scholarly journals Effectiveness of Nerve Blocks for Management of Head and Neck Cancer Associated Neuropathic Pain Disorders; a Retrospective Study

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Khawaja Shehryar Nasir ◽  
Haroon Hafeez ◽  
Arif Jamshed ◽  
Raza Hussain
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Pain Score ◽  
Nerve Block ◽  
Neck Cancer ◽  
Retrospective Chart Review ◽  
Research Centre ◽  
Fisher Exact Test ◽  
Nerve Blocks

Introduction: A portion of patients with head and neck cancer (HNC)-associated pain may not experience relief in symptoms with non-invasive modalities. A nerve block is a procedure in which a local anesthetic agent is injected along the nerve track to preferentially block sensory transmission. The literature on the effectiveness of nerve blocks in the management of HNC-related pain is limited. The purpose of this study was to determine the effectiveness of nerve blocks in management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders. Materials and Methods: A retrospective chart review of patients who underwent a nerve block or infiltration procedure in the regions of head and neck for management of breakthrough HNC-associated trigeminal or cervical neuropathic pain disorders in the Orofacial Pain Medicine clinic, Shaukat Khanum Memorial Cancer Hospital and Research Centre, between November 2018 and November 2019 was completed. Information regarding demographics, diagnosis, and pain characteristics was extracted and reviewed. The Fisher-exact test and Mann-Whitney U test were used for analysis between independent and dependent variables. Results: A total of 27 participants were included in the investigation, of which 66.7 % were males. The average pre-procedure pain score was 6.85 ± 2.54. Following intervention, 81.5 % of the participants experienced greater than 75 % relief in pain for longer than 48 hours. The mean immediate post-procedure pain score was 0.26 ± 1.02 and the average duration of relief was 6.10 ± 6.50 weeks. The significant effect of nerve blocks was found to be statistically associated with the concurrent use of amitriptyline (p = 0.017). Conclusion: Nerve blocks, as an adjunctive therapy to pharmacologic treatment, can provide significant relief to patients with breakthrough HNC-associated trigeminal and cervical neuropathic pain disorders. However, the duration of relief experienced by the participants is inconsistent. The beneficial effect of nerve blocks appears to be more common in patients that were concurrently using amitriptyline.

scholarly journals Identifying Neuropathic Pain in Patients with Head and Neck Cancer: Use of the Leeds Assessment of Neuropathic Symptoms and Signs Scale

2003 ◽  
Vol 96 (8) ◽  
pp. 379-383 ◽  
Author(s):  
Jean Potter ◽  
Irene J Higginson ◽  
John W Scadding ◽  
Columba Quigley
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Care Physician ◽  
Pain Specialist ◽  
Bedside Test ◽  
Symptoms And Signs

The Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) is a simple bedside test in two parts—a patient-completed questionnaire and a brief clinical assessment. Its diagnostic capabilities have never been tested in patients with cancer pain. To determine these we conducted a prospective study in outpatients with head and neck cancer. All patients with pain completed the LANSS and underwent a medical assessment with a palliative care physician, whose findings were then reviewed by a pain specialist blinded to the LANSS scores. We assessed acceptability and understanding of the LANSS by patients and calculated the sensitivity and specificity of total LANSS scores and subscores derived from the patient-completed section. Of 130 patients approached, 125 took part. 25 (20%) of these had cancer related pain, mean score on an 11 point numerical rating scale 6.3 (median 6.0, range 3-10). Average age was 60 years (median 60, range 27-84); 56% were male. LANSS completion time was about five minutes, and the procedure was acceptable to all patients. The pain specialist diagnosed neuropathic pain in 14/25 patients, in 13 of whom the neuropathic pain was part of a mixed pain picture. The LANSS correctly identified 11 of these cases (sensitivity 79%; specificity 100%). The patient-completed section alone had a sensitivity of 86% and a specificity of 91%. The LANSS is a simple and suitable screening test for neuropathic pain in patients with head and neck cancer related pain, although some modifications might improve it.

Cisplatin plus gemcitabine (GC) as induction chemotherapy in locally advanced head and neck cancer (HANC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6073-6073 ◽  
Author(s):  
A. Jamshed ◽  
R. Hussain ◽  
S. Ahmed ◽  
K. Rehman ◽  
K. Shehzad ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Haematological Toxicity ◽  
Active Agent ◽  
Research Centre ◽  
Induction Treatment

6073 Background: Cisplatin/infusional 5-fluorouracil chemotherapy is routinely administered as standard induction chemotherapy in advanced HANC. However, the optimum treatment remains to be defined. Gemcitabine is an active agent in HANC and few studies have evaluated induction GC in HANC. We have explored the activity and toxicity of GC as induction treatment in HANC and report the results. Methods: From August 2005 to September 2006, 55 patients with locally advanced HANC had induction chemotherapy with GC at Shaukat Khanum Memorial Cancer Hospital and Research Centre. We reviewed the medical records and prospectively collected data to determine activity and toxicity of induction GC. M:F ratio was 64%:36% with a median age of 50 years (range 19–80). All patients had histologically confirmed squamous cell carcinoma. The site of disease was nasopharynx, paranasal sinuses, oral cavity, oropharynx, larynx and hyopharynx in 4% (2), 11% (6), 51% (21), 2% (1), 11% (6) and 22% (11) respectively. According to AJCC staging 7% (4) had stage III and 93% (51) had stage IVa/IVb disease (T3N0 7%, T3N+ 2%, T4N0 38% and T4N+ 53%). Induction chemotherapy consisted of 2 cycles of cisplatin 75 mg/m2 day 1 and gemcitabine 1000 mg/m2 day 1 and 8 with treatment repeated three weekly. Fifty-three (94%) patients received 2 cycles as planned. Toxicity was scored after each cycle according to the NCI.CTC criteria. Response was assessed following completion of induction chemotherapy by clinical examination/MRI scan. Results: All patients were available for assessment of toxicity and response. A total of 111 cycles were delivered. The response rates are: complete 24% (13), partial 62% (34), no response 7% (4) and progression 7% (4). The overall response rate was 86% (complete 24%, partial 62%). No treatment related deaths occurred. Haematological G3/G4 toxicity included neutropenia (13%/7%) and thrombocytopenia (5%/0%). The non-haematological toxicity observed (nausea, vomiting and diarrhoea) was only G1/G2. Conclusions: GC is well tolerated with low toxicity and high anti tumour activity as neoadjuvant chemotherapy treatment in squamous cell head and neck cancer. Combination GC arm should be included in future trials. No significant financial relationships to disclose.

Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer

2016 ◽  
Vol 65 ◽  
pp. 121-129 ◽  
Author(s):  
J. Haumann ◽  
J.W. Geurts ◽  
S.M.J. van Kuijk ◽  
B. Kremer ◽  
E.A. Joosten ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer

scholarly journals HEAD AND NECK CANCER IN A DEVELOPING COUNTRY- A HOSPITAL BASED RETROSPECTIVE STUDY ACROSS 10 YEARS FROM PAKISTAN

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Abdul Waheed Anwer ◽  
Muhammad Faisal ◽  
Awais Amjad Malik ◽  
Arif Jamshed ◽  
Raza Hussain ◽  
...  
Keyword(s):  
Developing Countries ◽  
Head And Neck Cancer ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Developing Country ◽  
Neck Cancer ◽  
Research Centre ◽  
Western World ◽  
Healthcare Facilities

Purpose: Head and neck cancers (HNC) are among the most common cancers in developing countries, especially in the Southeast Asia. Oral cavity is the most commonly affected site. The risk factors are tobacco, betel nut and alcohol. The dimensions of the disease are quite different in developing countries than the western world. Poor socioeconomic status, poverty, lack of healthcare facilities and illiteracy are the factors that pose a major challenge to the management of the disease. The aim of this study is to analyse the database that has been collected over a period of 10 years showing the trends of the disease and the management outcome of these individuals.Methods: Men and women diagnosed with HNC from 2004 to 2014 from Cancer Registry Database of Shaukat Khanum Memorial Cancer Hospital and Research Centre have been retrospectively analysed.Results: In the 10 year period a total of 5027 patients presented to the head and neck clinic at our institution with a mean age + standard deviation of patients of 58.33 + 20.54. Oral cavity (42.6%) and larynx (13%) were the two mostcommon sites followed by the less frequent ones. Squamous cell carcinoma ranked as the most common histological type presented to our institute (69.2%), followed by basal cell carcinoma (6.6%), mucoepidermoid carcinoma (4%), adenoid cystic carcinoma (3.6%) and 1.9% adenocarcinoma.Conclusions: Being a third world country, the burden of the disease on the healthcare system is enormous. With limited resources and funding, there is a need to train people in the speciality and develop the National Cancer ControlProgram (NCCP) for better monitoring and disease control.Key words: Developing country, head and neck cancer, health infrastructure

Methadone is superior to fentanyl in treating neuropathic pain in patients with head-and-neck cancer

2016 ◽  
Vol 68 ◽  
pp. 199-200
Author(s):  
Xiulu Ruan ◽  
Jin Jun Luo ◽  
Alan David Kaye
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer

Retrospective analysis of the incidence and severity of acute kidney injury (AKI) in patients with head and neck cancer receiving weekly cisplatin with radiotherapy (RAISe-AKI)

2020 ◽  
pp. 107815522097845
Author(s):  
Stephen J Dierckes ◽  
Morgan E Ragsdale ◽  
Monica R Macik ◽  
Kellie J Weddle
Keyword(s):  
Head And Neck Cancer ◽  
Adverse Events ◽  
Head And Neck ◽  
Retrospective Analysis ◽  
Neck Cancer ◽  
Low Dose ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Weekly Cisplatin

Introduction Low-dose, weekly cisplatin (40 mg/m2) regimens are currently utilized at Eskenazi Health in Indianapolis, Indiana for the treatment of head and neck cancer due to enhanced tolerability. This retrospective analysis analyzes the incidence, severity, and risk factors for AKI in patients who received this regimen. Methods A retrospective chart review was conducted including patients with head and neck cancer treated with weekly, low dose cisplatin (40 mg/m2) with concurrent radiotherapy (RT). From this criteria, 22 patients were identified and included in the final analysis. AKI was defined by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Results Of the 22 patients included, 12 (54.5%) experienced AKI, with 10 patients (45.5%) experiencing grade 1 AKI and 2 patients (9.1%) experiencing grade 2 AKI. Six patients (27.3%) required dose adjustments or delays due to renal adverse events, all of which had initial cisplatin total weekly doses of >70 mg. Those receiving a total weekly cisplatin dose of >70 mg were found to have a higher risk of developing an episode of AKI compared to the group receiving <70 mg (p = 0.029). Conclusion This analysis showed patients receiving weekly doses >70 mg of cisplatin as their initial treatment dose for head and neck cancer were more likely to experience AKI. There are inconsistencies in the frequency of AKI in our study compared to published literature; however, this comparison is difficult due to the small sample size of our trial. This demonstrates the need for further investigation into the issue.

scholarly journals Diagnostic-To-Treatment Interval and Disease Progression among Head and Neck Cancer Patients Undergoing Surgery

2017 ◽  
Vol 32 (1) ◽  
pp. 33-36
Author(s):  
Gerard F. Lapiña ◽  
Samantha S. Castañeda
Keyword(s):  
Head And Neck Cancer ◽  
Tumor Progression ◽  
Head And Neck ◽  
Disease Progression ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Retrospective Chart Review ◽  
Treatment Delay ◽  
Treatment Interval ◽  
Number Of Patients

Objectives: To determine whether the interval from pathological diagnosis to treatment is significantly delayed, and the presence or absence of disease progression occurring in those with, and without treatment delay, among head and neck cancer patients in our institution. Methods: Study Design:            Retrospective Chart Review Setting:                       Tertiary Government Hospital Subjects: Medical records of 70 patients with newly diagnosed head and neck cancer who underwent primary surgery from January 2011 to December 2015 were retrieved and available data were extracted.  Results:  A total of 28 patients were included in this study.  Majority of the cancers were in the larynx (42.9%) and oral cavity (42.9%).  The mean diagnostic-to-treatment interval (DTI) was 54 days, but 5(17.8%) out of the 28 had a DTI of more than 60 days. Four (80%) with a DTI more than 60 days had an upstage during surgery while 4 (17.4%) patients with DTI less than or equal to 60 days also had an upstage. 2 (60%) patients with treatment delay had tumor progression compared to 5 (21.7%) of those without treatment delay.  Only 1 (20%) out of the 5 patients with treatment delay had increased nodal metastasis in contrast to 8 (34.8%) of those who did not have treatment delay. Conclusion:  A number of patients undergoing surgery in our institution experienced delay to initiate treatment of more than 60 days and majority of these patients were noted to have disease progression. However, even patients with treatment prior to 60 days had increases in tumor stage, which may suggest that the interval aimed for should be shorter than 60 days. Keywords: head and neck cancer, treatment delay, diagnostic interval, tumor progression

Longitudinal Perioperative Pain Assessment in Head and Neck Cancer Surgery

2017 ◽  
Vol 126 (9) ◽  
pp. 646-653 ◽  
Author(s):  
Marisa R. Buchakjian ◽  
Andrew B. Davis ◽  
Sebastian J. Sciegienka ◽  
Nitin A. Pagedar ◽  
Steven M. Sperry
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Postoperative Pain ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pain Assessment ◽  
Preoperative Pain ◽  
Pain Diary ◽  
Perioperative Pain ◽  
Pain Scores

Objective: To evaluate perioperative pain in patients undergoing major head and neck cancer surgery and identify associations between preoperative and postoperative pain characteristics. Methods: Patients undergoing head and neck surgery with regional/free tissue transfer were enrolled. Preoperative pain and validated screens for symptoms (neuropathic pain, anxiety, depression, fibromyalgia) were assessed. Postoperatively, patients completed a pain diary for 4 weeks. Results: Twenty-seven patients were enrolled. Seventy-eight percent had pain prior to surgery, and for 38%, the pain had neuropathic characteristics. Thirteen patients (48%) completed at least 2 weeks of the postoperative pain diary. Patients with moderate/severe preoperative pain report significantly greater pain scores postoperatively, though daily pain decreased at a similar linear rate for all patients. Patients with more severe preoperative pain consumed greater amounts of opioids postoperatively, and this correlated with daily postoperative pain scores. Patients who screened positive for neuropathic pain also reported worse postoperative pain. Conclusion: Longitudinal perioperative pain assessment in head and neck patients undergoing surgery suggests that patients with worse preoperative pain continue to endorse worse pain postoperatively and require more narcotics. Patients with preoperative neuropathic pain also report poor pain control postoperatively, suggesting an opportunity to identify these patients and intervene with empiric neuropathic pain treatment.

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