Effectiveness of opioid rotation in the control of cancer pain: The ROTODOL Study

2014 ◽  
Vol 10 (6) ◽  
pp. 395 ◽  
Author(s):  
Jesús González-Barboteo, MD ◽  
Xavier Gómez-Batiste Alentorn, MD, PhD ◽  
Felipe A. Calvo Manuel, MD, PhD ◽  
Vicente Alberola Candel, MD ◽  
M. Amalia Palacios Eito, MD ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Gastrointestinal Symptoms ◽  
Tertiary Hospital ◽  
Opioid Rotation ◽  
Average Pain ◽  
Control Pain

Objective: To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR. Setting: Thirty-nine tertiary hospital services.Patients: Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics.Intervention: Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (NRS) of 0-10. Average pain (AP) intensity in the last 24 hours, breakthrough pain (BTP), and the number of episodes of BTP on the days before and 1 week after OR were assessed. The pre-OR and post-OR opioid were recorded. The presence and intensity of any AEs occurring after OR were also recorded.Results: In the 67 patients evaluated, 75 ORs were recorded. In all cases, the main reason for OR was poor pain control. Pain intensity decreased by ≥2 points after OR in 75.4 percent and 57.8 percent of cases for AP and BTP, respectively. If the initial NRS score was ≥4, a decrease below <4 accounted for 50.9 percent and 32.3 percent of cases for AP and BTP, respectively. The number of episodes of BTP also decreased significantly (p < 0.001). A total of 107 AEs were reported, most of which were mild in intensity, with gastrointestinal symptoms predominating.Conclusions: Opioid rotation appears to be both safe and effective in the management of basal and breakthrough cancer pain.

Factors influencing the analgesic response over time of the oxycodone-naloxone association in painful cancer patients: GREAT study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10089-10089
Author(s):  
Oscar Corli ◽  
Lorenzo Legramandi ◽  
Mirko Marabese ◽  
Anna Roberto
Keyword(s):  
Pain Intensity ◽  
Cancer Patients ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Analgesic Efficacy ◽  
Average Pain ◽  
Numerical Rating ◽  
Analgesic Response ◽  
Over Time

10089 Background: The prolonged use of opioids is usually associated with the appearance of adverse events as drowsiness, constipation, nausea/vomiting, and dizziness. Some effects are self-limiting over time for the onset of tolerance while others, as constipation, persist. Clinical studies demonstrated that the association oxycodone-naloxone (OXN), reduced the constipation in the presence of unchanged analgesic efficacy. Though, the variability of the analgesic response to OXN is not explained yet. The aim of this study was to evaluate the association between the clinical and genetics factors and analgesics response at OXN. Methods: In this study the cancer patients with moderate to severe pain received OXN and followed for 28 days. At each visit pain intensity modifications of therapy and adverse drug reactions (ADRs) were recorded. The primary efficacy endpoint was the proportion of responders, defined as patients with a decrease of the average pain intensity from baseline to last visit ≥30% and a final average pain score≤4, measured on 0-10 numerical rating scale. Genetic tests to identify SNPs related to opioid response were performed in each patient. Results: 14 centers participated in the study and recruited 206 patients. Among 176 patients analyzed for a primary endpoint the mean age was 68 (SD 10); 56% were male. Average and worst pain intensity decreased from baseline to last visit from 6.2 to 2.9 and from 8.3 to 4.6 respectively. 81% of patients were responders. Digestive system tumors (p = 0.05), concomitant thyroid endocrinopathy (p = 0.023), psychological irritability (p = 0.0029) and breakthrough pain at baseline were found to decrease the risk of positive response. None of the investigated polymorphisms influenced the analgesic response. Moderate to severe intensity ADRs were mainly constipation (26%), drowsiness (19%) and dry mouth (12%). Conclusions: In patients with moderate to severe cancer pain, OXN showed a strong analgesic effect (about 50% pain reduction). In comparison with other studies the induced constipation appears substantially lower. Some clinical factors influence the analgesic response while none genetic polymorphisms modulate the response. Clinical trial information: NCT02293785.

scholarly journals Luaran Penggunaan Analgesik Opiat pada Pasien Kanker

2019 ◽  
Vol 9 (4) ◽  
pp. 284
Author(s):  
Salma Fajar Puspita ◽  
Zullies Ikawati, Apt. ◽  
Retno Muliawati
Keyword(s):  
Quality Of Life ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Disease Status ◽  
Cancer Center ◽  
Transdermal Fentanyl ◽  
Reduction Of Pain

Cancer pain might reduce the quality of life of cancer patients. Opioids are the drug of choice in cancer pain management. Fentanyl and other opioids are often prescribed. This study was aimed to compare the pain intensity reduction and quality of life of patients with cancer pain using transdermal fentanyl and other opioids. This prospective cohort study Oinvolved cancer outpatients with pain at the Tulip International Cancer Center of RSUP Dr. Sardjito, Yogyakarta fulfilling inclusion and exclusion criteria. Follow-up was carried out 2 weeks after recruitment. Pain intensity and quality of life were obtained through interview process using Numerical Rating Scale (NRS) and EORTC QLQ-C30 questionnaire. Patient demographic and disease status were obtained from medical records. Clinical outcomes (reduction in pain intensity and achievement of pain targets) and quality of life in the transdermal fentanyl and oral opioid groups were presented descriptively because of the low research power. Total respondents involved were 111 patients, 13 (11.71%) patients used transdermal fentanyl and 98 (88.29%) patients used oral opiates. The effect of opioid on reduction of pain intensity, achievement of pain targets and quality of life cannot be justified even though descriptively transdermal fentanyl shows better outcomes than oral opioid. The reduction of pain intensity was influenced by age (p = 0,000) and global health status was influenced by the stage of the cancer (p = 0.045).

scholarly journals Intravenous Oxycodone versus Intravenous Morphine in Cancer Pain: A Randomized, Open-Label, Parallel-Group, Active-Control Study

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Kyung-Hee Lee ◽  
Jung-Hun Kang ◽  
Ho-Suk Oh ◽  
Moon-Ki Choi ◽  
Byoung-Yong Shim ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Adverse Events ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Efficacy And Safety ◽  
Open Label ◽  
Patients With Cancer ◽  
Average Pain Intensity ◽  
Average Pain

Objective. To compare efficacy and safety of intravenous continuous infusion of oxycodone with morphine in patients with cancer pain.Methods. A 5-day, randomized, open-label, exploratory study at 6 sites in the Republic of Korea. Sixty-six adults aged ≥19 years with moderate-to-severe cancer pain (Numeric Rating Scale [NRS] ≥ 4) were enrolled. The study group received intravenous (IV) oxycodone, and the comparator group received IV morphine which were titrated depending on pain intensity. The efficacy endpoint is change in average NRS score from baseline to Day 5. Other assessments included worst, current, and average pain intensity; patient satisfaction; medication dose; and adverse events.Results. Both groups achieved >50% reduction in average pain intensity: from “moderate” at baseline (oxycodone versus morphine: 6.0 ± 1.8 versus 5.9 ± 1.4) to “mild” at Day 5 (2.5 ± 1.8 versus 2.8 ± 1.6). While this reduction was similar between groups (3.5 ± 2.2 versus 3.1 ± 1.8,Pvalue = 0.562), oxycodone achieved faster pain relief (average pain: 3.0 ± 1.6 versus 3.9 ± 1.6,Pvalue = 0.020) on Day 2 and significant NRS reductions for worst pain on Day 2 (Pvalue = 0.045) and current pain on Day 2 (Pvalue = 0.035) and Day 5 (Pvalue = 0.020) compared to morphine. Patient satisfaction, adverse events, and adverse drug reactions were similar for both groups.Conclusions. For Asian patients with cancer pain, IV oxycodone is faster acting and showed similar analgesic efficacy and safety profiles as IV morphine. This trial is registered with Clinicaltrials.govNCT02660229.

Acupuncture combined with opioids for cancer pain: a pilot pragmatic randomized controlled trial

2021 ◽  
pp. 096452842110560
Author(s):  
Yihan He ◽  
Haibo Zhang ◽  
Yifang Li ◽  
Shunqin Long ◽  
Shujing Xiao ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Adjunctive Therapy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Hospital Setting ◽  
Acupuncture Group ◽  
Control Group ◽  
Clinical Effects

Objective: Given the existing evidence for the analgesic effect of acupuncture, the current study aimed to assess whether acupuncture could be feasible and manageable as an adjunctive therapy for cancer pain in a real-world hospital setting. Methods: Thirty patients in an Oncology department with moderate or severe pain were recruited and randomized to an adjunctive acupuncture group or control group, who received pharmacotherapy for pain management without acupuncture. The duration of the treatment course was 1 week with a 2-week follow-up. In total, four acupuncture sessions were administered, on days 1/2/4/6 of the trial. Pain intensity was measured using a numerical rating scale (NRS) and the daily opioid dose was recorded. Results: The overall trends favored acupuncture for both pain intensity and daily opioid consumption. The proportion of participants experiencing at least a 2-point reduction in the NRS at the end of the treatment was 93% (n = 14/15) for the acupuncture group and 57% (n = 8/14) for the control group (risk difference (RD) 36.1%, 95% confidence interval (CI) [7.4%–65.0%]; relative risk (RR) 1.63, 95% CI [1.02–2.62]; p = 0.04). There were no serious adverse events and no dropouts during the treatment. Conclusion: This pilot study showed that adding acupuncture to routine analgesia for patients with cancer pain was feasible and acceptable to patients. The clinical effects of adding acupuncture as an adjunctive therapy need to be further evaluated. Clinical trial registration number: ChiCTR1800017023 (Chinese Clinical Trial Registry)

scholarly journals Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign

2017 ◽  
Vol 5 (3) ◽  
pp. 310-315 ◽  
Author(s):  
Nikolina Farčić ◽  
Ivana Barać ◽  
Stana Pačarić ◽  
Ivana Lovrić ◽  
Vesna Ilakovac
Keyword(s):  
Hospital Admission ◽  
Pain Intensity ◽  
Medical Staff ◽  
Rating Scale ◽  
Pain Treatment ◽  
Numerical Rating Scale ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Average Pain Intensity ◽  
Average Pain

AIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment.PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain.RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4–10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4–7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally.CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn’t ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.

scholarly journals Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Richard Mwase ◽  
Tonny Stone Luggya ◽  
John Mark Kasumba ◽  
Humphrey Wanzira ◽  
Andrew Kintu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Mulago Hospital ◽  
Clinical Trial Registry ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Intravenous Ketamine

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects.Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.”Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group.Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry numberPACTR201404000807178.

scholarly journals Electroanalgesia for the postoperative control pain in dogs

2012 ◽  
Vol 27 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Renata Navarro Cassu ◽  
Daniele Alves da Silva ◽  
Túlio Genari Filho ◽  
Helaine Stevanin
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Serum Cortisol ◽  
Acupuncture Points ◽  
Rescue Analgesia ◽  
Postoperative Control ◽  
Lower Pain ◽  
Numerical Rating ◽  
Control Pain ◽  
Electrical Stimuli

PURPOSE: To evaluate the analgesic and neuroendocrine effects of electroanalgesia in dogs undergoing ovariohysterectomy. METHODS: Eighteen dogs were randomly distributed to three groups of six animals each and received either electrical stimuli at acupuncture points (EA), at peri-incisional dermatomes (DER) and at both acupuncture points and peri-incisional dermatomes (EAD). Pre-anesthetic medication was acepromazine (0.05mg kg-1, IV). Anesthesia was induced with propofol (4 to 5mg kg-1, IV) and maintained with isoflurane. Postoperatively pain degree was measured using a numerical rating scale. Dogs were scored at 1, 3, 6, 12 and 24 hours postoperative. If the pain score was ≥6, supplemental morphine (0.5mg kg-1, IM) was administered. Serum cortisol concentration was measured before pre-anesthetic medication (basal), and at 1, 12 and 24 hours postoperative. RESULTS: EA and EAD- treated dogs had lower pain scores than DER treated dogs one hour postoperatively. Fewer EA and EAD-treated dogs required rescue analgesia. Serum cortisol did not differ among treatments. CONCLUSION: Preoperative application of electrical stimuli to acupuncture points isolated or in combination with peri-incisional dermatomes provides a reduced postoperative opioid requirement and promotes an effective analgesia in dogs undergoing ovariohyterectomy.

scholarly journals Effectiveness of Neck Myofascial Release Techniques and Exercise Therapy on Pain Intensity and Disability in Patients with Chronic Tension-Type Headache

2016 ◽  
Vol 9 (6) ◽  
pp. 47
Author(s):  
Mohammad Hosseinifar ◽  
Razieh Bazghandi ◽  
Zahra Azimi ◽  
Bahareh Khodadadi Bohlouli
Keyword(s):  
Pain Intensity ◽  
Exercise Therapy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Tension Type Headache ◽  
Control Group ◽  
Myofascial Release ◽  
Headache Intensity ◽  
Headache Disability ◽  
Type Headache

PURPOSE: Tension type headache (TTH) is one of the most prevalent types of headache. TTH is classified as episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. Tension, anxiety and depression are some etiological factors for TTH which leads to work efficiency reduction. Today the interest in non-pharmacological methods is increasing; massage is one of these approaches which has no side effects. Aim of this study was to investigate the effects of neck Myofascial Release (MFR) techniques and exercise therapy on pain intensity and disability in patients with chronic tension-type headache.METHODS: This randomized clinical trial study was investigated on 30 females suffering from TTH. Participants were randomly assigned into two equal groups (n=15). The MFR group received neck MFR massage and exercise therapy four times a week for 3 weeks, each session lasting 45 minutes. Control group had no intervention. Outcomes were headache intensity and disability measured by numerical rating scale (NRS) and headache disability index (HDI), respectively. Data was analysed through independent and pair t-test.RESULTS: Between group comparison showed significant improvement of headache intensity and disability rate in MFR group (p<0.05) than control group (p=0.000).DISCUSSION: This study provides evidences that MFR technique and exercise therapy have significant effect on patients with TTH.

Acupuncture for Low Back Pain in Pregnancy – a Prospective, Quasi- Randomised, Controlled Study

2004 ◽  
Vol 22 (2) ◽  
pp. 60-67 ◽  
Author(s):  
João Bosco Guerreiro da Silva ◽  
Mary Uchiyama Nakamura ◽  
José Antonio Cordeiro ◽  
Luiz Kulay
Keyword(s):  
Pelvic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Real Life ◽  
Acupuncture Group ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Low Back ◽  
Average Pain

This study was undertaken to investigate the effects of acupuncture in low back and pelvic pain during pregnancy under real life conditions, as compared with patients undergoing conventional treatment alone. A total of 61 conventionally treated pregnant women were allocated randomly into two groups to be treated or not by acupuncture. Twenty-seven patients formed the study group and 34 the control group. They reported the severity of pain using a Numerical Rating Scale from 0 to 10, and their capacity to perform general activities, to work, and to walk. We also assessed the use of analgesic drugs. Women were followed up for eight weeks and interviewed five times, at two-week intervals. All women completed the study. In the study group the average pain during the study period showed a larger reduction (4.8 points) than the control group (−0.3 points) (P<0.0001). Average pain scores decreased by at least 50% over time in 21 (78%) patients in the acupuncture group and in five (15%) patients in the control group (P<0.0001). Maximum pain and pain at the moment of interview were also less in the acupuncture group compared with the control group. The capacity to perform general activities, to work and to walk was improved significantly more in the study group than in the control group (P<0.05). The use of paracetamol was lower in the acupuncture group (P<0.01). These results indicate that acupuncture seems to alleviate low back and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period.

scholarly journals A Case Report on a Fibromyalgia Patient with Gastrointestinal Symptoms Treated with Odu-tang

2021 ◽  
Vol 42 (5) ◽  
pp. 863-871
Author(s):  
Hye-yeon Jang ◽  
Sang-gu Yu ◽  
Do-hyeong Kim ◽  
Young-su Lee
Keyword(s):  
Medical Treatment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Gastrointestinal Symptoms ◽  
Herbal Medicines ◽  
Individual Characteristics ◽  
Fibromyalgia Patient ◽  
Gastrointestinal Symptom Rating Scale ◽  
Numerical Rating ◽  
Symptom Rating

Objective: The purpose of this study was to investigate the effects of Korean medical treatment on a fibromyalgia patient with gastrointestinal symptoms, using herbal medicines selected according to new rather than existing standards.Method: A 52-year-old female patient with fibromyalgia was treated with Odu-tang and acupuncture, cupping, and moxibustion for 22 days. To evaluate the treatment, we used the Numerical Rating Scale (NRS), American College of Rheumatology’s Preliminary Diagnostic Criteria (ACR), and Korean Gastrointestinal Symptom Rating Scale (KGSRS).Result: Following treatment, pantalgia diminished, NRS, and ACR scores improved, and the GSRS score decreased from 29 to 11.Conclusion: This study suggests that Korean medical treatment could effectively reduce pain and improve digestive symptoms in patients with fibromyalgia. It also presents a new method that considers individual characteristics when choosing herbal medicine.

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