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1.
Integr Cancer Ther ; 22: 15347354231198086, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37706457

RESUMEN

PURPOSE: The study aimed to (1) examine the feasibility of providing a training course on auricular point acupressure (APA) for clinical oncology nurses to integrate APA into real-world nursing care settings, and (2) examine the effectiveness of APA on cancer-related pain (CRP) under usual inpatient oncology ward conditions. METHODS: This was a 2-phase feasibility study. Phase 1, an in-person, 8 hour training program was provided to oncology nurses. Phase 2, a prospective and feasibility study was conducted to evaluate the integration of APA into nursing care activities to manage CRP. Oncology patients were included if their pain was rated at ≥4 on a 0 to 10 numeric rating scale in the past 24 hours. Patients received 1 APA treatment administered by the nurses and were instructed to stimulate the points for 3 days. Study outcomes (pain intensity, fatigue, and sleep disturbance), pain medication use, and APA practice were measured by a phone survey daily. RESULTS: Ten oncology nurses received APA training in phase 1. APA had been added to the hospital's electronic health records (EHRs) as a pain treatment. In phase 2, 33 oncology patients received APA treatment with a 100% adherence rate (pressing the seeds 3 times per day, 3 minutes per time based on the suggestion). The side effects of APA were minimal (~8%-12% felt tenderness on the ear). After 3 days of APA, patients reported 38% pain relief, 39% less fatigue, and 45% improvement in sleep disturbance; 24% reduced any type of pain medication use and 19% reduced opioid use (10 mg opioids using milligram morphine equivalent). The major barrier to integrating APA into routine nursing practice was time management (how to include APA in a daily workflow). CONCLUSION: It is feasible to provide 8-hour training to oncology nurses for mastering APA skill and then integrating APA into their daily nursing care for patients with CRP. Based on the promising findings (decreased pain, improved fatigue and sleep disturbance, and less opioid use), the next step is to conduct a randomized clinical trial with a larger sample to confirm the efficacy of APA for oncology nurses to treat CRP in real-world practice.ClinicalTrial.gov identifier number: NCT04040140.


Asunto(s)
Acupresión , Dolor en Cáncer , Neoplasias , Humanos , Analgésicos Opioides , Dolor en Cáncer/terapia , Fatiga , Estudios de Factibilidad , Neoplasias/complicaciones , Estudios Prospectivos , Resultado del Tratamiento
2.
Curr Opin Anaesthesiol ; 33(6): 825-831, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33110020

RESUMEN

PURPOSE OF REVIEW: The prevalence of cancer pain will continue to rise as pain is common among the survivorship and general cancer population. As interest in cannabis and cannabinoids for medicinal use including pain management continues to rise, there is growing need to update and review the current state of evidence for their use. The literature was searched for articles in English with key words cannabis, cannabinoids, and cancer pain. The sources of articles were PubMed, Embase, and open Google search. RECENT FINDINGS: In a double-blind randomized placebo-controlled trial including a 3-week treatment period of nabiximol for advanced cancer patients with pain refractory to optimized opiate therapy, improvements in average pain were seen in the intention to treat population (P = 0.0854) and per- protocol population (P = 0.0378). SUMMARY: To date, preclinical data has demonstrated evidence to suggest promising potential for cancer pain and the urgent need to translate this into clinical practice. Unfortunately, due to limited data, for adults with advanced cancer being treated with opiate therapy, the addition of cannabis or cannabinoids is not currently supported to address cancer pain effectively.


Asunto(s)
Dolor en Cáncer/tratamiento farmacológico , Cannabinoides/uso terapéutico , Cannabis , Neoplasias/complicaciones , Adulto , Analgésicos , Método Doble Ciego , Humanos , Resultado del Tratamiento
3.
J Clin Neurosci ; 70: 140-145, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31421990

RESUMEN

Transcranial direct current stimulation (tDCS) has been shown to be effective for reducing pain, and a growing body of literature shows the potential analgesic effects of mindfulness-based meditation (MBM). However, few studies have investigated the potential benefits associated with combining tDCS and MBM in older adults with knee osteoarthritis (OA). Therefore, the aim of this study was to examine the feasibility and preliminary efficacy of home-based tDCS paired with MBM in older adults with knee OA. Thirty participants 50-85 years old with symptomatic knee OA were randomly assigned to receive 10 daily sessions of home-based 2 mA tDCS paired with active MBM for 20 min (n = 15) or sham tDCS paired with sham MBM (n = 15). We measured clinical pain and OA symptoms via a Numeric Rating Scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Pressure pain sensitivity and conditioned pain modulation were measured using quantitative sensory testing. Participant satisfaction and side effects were assessed via a questionnaire. Active tDCS paired with active MBM significantly reduced scores on the Numeric Rating Scale and Western Ontario and McMaster Universities Osteoarthritis Index and increased pressure pain thresholds and conditioned pain modulation. Participants tolerated tDCS paired with MBM well without serious adverse effects and were satisfied with the treatment. Our findings demonstrate promising clinical efficacy of home-based tDCS paired with MBM for older adults with knee OA.


Asunto(s)
Meditación/métodos , Atención Plena/métodos , Osteoartritis de la Rodilla/terapia , Manejo del Dolor/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dolor/etiología , Proyectos Piloto , Resultado del Tratamiento
4.
Support Care Cancer ; 24(6): 2807-14, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27041741

RESUMEN

PURPOSE: Chronic pain is a widespread and debilitating condition, encountered by physicians in a variety of practice settings. Although many pharmacologic and behavioral strategies exist for the management of this condition, treatment is often unsatisfactory. Scrambler Therapy is a novel, non-invasive pain modifying technique that utilizes trans-cutaneous electrical stimulation of pain fibers with the intent of re-organizing maladaptive signaling pathways. This review was conducted to further evaluate what is known regarding the mechanisms and mechanics of Scrambler Therapy and to investigate the preliminary data pertaining to the efficacy of this treatment modality. METHODS: The PubMed/Medline, SCOPUS, EMBASE, and Google Scholar databases were searched for all articles published on Scrambler Therapy prior to November 2015. All case studies and clinical trials were evaluated and reported in a descriptive manner. RESULTS: To date, 20 reports, of varying scientific quality, have been published regarding this device; all but one small study, published only as an abstract, provided results that appear positive. CONCLUSION: The positive findings from preliminary studies with Scrambler Therapy support that this device provides benefit for patients with refractory pain syndromes. Larger, randomized studies are required to further evaluate the efficacy of this approach.


Asunto(s)
Dolor Crónico/terapia , Terapia por Estimulación Eléctrica/métodos , Terapia por Estimulación Eléctrica/instrumentación , Humanos
5.
Gynecol Oncol ; 136(3): 453-9, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25584767

RESUMEN

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several chemotherapeutics used in the treatment of all the most common malignancies. There are several defined mechanisms of nerve damage that take place along different areas of the peripheral and the central nervous system. Treatment is based on symptom management and there are several classes of medications found to be efficacious in the treatment of neuropathic pain. Neuropathic pain that persists despite appropriate pharmacotherapy may respond to interventional procedures that span a range of invasiveness. The purpose of this review article is to examine the basic science of neuropathy and currently available treatment options in the context of chemotherapy induced peripheral neuropathy.


Asunto(s)
Antineoplásicos/efectos adversos , Neoplasias/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/terapia , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Humanos , Neoplasias/complicaciones , Neuralgia/inducido químicamente , Neuralgia/diagnóstico , Neuralgia/fisiopatología , Neuralgia/terapia , Terapia Ocupacional , Dolor/inducido químicamente , Dolor/diagnóstico , Dolor/fisiopatología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Modalidades de Fisioterapia , Estimulación Eléctrica Transcutánea del Nervio
7.
Clin J Pain ; 26(1): 60-9, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20026956

RESUMEN

OBJECTIVE: We briefly discuss the history of acupuncture and its postulated mechanisms of action, but our primary objective is to discuss the evidence for acupuncture's efficacy in low back pain as well as approaches of newer study protocols to define more clearly the true usefulness of this alternative modality in low back pain. METHODS: Pubmed online search of all articles and other literature in the past 50 years related to acupuncture efficacy in low back pain, including case reports, randomized controlled trials and meta-analyses. RESULTS: Lower back pain and its associated incapacitating sequelae constitute an important healthcare and socioeconomic problem. There have been multiple, generally poor quality studies on the efficacy of acupuncture for this multi-factorial pain condition. Although newer studies seem to show promise, effectiveness has not been clearly demonstrated. CONCLUSIONS: There is a paucity of high-quality research assessing efficacy of acupuncture in the management of LBP. Nonetheless, it continues to play a significant role in our clinical practice, not as a sole therapeutic modality but rather as an adjunct to a multidisciplinary integrative approach of LBP management. Most of the published articles about acupuncture in the biomedical literature consist of case reports, case series, or intervention studies with designs inadequate to assess its efficacy. Thus it is imperative that further research be performed, both preclinical to help elucidate the mechanisms underlying acupuncture, and clinical to justify its clinical application.


Asunto(s)
Terapia por Acupuntura/métodos , Dolor de la Región Lumbar/terapia , Terapia por Acupuntura/historia , Historia del Siglo XV , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Humanos
8.
Pain Physician ; 12(4): 699-802, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19644537

RESUMEN

BACKGROUND: Comprehensive, evidence-based guidelines for interventional techniques in the management of chronic spinal pain are described here to provide recommendations for clinicians. OBJECTIVE: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. DESIGN: Systematic assessment of the literature. METHODS: Strength of evidence was assessed by the U.S. Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence ranging from Level I to III with 3 subcategories in Level II. OUTCOMES: Short-term pain relief was defined as relief lasting at least 6 months and long-term relief was defined as longer than 6 months, except for intradiscal therapies, mechanical disc decompression, spinal cord stimulation and intrathecal infusion systems, wherein up to one year relief was considered as short-term. RESULTS: The indicated evidence for accuracy of diagnostic facet joint nerve blocks is Level I or II-1 in the diagnosis of lumbar, thoracic, and cervical facet joint pain. The evidence for lumbar and cervical provocation discography and sacroiliac joint injections is Level II-2, whereas it is Level II-3 for thoracic provocation discography. The indicated evidence for therapeutic interventions is Level I for caudal epidural steroid injections in managing disc herniation or radiculitis, and discogenic pain without disc herniation or radiculitis. The evidence is Level I or II-1 for percutaneous adhesiolysis in management of pain secondary to post-lumbar surgery syndrome. The evidence is Level II-1 or II-2 for therapeutic cervical, thoracic, and lumbar facet joint nerve blocks; for caudal epidural injections in managing pain of post-lumbar surgery syndrome, and lumbar spinal stenosis, for cervical interlaminar epidural injections in managing cervical pain (Level II-1); for lumbar transforaminal epidural injections; and spinal cord stimulation for post-lumbar surgery syndrome. The indicated evidence for intradiscal electrothermal therapy (IDET), mechanical disc decompression with automated percutaneous lumbar discectomy (APLD), and percutaneous lumbar laser discectomy (PLDD) is Level II-2. LIMITATIONS: The limitations of these guidelines include a continued paucity of the literature, lack of updates, and conflicts in preparation of systematic reviews and guidelines by various organizations. CONCLUSION: The indicated evidence for diagnostic and therapeutic interventions is variable from Level I to III. These guidelines include the evaluation of evidence for diagnostic and therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain. However, these guidelines do not constitute inflexible treatment recommendations. Further, these guidelines also do not represent "standard of care."


Asunto(s)
Dolor de Espalda/terapia , Protocolos Clínicos/normas , Medicina Basada en la Evidencia/métodos , Dolor Intratable/terapia , Enfermedades de la Columna Vertebral/complicaciones , Anestésicos Locales/administración & dosificación , Anestésicos Locales/normas , Dolor de Espalda/etiología , Dolor de Espalda/fisiopatología , Enfermedad Crónica/terapia , Discectomía Percutánea/métodos , Discectomía Percutánea/normas , Terapia por Estimulación Eléctrica/métodos , Medicina Basada en la Evidencia/normas , Humanos , Inyecciones Intraarticulares/métodos , Inyecciones Intraarticulares/normas , Dolor Intratable/etiología , Dolor Intratable/fisiopatología , Enfermedades de la Columna Vertebral/fisiopatología
9.
Tech Reg Anesth Pain Manag ; 11(3): 141-147, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18591992

RESUMEN

Prevention of complications is one of the most important aspects of patient care in pain management. The objective of this study is to review documented complications in medical literature that are associated with interventional pain management, specifically those associated with joint, tendon, and muscle injections. We conducted Medline research from 1966 to November 2006 using keywords complication, injection, radiofrequency, closed claim, facet, zygophyseal joint, sacroiliac joint, shoulder, hip, knee, carpel tunnel, bursa, and trigger point. We found over 35 relevant papers in forms of original articles, case reports, and reviews. The most common complications appear to be infections that have been associated with virtually all of these injections. These infections include spondylodiscitis, septic arthritis, epidural abscess, necrotizing fasciitis, osteomyelitis, gas gangrene, and albicans arthritis. Other complications include spinal cord injury and peripheral nerve injuries, pneumothorax, air embolism, pain or swelling at the site of injection, chemical meningism, granulomatous inflammation of the synovium, aseptic acute arthritis, embolia cutis medicamentosa, skeletal muscle toxicity, and tendon and fascial ruptures. We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies.

10.
Clin J Pain ; 22(5): 468-81, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16772802

RESUMEN

Diagnosis and treatment of lumbar discogenic pain due to internal disc disruption (IDD) remains a challenge. It accounts for 39% of patients with low back pain. The mechanism of discogenic pain remains unclear and its clinical presentation is atypical. Magnetic resonance imaging (MRI) can find high-intensity zone as an indirect indication of IDD. However, relative low sensitivity (26.7% to 59%) and high false-positive (24%) and false-negative (38%) rates reduce the value of MRI in screening for the existence of painful IDD. Provocative discography can provide unique information about the pain source and the morphology of the disc. It may also provide information for selecting appropriate treatment for the painful annular tear. Adjunctive therapies, including nonsteroidal anti-inflammatory drugs, physical therapy, rehabilitation, antidepressants, antiepileptics, and acupuncture, have been used for low back pain. The value of these treatments for discogenic pain is yet to be established. Intradiscal steroid injection has not been proved to provide long-term benefits. Intradiscal electrothermal therapy may offer some pain relief for a group of well-selected patients. No benefits have been found for the intradiscal radiofrequency thermocoagulation. A block in the ramus communicans may interfere with the transition of painful information from the discs to the central nervous system. Disc cell transplantation is in the experimental stage. It has the potential to become a useful tool for the prevention and treatment of discogenic pain. Minimally invasive treatments provide alternatives for discogenic pain with the appeal of cost-effectiveness and, possibly, less long-term side effects. However, the value of most of these therapies is yet to be established. More basic science and clinical studies are needed to improve the clinical efficacy of minimally invasive treatments.


Asunto(s)
Desplazamiento del Disco Intervertebral/complicaciones , Vértebras Lumbares/patología , Dolor/etiología , Animales , Trasplante de Células/métodos , Terapia por Estimulación Eléctrica/métodos , Humanos , Coagulación con Láser/métodos , Vértebras Lumbares/efectos de los fármacos , Vértebras Lumbares/efectos de la radiación , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética/métodos , Bloqueo Nervioso , Dolor/diagnóstico , Manejo del Dolor , Dimensión del Dolor , Literatura de Revisión como Asunto , Esteroides/uso terapéutico
11.
Curr Opin Anaesthesiol ; 15(5): 563-7, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17019255

RESUMEN

PURPOSE OF REVIEW: Burn pain is often under treated. Burn patients suffer from daily background pain as well as procedural pain. Direct mechanical and chemical stimulation to peripheral nociceptors, peripheral- and central sensitization contribute to the pathophysiology of pain. The purpose of this review is to discuss the current management of burn pain and also to stimulate future studies. RECENT FINDINGS: Background pain is best treated with mild to moderate potent analgesics administered regularly to maintain a steady plasma drug concentration. Procedural pain should be treated vigorously with intravenous opioids, local or even general anesthesia if needed. Opioids are the mainstay of treatment for severe acute pain. PCA should be used wherever applicable. Further opioids should not be substituted by high dose NSAIDs in the management of procedural pain. Hypnosis, therapeutic touch, massage therapy, distracting techniques and other behavioral cognitive techniques have demonstrated some intriguing impact on acute as well as chronic burn pain treatment. SUMMARY: There is no clear evidence to show that the use of opioids in acute pain may increase the likelihood of developing opioid dependency. Thus, pain after burn injury should be aggressively treated using pharmacologic and non-pharmacologic approaches. Further controlled studies are yet to be conducted to define appropriate treatments for different burn patients and to establish standard treatment protocols for burn pain.

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