Clinical role and safety of tapentadol in patients with cancer: A single-center experience.

OBJECTIVE: To evaluate real-world data on the use of tapentadol (TAP) in cancer patients. DESIGN: Single-center retrospective study. SETTING: Curative/palliative. PATIENTS, PARTICIPANTS: Patients who started TAP between October 2014 and December 2018 at our institution. MAIN OUTCOME MEASURE(S): The primary outcome was the reason for TAP initiation. Secondary outcomes included prescription duration, TAP cessation rate, reason for cessation, and adverse events (AEs). Since the palliative care team (PCT) tended to prescribe to cancer patients with intractable pain more often than patients in usual care, and also tended to prescribe opioids based on their characteristics, we decided to compare patients with and without PCT intervention. RESULTS: There were 175 patients who first received TAP during the study period, of whom 81 patients (46.3 percent) were male. The median age was 60 years. TAP was prescribed for opioid-naive patients in 45 (26 percent) cases and opioid switch in 130 (74 percent) cases. When comparing the PCT group (n = 121) and the non-PCT group (n = 54) using univariate analysis, the PCT group had a higher opioid switch rate (81.8 percent vs 57.4 percent, p < .001), higher proportion of patients with neuropathic pain (NP) (65.3 percent vs 16.7 percent, p < .001), and a higher proportion of patients with a history of nausea (41.3 percent vs 18.5 percent, p < .01). The cessation rate due to AEs was 8 percent overall. CONCLUSIONS: Palliative care physicians prescribed TAP for patients with NP or a history of nausea. Opioid-naive patients were preferred by oncologists. TAP has good tolerability in both groups, with a low dropout rate due to AEs.

[A Case of Abdominal Fullness Caused by a Retroperitoneal Bulky Tumor Treated with Epidural Analgesia].

We presented the case of a 63-year-old woman with severe abdominal distention due to recurrent retroperitoneal sarcoma. Further, the rapid progression of the tumor made it difficult to relieve the abdominal distention. Titrated intravenous morphine was administered. Although the dose of morphine was escalated and the patient was sedated, she continued to experience pain. The addition of a continuous epidural analgesic lidocaine to manage the abdominal distention was effective. This case report describes a stepwise approach with continuous epidural analgesia of lidocaine for a bulky tumor- related abdominal distention.

Temporal exploration in sequential movements shapes efficient neuromuscular control.

The interaction of early and deliberate practice with genetic predisposition endows experts with virtuosic motor performance. However, it has not been known whether ways of practicing shape motor virtuosity. Here, we addressed this issue by comparing the effects of rhythmic variation in motor practice on neuromuscular control of the finger movements in pianists. With the use of a novel electromyography system with miniature active electrodes, we recorded the activity of the intrinsic hand muscles of 27 pianists while they played the piano and analyzed it by using a nonnegative matrix factorization algorithm and cluster analysis. The result demonstrated that practicing a target movement sequence with various rhythms reduced muscular activity, whereas neither practicing a sequence with a single rhythm nor taking a rest without practicing changed the activity. In addition, practice with rhythmic variation changed the patterns of simultaneous activations across muscles. This alteration of muscular coordination was associated with decreased activation of muscles not only relevant to, but also irrelevant to the task performance. In contrast, piano practice improved the maximum speed of the performance, the amount of which was independent of whether rhythmic variation was present. These results suggest that temporal variation in movement sequences during practice co-optimizes both movement speed and neuromuscular efficiency, which emphasizes the significance of ways of practice in the acquisition of motor virtuosity. NEW & NOTEWORTHY A key question in motor neuroscience is whether "ways of practicing" contribute to shaping motor virtuosity. We found both attenuation of activities and alteration of coordination of the intrinsic hand muscles of pianists, specifically through practicing a movement sequence with various rhythms. The maximum speed of the finger movements was also enhanced following the practice. These results emphasize the importance of ways of practicing in facilitating multiple skills: efficiency and speed.