RESUMO
The purpose of this study is to determine if sequential interventional therapy can become a mainstay option in providing palliation from fastidious osseous neoplasms in patients with pain refractory to oral analgesia and radiotherapy. This retrospective monocentric study was approved by our institutional review board. Between July 2012 and August 2014, we reviewed 15 patients (6 women, 9 men; age range of 36-81 years) who underwent embolization followed by cryoablation, with or without osteoplasty. Patient demographics and tumor characteristics, including primary histology and the location of metastasis, were included in our review. Pain intensity at baseline, after radiotherapy, and after sequential interventional therapy was reviewed using the hospital electronic medical record. The use of oral analgesia and procedural complications was also noted. Data was then assessed for normality and a two-tailed Student's t-test was performed on mean pain scores for difference phases of treatment. While radiotherapy offers pain relief with a mean pain score of 7.25 ±1.5 (p =<.0001), sequential interventional therapy results in better comfort as demonstrated by a mean pain score of 3.9 ± 2.6 (p=.0015). Moreover, all patients who reported oral analgesic use at presentation reported a decrease in their requirement after sequential interventional therapy. Embolization and cryoablation were performed in all patients, while osteoplasty was indicated in 6 cases. There was no difference in postprocedural pain intensity between patients who required osteoplasty and patients who did not (p = 0.7514). There were no complications observed during treatment. This retrospective study shows that sequential intervention with transarterial embolization, cryoablation, and osteoplasty is both safe and efficacious for bone pain refractory to the current standard of care. We demonstrated that this combination therapy has the potential to become an effective mainstay treatment paradigm in the palliative care of osseous neoplasm to improve quality of life.
RESUMO
OBJECTIVES: Smoking is associated with chronic pain and pain-related functional impairment. Some studies suggest that pain activates smoking urges and others suggest that smoking is analgesic. We evaluated these associations using ecological momentary assessment, a method for real-time measurement of health-related phenomena. METHODS: For 1 week, 36 chronic pain patients who smoked a mean of 17.5 (SD=9.4) cigarettes per day completed multiple daily assessments on a handheld computer. RESULTS: The sample included 67% women and 39% whites; 67% had back pain, with an average (SD) worst pain severity during the past week of 8.6 (1.5) on a 0 to 10 numeric rating scale. Patients completed an average (SD) of 44 (24) random assessments. At each assessment, the patient recorded pain "right now" on a 0 to 10 scale, whether he/she was "about to smoke," and if he/she had "just smoked in the past 30 minutes," pain before smoking. After controlling for other significant correlates of pain, patients who were about to smoke had more pain than at other times (M [SD]=6.5 [2.3] vs. 5.2 [2.4]; P<0.01), but pain before and after smoking was not different (M [SD]=6.1 [2.2] vs. 5.9 [2.3]; P=0.18). DISCUSSION: These findings support the hypothesis that smoking behavior is triggered by pain, but smoking is not analgesic. Future studies should clarify potential explanatory mechanisms for this pain-related trigger and evaluate tailored cessation strategies for pain patients.