽

Yael Shaked ◽

Ferrah Raza

Keyword(s):

Chronic Pain ◽

Panel Study ◽

Secondary Analysis ◽

Population Based ◽

National Population Health Survey ◽

Community Based ◽

Population Based Study ◽

Kaplan Meier ◽

The Mean ◽

Mean Time

Individuals with arthritis are vulnerable to depression. In this study, we calculated time to remission from depression in a representative community-based sample of depressed Canadians with arthritis who were followed for 12 years. We conducted secondary analysis of a longitudinal panel study, the National Population Health Survey, which was begun in 1994/95 and has included biennial assessment of depression since that time. Our analysis focused on a total of 216 respondents with arthritis who were depressed at baseline. The mean time to remission from depression was calculated using the Kaplan-Meier procedure and compared across categories of each of the potential predictors. The percentage of those no longer screening positive for depression was calculated at two years after baseline. At two years after baseline, 71% of the sample had achieved remission from depression. Time to remission was significantly longer for those depressed adults who were under the age of 55, those who reported more chronic pain at baseline, those with comorbid migraine, and those who experienced childhood physical abuse or parental addictions. These findings highlight the importance of screening for these factors to improve the targeting of interventions to depressed patients with arthritis.

Download Full-text

The Impact of Preemptive Perianal Anaesthetic Block in Open Haemorrhoidectomy – a randomised controlled trial

10.53350/pjmhs211592165 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2165-2167

Author(s):

Wajeeha I. Andrabi ◽

M Asadullah Khawaja ◽

K. Fatima ◽

S I. Hussain Andrabi ◽

A. Shafique ◽

...

Keyword(s):

Placebo Group ◽

Hospital Stay ◽

Pain Intensity ◽

P Value ◽

Open Hemorrhoidectomy ◽

Group A ◽

The Mean ◽

Group B ◽

The Impact ◽

Mean Time

Background: the study was conducted to analyze the efficacy of 0.75% ropicaine at perianal block for open haemrrhoidectomy with regards to pain intensity, first demand of analgesia and hospital stay. Method: 50 patients were selected for open haemrrhoidectomy under GA which were divided into two groups.it was a randomized control trial in which sealed envelope method was used for the group delegation in which Group A was designated to the patients having the perianal block with 0.75% ropivacaine while the group B was the placebo group having normal saline injected in the perianal region. The variables compared were the first demand of analgesia, pain intensity and the duration of the hospital stay. In order to make the site of injection more authentic the injections were sited under ultrasound guidance. Results: The pain intensity which was analyzed with the visual analogue score (VAS) had a median of 3.8 (high=6, low=3) in group A while 5.5 (high=8, low=4) in the Group B with the p value of < 0.05. The mean time recorded for the first demand of analgesia was 6.20 ± 1.20 hours in the Group A which had improved from 1.20 ± 1.0 hours in the Placebo Group while the p value was < 0.001, while the mean time of hospital stay got reduced from 22.5±3.30 hours to 12.4 ± 3.10 hours with the significant p value of < 0.002. Conclusion: It was observed that with preemptive analgesia with 0.75% ropivacaine administered led to a substantial reduction in pain perception, request for an analgesic and hospital stay. Therefore it is appropriate to administer it before open hemorrhoidectomy. Keywords: preemptive anaesthesia, local anesthesia, postoperative pain, ropivacaine, open hemorrhoidectomy

Download Full-text

Is Pain Intensity a Predictor of the Complexity of Cancer Pain Management?

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.1660 ◽

2009 ◽

Vol 27 (4) ◽

pp. 585-590 ◽

Cited By ~ 63

Author(s):

Robin L. Fainsinger ◽

Alysa Fairchild ◽

Cheryl Nekolaichuk ◽

Peter Lawlor ◽

Sonya Lowe ◽

...

Keyword(s):

Pain Management ◽

Cancer Pain ◽

Pain Intensity ◽

Classification System ◽

Pain Control ◽

Severe Pain ◽

Cox Regression ◽

Secondary Analysis ◽

Initial Assessment ◽

Opioid Dose

Purpose The lack of a standardized cancer pain (CP) classification system prompted the development of the Edmonton Classification System for Cancer Pain (ECS-CP). Its five features have demonstrated value in predicting pain management complexity. Pain intensity (PI) at initial assessment has been proposed as having additional predictive value. We hypothesized that patients with moderate to severe CP would take longer to achieve stable pain control, use higher opioid doses, and require more complicated analgesic regimens than would patients with mild CP at initial assessment. Methods A secondary analysis of a multicenter ECS-CP validation study involving patients with advanced cancer was conducted (n = 591). Associations between PI and length of time to stable pain control (Cox regression), final opioid dose (Kruskal-Wallis one-way analysis of variance), and number of adjuvant modalities (χ2) were calculated. PI at initial assessment was defined using a numerical scale as mild (0 to 3), moderate (4 to 6), or severe (7 to 10). Results Patients with moderate and severe pain required a significantly longer time to achieve stable pain control (P < .0001). PI was a significant predictor of length of time to stable pain control in the univariate regression analysis. The four significant predictors in the multivariate model were moderate and severe PI (P < .0001), age (P = .001), and neuropathic pain (P = .002). Patients with moderate to severe pain required significantly higher final opioid doses (P < .0001) and more adjuvant modalities (P = .015). Conclusion PI at initial assessment is a significant predictor of pain management complexity and length of time to stable pain control. Incorporation of this feature into the ECS-CP needs additional consideration.

Download Full-text

Ultrasound-Guided Radiofrequency Treatment of Intercostal Nerves for the Prevention of Incidental Pain Arising Due to Rib Metastasis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115617933 ◽

2016 ◽

Vol 34 (2) ◽

pp. 115-124 ◽

Cited By ~ 5

Author(s):

Arif Ahmed ◽

Sushma Bhatnagar ◽

Deepa khurana ◽

Saurabh Joshi ◽

Sanjay Thulkar

Keyword(s):

Quality Of Life ◽

Functional Status ◽

Breakthrough Pain ◽

Short Form ◽

Opioid Dose ◽

Sf 36 ◽

Background Pain ◽

Intercostal Nerves ◽

Incidental Pain

Background: Breakthrough pain (BTP) arising due to rib metastasis is very distressing and often very difficult to manage by titration of traditional analgesics. This study is undertaken to determine the efficacy of radiofrequency (RF) treatment of intercostal nerves for the prevention of BTP. Methods: The RF treatment of the intercostal nerves was carried out in 25 patients with uncontrolled BTP arising out of the rib metastasis. The intensity and episode of BTP, background pain, opioid dose, functional status (Karnofky score), and quality of life (Short-Form Health Survey [SF-36]) were noted at baseline visit and subsequently after the RF treatment. Results: After the RF treatment, there was more than 50% decrease in both intensity and frequency of BTP in more than 50% of patients for 3 months, and there was more than 50% decrease in BTP opioid dose in more than 50% of patients throughout the study period. There was also significant improvement in background pain, functional status, and the quality of life after the RF. Interestingly, pain relief, lowering of opioid dose, and functional status improvement were found mostly in patients with mixed and neuropathic type of pain and in patients in whom the metastasis were confined to the ribs only. Conclusion: RF of the intercostal nerves is effective in preventing and deceasing the severity of BTP arising due to rib metastasis in selected group of patients with mixed and neuropathic type of pain and with the metastasis involving the ribs only.

Download Full-text

Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients

Cancers ◽

10.3390/cancers10060175 ◽

2018 ◽

Vol 10 (6) ◽

pp. 175 ◽

Cited By ~ 19

Author(s):

Sebastiano Mercadante ◽

Paolo Marchetti ◽

Arturo Cuomo ◽

Augusto Caraceni ◽

Rocco Mediati ◽

...

Keyword(s):

Pain Intensity ◽

Cancer Patients ◽

Clinical Presentation ◽

Breakthrough Pain ◽

Fast Onset ◽

Long Duration ◽

Background Pain ◽

Different Characteristics ◽

Interdependent Relationships ◽

Variable Presentation

Background: The aim of this study was to identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP). Methods: Cancer patients with a diagnosis of BTP were enrolled. Demographic and clinical characteristics, as well as background pain and BTP characteristics were collected. Multivariate analyses were conducted to assess the correlation between BTP characteristics and the variables examined. Results: Data of 4016 patients were analysed. Average daily number of BTP episodes was 2.4, mean intensity was 7.5, and a mean duration was 43.3 min. A short onset BTP was observed in 68.9% of patients. In 30.5% of patients BTP was predictable. There were 86.0% of participants who reported a marked interference of BTP with their daily activities. Furthermore, 86.8% of patients were receiving opioids for the management of BTP. The average time to meaningful pain relief was 16.5 min and 70.9% of patients were satisfied with their BTP medications. Age, head and neck cancer, Karnofsky, background pain intensity, predictable and fast onset BTP were independently associated with the number of BTP episodes. BTP pain intensity was independently associated with background pain intensity, fast onset BTP, and Karnofsky. Neuropathic pain mechanism was independently associated with unpredictable BTP. Variables independently associated with a longer duration of BTP were age, place of visit, cancer diagnosis, disease-oriented therapy, background pain intensity and mechanism, and unpredictable BTP. Age, Karnofsky, background pain intensity, fast onset, and long duration of BTP were independently associated with interference with daily activity. Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics.

Download Full-text

Efficacy of Ketamine Hcl and Tramadol Hcl by epidural route for lower abdominal surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193269 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1188

Author(s):

B. Srinivasulu Reddy ◽

G. Pratapa Reddy

Keyword(s):

Postoperative Pain ◽

Postoperative Pain Management ◽

Catheter Migration ◽

Background Pain ◽

Pain Pathway ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Time ◽

Ketamine Hcl

Background: Pain pathway has profound implications for management of acute pain and provoked interest in the use of pre-emptive analgesia and new methods of postoperative pain management with new agents like opioid and non-opioid drugs either independently or in combination. The objective of the study was to study efficacy of Ketamine Hcl and Tramadol Hcl (preservative free) by epidural route for lower abdominal surgeries.Methods: This study has been conducted on hundred patients in the age group of 20 to 50 years. These patients have undergone various lower abdominal surgeries, gynecological and surgical procedures. Failed epidurals, catheter kinking, catheter migration and dural puncture cases are excluded from the study. The patients were divided into two groups namely Group-A and Group-B, with 50 patients in each group.Results: Both groups were similar in terms of age, sex and weight. In Group-A patients who received 30 mg of Ketamine, the mean time of onset of analgesia being 17.01+2.65 minutes compared to 12.18+2.28 minutes in Group -B patients who received 100 mg of tramadol, In Group-A the mean time of duration of analgesia is 6.75+0.46 hours compared to 9.36+0.84 hours in Group-B. Nausea and vomiting (24% vs. 2%), urinary retention (4% vs. 2%) was more in group B compared to group A patients. Backache was equal in both the group patients (6% vs. 6%). Pain on injection more in group A patients i.e. 8% compared to only 2% in patients who belonged to group B.Conclusions: Epidural tramadol is superior to epidural ketamine for postoperative pain relief.

Download Full-text