Perioperative pain, analgesics and cancer-related outcomes: where do we stand?

Cancer-related pain is one of the most common and debilitating symptoms among cancer patients. Undertreated cancer-related pain interferes with daily activities and increases morbidity and mortality. While opioids continue to play an essential role in treating moderate to severe cancer-related pain, they are associated with many adverse effects including misuse. While preclinical and retrospective studies have shown a negative association between opioid use and cancer outcomes, randomized control trials demonstrate that opioid use does not influence cancer recurrence. Additionally, analgesics and adjuvants used for perioperatively or chronic pain control are unlikely to improve oncological outcomes. This article focuses on the pharmacological management of cancer-related pain and offers an overview regarding the use of these medications perioperatively and the cancer outcomes.

Current treatment of post-tonsillectomy pain: a review

<p class="abstract">Tonsillectomy is one of the most common surgical procedures performed by an otorhinolaryngologist. This surgery is done more in the pediatric age group. Although tonsillectomy is safe and effective surgery, it is usually associated with significant post-operative pain. Analgesics used for post-tonsillectomy pain is often inadequate. Severe throat pain following tonsillectomy has been documented for decades. Patients or parents/caretakers often worry about such severe pain in the home. The pain following tonsillectomy is usually intense and long-lasting. The severe post-tonsillectomy pain often overstrains the patient, family, and hospital staff. Regular changes in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more challenging. Pain following the tonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the post-tonsillectomy period can result in significant morbidity among patients. There are different analgesics available; each one has its risk profile and side effects when used for controlling post-tonsillectomy pain. This review article discusses on recent management of post-tonsillectomy pain. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain, and details of medications used for controlling post-tonsillectomy pain.</p>

Progress in analgesic development: How to assess its real merits?

Background: Assessing analgesic drugs developed over preceding 50 years demonstrated that very intensive efforts directed at diverse molecular pain targets produced thousands of PubMed articles and the introduction of more than 50 new analgesics. Nevertheless, these analgesics did not have a sufficiently broad spectrum of action and level of effectiveness to demonstrably affect the use of opioids or nonsteroidal anti-inflammatory drugs for the treatment of pain. Analgesics in current are only modestly effective in chronic pain (at least with respect to neuropathic pain), and the widespread application of mu opioid receptor agonists for this purpose culminated in the global "opioid crisis”. The introduction of every new drug is regarded as an important success, at least initially. Assessing the merit of a new analgesic is extremely complicated. Objective: The aim of this article is to describe an approach that combines very different categories of drug evaluation – multifactorial approach to assessment of new analgesics. It is based on conclusiveness of clinical trials, novelty of a drug’s molecular target, a drug’s commercial appeal, and the interest in a drug reflected by scientometric indices. Results: This approach was applied to analgesics developed in 1982-2016. It shows that although several new agents have completely novel mechanisms of action, all newly approved drugs, and drug candidates, demonstrated the same persistent problems: relatively low therapeutic advantage over previous treatment and narrow spectrum of use in different types of pain, compared to opioids or NSAIDs. Conclusion: The use of the suggested multifactorial approach to drug assessment may provide a better view of the whole spectrum of analgesics advantages and disadvantages.

Pain in German physiotherapists: an analysis of pain prevalence and analgesics intake

Background Healthcare professionals of different occupations report pain, in particular back pain. It is known that the handling of patients and standing for long periods of time – like physiotherapists do, as well as working in bent posture – are causes of back pain. A high prevalence of low back pain (LBP) in German physiotherapists is to be expected. Objective To determine pain point prevalence, severity of pain, type of pain (acute, chronic, recurrent), most affected body locations and extent of analgesics intake in German physiotherapists. Method This was a nationwide online survey with German physiotherapists. Univariable and multivariable methods were applied to identify associations between sociodemographic variables and pain, type of pain and pain location as well as analgesic intake by type of pain. In addition, severity of pain by type was examined using the Kruska-Wallis Test. Results A total of 550 physiotherapists were included in the analysis. Prevalence of pain was 63.09 % (acute: 4.18 %, chronic: 15.27 %, recurrent: 43.64 %). Most frequently mentioned pain locations were lumbar spine (49.27 %), cervical spine (48.39 %) and head (40.47 %). Participants with chronic pain reported a higher pain severity than physiotherapists with recurrent pain. Analgesics were used by 35.29 % of study participants with pain. Participants with chronic pain indicated a significantly higher probability of using analgesics compared to physiotherapists with recurrent pain. Conclusion This study indicates a high prevalence of pain and analgesics intake in participating physiotherapists. Therefore, measures are needed to reduce pain in German physiotherapists.

Past, present and future of electroanalytical sensor for aspirin, ibuprofen and paracetamol detection

Background: Pain not only affects quality of life but can also lead to people suffering from mental illness due to the lack of effective treatment for long-term pain. Analgesics refer to drugs that can partially or completely relieve pain, including non-steroidal anti-inflammatory drugs and central analgesics. Methods: In recent years, the cross integration of electrochemical analysis technology with biochemistry, materials science, biomedicine and other disciplines has driven the vigorous development of electrochemical sensing technology in the field of life sciences. The electrochemical sensor has many advantages, such as simple equipment, good specificity, high sensitivity, economy and convenience. As a newly emerging technology, electrochemical sensing technology is increasingly widely used in drug analysis. Results: This review introduces the recent advances of the detection of analgesics using electrochemical technology. We deliberately selected three representative drugs for discussion: aspirin, ibuprofen and paracetamol. Conclusion: Electrochemical sensing technology has the advantages of high sensitivity, a low detection limit and simple operation. However, sensors still have some technical problems, such as the existence of many interference factors in actual samples in blood drug concentration monitoring and the need for the further optimization of the method conditions for multi-channel detection. With the continuous advancement of research, the application of new detection methods, nanomaterials, and biomolecules has enabled electrochemical technology to make certain progress in the field of drug analysis. In particular, the emergence of new nanomaterials will greatly promote the development of electrochemical sensing technology in drug analysis. As a cutting-edge technology, electrochemical sensing technology has enormous potential application value.

Perioperative outcomes of frenectomy using laser versus conventional surgery: a systematic review

Introduction: Frenectomy is an oral surgical procedure usually performed with a scalpel. Several authors recently reported the interest of laser, as a minimally invasive and efficient alternative tool to perform frenectomy. This study aimed to compare the perioperative management of patients requiring a frenectomy using scalpel versus laser. Materials and methods: A systematic review of the literature has been carried out from Pubmed and Scopus databases following PRISMA guidelines. PICO method was used to select the relevant articles. Clinical studies comparing the perioperative outcomes of patients requiring frenectomies using scalpel versus laser were included. Results: Ten articles involving 375 patients were included. Pre-operative parameter (anxiety before surgery) and per-operative data such as anesthesia, surgery duration, bleeding, suture and difficulty were assessed. The post-operative outcomes investigated were pain, analgesics use, functional discomfort, edema, healing and satisfaction of patients. Laser achieved satisfactory peri-operative outcomes such as shorter operative time, without suturing requirement, as well as less post-operative pain and functional discomfort. Discussion: The low number of eligible studies, the different type of lasers used and heterogeneity across the methodology of the selected studies were the limits of the study. Conclusion: Laser-assisted surgery became an attractive tool to perform oral soft tissue surgery.

The Use of Music by Adolescents and Young Adults With Sickle Cell Disease

Pain is common and often severe in people with sickle cell disease (SCD), occurring as acute intermittent pain episodes called vaso-occlusive episodes (VOEs), as well as chronic pain conditions including bone infarctions, avascular necrosis of joints, and neuropathic pain. Analgesics such as opioids, nonsteroidal anti-inflammatory medications (NSAIDS), and anticonvulsants for neuropathic pain, although often necessary to manage these types of pain, are associated with side effects. Nonpharmacologic interventions such as to listening to music and music therapy may reduce pain. The objectives of this study were to determine whether the use of music by adolescents and young adults with SCD was helpful, and if so, the types of music that helped, and how music helped them. A convenience sample of nine English-speaking inpatients ages 13 to 21 years, with SCD and at least two prior hospitalizations for VOE, took part in interviews with music therapists. Participants were asked open-ended questions about both pain and music. Participants identified that music was helpful for pain relief as well as for mood regulation, focusing attention during cognitive tasks such as homework, distraction, relaxation, and feeling understood or connected with others. Despite this, while hospitalized, participants reported that they did not tend to use music to help with pain. These findings support the use of both music medicine and music therapy as interventions for pain and distress in adolescents and young adults with SCD.

The relationship between pain, analgesics and survival in patients with advanced cancer; a secondary data analysis of the international European palliative care Cancer symptom study.

Purpose Opioids reduce cancer-related pain but an association with shorter survival is variably reported. Aim: To investigate the relationship between pain, analgesics, cancer and survival within the European Palliative Care Cancer Symptom (EPCCS) study to help inform clinical decision making. Methods Secondary analysis of the international prospective, longitudinal EPCCS study which included 1739 adults with advanced, incurable cancer receiving palliative care. In this secondary analysis, for all participants with date of death or last follow up, a multilevel Weibull survival analysis examined whether pain, analgesics, and other relevant variables are associated with time to death. Results Date of death or last follow-up was available for 1404 patients (mean age 65.7 [SD:12.3];men 50%). Secondary analysis of this group showed the mean survival from baseline was 46.5 (SD:1.5) weeks (95% CI:43.6–49.3). Pain was reported by 76%; 60% were taking opioids, 51% non-opioid analgesics and 24% co-analgesics. Opioid-use was associated with decreased survival in the multivariable model (HR = 1.59 (95% CI:1.38–1.84), p < 0.001). An exploratory subgroup analysis of those with C-reactive protein (CRP) measures (n = 219) indicated higher CRP was associated with poorer survival (p = 0.001). In this model, the strength of relationship between survival and opioid-use weakened (p = 0.029). Conclusion Opioid-use and survival were associated; this relationship weakened in a small sensitivity-testing subgroup analysis adjusting for CRP. Thus, the observed relationship between survival and opioid-use may partly be due to tumour-related inflammation. Larger studies, measuring disease activity, are needed to confirm this finding to more accurately judge the benefits and risks of opioids in advanced progressive disease.

Patients with Pain During Pregnancy

Most women experience some degree of pain during pregnancy. Back pain occurs in about half of all pregnant women, with pain typically in the low back due to the physiologic changes in the body that occur with pregnancy, such as weight gain, changed center of gravity, increased ligament and joint laxity, and altered posture. Pelvic pain, leg cramps, and abdominal pain are all common among pregnant women. Many women who have pain during pregnancy are reluctant to use analgesics due to concerns about what the medications may do to their unborn child. Because of this, it is hypothesized that many women are either undertreated for pain or do not receive any treatment. Chronic, severe pain that is ineffectively treated is associated with hypertension, anxiety, and depression, all of which do not lead to a healthy pregnancy. A variety of interventional procedures are commonly performed during pregnancy that can safely alleviate pain. This review goes into detail about the types of pain treatments that are available to pregnant women and are safe and effective in alleviating pregnancy-related pain. Keywords: Pelvic pain, leg cramps, abdominal pain, hypertension, anxiety, depression, joint laxity, ligament laxity, back pain, analgesics, pregnancy