Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics

2007 ◽  
Vol 5 (8) ◽  
pp. 851-858 ◽  
Author(s):  
Anthony Eidelman ◽  
Traci White ◽  
Robert A. Swarm
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pain Control ◽  
Analgesic Efficacy ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Inflammatory Drugs ◽  
Control Pain ◽  
Interventional Therapies

Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.

Pain Management in the Cancer Patient

1998 ◽  
Vol 11 (5) ◽  
pp. 349-373 ◽  
Author(s):  
Kristi L. Lenz ◽  
Eileen M. Marley
Keyword(s):  
Pain Management ◽  
Cancer Patient ◽  
Cancer Pain ◽  
Pain Control ◽  
Cancer Pain Management ◽  
Basic Principles ◽  
Adequate Pain Management

Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.

Pain management

2020 ◽  
pp. 629-633
Author(s):  
Marie Fallon
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Relief ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Daily Functioning ◽  
Opioid Analgesia ◽  
Patients With Cancer ◽  
Good Pain Relief

Pain occurs in more than 50% of patients with advanced disease, interferes with daily functioning and quality of life, and is very often undertreated. Patients can find it difficult to articulate the character of their pains, but it is important to determine whether it is somatic, neuropathic, or visceral since this has important implications for management. For most patients with cancer pain, a three-step approach combining simple or opioid analgesia (depending on severity) along with an adjuvant analgesic (depending on cause) will result in good pain relief, but the challenge is to achieve good pain relief without unacceptable adverse effects.

Opioid Rotation for Toxicity Reduction (DRAFT)

2018 ◽  
Author(s):  
Anna Cecilia Tenorio ◽  
Akhila Reddy
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Clinical Case ◽  
Cancer Pain Management ◽  
Opioid Rotation ◽  
Patients With Cancer ◽  
Daily Dose ◽  
Study Intervention ◽  
Morphine Equivalent

This chapter discusses the de Stoutz et al. retrospective review of patients with cancer pain who developed dose-limiting toxicities and underwent opioid rotation that resulted in improvement of symptoms related to opioid induced neurotoxicity, uncontrolled pain, and reduction in morphine equivalent daily dose. This study is the first to establish that opioid rotation, which is substituting one opioid with another using established equianalgesic conversion ratios, is a valuable tool in cancer pain management. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Cancer pain management in Mexico

2019 ◽  
pp. bmjspcare-2019-001871
Author(s):  
Sarah Barry Lincoln ◽  
Enrique Soto-Perez-de-Celis ◽  
Yanin Chavarri-Guerra ◽  
Alfredo Covarrubias-Gomez ◽  
Mariana Navarro ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Latin American ◽  
Low Income ◽  
Pain Control ◽  
Current Status ◽  
Cancer Pain Management ◽  
Middle Income ◽  
Care Training

BackgroundPain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack of access to opioid analgesics to alleviate pain from various conditions such as cancer.ObjectivesWe aimed to review the history and current status of cancer pain management in Mexico, a middle-income Latin American country. Our objective was to identify existing barriers to proper, effective opioid use, as well as provide practical recommendations for improvement.MethodsUsing a search of EBSCOhost database, PubMed and Google, we found official documents and peer-reviewed articles related to health legislation, opioid consumption, palliative care infrastructure and palliative care training in Mexico.ResultsDespite advances in palliative care and access to opioids in Mexico, there are still several barriers that undermine effective pain management, showing a major gap between policy and practice. Although Mexican legislation and guidelines include adequate palliative care and pain control as a right for all patients with cancer, the lack of adequate infrastructure and trained personnel severely hampers the implementation of these policies. Additionally, there are important barriers to prescribing opioids, many of which are related to attempts at reducing the consumption of recreational drugs.ConclusionsAlthough Mexico has made significant improvements in pain control and palliative care, much needs to be done. Expansion of drug availability, improvement of palliative care training, and constant oversight of regulations and guidelines will help to strengthen Mexico’s palliative care services.

A physician's practice, attitude and approach for the management of palliative care for cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 112-112
Author(s):  
Shijian Feng ◽  
Qiongwen Zhang ◽  
Chunhua Yu ◽  
Huashan Shi ◽  
Wenxiu Yao ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Professional Education ◽  
Physician Education ◽  
Dose Titration ◽  
Categorical Variables ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Knowledge Of Cancer ◽  
Chi Square Analysis

112 Background: Pain is the most frequent and persistent symptom experienced by cancer patients. Thus, exploring how to achieve the best outcome of cancer pain management in China is clearly extremely important. Our study focuses on the Chinese physicians' current clinical practice, attitudes, toward and barriers to opioid use, and knowledge of cancer pain management. Methods: A face to face survey include 23 items was designed and conducted to the doctors working with cancer pain managements (oncologists, internists, hematologists, et al) responsible for the care of patients with cancer in 11 tertiary hospitals in China. Descriptive statistics were used to characterize the total sample and for multiple choice questions and each item. Chi-square analysis was used to examine the difference between categorical variables. Results: 500 questionnaires were received out of 550. Most (62.2%) physicians assessed patients’ cancer pain every day, but 85.5% never or occasionally treated patients’ cancer pain together with psychologists. Most respondents appreciated that > 50% of patients with cancer experience severe chronic pain warranting analgesic therapy (73.5%), and that this therapy could control pain adequately in > 50% of patients (77.2%). More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. A majority (65.0%) of physicians responded incorrectly (60.0% agreed and 5.0% had no opinion) that they would increase the dosage of a potent opioid and administer it every 4 h as needed (q4h PRN). Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently barriers to physicians’ pain management. Conclusions: Our results revealed that physician education in cancer pain management in China does not currently provide the necessary levels of knowledge and skills. Therefore, effective strategies and professional education are still needed to encourage physicians’ concern with, experience in, and knowledge of cancer pain management in China.

Analysis of the patient-related barriers in cancer pain anagement in Turkish patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20699-e20699
Author(s):  
G. Bagçivan ◽  
N. Tosun ◽  
S. Kömürcü ◽  
A. Özet ◽  
N. Akbayrak
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Brief Pain Inventory ◽  
Cancer Pain Management ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Demographic Questionnaire ◽  
Average Pain ◽  
Turkish Patients ◽  
Reliable Scale

e20699 Background: The most important issue, which may be preventing effective cancer pain management, have generally been the barriers originating from misbelieve or misunderstandings, which lead patients to be reluctant to report pain and receive the appropriate analgesic. It is the first study about this issue in Turkey. Methods: This study was planned as a descriptive and cross-sectional. The sample was 170 patients with cancer, who used or is still using analgesic medication for pain related to cancer. Demographic Questionnaire, Brief Pain Inventory and BQ-II were used for data collection. The reliability coefficient for the total scale and subscales (Cronbach's α) were calculated. Test and retest results were compared to determine the scales validity for Turkish patients. All statistical analyses were performed with the SPSS 15.0.The value p≤0.05 was considered ‘statistically significant’. Results: As a result of the factor analysis made for BQ-II, seven factors that make up for 66.451% of the total variance were found. Cronbach's alpha value was 0.87 for the BQ-II. According to the points given by patients to the items in BQ-II, it was seen that they have beliefs that may be barriers to optimal pain management mostly in “addiction” and minimally in “physical side effects” subscale. It was ascertained that male, not married patients, patients with a chronic disease other than cancer, patients whose “average pain” level is >5 and who use inadequate analgesic have more beliefs that may be barriers to optimal pain management. Conclusions: BQ-II was a valid and reliable scale for Turkish defining patient related barriers in cancer pain management. Items suggested by patients such as “family related barriers” and “family members’ role and responsibilities” could be added to the BQ-II for future studies. No significant financial relationships to disclose.

Physician-related barriers to cancer pain management with opioid analgesics: A systematic review

2007 ◽  
Vol 3 (4) ◽  
pp. 207 ◽  
Author(s):  
Ramune Jacobsen, MS, MPH ◽  
Per Sjøgren, MD, DMS ◽  
Claus Møldrup, PhD ◽  
Lona Christrup, PhD
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Cancer Pain ◽  
Search Strategy ◽  
Opioid Analgesics ◽  
Drug Prescribing ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Text Word ◽  
Questionnaire Surveys

Objective: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics.Methods: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full texts were not available in PUBMED were retrieved from the electronic databases of specific journals.Results: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians’ barriers to cancer pain management were studied in questionnaire surveys and in the reviews of drug prescribing documents. The results of the articles found were analyzed with respect to (a) knowledge, beliefs, concerns, problems endorsed or acknowledged by physicians treating cancer pain, (b) physicians’ skills in pain assessment, and (c) adequacy of opioid prescription.Conclusions: This review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence of cultural-social-economical background, as well as the differences between the various specialists involved in the care of patients with cancer, should be explored to better understand physicians’ barriers and more effectively address them in interventional and educational programs.

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