Lidocaine infusion for malignant visceral pain: case report.

BACKGROUND: Visceral pain accounts for nearly 28% of cancer-related pain, and its effective management poses significant challenges. The diverse pathways of neurotransmission, neurotransmitters, channels, and receptors suggest the need for individualized analgesic therapy. Our objective is to explore a therapeutic alternative for managing malignant visceral pain in advanced cancer. CASES: In this report, we present two patients with malignant bowel obstruction and severe visceral pain, despite receiving opioid treatment, necessitating an alternative approach. Surgical interventions were considered but promptly ruled out. Paracentesis was performed as necessary. Pain management was initiated using a combination of opioids and co-analgesics. However, both patients required opioid dose escalation without achieving adequate pain control or tolerating the associated side effects. Consequently, a lidocaine infusion was administered to alleviate pain. OUTCOME: Following 24-48 hours of lidocaine infusion, both patients achieved satisfactory symptom control, enabling a reduction in opioid doses and improvement in intestinal transit. No side effects were reported during the treatment. DISCUSSION: Lidocaine infusions may be beneficial for pain management in patients with malignant bowel obstruction and visceral pain. The extent of pain control achieved in comparison to other therapeutics remains challenging to ascertain. We posit that lidocaine infusions, with their potential impact on visceral hypersensitivity, can enhance pain control and facilitate the recovery of bowel transit. Further studies are warranted to validate these findings.

Use of complementary and alternative medicine by cancer patients in Colombia.

BACKGROUND: The use of complementary and alternative medicines (CAM) among cancer patients varies greatly. The available data suggest an increasing use of CAM over time and a higher prevalence in low- and middle-income countries. However, no reliable data are available from Latin America. Accordingly, we examined the prevalence of CAM use among cancer patients from six Colombian regions. METHODS: We conducted a survey on cancer patients attending comprehensive cancer centres in six capital cities from different regions. The survey was designed based on a literature review and information gathered through focus groups on CAM terminology in Colombia. Independent random samples of patients from two comprehensive cancer centres in every city were obtained. Patients 18 years and older with a histopathological diagnosis of cancer undergoing active treatment were eligible. The prevalence of CAM use is reported as a percentage with the corresponding confidence interval. CAM types are reported by region. The sociodemographic and clinical characteristics of CAM users and non-users were compared using Chi square and t tests. RESULTS: In total, 3117 patients were recruited. The average age 59.6 years old, and 62.8% were female. The prevalence of CAM use was 51.7%, and compared to non-users, CAM users were younger, more frequently women, affiliated with the health insurance plan for low-income populations and non-Catholic. We found no differences regarding the clinical stage or treatment modality, but CAM users reported more treatment-related side effects. The most frequent types of CAM were herbal products, specific foods and vitamins, and individually, soursop was the most frequently used product. Relevant variability between regions was observed regarding the prevalence and type of CAM used (range: 36.6% to 66.7%). The most frequent reason for using CAM was symptom management (30.5%), followed by curative purposes (19.5%). CONCLUSIONS: The prevalence of CAM use among cancer patients in Colombia is high in general, and variations between regions might be related to differences in cultural backgrounds and access to comprehensive cancer care. The most frequently used CAM products and practices have little scientific support, suggesting the need to enhance integrative oncology research in the country.

Dolor en pacientes hospitalizados en una institución de salud de tercer nivel / Pain in hospitalized patients in a third-level health care institution

Abstract Introduction: Pain is one of the major symptoms experienced by hospitalized patients. Objective: To establish the hospital care quality indicators associated with pain management (prevalence, intensity, and interference) in adult inpatients, following the implementation of strategies framed within the pain-free Hospital Policy at a third-level institution. Methodology: Observational, descriptive, cross-sectional trial. Patients over 18 years of age, hospitalized for more than 24hours, and who previously signed their informed consent were included. The Brief Pain Inventory - Short Form in Spanish was adminis tered for pain evaluation, and the sex and service differences were estimated using the Wilcoxon test for quantitative variables and x2 for qualitative variables. Results: Three hundred thirty-eight participants were includ ed. The prevalence of pain was 43.4%, with a higher percentage among females (52.1% vs 28.8%, P <0.001) and in the surgical services (48.0% vs 37.5%, P = 0.05). Women showed higher intensity in the "minimum pain" item (median 3 interquartile range 2-5 vs median 2 interquartile range 0-1, P=0.009). The activities with the highest interference were sleep and general activity in both sexes and services. Discussion: The hospital quality of care indicators herein measured allow for an enhanced approach to characterize pain in this population group, with a view to improving pain identifica tion and management in the future to provide a more comfortable experience for the patient.

Resumen Introducción: El dolor es uno de los principales síntomas que presentan los pacientes hospitalizados. Objetivo: Establecer los indicadores de la calidad del cuidado hospitalario relacionados con el manejo del dolor (prevalencia, intensidad e interferencia) en pacientes adultos hospitalizados posterior a la implementación de estrategias enmarcadas en la Política Clínica sin dolor de una institución de tercer nivel. Metodología: Estudio observacional descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años con más de 24 horas de hospitalización y previa firma de consenti miento informado, se aplicó el instrumento Brief Pain Inventory -Short Form (Inventario Breve de Dolor) en español para la evaluación del dolor. Las diferencias por género y servicio se estimaron a través del test de Wilcoxon para las variables cuantitativas y X2 para las variables cualitativas. Resultados: Se incluyeron 338 participantes. La prevalencia de dolor fue 43,4%, siendo más alta en mujeres (52,1% vs. 28,8%, p = < 0.001) y servicios quirúrgicos (48,0% vs. 37,5%, p = 0.05). Las mujeres presentaron mayor intensidad en el ítem "dolor mínimo" (mediana 3 Rango intercuartílico 2-5 vs. mediana 2 Rango intercuartílico 0-1, p = 0.009). Las actividades con mayor interferencia fueron el sueño y la actividad general en ambos sexos y servicios. Discusión: Los indicadores de la calidad del cuidado hospita lario medidos en este estudio permiten caracterizar de una mejor forma el dolor en este tipo de población, lo cual permite mejorar a futuro la identificación y manejo de éste síntoma para brindar mayor confort al paciente.