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1.
Zhen Ci Yan Jiu ; 45(2): 87-92, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32144916

RESUMO

OBJECTIVE: To observe the effect of bone-edge electroacupuncture (EA) intervention on mechanical pain threshold (PT) and expression of G protein-coupled receptor kinase (GRK5), ß-arrestin 2, total and phosphorylated PKC alpha (p-PKCα) proteins in the locus coeruleus (LC) of rats with bone cancer pain induced morphine tolerance, so as to reveal its partial central mechanisms underlying pain relief. METHODS: Forty SD rats were randomly divided into 5 groups, namely sham bone cancer, bone cancer pain, morphine tolerance, bone-edge EA, and sham EA (n= 8 rats in each group). The bone cancer with morphine tolerance model was established by intramedullary injection of MRMT-1 cells into the tibial cavity, and then intraperitoneal injection of morphine hydrochloride injection. After successful establishment of morphine tolerance model, the bone-edge EA (2 Hz/100 Hz,0.5-1.5 mA) was applied to bilateral "Zusanli" (ST36) and "Kunlun" (BL60) for 30 min, once a day for 7 days, after inserting the needle-tip to the tibial bone surface. The ipsilateral mechanical paw withdrawal thresholds (PWTs) were detected dynamically. The expression levels of GRK5, ß-arrestin 2, PKCα and p-PKCα in the LC area were measured by Western blot. RESULTS: The PWTs of bone cancer pain rats were decreased on day 10 after inoculation of cancer cells (P<0.01). After i.p. of morphine for 11 days, no analgesic effect and pain tolerance appeared (P>0.05). The PWTs were significantly increased in the bone-edge EA intervention group (P<0.01), not in the sham EA group (P>0.05). In comparison with the sham bone cancer group, the expression of GRK5 protein in morphine tolerance group was significantly decreased (P<0.01); compared with morphine tolerance group, the expression of GRK5 protein in bone-edge EA group was increased(P<0.01). In comparison with the sham bone cancer group, the expression of ß-arrestin 2 and p-PKCα in bone cancer group significantly increased (P<0.01). After the intervention, the increased ß-arrestin 2 and p-PKCα expressions were reversed in the bone-edge EA group (P<0.01); compared with morphine tolerance group and sham EA group, the expression of PKCα protein was decreased(P<0.01). CONCLUSION: Bone-edge EA can effectively relieve morphine tolerance in bone cancer pain rats, which may be related to its functions in up-regulating GRK5 protein and down-regulating ß-arrestin 2, PKCα and p-PKCα proteins in LC. .


Assuntos
Neoplasias Ósseas , Dor do Câncer , Eletroacupuntura , Pontos de Acupuntura , Animais , Quinase 5 de Receptor Acoplado a Proteína G , Locus Cerúleo , Morfina , Proteína Quinase C-alfa , Ratos , Ratos Sprague-Dawley , beta-Arrestina 2
3.
Zhonghua Yi Xue Za Zhi ; 100(5): 357-362, 2020 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-32074779

RESUMO

Objective: To analyze the analgesic effect of CT-guided celiac nerve plexus destruction or celiac plexus destruction combined with absolute ethanol injection on retroperitoneal enlarged lymph nodes in patients with pancreatic cancer with retroperitoneal lymph node metastasis (combined therapy). Methods: Retrospective analysis of clinical data of 187 patients with pancreatic cancer and retroperitoneal lymph node metastasis admitted to Zhengzhou University Cancer Hospital from January 2014 to December 2018 due to poor abdominal pain control. According to the treatment method, they were divided into 2 groups: Group A (n=48) , treated with CT-guided celiac plexus destruction; Group B (n=139) , treated with CT-guided combined therapy. The analgesic effect, morphine application dose, and adverse reactions were compared before surgery, 1 week, 1 month, and 3 months after surgery. Results: The oral morphine doses of patients in Group A before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (107±34) , (65±23) , (35±12) , (48±18) , (81±25) mg. The oral morphine doses of patients in Group B before surgery and 1 day, 1 week, 1 month, and 3 months after surgery were (112±37) , (53±17) , (27±14) , (42±16) , (63±20) mg. Compared with that before surgery, the oral morphine doses were significantly reduced at 1 day, 1 week, 1 month, and 3 months after surgery in both groups (P<0.05 or P<0.01) . The effective rate and excellent rate of pain treatment in Group A at 1 week after operation were 83.3% and 60.4%, in Group B were 95.7% and 75.5%, respectively. The effective rate and excellent rate of pain treatment in Group A at one month after operation were 71.7% and 45.6%, in Group B were 89.0% and 67.6%, respectively; The effective rate and excellent rate of pain treatment in Group A at three months after operation were 48.6% and 25.7%, respectively, in Group B were 72.6% and 47.0%; Compared with Group A, the effective rate and excellent rate of pain treatment in Group B were increased, and the differences were statistically significant (P<0.05 or P<0.01). There was no significant difference in the incidence of nausea and vomiting between the two groups of patients before and 1 day after surgery, but the incidence of nausea and vomiting at 1 week, 1 month, and 3 months after surgery in Group B was significantly reduced, and the differences were statistically significant (P<0.05 or P<0.01). Compared with that before surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after operation, and the difference was statistically significant (P<0.01); The incidence of nausea and vomiting in Group B was significantly reduced at 1 day, 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (P<0.01). Compared with 1 day after surgery, the incidence of nausea and vomiting in Group A was significantly reduced at 1 week and 1 month after surgery (P<0.05 or P<0.01). The incidence of nausea and vomiting in Group B was significantly reduced at 1 week, 1 month, and 3 months after operation, and the differences were statistically significant (P<0.01). Compared with 1 week after surgery, the incidence of nausea and vomiting in the two groups increased at 3 months after surgery, and the differences were statistically significant (P<0.05 or P<0.01). Compared with 1 month after surgery, the incidence of nausea and vomiting in Group A increased at 3 months after surgery, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of transient hypotension after surgery in the two groups. The difference in the incidence of postoperative diarrhea was not statistically significant. The incidence was highest within 1 day after surgery and generally recovered within 7 days after surgery. Conclusions: The two schemes can effectively relieve pain in patients with pancreatic cancer with retroperitoneal lymph node metastasis, reduce morphine dose. The combination therapy has higher efficiency and excellent rate, lower morphine dosage after surgery, and lower incidence of nausea and vomiting.


Assuntos
Dor do Câncer , Plexo Celíaco , Analgésicos Opioides , Humanos , Linfonodos , Morfina , Dor Pós-Operatória , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(5): e18924, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000405

RESUMO

Adiponectin is an adipose tissue-derived cytokine that exerts its antiinflammatory effects by binding to 2 adiponectin receptors, adiponectin receptor 1 (ADIPOR1) and adiponectin receptor 2 (ADIPOR2). However, the role of these adiponectin receptors on inflammatory pain remains unclear. We investigated the association between single nucleotide polymorphisms (SNPs) of these genes and inflammatory pain, such as postoperative pain and cancer pain.We analyzed 17 SNPs of the ADIPOR1 gene and 27 SNPs of the ADIPOR2 gene in 56 adult patients with postlaparotomy pain. We compared these genotypes with pain intensity and opioid consumption, adjusting for multiple testing. We analyzed the genotypes of 88 patients with cancer pain and examined the association of the relevant SNP(s) with pain intensity and opioid consumption.One variant of the ADIPOR1 gene (rs12045862) showed significant association with postoperative pain intensity; patients with minor allele homozygote (n = 7) demonstrated significantly worse pain intensity than that of combined patient group exhibiting major allele homozygote or the heterozygote (n = 49; Mann-Whitney test, P < .00002), although their opioid consumptions were comparable. Cancer pain intensity between minor allele homozygote patients (n = 7) and other 2 genotype patients (n = 81) were comparable.The rs12045862 SNP of the ADIPOR1 gene was associated with postoperative pain but not cancer pain. This might result from functional alteration of the ADIPOR1 signalling pathways, which influence the inflammatory process. ADIPOR1 may be a novel potential target for developing analgesics of postoperative pain.


Assuntos
Dor do Câncer/genética , Dor Pós-Operatória/genética , Polimorfismo de Nucleotídeo Único , Receptores de Adiponectina/genética , Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Neoplasias Colorretais/genética , Neoplasias Colorretais/cirurgia , Feminino , Estudos de Associação Genética , Humanos , Inflamação/genética , Laparotomia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico
5.
Medicine (Baltimore) ; 99(5): e18939, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000411

RESUMO

RATIONALE: Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS: A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES: Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS: The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES: The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS: The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.


Assuntos
Analgésicos/administração & dosagem , Dor do Câncer/tratamento farmacológico , Doxorrubicina/administração & dosagem , Dor Intratável/tratamento farmacológico , Neoplasias da Coluna Vertebral/secundário , Tomografia Computadorizada por Raios X , Dor do Câncer/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Intratável/diagnóstico por imagem , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico
6.
Int J Radiat Oncol Biol Phys ; 106(2): 261-268, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31628959

RESUMO

PURPOSE: In patients with spinal instability, cord compression, or neurologic deficits, the standard of care is surgery followed by radiation therapy (RT). Recurrence rates after conventional RT remain high. The purpose of this study is to prospectively examine the efficacy of postoperative stereotactic body RT (SBRT) in patients who have undergone surgical intervention for spine metastases. We hypothesize that postoperative SBRT to the spine would be associated with higher local control than historical rates after conventional RT. METHODS AND MATERIALS: Thirty-five adult patients with a Karnofsky Performance Status score ≥40 and spine metastases from solid tumors with no prior overlapping RT and target volumes ≤3 consecutive vertebral levels were enrolled. Thirty-three patients were treated. Two patients underwent treatment to 2 target volumes for a total of 35 target volumes. All patients received SBRT 30 Gy in 5 fractions. Patients were followed with neurological examinations and computed tomography and/or magnetic resonance imaging every 3 months. Neurologic function was assessed at the same time points using the American Spinal Injury Association (ASIA) impairment score. Pain was rated according to the 10-point visual analogue scale and MD Anderson Cancer Center brief pain index. Toxicity was recorded according to National Cancer Institute Common Toxicity Criteria for Adverse Events Version 4. The primary objective was the rate of radiographic local recurrence at 12 months after completion of SBRT. RESULTS: Patient characteristics were as follows: 34.3% had radioresistant primaries; 71.4% were ASIA E and the remainder ASIA D; and the median baseline Karnofsky Performance Status score was 70 (range, 50-100). Radiographic and symptomatic local control at 1 year were 90% (95% confidence interval, 76%-98%). The median time to recurrence in these 3 patients was 3.5 months (range, 3.4-5.8 months), all had radiosensitive tumors, and all recurrences were epidural. No patients experienced wound dehiscence, hardware failure, or spinal cord myelopathy. The median time to return to systemic therapy was 0.5 months (range, 0-9.4 months). CONCLUSIONS: This prospective study of postoperative spine SBRT demonstrates excellent local control with low toxicity. These data suggest superior rates of local control compared with conventional RT; however, a formal comparative study is warranted.


Assuntos
Recidiva Local de Neoplasia , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Dor do Câncer/diagnóstico , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Exame Neurológico/estatística & dados numéricos , Medição da Dor/métodos , Período Pós-Operatório , Estudos Prospectivos , Tolerância a Radiação , Radiocirurgia/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Tumori ; 106(1): 25-32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31456509

RESUMO

BACKGROUND: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. MEASURES: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. RESULTS: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. CONCLUSION: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.


Assuntos
Dor do Câncer/epidemiologia , Pacientes Internados , Manejo da Dor , Medição da Dor , Melhoria de Qualidade , Dor do Câncer/diagnóstico , Dor do Câncer/terapia , Cuidadores , Gerenciamento Clínico , Feminino , Seguimentos , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Modelos Teóricos , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Medição da Dor/normas , Educação de Pacientes como Assunto , Encaminhamento e Consulta
8.
Support Care Cancer ; 28(1): 141-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30993452

RESUMO

PURPOSE: Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14. METHODS: Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants' global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, α); test-retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported 'no change' on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance. RESULTS: FACIT-Pal had better internal consistency (α ranged 0.59-0.80, 15/18 ≥ 0.70) than QLQ-C15-PAL (0.51-0.85, 4/8 ≥ 0.70) and FACT-G7 (0.54-0.64, 0/2 ≥ 0.70). FACIT scales had better test-retest reliability (FACIT-Pal 11/27 ICCs ≥ 0.70, FACT-G7 2/3 ICCs ≥ 0.70) than QLQ-C15-PAL (2/30 ICCs ≥ 0.70, 18/30 ≤ 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total). CONCLUSIONS: No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated.


Assuntos
Cuidados Paliativos , Medidas de Resultados Relatados pelo Paciente , Psicometria , Qualidade de Vida , Adulto , Idoso , Austrália/epidemiologia , Dor do Câncer/epidemiologia , Dor do Câncer/terapia , Dor Crônica/epidemiologia , Dor Crônica/terapia , Ensaios Clínicos Fase III como Assunto/estatística & dados numéricos , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Psicometria/métodos , Psicometria/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Vômito/epidemiologia , Vômito/terapia
9.
Support Care Cancer ; 28(1): 279-285, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31041583

RESUMO

PURPOSE: Tumor-related cancer pain often comprises mixed pain with both nociceptive and neuropathic components. Whether tumor-related cancer pain includes a neuropathic component impacts the therapeutic strategy. The aim of this cross-sectional study was to investigate the usefulness of two screening tools for neuropathic pain, painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain. METHOD: This cross-sectional study recruited consecutive inpatients and outpatients at a single site. The diagnostic accuracy of painDETECT and S-LANSS was evaluated using receiver operating characteristic curve analysis and classification probability. RESULTS: Of the study group, 106 patients had tumor-related cancer pain. Analyses of the nociceptive and mixed pain groups (n = 104) showed that neither painDETECT nor S-LANSS had satisfactory areas under the curve (AUCs) for identifying the neuropathic component of mixed pain (0.59 for painDETECT and 0.56 for S-LANSS). By pain intensity, the AUC for painDETECT was significantly higher in the mild pain group than in the moderate or severe pain group (0.77 vs. 0.43, P = 0.002). All parameters of classification probability for both tools were higher in the mild pain group than in the moderate or severe pain group. CONCLUSIONS: painDETECT and S-LANSS could not identify the neuropathic component of mixed pain among patients with tumor-related cancer pain, especially when pain was moderate or severe. Contrarily, these screening tools might be useful for identifying the neuropathic component of mixed pain for mild pain.


Assuntos
Dor do Câncer/diagnóstico , Programas de Rastreamento/métodos , Neuralgia/diagnóstico , Medição da Dor/métodos , Autorrelato , Idoso , Dor do Câncer/epidemiologia , Comorbidade , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neuralgia/epidemiologia , Neuralgia/etiologia , Valor Preditivo dos Testes , Autoavaliação , Inquéritos e Questionários
10.
Support Care Cancer ; 28(1): 5-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650294

RESUMO

BACKGROUND: Gabapentinoid use for long-term cancer pain control may be problematic, given unclear mechanisms of action and increased concerns for physical dependence. The purpose of this report is to examine trends of gabapentinoid use among US adults with cancer from 2005 to 2015. METHODS: We conducted a serial, cross-sectional study using data from the Medical Expenditure Panel Survey (MEPS). We performed multiple logistic regression to examine the annual percentages of gabapentinoid users, which were adjusted for age, sex, and US region of residence. The amount of gabapentinoid prescriptions filled in 2015 was also estimated. RESULTS: The adjusted percentage of gabapentinoid users in 2015 was 5.60% (3.79%, 7.41%), 2.39 times greater than the percentage in 2005 (p < .001). By 2015, the number of gabapentinoid prescriptions had grown to approximately 3.52 million (2.40 million, 4.65 million). CONCLUSION: We observed greater than a twofold increase in the trend of gabapentinoid medication use among US adults with cancer. Investigations on the long-term efficacy of gabapentinoids for complex pain syndromes, and mitigation of risks, is essential to guide informed clinical management and keep patients safe.


Assuntos
Analgésicos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Gabapentina/uso terapêutico , Neoplasias/tratamento farmacológico , Manejo da Dor/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/epidemiologia , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Estudos Transversais , Feminino , Gabapentina/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Cuidados Paliativos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
11.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 27(6): 1901-1906, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31839057

RESUMO

OBJECTIVE: To analyze the efficacy of continuous prevention injury combined with interference of pain on enhomcement of physical safety inside and outside hospital and pain control in patients with multiple myeloma (MM). METHODS: Two hundred and thirty-three MM patients admitted in our hospital from January 2016 to December 2017 were divided into 2 group according to odd-even number of hospitalization: routine nursing group (odd number) and combined nursing group (ever number). 119 patients in routine nursing group were given routine nursing, 114 patients in combined nursing group were given combined nursing consisting of continuous prevention of injury combined with interference of pain. The safety event incidence, pain relief, life quality and mental status of patients in 2 groups were compared. RESULTS: The incidence of accidental injuries and disease damages in combined nursing group was significantly lower than that in routine nursing group (3.51% and 4.29% vs 11.76% and 12.61%) (P<0.05). The numeric rating scale (NRS) pain score on the day of hospitalization was not significantly different between 2 groups (P>0.05), after interference, the NRS score and the six-point behavior score in combined nursing group were superior to those in routine nursing group (P<0.05). Before interference, the life quality scores were not significantly different between 2 groups (P>0.05), after interference, the some indicators of life quality in 2 groups were impromoved, the scores of physical function, role function, coguitive function, emotional function, and social function of patients in combined nursing group were superior to those in routine nursing group, the scores related with fatigue, nausea and vomiting, pain, loss of appetite, insomnia and overall health status of patients in combined nursing group were superior to those in routine nursing group (P<0.05). Before interference, there were no significant difference in scores of HAMA scale and HAMD scale between 2 groups (P>0.05), after interference, the scores of HAMA scale and HAMD scale in 2 groups both decreased, but the scores of above-mentioned scales in combined nursing group was lower than those in routine nursing group (P<0.05). CONCLUSION: The Continuous prevention of injury combined with interference of pain shows the better safety of inside and outside hospital and good efficacy of pain control for MM patients.


Assuntos
Dor do Câncer , Mieloma Múltiplo , Humanos , Náusea , Qualidade de Vida , Vômito
12.
Zhonghua Yi Xue Za Zhi ; 99(47): 3720-3724, 2019 Dec 17.
Artigo em Chinês | MEDLINE | ID: mdl-31874497

RESUMO

Objective: To investigate the relationship between single nucleotide polymorphisms of opioid-related genes and high-dose opioid tolerance in patients with cancer pain. Methods: Twenty patients (high-dose opioid tolerance group, group A) who were hospitalized in Henan Cancer Hospital from June 2016 to June 2018 and who received high-dose opioid for pain control for more than 1 week were selected as case groups (group A). Thirty patients with stage Ⅳ tumors who were hospitalized in Henan Cancer Hospital and did not have opioid tolerance were randomly selected as the control group (group B). The peripheral blood samples of two groups were taken for DNA extraction. Gene polymorphisms were detected in 15 single nucleotide polymorphisms (SNP) (rs1799971, rs754891060, rs200637194, rs1045642, rs7438135, rs7439366, rs2242480, rs1080985, rs529520, rs581111, rs2234918, rs4680, rs6276, rs3732765, rs9859538) of the nine opioid receptor-related genes (OPRM1,ABCB1,UGT2B7,CYP3A4,CYP2D6,OPRD1, COMT,DRD2,P2RY12) which most likely to affect high-dose opioid tolerance in patients with cancer pain. Results: The distribution of different genotypes of rs7438135 locus in UGT2B7 gene were statistically significant between the two groups (χ(2)=9.68, P=0.004). The difference in the distribution of the different genotypes of the rs3732765 locus of the P2RY12 gene in the two groups were at the significant edge (χ(2)=5.57, P=0.05). A correlation analysis between the relevant SNP locus and the risk of high-dose opioid tolerance in cancer patients indicated that individuals with rs7438135 GA genotype in cancer patients were at 6.19 times more likely to have high doses of opioid tolerance than individuals with AA genotypes. Conclusions: The rs7438135 locus gene polymorphism of UGT2B7 gene may be a risk predictor for high-dose opioid tolerance. The rs3732765 site of the P2RY12 gene may be a potential predictor of high-dose opioid tolerance.


Assuntos
Analgésicos Opioides , Dor do Câncer , Dor do Câncer/tratamento farmacológico , Tolerância a Medicamentos , Genótipo , Humanos , Polimorfismo de Nucleotídeo Único , Receptores Opioides mu
13.
Medicine (Baltimore) ; 98(51): e17820, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860946

RESUMO

INTRODUCTION: With the development of economy and the acceleration of population aging, Prostate cancer (PCa) has presented a situation of high morbidity and mortality worldwide. The recent studies have shown that Chinese patent medicine combined with endocrine therapy in the treatment of prostate cancer not only plays a synergistic role in enhancing the efficacy. This review hopes to adopt meta-analysis to evaluate the efficacy and safety of Chinese patent medicine in the treatment of pain caused by prostate cancer and provides evidence for its application in clinical practice. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to June 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of pain caused by prostate cancer. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of Chinese patent medicine for pain caused by prostate cancer. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131544.


Assuntos
Dor do Câncer/terapia , Medicina Tradicional Chinesa/métodos , Manejo da Dor/métodos , Neoplasias da Próstata/complicações , Idoso , Dor do Câncer/diagnóstico , China , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/fisiopatologia , Medição da Dor , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/mortalidade , Medição de Risco , Análise de Sobrevida
14.
Gan To Kagaku Ryoho ; 46(12): 1861-1865, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879404

RESUMO

In this study, we examined 239 outpatients receiving chemotherapy for breast cancer for a period of 6 months from July 2016 to December 2016. Using a questionnaire, we investigated the patients' symptom score and uneasiness. A symptom score of 2 and over was found in 24.7%(59)of the cases. Twenty-seven of the 59 cases experienced adverse effects of chemotherapy. Peripheral neuropathy was observed in 20 cases, of which only 2 cases improved after providing palliative care. Palliative care was effective against nausea, constipation, malaise, and sleeping disorders. Thirty-two cases(13.4%)had 5 or more painful feeling score. Among these, 10 cases resulted from the adverse effects of treatment, 10 cases from the aggravation of existing cancer, and 6 cases showed anxiety for the illness, family, and future. In 15 of the 32 cases, the pain score improved by providing palliative care, conversation with the nursing staff, reduction in the quantity of drug intake, etc.


Assuntos
Neoplasias da Mama , Ansiedade , Dor do Câncer , Humanos , Pacientes Ambulatoriais , Cuidados Paliativos
15.
Medicine (Baltimore) ; 98(45): e17844, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702641

RESUMO

BACKGROUND: Several treatments are beneficial for patients with cancer-related pain (CRP), and there are numbers of systematic reviews evaluating the effectiveness and safety of these treatments. However, the overall quality of the evidence has not been quantitatively assessed. The aim of this study is to overcome the inconclusive evidence about the interventions of CRP. METHODS: We will perform an umbrella systematic review to identify eligible randomised controlled trials (RCTs). A comprehensive literature search will be conducted in MEDLINE, EMBASE, and the Cochrane library for systematic reviews, meta-analyses and RCTs. We will describe the general information of the RCTs for participants, interventions, outcome measurements, comparisons, and results. Network meta-analysis will be developed to determine the comparative effectiveness of the treatments. RESULTS: The result of this network meta-analysis will provide direct and indirect evidence of treatments for CRP. CONCLUSION: The conclusion of our study will help clinicians and CRP patients to choose suitable treatment options. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as the data are not individualized. The findings of this systematic review will be disseminated in a peer-reviewed publication and/or presented at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42019131721.


Assuntos
Dor do Câncer/terapia , Manejo da Dor/métodos , Humanos , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
16.
Pain Res Manag ; 2019: 5050979, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687057

RESUMO

Introduction: Pain is one of the most common and unpleasant symptoms that distress the well-being of patients with cancer. Considerable evidence supports the validity and reliability of the McGill Pain Questionnaire (MPQ) and its short forms, the SF MPQ and SF MPQ-2-which are the most widely used tools for pain assessment-in terms of patients with cancer. Pain and its characteristics are best assessed using validated and culturally adapted tools developed in participants' mother tongue. Although many pain assessment tools are available worldwide, only a limited number of them have been translated into Sinhala language and validated in Sri Lanka. We aimed to translate SF MPQ-2 into Sinhala language and validate using Sinhala-speaking patients suffering from cancer pains in Sri Lanka. Materials and Methods: Translation has been conducted according to the guidelines laid down by Mapi Research Trust, in five stages, namely, forward translation, backward translation, expert opinion, cognitive debriefing interviews, and proofreading. The questionnaire was administered among 207 patients attending Apeksha Hospital, Sri Lanka, who are suffering from cancer pain. Content validity was tested using expert opinion, and face validity, by interviewing patients with cancer pain. Factor structure was tested through a factor analysis, and reliability, by internal consistency with Cronbach's alpha. Results: A total of 207 participants (112 males and 95 females), aged between 20 and 80 years, were included in the study. Factor analysis identified four factors compatible with studies done in other countries, which explained 53.5% of the variance. The analysis of data indicated Cronbach's alpha of neuropathic, affective, intermittent, and continuous subscales as 0.768, 0.791, 0.824, and 0.789, respectively, which were over the acceptable threshold of 0.70. Confirmatory factor analysis supported the four-factor model. Conclusion: SF MPQ-2-Sinhala version is a statistically proven reliable and valid pain descriptor which can be utilized to evaluate pain suffered by patients with cancer in Sri Lanka whose mother tongue is Sinhala.


Assuntos
Linguagem , Medição da Dor , Psicometria , Traduções , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Reprodutibilidade dos Testes , Sri Lanka , Inquéritos e Questionários , Adulto Jovem
17.
Medicine (Baltimore) ; 98(44): e17381, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689744

RESUMO

BACKGROUND: This study will assess the effectiveness of electroacupuncture (EA) for pain in patients with osteosarcoma post surgery (OSPS). METHODS: In this study, we will comprehensively search the following electronic databases from inception to the present without language restrictions: Cochrane Library, EMBASE, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. Two authors will independently carry out study selection, data extraction, and methodological assessments. RevMan 5.3 software will be used for statistical analysis. RESULTS: The primary outcome is pain intensity. The secondary outcomes consist of event-free survival, overall survival, quality of life, and adverse events. CONCLUSION: The findings of this study will provide helpful evidence of EA treatment for patients with OSPS. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019146696.


Assuntos
Dor do Câncer/terapia , Eletroacupuntura/métodos , Osteossarcoma/terapia , Intervalo Livre de Doença , Eletroacupuntura/efeitos adversos , Humanos , Osteossarcoma/cirurgia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
18.
Medicine (Baltimore) ; 98(44): e17624, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689770

RESUMO

INTRODUCTION: Prostate cancer is a male malignant tumor disease with high prevalence in recent years. Patients with advanced prostate cancer are more likely to have bone metastasis and have strong bone pain, and even lead to pathological fracture, which has a serious impact on the quality of life of patients. Traditional Chinese medicine has good clinical efficacy in treating pain caused by prostate cancer .This review hopes to adopt meta-analysis to evaluate the efficacy and safety of TCM in the treatment of pain caused by prostate cancer and provide evidence for its application in clinical practice. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to June 2019.We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of pain caused by prostate cancer. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of TCM for pain caused by prostate cancer. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131544.


Assuntos
Neoplasias Ósseas/secundário , Dor do Câncer/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Neoplasias da Próstata/patologia , Relação Dose-Resposta a Droga , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Masculino , Recidiva Local de Neoplasia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
19.
Gan To Kagaku Ryoho ; 46(11): 1727-1731, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31748482

RESUMO

We retrospectively examined 106 cases of tapentadol use in Japan in August 2014 for cancer pain at our hospital.The advantage of the opioid medication tapentadol is that its introduction is suitable in patients undergoing anti-cancer treatment because of the low incidence of gastrointestinal symptoms, with glucuronidation involved in the metabolism, and lack of interactions with other drugs.However, depending on the dosage form and presence of swallowing disorders, the administration should be considered carefully.


Assuntos
Dor do Câncer , Tapentadol/uso terapêutico , Analgésicos Opioides , Dor do Câncer/tratamento farmacológico , Humanos , Japão , Fenóis , Estudos Retrospectivos
20.
Isr Med Assoc J ; 21(11): 710-715, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713356

RESUMO

BACKGROUND: The policies and practices related to medical cannabis are currently in flux. These changes have been associated with many controversies, and there is a lack of consensus within the medical community regarding medical cannabis practices. OBJECTIVES: To validate clinical vignettes that can be used to examine and improve medical cannabis practices. METHODS: Ten physicians participated in a Delphi survey of two consequent rounds in which they quantified the eligibility of medical cannabis therapy for six clinical vignettes describing both chronic pain and cancer patients. RESULTS: Higher consensus was achieved for the vignettes of cancer patients, which were additionally rated as more eligible for medical cannabis therapy. The highest level of consent (4.3 out of 5) was achieved regarding a vignette of a metastatic cancer patient. While in some cases physicians consolidated their ratings toward the group's average, in other cases they remained stable in their responses. CONCLUSIONS: While controversies related to medical cannabis are expected to remain rampant, the validated vignettes may facilitate assessment of clinical practices, which is essential for a successful implementation of medical cannabis policies. These vignettes may additionally be used in medical training for appropriate patient selection for medical cannabis authorization.


Assuntos
Dor do Câncer/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Tomada de Decisão Clínica , Maconha Medicinal , Neoplasias/tratamento farmacológico , Técnica Delfos , Humanos , Israel
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