Towards a pain free hospital: an in-depth qualitative analysis of the pain experiences of head and neck cancer patients undergoing radiotherapy.

BACKGROUND: Treatment for head and neck cancer can frequently be a painful experience with implications for patients in terms of quality of life, nutrition and ultimately treatment outcomes. Pain may arise for a number of reasons in this patient group including the influence of localised tissue damage from radiotherapy, the effects of chemotherapeutic agents as well as the disease process itself. Early identification of cancer pain, through screening and early analgesic and pain management are thought to be the most appropriate approaches to the problem. AIM: To explore in-depth, patients' views of the experience of pain related to radiotherapy for head and neck cancer, within the context of a randomised controlled trial (RCT) of pain screening and intervention. SAMPLE: A purposive sample of head and neck cancer patients undergoing radiotherapy who were participating in a separate RCT of a proactive pain screening intervention. METHODS: A qualitative design using one-off, face-to-face, in-depth interviews. Data were inductively analysed for themes using thematic analysis. Data were collected from September 2012 to January 2013. FINDINGS: Eight participants were interviewed. Several issues around pain management arose and the influence of various factors became apparent. Four dominant themes emerged: facets of radiotherapy pain in head and neck cancer, facilitators and barriers to pain management, pain services and finally interdisciplinary working. CONCLUSION: The specific issues faced by head and neck cancer patients undergoing radiotherapy highlight the need for pain relieving interventions delivered by pain specialists, in tandem with the development of robust self-management strategies. An integrated approach to care is optimal, comprising pain screening at each outpatient encounter, and review by specialists as necessary.

Postoperative pain management.

This article provides an overview of current methods used in acute pain management and explains why effective analgesia is crucial in the early postoperative period. It describes the pharmacology of both common and specialist analgesics, as well as explaining the role and uses of regional and neuraxial analgesia, for the non-anaesthetist.

Tramadol and acetaminophen combination for chronic non-cancer pain.

INTRODUCTION: There is some evidence to support the use of tramadol in chronic non-cancer pain, especially osteoarthritis pain, but modest analgesic activity is tempered by adverse effects. Combination of a lower dose of tramadol and acetaminophen is postulated to act synergistically, potentially reducing adverse effects without reduction in analgesic efficacy. AREAS COVERED: This review discusses use of tramadol in chronic non-cancer pain and the pharmacokinetics/pharmacodynamics of tramadol and acetaminophen and when combined. Existing published controlled trial data for the effectiveness (efficacy and adverse effects) of tramadol/acetaminophen combination therapy in chronic non-cancer pain is critically appraised. EXPERT OPINION: Combination therapy with tramadol and acetaminophen reduces pain outcomes in several types of chronic non-cancer pains. However, the effect is limited and is based on short duration trials and is associated with a significant adverse effect profile. There are few data comparing other pharmacological options and also sparse evidence to confirm benefits of the putative synergism of tramadol with acetaminophen. Nevertheless, other medications used for these chronic pains also have appreciable side effects and the combination may have a role to play. Increasing incidence of tramadol-associated deaths may lead to legislative changes that could alter prescription trends of tramadol-based medication.

Pharmacogenetics of analgesic drugs.

• Individual variability in pain perception and differences in the efficacy of analgesic drugs are complex phenomena and are partly genetically predetermined. • Analgesics act in various ways on the peripheral and central pain pathways and are regarded as one of the most valuable but equally dangerous groups of medications. • While pharmacokinetic properties of drugs, metabolism in particular, have been scrutinised by genotype-phenotype correlation studies, the clinical significance of inherited variants in genes governing pharmacodynamics of analgesics remains largely unexplored (apart from the µ-opioid receptor). • Lack of replication of the findings from one study to another makes meaningful personalised analgesic regime still a distant future. • This narrative review will focus on findings related to pharmacogenetics of commonly used analgesic medications and highlight authors' views on future clinical implications of pharmacogenetics in the context of pharmacological treatment of chronic pain.