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1.
Zhongguo Zhen Jiu ; 41(2): 121-4, 2021 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-33788457

RESUMO

OBJECTIVE: To observe the effectiveness and safety of electrothermal acupuncture therapy for patients of moderate to severe cancer pain with yin-cold stagnation. METHODS: A total of 60 patients of moderate to severe cancer pain with yin-cold stagnation were randomized into an observation group and a control group, 30 cases in each one. In the control group, opioid painkillers (oxycodone hydrochloride prolonged-release tablet or morphine sulfate sustained-release tablet) were taken. On the basis of the control group, electrothermal acupuncture was applied at Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36), Hegu (LI 4), Sanyinjiao (SP 6) in the observation group, 30 min each treatment, once a day for 5 days. Before and after treatment, the scores of pain numerical rating scale (NRS) and Karnofsky performance scale (KPS) were observed in the two groups. The pain remission rate, reduction of opioid painkillers and safety were compared. RESULTS: The variation of NRS scores in the observation group were larger than the control group 3, 5 days into treatment (P<0.01, P<0.05). The variation of KPS score in the observation group was larger than the control group after treatment (P<0.05). The pain remission rate was 100.0% (30/30) in the observation group, higher than 86.7% (26/30) in the control group (P<0.05). The reduction of opioid painkillers in the observation group was larger than the control group (P<0.01). There was no adverse reaction during the treatment in the two groups. CONCLUSION: On the basis of the conventional western medication for analgesia, electrothermal acupuncture could relieve pain, reduce the dose of opioid painkillers and improve the quality of life in patients of moderate to severe cancer pain with yin-cold stagnation, has a better safety.


Assuntos
Terapia por Acupuntura , Dor do Câncer , Neoplasias , Pontos de Acupuntura , Dor do Câncer/terapia , Humanos , Neoplasias/complicações , Neoplasias/terapia , Oxicodona , Qualidade de Vida , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(12): e24320, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761631

RESUMO

ABSTRACT: Palliative care is a central component of the therapy in terminally ill patients. During treatment in non-palliative departments this can be realized by consultation.To analyze the change in symptom burden during palliative care consultation.In this observational study, we enrolled all cancer cases (n = 163) receiving inpatient treatment for 2015 to 2018 at our institution. We used the MDASI-questionnaire (0 = 'not present' and 10 = "as bad as you can imagine") and the FAMCARE-6 (1 = very satisfied, 5 = very dissatisfied) to analyze the treatment effect and patient satisfaction, respectively.We examined the association of symptom burden and patient satisfaction using Spearman-correlation. Comparing mean values, we applied the Wilcoxon-test and one-way ANOVA.An improvement in MDASI-core-items after treatment completion was significant (P < .05) in 14/18 symptoms. The change in perception of pain showed the strongest improvement (median: 5 to 3). Initially the MDASI-items "activity" (median = 8) and emotional distress (median = 5 and 6) were viewed as especially incriminating. There was no evidence for a correlation between patients' age, the type of diagnosis and time since diagnosis.The analysis of FAMCARE-6 patient contentment was lower or equal to two in all of the six items. There was a weak negative association between the change in symptom burden of psycho-emotional items "distress/feeling upset" (P = .006, rSp = -0,226), "sadness" and patient satisfaction in FAMCARE-6.A considerable improvement of the extensive symptom burden particularly of pain relief was achieved by integrating palliative consultation in clinical practice.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Cuidados Paliativos/psicologia , Satisfação do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Medição da Dor/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Doente Terminal/psicologia , Doente Terminal/estatística & dados numéricos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(5): e23748, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592831

RESUMO

BACKGROUND: Up to 80% of patients with pancreatic cancer experience abdominal and back pain. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a non-invasive physical modality and had been widely applied for pain relieving, yet no study has investigated the effectiveness of TENS for pain in pancreatic cancer. METHODS: Eligible patients were randomly assigned in a 1:1 ratio to TENS group or control group. The primary outcome was percentage change of numerous rating scale (NRS) after treatment. Secondary outcomes included percentage change of analgesic medication consumption and effect on constipation and poor appetite. RESULTS: One hundred seventy-one patients were recruited (84 to control group and 87 to TENS group). NRS in TENS group has been largely decreased 77.9% right after treatment and 27.1% in 2 hours, before applying any analgesic medication, while that in control group was slightly downregulated right after treatment but gave a trend to increase at 1, 2, and 3 hours. When comparing both groups, pain was significantly well controlled without analgesic medication supplement in TENS group at 0 hour (difference in mean percent change in NRS = 50.0 [95% CI, 50-51.4], P < .01) and 3 hours (difference in mean percent change in NRS = 134.0 [95% CI, 130.0-142.7], P < .01) after treatment, and this analgesic effect last to 3 weeks after treatment cycle (difference in mean percent change in NRS = 22.5 [95% CI, 17.6-27.3], P < .01) without increase of analgesic medication consumption. CONCLUSIONS: TENS reduces pain without increase analgesic medication consumption in patients with pancreatic cancer pain. It provides an alternative therapy for pain in pancreatic cancer. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, identifier NCT03331055.


Assuntos
Dor do Câncer/terapia , Neoplasias Pancreáticas/epidemiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Idoso , Analgésicos Opioides/administração & dosagem , Apetite/fisiologia , Constipação Intestinal/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Manejo da Dor , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos
6.
Medicine (Baltimore) ; 99(45): e23119, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157988

RESUMO

BACKGROUND: Cancer pain (CP) is one of the common complications of cancer. During the treatment, oral medication, radiotherapy and chemotherapy bring certain adverse reactions to patients with CP; a safe way to treat this disease is necessary. Acupuncture and related therapies for CP with few side effects have been gradually accepted. But at present the evidence is insufficient, the related research is not thorough enough. The purpose of this study was to investigate the efficacy and safety of acupuncture and related therapies for CP. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines were used to design this protocol. The final study will also be conducted under the PRISMA guidelines for systematic reviews and meta-analysis. An electronic search will be conducted in Medline, Embase, and the Cochrane Central Register of Controlled Trials databases through January 2020. The search will be conducted in English. Risk of bias will be assessed by the Cochrane Collaboration tool and the collected evidence will be nar-ratively synthesized. We will also perform a meta-analysis to pool estimates from studies considered to be homogenous. Subgroup analyses will be based on intervention or overall bias. The strength of evidence will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluation scale. RESULTS: This systematic review will summarize high quality clinical evidence to assess and appraise the effectiveness and safety of acupuncture and related therapies for CP patients. CONCLUSION: The meta-analysis will assess evidence from randomized controlled trials of acupuncture and related therapies and CP types. INPLASY REGISTRATION NUMBER: INPLASY202040129.


Assuntos
Terapia por Acupuntura , Dor do Câncer/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Terapia por Acupuntura/efeitos adversos , Humanos , Resultado do Tratamento
7.
Rev Lat Am Enfermagem ; 28: e3377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027406

RESUMO

OBJECTIVE: to synthesize the knowledge and to critically evaluate the evidences arising from randomized controlled trials on the efficacy of the complementary therapies in the management of cancer pain in adult patients with cancer in palliative care. METHOD: a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search for articles in the MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane, and PsycINFO databases, as well as the manual search, selection of studies, data extraction, and methodological assessment using the Cochrane Bias Risk tool were performed independently by two reviewers. RESULTS: eight hundred and fifteen (815) studies were identified, six of them being selected and analyzed, of which three used massage therapy, one study used a combination of progressive muscle relaxation and guided imaging, and another two studies used acupuncture. Most of the studies had an uncertain risk of bias (n=4; 67%). CONCLUSION: while the evidence from the studies evaluating the use of massage therapy or the use of progressive muscle relaxation and guided imaging for the management of cancer pain in these patients demonstrated significant benefits, the other two studies that evaluated the use of acupuncture as a complementary therapy showed contradictory results, therefore, needing more research studies to elucidate such findings.


Assuntos
Terapia por Acupuntura , Dor do Câncer , Terapias Complementares , Neoplasias , Adulto , Dor do Câncer/terapia , Humanos , Massagem , Neoplasias/complicações , Neoplasias/terapia , Cuidados Paliativos
9.
Br J Radiol ; 93(1115): 20200465, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783618

RESUMO

Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.


Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
10.
Oncology (Williston Park) ; 34(8): 317-319, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32785928

RESUMO

A 78-year-old man had a medical history of hypertension, atrial fibrillation, chronic kidney disease, and metastatic castration-resistant prostate cancer (CRPC). He had progressed to first-line therapy for CRPC with abiraterone plus androgen-deprivation therapy (ADT) and as second-line therapy he was being treated with docetaxel, with biochemical progression in his last prostate specific antigen measurement. He was admitted to the hospital on April 2020, in the middle of the coronavirus disease 2019 (COVID-19) pandemic, because of painful bone lesions and deterioration of renal function.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Infecções por Coronavirus/terapia , Cuidados Paliativos , Pneumonia Viral/terapia , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Insuficiência Respiratória/terapia , Idoso , Antagonistas de Androgênios/uso terapêutico , Androstenos/uso terapêutico , Antineoplásicos/uso terapêutico , Betacoronavirus , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Dor do Câncer/complicações , Dor do Câncer/terapia , Infecções por Coronavirus/complicações , Progressão da Doença , Docetaxel/uso terapêutico , Combinação de Medicamentos , Definição da Elegibilidade , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Lopinavir/uso terapêutico , Masculino , Oxigenoterapia , Pandemias , Pneumonia Viral/complicações , Neoplasias de Próstata Resistentes à Castração/complicações , Neoplasias de Próstata Resistentes à Castração/patologia , Insuficiência Renal , Insuficiência Respiratória/etiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ritonavir/uso terapêutico , Índice de Gravidade de Doença , Ácido Zoledrônico/uso terapêutico
11.
Medicine (Baltimore) ; 99(30): e21311, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791718

RESUMO

BACKGROUND: This systematic review will assess the effectiveness and safety neuromuscular electrical stimulation (NMES) for cancer pain (CP) in children with osteosarcoma. METHODS: This systematic review protocol will retrieve the following electronic databases from inception to June 1 in Cochrane Library, MEDLINE, EMBASE, Web of Science, Scopus, CNKI, and VIP database. Manual head-searching of reference lists and conference proceedings will be performed to further examine the articles of interest. No restrictions will be applied to language and publication status. We will utilize a 3-stage approach to scan titles, abstracts, and full-text studies against all eligibility criteria, and collect data from included trials. Study quality will be evaluated by the Cochrane Risk of Bias Tool. If possible, we will narratively summarize study results and carry out meta-analysis. RESULTS: This study will recapitulate the present high quality trials to appraise the effectiveness and safety of NMES for CP in children with osteosarcoma. CONCLUSION: The findings of this study will present evidence to determine whether NMES is effective and safe for CP in children with osteosarcoma.


Assuntos
Dor do Câncer/terapia , Terapia por Estimulação Elétrica/métodos , Osteossarcoma/patologia , Adolescente , Criança , Feminino , Humanos , Masculino , Osteossarcoma/epidemiologia , Segurança , Resultado do Tratamento
13.
J Cancer Res Ther ; 16(3): 534-538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32719263

RESUMO

Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB.


Assuntos
Bupivacaína/administração & dosagem , Dor do Câncer/terapia , Nervo Glossofaríngeo/efeitos dos fármacos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Neoplasias da Língua/terapia , Triancinolona Acetonida/administração & dosagem , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Dor do Câncer/etiologia , Dor do Câncer/patologia , Vias de Administração de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Neoplasias da Língua/patologia , Adulto Jovem
14.
Pain Physician ; 23(4): 349-364, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709170

RESUMO

BACKGROUND: Certain types of cancer pain have remained hard to control even by highly skilled pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning, and leads to psychological distress. From this perspective, nonpharmacologic modalities of treatment are important. Neuromodulatory techniques, such as transcutaneous electrical nerve stimulation and scrambler therapy (ST), have gained popularity in recent times. ST is a relatively new therapy that has been used for the management of cancer pain resistant to pharmacologic management. Several studies have shown that ST is an effective therapy for this type of pain. OBJECTIVES: The aim of this study was to detect possible gaps in the literature regarding the efficacy of ST for cancer pain and formulate recommendations for research through a systematic review of the literature. STUDY DESIGN: A systematic review of the literature was performed following the recommendations of the PRISMA Statement. METHODS: PubMed and EMBASE were searched for studies that met the inclusion criteria using a predetermined search strategy. Reference list of retrieved studies and Google Scholar were used to verify that no relevant studies had been omitted. Data were extracted from the studies with a data extraction sheet. A qualitative analyses of the extracted data was undertaken. RESULTS: Twenty-seven studies were retrieved. Ten were articles that were categorized as literature reviews, including 7 general literature reviews not following a specific review methodology, 1 editorial, and 2 systematic reviews. Seventeen were original studies, including 2 single-arm trials, 1 randomized controlled trial, 4 pilot trials, 4 case reports, 2 retrospective studies, and 4 prospective studies. By and large, the available literature supports the use of ST as an effective therapy for the management of refractory cancer pain. However, the level of evidence for its application to cancer pain is not particularly strong, and improvement in pain with ST may even be owing to a placebo effect. LIMITATIONS: This study was not a meta-review. Because of the limited number of clinical trials on ST in cancer pain, such a meta-review could not meaningfully be performed. CONCLUSIONS: Methodologically sound, large randomized control trials are needed in this area. However at this stage, ST may be considered a good option for cancer patients suffering from pain that does not respond to pharmacologic treatment. KEY WORDS: Scrambler therapy, cancer, cancer pain, neuropathic pain, Calmare therapy, evidence, noninvasive pain treatment, chronic pain.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Manejo da Dor/métodos , Estresse Psicológico/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Dor Crônica/terapia , Ensaios Clínicos como Assunto/métodos , Humanos , Neoplasias/psicologia , Neuralgia/diagnóstico , Neuralgia/psicologia , Neuralgia/terapia , Estudos Prospectivos , Qualidade de Vida/psicologia , Estudos Retrospectivos , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
15.
Cochrane Database Syst Rev ; 6: CD007568, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32483832

RESUMO

BACKGROUND: People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being, and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. OBJECTIVES: To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (e.g. with/without additional support such as face-to-face, printed or electronic resources) and duration/frequency of intervention calls mediate observed cancer symptom outcome effects. SEARCH METHODS: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1); MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); (CINAHL) via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsycINFO (1989 to January 2019). We searched conference proceedings to identify published abstracts, as well as SIGLE and trial registers for unpublished studies. We searched the reference lists of all included articles for additional relevant studies. Finally, we handsearched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, and Palliative Medicine. We restricted our search to publications published in English. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared one or more telephone interventions with one other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adults (over 18 years) with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment, and time of recruitment (e.g. before, during, or after treatment). DATA COLLECTION AND ANALYSIS: We used Cochrane methods for trial selection, data extraction and analysis. When possible, anxiety, depressive symptoms, fatigue, emotional distress, pain, uncertainty, sexually-related and lung cancer symptoms as well as secondary outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and we presented a descriptive synthesis of study findings. We reported on findings according to symptoms addressed and intervention types (e.g. telephone only, telephone combined with other elements). As many studies included small samples, and because baseline scores for study outcomes often varied for intervention and control groups, we used change scores and associated standard deviations. The certainty of the evidence for each outcome was interpreted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Thirty-two studies were eligible for inclusion; most had moderate risk of bias,often related to blinding. Collectively, researchers recruited 6250 people and studied interventions in people with a variety of cancer types and across the disease trajectory, although many participants had breast cancer or early-stage cancer and/or were starting treatment. Studies measured symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, and pain, as well as sexually-related symptoms and general symptom intensity and/or distress. Interventions were primarily delivered by nurses (n = 24), most of whom (n = 16) had a background in oncology, research, or psychiatry. Ten interventions were delivered solely by telephone; the rest combined telephone with additional elements (i.e. face-to-face consultations and digital/online/printed resources). The number of calls delivered ranged from 1 to 18; most interventions provided three or four calls. Twenty-one studies provided evidence on effectiveness of telephone-delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 contributed to quantitative CS results); and emotional distress (7 studies; 5 contributed quantitative CS results). Due to significant clinical heterogeneity with regards to interventions introduced, study participants recruited, and outcomes measured, meta-analysis was not conducted. For other symptoms (uncertainty, pain, sexually-related symptoms, dyspnoea, and general symptom experience), evidence was limited; similarly meta-analysis was not possible, and results from individual studies were largely conflicting, making conclusions about their management through telephone-delivered interventions difficult to draw. Heterogeneity was considerable across all trials for all outcomes. Overall, the certainty of evidence was very low for all outcomes in the review. Outcomes were all downgraded due to concerns about overall risk of bias profiles being frequently unclear, uncertainty in effect estimates and due to some inconsistencies in results and general heterogeneity. Unsubstantiated evidence suggests that telephone interventions in some capacity may have a place in symptom management for adults with cancer. However, in the absence of reliable and homogeneous evidence, caution is needed in interpreting the narrative synthesis. Further, there were no clear patterns across studies regarding which forms of interventions (telephone alone versus augmented with other elements) are most effective. It is impossible to conclude with any certainty which forms of telephone intervention are most effective in managing the range of cancer-related symptoms that people with cancer experience. AUTHORS' CONCLUSIONS: Telephone interventions provide a convenient way of supporting self-management of cancer-related symptoms for adults with cancer. These interventions are becoming more important with the shift of care closer to patients' homes, the need for resource/cost containment, and the potential for voluntary sector providers to deliver healthcare interventions. Some evidence supports the use of telephone-delivered interventions for symptom management for adults with cancer; most evidence relates to four commonly experienced symptoms - depression, anxiety, emotional distress, and fatigue. Some telephone-delivered interventions were augmented by combining them with face-to-face meetings and provision of printed or digital materials. Review authors were unable to determine whether telephone alone or in combination with other elements provides optimal reduction in symptoms; it appears most likely that this will vary by symptom. It is noteworthy that, despite the potential for telephone interventions to deliver cost savings, none of the studies reviewed included any form of health economic evaluation. Further robust and adequately reported trials are needed across all cancer-related symptoms, as the certainty of evidence generated in studies within this review was very low, and reporting was of variable quality. Researchers must strive to reduce variability between studies in the future. Studies in this review are characterised by clinical and methodological diversity; the level of this diversity hindered comparison across studies. At the very least, efforts should be made to standardise outcome measures. Finally, studies were compromised by inclusion of small samples, inadequate concealment of group allocation, lack of observer blinding, and short length of follow-up. Consequently, conclusions related to symptoms most amenable to management by telephone-delivered interventions are tentative.


Assuntos
Neoplasias/complicações , Telemedicina/métodos , Telefone , Adulto , Ansiedade/etiologia , Ansiedade/terapia , Dor do Câncer/terapia , Depressão/etiologia , Depressão/terapia , Dispneia/etiologia , Dispneia/terapia , Fadiga/etiologia , Fadiga/terapia , Feminino , Humanos , Masculino , Neoplasias/psicologia , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Avaliação de Sintomas , Telefone/estatística & dados numéricos , Fatores de Tempo , Incerteza
16.
Zhongguo Zhen Jiu ; 40(6): 601-4, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32538009

RESUMO

OBJECTIVE: To evaluate the clinical effect of filiform fire needling on moderate and severe pain in advanced cancer. METHODS: A total of 66 patients with moderate and severe pain in advanced cancer were randomly divided into an observation group (34 cases, 4 cases dropped off) and a control group (32 cases, 2 cases dropped off). The two groups were treated with oral analgesics continuously for 4 weeks. The moderate pain patients was given bucinnazine hydrochloride tablets (starting at 30 mg, once every 6 hours, increasing by 30%-50% until the titration volume was reached), and the severe pain patients were given oxycodone hydrochloride sustained-release tablets (starting at 20 mg every 12 hours and increasing by 25%-50% until the titration volume was reached). The observation group was cooperated with filiform fire needling at ashi point, Zusanli (ST 36), Liangqiu (ST 34), Qihai (CV 6), Guanyuan(CV 4), Quchi (LI 11) and Waiguan (TE 5) once every other day for 4 weeks. The changes of numerical rating scales (NRS) scores were observed in both groups before and after treatment, and the amount of analgesics and the incidence of adverse reactions were recorded. The clinical effects in the two groups were evaluated. RESULTS: The effective rate was 90.0% (27/30) in the observation group, which was higher than 66.7% (20/30) in the control group (P<0.05). After treatment, the NRS scores of both groups were lower than those before treatment (P<0.05), and the reducing degree in the observation group was larger than that in the control group (P<0.05). The average dosage of bunarizine hydrochloride tablets and oxycodone hydrochloride sustained release tablets to titration volume in the observation group was less than that in the control group (P<0.05). The incidence of adverse reactions was 23.3% (28/120) in the observation group, which was lower than 44.2% (53/120) in the control group (P<0.05). CONCLUSION: Filiform fire needling can alleviate pain symptoms of patients with moderate and severe pain in advanced cancer, reduce the amount of analgesics, and decrease the incidence of adverse reactions.


Assuntos
Terapia por Acupuntura , Dor do Câncer/terapia , Neoplasias/terapia , Manejo da Dor , Pontos de Acupuntura , Analgésicos/uso terapêutico , Humanos , Neoplasias/complicações , Oxicodona/uso terapêutico , Piperazinas/uso terapêutico , Resultado do Tratamento
17.
Zhongguo Zhen Jiu ; 40(6): 671-7, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32538022

RESUMO

Based on the internationally-recognized Consolidated Standards for Reporting of Trials (CONSORT) statement and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA), the reported quality of randomized controlled trials (RCTs) of acupuncture for cancer pain during last 10 years were evaluated. The RCTs of acupuncture for cancer pain were searched by computer. The English databases included PubMed and EMbase while the Chinese databases included CNKI, Wanfang, VIP and SinoMed. The publication date of the literature was from March 2009 to March 2019. As a result, 22 Chinese RCTs and 13 English RCTs were included. According to the CONSORT statement, among the Chinese studies, 1 RCT reported primary and secondary outcomes, 8 RCTs reported randomization, none of RCTs reported allocation concealment and blind method, and 4 RCTs reported baseline data; among the English studies, 8 RCTs reported primary and secondary outcomes, 8 RCTs reported randomization, 6 RCTs reported described allocation concealment, 7 RCTs reported blind method, and 13 RCTs reported baseline data. According to the STRICTA statement, among the Chinese studies, 17 RCTs reported the name of acupoints, 6 RCTs reported depth of insertion, 17 RCTs reported acupuncture response sought, and none of RCTs reported the qualifications of acupuncturists; among the English studies, 12 RCTs reported the name of acupoints, 7 RCTs reported depth of insertion, 8 RCTs reported acupuncture response sought, and 7 RCTs reported the qualifications of acupuncturists. The Chinese RCTs have more detailed description of acupuncture intervention and theory, but not enough attention is paid to methodological description such as randomization, blindness, data analysis. On the other hand, the English RCTs have better description of methodology, but the description of theory and details of acupuncture is relatively weak. It is concluded that more efforts were needed to further improve the clinical trial design according to the CONSORT statement and STRICTA statement to improve the quality of clinical evidence.


Assuntos
Terapia por Acupuntura , Dor do Câncer/terapia , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Humanos , Neoplasias/complicações
18.
J Oral Pathol Med ; 49(6): 484-489, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32531095

RESUMO

BACKGROUND: Pain is a common symptom of head and neck cancers. In some instances, pain may not resolve with conventional modalities and become refractory. Chemical neurolysis is a technique that utilizes chemical neurolytic agents to temporarily denervate a targeted nerve and provide relief in pain-related symptoms. The aim of this investigation was to determine the effectiveness, safety, and predictors of chemical neurolysis procedures for management of refractory head and neck cancer-related pain. METHODS: A retrospective chart review of patients who underwent chemical neurolysis procedure in the regions of head and neck for management of head and neck cancer-related pain was conducted between November 2017 and November 2018. All adult male and female patients who had undergone chemical neurolysis procedure in the head and neck region for management of refractory head and neck related pain, in Orofacial Pain Clinic, Shaukat Khanum Memorial Cancer Hospital and Research Center were included in the investigation. RESULTS: Among 33 participants enrolled, 72.7% of participants experienced 75% or greater relief in pain at the 1-month follow-up. However, 9.1% reported experiencing an adverse effect following neurolysis. A statistically significant association was found between neurolysis effectiveness and chronicity of pain. CONCLUSIONS: Chemical neurolysis can provide significant relief to patients with refractory head and neck cancer-related pain as an adjunctive therapy. However, it was found to be associated with mild risk of manageable adverse effects. Shorter chronicity of pain was found to be associated with successful outcome.


Assuntos
Dor do Câncer , Neoplasias de Cabeça e Pescoço , Bloqueio Nervoso , Adulto , Dor do Câncer/terapia , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Dor , Medição da Dor , Estudos Retrospectivos
19.
Cancer Radiother ; 24(5): 374-378, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32527694

RESUMO

Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Fraturas Espontâneas/terapia , Radiologia Intervencionista/métodos , Anestesia Local , Cimentos para Ossos/uso terapêutico , Ablação por Cateter/métodos , Cementoplastia/métodos , Criocirurgia/métodos , Embolização Terapêutica/métodos , Etanol/administração & dosagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Hemorragia/prevenção & controle , Humanos , Micro-Ondas/uso terapêutico , Bloqueio Nervoso/métodos , Cuidados Paliativos/métodos , Ablação por Radiofrequência/métodos , Solventes/administração & dosagem , Vertebroplastia/métodos
20.
Anesth Analg ; 130(6): 1638-1652, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384350

RESUMO

One of the most prevalent symptoms after major surgery is pain. When postoperative pain treatment is unsatisfactory, it can lead to poor surgical recovery, decreased quality of life, and increased health care costs. Current analgesics, single or in combination, have limited efficacy due to low potency, limited duration of action, toxicities, and risk of addiction. The lack of nonaddictive strong analgesics along with the over prescription of opioids has led to an opioid epidemic in the United States. Therefore, there is an urgent need for the development of newer analgesics. Microribonucleic acids (miRNAs) are small noncoding RNA molecules that modulate protein synthesis in neurons and supporting cells (glia, leukocytes, and Schwann cells). The literature indicates that miRNA regulation is important in nociception. Here, we summarize the current evidence on the role of miRNAs on mechanisms involved in incisional, inflammatory, neuropathic, and cancer pain. We also discuss the role of modulating miRNA functions as potential therapeutic targets for analgesic use and opioid tolerance. Finally, we propose how the delivery of analog miRNAs (mimic-miRNAs or antago-miRNAs) could be introduced into clinical practice to provide analgesia in the perioperative period.


Assuntos
MicroRNAs/metabolismo , Dor Pós-Operatória/genética , Dor Pós-Operatória/metabolismo , Dor Aguda/genética , Dor Aguda/metabolismo , Dor Aguda/terapia , Analgesia , Analgésicos/administração & dosagem , Analgésicos Opioides/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor do Câncer/terapia , Tolerância a Medicamentos , Epigênese Genética , Custos de Cuidados de Saúde , Humanos , Inflamação , Manejo da Dor/métodos , Medição da Dor , Dor Pós-Operatória/terapia , Período Perioperatório , Qualidade de Vida , Medula Espinal/metabolismo
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