Opioid-induced bowel dysfunction in cancer-related pain: Causes, consequences, and a novel approach for its management

2018 ◽  
Vol 5 (3) ◽  
pp. 145 ◽  
Author(s):  
Peter Holzer, PhD ◽  
Sam H. Ahmedzai, BSc, MBChB, FRCP ◽  
Norbert Niederle, MD ◽  
Petra Leyendecker, PhD ◽  
Michael Hopp, MD ◽  
...  
Keyword(s):  
Analgesic Efficacy ◽  
Bowel Function ◽  
Bowel Dysfunction ◽  
Opioid Therapy ◽  
Common Side Effect ◽  
Prolonged Release ◽  
The Novel ◽  
Patients With Cancer ◽  
Novel Approach

Opioids are the mainstay of management for patients with cancer-related pain. Although the analgesic efficacy of opioid therapy is well documented, the recent European Pain in Cancer survey demonstrated that the management of moderate-to-severe pain in patients with cancer is far from optimal. Bowel dysfunction, and importantly constipation, is a common side effect and has a significant impact on the patient’s morbidity and quality of life. Nonpharmacological strategies and laxatives are often not effective in the management of opioid-induced constipation (OIC), making it necessary to search for new strategies for the treatment of opioid-induced bowel dysfunction. One promising strategy is the prevention of OIC with peripherally acting opioid antagonists that specifically target the underlying cause of this condition, without affecting centrally mediated analgesia. In recent studies, the novel combination of prolonged-release oral oxycodone and prolonged-release oral naloxone provided effective analgesia with improved bowel function in patients suffering from severe cancer-related and noncancer-related pain. The combination has the potential to improve the quality of pain management significantly in these patients.

scholarly journals Opioid-induced constipation in patients with cancer pain in Japan (OIC-J study): a post hoc subgroup analysis of patients with gastrointestinal cancer

2020 ◽  
Vol 26 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Toshiyuki Harada ◽  
Hisao Imai ◽  
Soichi Fumita ◽  
Toshio Noriyuki ◽  
Makio Gamoh ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Bowel Function ◽  
Opioid Therapy ◽  
Common Side Effect ◽  
Post Hoc Analysis ◽  
Patients With Cancer ◽  
Gi Cancer ◽  
Bowel Movements ◽  
Baseline Characteristics ◽  
Post Hoc

Abstract Background Constipation is a common side effect of opioid therapy. An observational study of opioid-induced constipation (OIC) in Japanese patients with cancer (OIC-J) included 212 patients with various tumor types. This post hoc analysis of OIC-J evaluated a subgroup of patients with gastrointestinal (GI) cancer. Methods Patients were aged ≥ 20 years, starting strong opioid therapy, had an ECOG PS of ≤ 2, and must have had ≥ 3 bowel movements during the week before enrollment. OIC was evaluated for 2 weeks after opioid initiation using the Rome IV diagnostic criteria for colorectal disorders, as well as physician’s diagnosis, number of spontaneous bowel movements, Bowel Function Index score, and patient’s self-assessment. Relationships between baseline characteristics and OIC incidence, and the effects of OIC on quality of life (QOL) were also explored. Results Fifty patients from OIC-J who had GI cancer [colon (50%), stomach (28%), and esophageal (22%)] were included. OIC incidence varied by which diagnostic criteria were used (46.0–62.0%) and occurred rapidly after initiating opioid therapy. The use of prophylactic laxatives reduced the overall incidence rate of OIC from 71.0% to 47.4%. No baseline characteristics, except comorbidities, were associated with OIC incidence. Change from baseline to day 15 in PAC-SYM total score was significantly greater for patients with OIC versus those without OIC (0.188 versus −0.362; P = 0.0011). Conclusions This post hoc analysis suggests that OIC occurs rapidly in patients with GI cancer after initiating opioid therapy, and negatively impacts QOL. Early and effective intervention strategies may be particularly useful in this group. Additional Information Coauthor Makio Gamoh is deceased.

An Efficient and Effective Approach to Developing Engineering E-Training Courses

2011 ◽  
pp. 26-39
Author(s):  
Judy C.R. Tseng ◽  
Wen-Ling Tsai ◽  
Gwo-Jen Hwang ◽  
Po-Han Wu
Keyword(s):  
New Technologies ◽  
Experimental Results ◽  
Traditional Learning ◽  
The Novel ◽  
Learning Materials ◽  
Challenging Issue ◽  
Novel Approach ◽  
Training Courses ◽  
Oriented Approach

In developing traditional learning materials, quality is the key issue to be considered. However, for high technical e-training courses, not only the quality of the learning materials but also the efficiency of developing the courses needs to be taken into consideration. It is a challenging issue for experienced engineers to develop up-to-date e-training courses for inexperienced engineers before further new technologies are proposed. To cope with these problems, a concept relationship-oriented approach is proposed in this paper. A system for developing e-training courses has been implemented based on the novel approach. Experimental results showed that the novel approach can significantly shorten the time needed for developing e-training courses, such that engineers can receive up-to-date technologies in time.

The role of oxycodone/naloxone in pain management

Ból ◽  
2017 ◽  
Vol 17 (4) ◽  
pp. 26-40
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Anna Przeklasa-Muszyńska ◽  
Jan Dobrogowski
Keyword(s):  
Side Effects ◽  
Pain Treatment ◽  
Treatment Options ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Bowel Dysfunction ◽  
Prolonged Release ◽  
Gastrointestinal Side Effects ◽  
Strong Opioids ◽  
Pain Patients

ABSTRACT: Strong opioid analgesics are essential for pain treatment of moderate to severe intensity, regardless of its etiology. An important factor limiting safety and efficacy of opioids are side effects, particularly gastrointestinal. Constipation as part of opioid induced bowel dysfunction is one of the most common reason for discontinuation of strong opioids. Introduction of novel oxycodone/naloxone formulation is an attempt to resolve the problem of opioid induced gastrointestinal side effects. On the basis of clinical trials from 2008-2016 the authors discuss the applicability of oxycodone/naloxone prolonged release in management of different pain syndromes in humans, in cancer patients, in neuropathic pain patients, in the elderly, in acute post-operative pain and other clinical indications for example restless leg syndrome. Presented data indicate comparable or in some cases even better analgesic efficacy of oxycodone with naloxone and lower risk of gastrointestinal side effects, especially constipation, when compared to other strong opioids. The introduction of oxycodone with naloxone significantly expands treatment options for chronic pain patients, likewise improving safety and thus the effectiveness of treatment with strong opioids.

scholarly journals 293P Prolonged release (PR) oxycodone/naloxone (OXN) for cancer pain (CP) & its impact on bowel function, safety & quality of life (QoL): Systematic review

2020 ◽  
Vol 31 ◽  
pp. S1356
Author(s):  
S.H. Ahmedzai ◽  
A. Covarrubias-Gómez ◽  
G. De Simone ◽  
M. Green ◽  
L. Langenhoven ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cancer Pain ◽  
Bowel Function ◽  
Prolonged Release

scholarly journals Opioid-induced constipation in patients with cancer pain in Japan (OIC-J study): a post hoc subgroup analysis of patients with lung cancer

2020 ◽  
Author(s):  
Hisao Imai ◽  
Soichi Fumita ◽  
Toshiyuki Harada ◽  
Toshio Noriyuki ◽  
Makio Gamoh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Pain ◽  
Diagnostic Criteria ◽  
Bowel Function ◽  
Early Management ◽  
Patients With Cancer ◽  
Bowel Movements ◽  
Post Hoc

Abstract Objective To evaluate the opioid-induced constipation burden in the subgroup of patients with lung cancer who participated in the observational Opioid-Induced Constipation in Patients with Cancer Pain in Japan (OIC-J) study. Methods The prospective, observational study, OIC-J, included 212 patients with various tumour types, 33% of whom had lung cancer. The incidence of opioid-induced constipation was evaluated using several diagnostic criteria, as well as the physician’s diagnosis and patient’s subjective assessment. Following initiation of opioids, patients recorded details of bowel movements (i.e. date/time, Bristol Stool Scale form, sensations of incomplete evacuation or anorectal obstruction/blockage and degree of straining) in a diary for 2 weeks. Relationships between patient characteristics and opioid-induced constipation onset and effects of opioid-induced constipation on quality of life were explored. Results In total, 69 patients were included in this post hoc analysis. The incidence of opioid-induced constipation varied (39.1–59.1%) depending on which diagnostic criteria was used. Diagnostic criteria that included a quality component or a patient’s feeling of bowel movement as an evaluation item (i.e. Rome IV, physician’s diagnosis, Bowel Function Index, patient’s assessment) showed higher incidences of opioid-induced constipation than recording the number of spontaneous bowel movements alone. Opioid-induced constipation occurred rapidly after initiating opioids and had a significant impact on Patient Assessment of Constipation Symptoms total score (P = 0.0031). Patient baseline characteristics did not appear to be predictive of opioid-induced constipation onset. Conclusions In patients with lung cancer, opioid-induced constipation can occur quickly after initiating opioids and can negatively impact quality of life. Early management of opioid-induced constipation, with a focus on quality-of-life improvement and patient’s assessments of bowel movements, is important for these patients.

A virtual e-bespoke men's shirt based on new body measurements and method of pattern drafting

2020 ◽  
Vol 90 (19-20) ◽  
pp. 2223-2244
Author(s):  
Jiaqi Yan ◽  
Victor E Kuzmichev
Keyword(s):  
New Technologies ◽  
Apparel Industry ◽  
Morphological Features ◽  
Evaluation Procedure ◽  
Body Measurements ◽  
The Novel ◽  
Novel Approach ◽  
The One ◽  
High Level

Customization is prevailing in the apparel industry with increasing requirements from consumers and the popularization of new technologies. This study aimed to establish the novel approach of applying existing and new body measurements to customize the pattern block of a men's shirt, to enrich the anthropometric database, and to develop the fit evaluation procedure. New body measurements were extracted from 156 scanned male mesh bodies in accordance with the morphological features and developing method of pattern block sketching. Owing to these new body measurements, the customized shirt with assured high-level fit can be obtained by generating original patterns as bespoke, on the one hand, and by transforming ready-to-wear patterns, on the other hand. The first way is e-bespoke tailoring that utilizes the developed schedule of body morphological features, improved shirt pattern of desired style (body fit, slim fit, regular fit, and comfort fit), and virtual try-on software CLO 3D. The proposed method of virtual e-bespoke design allows readily completing a well-fitted and balanced men's shirt, which will contribute to the efficiency of customization and quality of end-products for the apparel industry.

scholarly journals Checkpoint inhibitors and radiotherapy in refractory malignant melanocytic schwannoma with Carney complex: first evidence of efficacy

2021 ◽  
Vol 14 (5) ◽  
pp. e240296
Author(s):  
Jyoti Bajpai ◽  
Akhil Kapoor ◽  
Rakesh Jalali ◽  
Mrinal M Gounder
Keyword(s):  
Progressive Disease ◽  
Checkpoint Inhibitors ◽  
External Beam Radiotherapy ◽  
Carney Complex ◽  
Spinal Nerve ◽  
The Novel ◽  
Nerve Roots ◽  
Novel Approach ◽  
History Of

Melanocytic schwannoma (MS) is a rare nerve sheath tumour characterised by melanin-producing neoplastic schwann cells that typically affects the posterior spinal nerve roots. We report an ultrarare case of recurrent/metastatic MS associated with Carney complex in a young woman with family history of breast cancer. This highlights the novel approach of combined checkpoint inhibitors (CPI) and radiotherapy. The patient was initially treated with Nivolumab along with concurrent external beam radiotherapy. There was sustained clinical benefit achieved for over 15 months with preserved quality of life. Addition of Ipilimumab, which she tolerated reasonably well, helped to control the progressive disease again for another 12 months. She harboured a rare PRKAR1A R228 mutation (Carney complex) and received appropriate targeted therapy. She survived for 51 and 35 months from her initial diagnosis and start of CPI, respectively, which to the best of our knowledge is the longest documented survival in this rare entity.

Effects of prolonged-release oxycodone/naloxone on pain control, bowel function and quality of life: A prospective observational study

2014 ◽  
Vol 5 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Sabine Hesselbarth ◽  
Oliver Löwenstein ◽  
Thomas Cegla
Keyword(s):  
Pain Intensity ◽  
Functional Impairment ◽  
Pain Control ◽  
Bowel Function ◽  
Control Group ◽  
Prolonged Release ◽  
Data Set ◽  
Strong Opioids ◽  
Higher Doses

AbstractBackground and aimStrong opioids including oxycodone are amongst the most effective analgesics to combat moderate to severe pain of various aetiologies, but opioid-induced bowel dysfunction (OIBD) represents a relevant problem. The rationale for development of a prolonged-release (PR) fixed combination of oxycodone and naloxone was to counteract OIBD. Due to its negligible oral bioavailability, the μ-opioid receptor antagonist naloxone is able to selectively displace opioids from local μ-receptors in the gastrointestinal tract without affecting central opioid binding sites. Pivotal trials of PR oxycodone/naloxone not only demonstrated improved bowel function but also equivalent analgesic efficacy compared to PR oxycodone alone. Controlled clinical trials comparing PR oxycodone/naloxone with strong opioids other than oxycodone are not available. The present study is the first data set aimed at comparing pain control, bowel function, and quality of life (QoL) in patients newly treated with or switched to PR oxycodone/naloxone or other strong opioids during routine clinical practice.MethodsIn this three-arm, prospective observational study, 588 patients with moderate to severe pain of varying aetiologies received either PR oxycodone/naloxone (OXN group and OXN 40/20 group with indicated use of the 40 mg/20 mg dose strength at baseline) or other strong opioids (control group), dosed according to pain severity, for 4–6 weeks. Data documented include pain intensity (NRS), bowel function (Bowel Function Index, BFI), pain-related functional impairment (BPI-SF), QoL (EuroQol EQ-5D-3L), and a global assessment of treatment.ResultsPatients receiving PR oxycodone/naloxone experienced a clinically important reduction in pain intensity and pain-related functional impairment of approximately 40%. The reductions of pain intensity (−2.9 ± 2.3) and pain-related functional impairment (−2.4 ± 2.3) in the OXN group were significantly more pronounced than in the control group (−2.1 ± 2.1 and −1.8 ± 1.7). In the control group, mean reductions in pain intensity did not reach the threshold of ≥30% for at least moderate clinically important differences, although patients were prescribed higher doses of morphine equivalents than OXN group patients. Improvements in bowel function (OXN: −16.0 ± 27.6; control: 3.1 ± 24.4) and QoL (OXN: 20.8 ± 24.2; control: 13.2 ± 23.1) were also significantly more pronounced in the OXN group, with BFI scores reduced to a level that reflects normal bowel function. Results for the OXN 40/20 group receiving higher doses of PR oxycodone/naloxone were in line with those for the OXN group. In the control group, more frequent gastrointestinal adverse events and less favourable ratings of tolerability resulted in a higher rate of treatment discontinuations due to adverse events.ConclusionsIn patients receiving PR oxycodone/naloxone, more favourable outcomes compared with other strong opioids regarding pain control, bowel function, and QoL were observed.ImplicationsThe present findings underline the value of PR oxycodone/naloxone in the management of patients with moderate to severe chronic pain. The data set further adds to our understanding of the benefits and risks of opioid treatment in routine clinical practice.

An Efficient and Effective Approach to Developing Engineering E-Training Courses

2008 ◽  
pp. 1901-1914
Author(s):  
Judy C.R. Tseng ◽  
Wen-Ling Tsai ◽  
Gwo-Jen Hwang ◽  
Po-Han Wu
Keyword(s):  
New Technologies ◽  
Experimental Results ◽  
Traditional Learning ◽  
The Novel ◽  
Learning Materials ◽  
Challenging Issue ◽  
Novel Approach ◽  
Training Courses ◽  
Oriented Approach

In developing traditional learning materials, quality is the key issue to be considered. However, for high technical e-training courses, not only the quality of the learning materials but also the efficiency of developing the courses needs to be taken into consideration. It is a challenging issue for experienced engineers to develop up-to-date e-training courses for inexperienced engineers before further new technologies are proposed. To cope with these problems, a concept relationship-oriented approach is proposed in this paper. A system for developing e-training courses has been implemented based on the novel approach. Experimental results showed that the novel approach can significantly shorten the time needed for developing e-training courses, such that engineers can receive up-to-date technologies in time.

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