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1.
Anticancer Res ; 40(4): 1789-1796, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234867

RESUMO

Pancreatic cancer is often diagnosed due to the patient seeking medical attention for abdominal pain. It is among the most painful cancers, with pain severity strongly correlating with prognosis. Perineural invasion is a prominent feature of pancreatic cancer and often the first route of metastasis resulting in neuropathic pain. While surgical pain is present, it is generally short-lived; chemo- and radio-therapy associated side effect pain is often longer lasting and more difficult to manage. Treatment-induced mucositis in response to chemotherapy occurs throughout the GI tract resulting in infection-prone ulcers on the lip, buccal mucosa, palate or tongue. Cisplatin treatment is associated with axonal neuropathy in the dorsal root ganglion, although other large sensory fibers can be affected. Opioid-induced hyperalgesia can also emerge in patients. Along with traditional means to address pain, neurolytic celiac plexus block of afferent nociceptive fibers has been reported to be effective in 74% of patients. Moreover, as cancer treatments become more effective and result in improved survival, treatment-related side effects become more prevalent. Here, pancreatic cancer and treatment associated pain are reviewed along with current treatment strategies. Potential future therapeutic strategies to target the pathophysiology underlying pancreatic cancer and pain induction are also presented.


Assuntos
Dor do Câncer/tratamento farmacológico , Mucosite/tratamento farmacológico , Manejo da Dor/efeitos adversos , Neoplasias Pancreáticas/tratamento farmacológico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Bupivacaína/uso terapêutico , Dor do Câncer/patologia , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Humanos , Mucosite/induzido quimicamente , Medição da Dor , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia
2.
Med Clin North Am ; 104(3): 471-489, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312410

RESUMO

The purpose of this article is to present evidence on the efficacy and safety of medical cannabis as a therapy for symptom management in palliative care. This article provides an overview of the evidence on the risks and benefits of using medical cannabis for the indications of chronic pain, cancer-related pain, cancer cachexia, dementia, and Alzheimer's disease. Currently, there is insufficient evidence to determine the effectiveness and safety of cannabinoids for most reviewed indications, with the exception of chronic pain. Future research is required before palliative care clinicians can make evidence-based decisions on the integration of medical cannabis as adjunct therapies.


Assuntos
Canabinoides/uso terapêutico , Dor Crônica/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/tratamento farmacológico , Caquexia/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Canabinoides/efeitos adversos , Demência/tratamento farmacológico , Humanos , Maconha Medicinal/efeitos adversos , Metanálise como Assunto , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Manejo da Dor/tendências , Cuidados Paliativos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Ann Palliat Med ; 9(2): 558-570, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233627

RESUMO

In this era of crisis and controversy surrounding opioid therapy, we must remember that cancer patients entrust us with supporting them through what might be the most difficult, and oftentimes final, period of their life. The factors that affect the benefits and risks of opioid use in cancer patients and the non-cancer population are quite different. In fact, opioid-associated deaths are 10 times less likely in the former than the latter population, suggesting that a reluctance to initiate opioids in cancer patients can risk under treatment of complex pain. In this review, we outline the considerations and evidence-based practices required to manage the clinical situations that challenge the judicious use of opioids in patients with cancer. A comprehensive review that enable us to better understand and quantify the root causes of variability in pain control, as well as risks of opioid misuse or abuse, would arm healthcare providers with the tools they need to implement multi-modal approaches to treatment planning.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/métodos , Analgésicos Opioides/efeitos adversos , Dor do Câncer/prevenção & controle , Gerenciamento Clínico , Humanos , Transtornos Relacionados ao Uso de Opioides/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor/métodos
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.
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
7.
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
8.
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
9.
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
10.
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
11.
Niger J Clin Pract ; 22(10): 1319-1323, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607718

RESUMO

Background: Morphine is a common analgesic often used to manage chronic pain, especially for patients with pain due to malignancies. Since UGT2B7 plays an important role in the metabolism of morphine, UGT2B7 gene mutation may influence the efficacy of morphine in patients with cancer being treated by this medication. Aims: The aim of this study is to investigate the relationship between the polymorphisms of UGT2B7 and the efficacy of morphine treatment on cancer pain among the Chinese Han population. Materials and Methods: A total of 120 patients with cancer pain were enrolled in this study. Morphine was administrated through patient-controlled analgesia infusion pump, and the visual analog score (VAS) was used for pain assessment at 0.5, 4, 6, 12, 24, 48, and 72-h post morphine treatment, respectively. The plasma concentration of morphine and genetic polymorphism of UGT2B7 C802T and G221T was analyzed, respectively. Results: The frequencies of UGT2B7 C802T were CC: 13.33%, CT: 45% and TT: 41.67%, and the frequencies of UGT2B7 G221T were GG: 76.67%, GT: 22.5% and TT: 0.83%. Moreover, the VAS score of patients with either C802T CT or TT was significantly higher than that in patients with C802T CC. However, no difference of VAS scores was observed between patients carrying G221T GG and patients carrying G221T GT. The plasma concentration of morphine for patients with the C802T CC was significantly lower than that in patients carrying C802T CT or TT, while there was no significant difference in the level of morphine between patients with G221T GG and G221T GT. Conclusion: The polymorphism of UGT2B7 C802T, but not UGT2B7 G221T, has been associated with the efficacy of morphine treatment on cancer pain among Chinese Han population.


Assuntos
Analgésicos Opioides/sangue , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Dor do Câncer/tratamento farmacológico , Glucuronosiltransferase/genética , Morfina/sangue , Neoplasias/sangue , Polimorfismo Genético/genética , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Grupo com Ancestrais do Continente Asiático/genética , Dor do Câncer/genética , Feminino , Genótipo , Humanos , Bombas de Infusão , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/uso terapêutico , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/genética , Medição da Dor , Escala Visual Analógica
12.
Biol Pharm Bull ; 42(10): 1674-1678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31582655

RESUMO

Pain control becomes poor in some cases after opioid switching from oxycodone tablet (OXC) to fentanyl patch (FP). However, fewer studies on risk factors have been reported. In this study, we surveyed the states of pain control (PC) and opioid administration, patient background, laboratory test values, and concomitant drugs retrospectively in 86 patients switching from OXC to FP between June 2010 and April 2018 in Mazda Hospital and Hiroshima Prefectural Hospital. The subjects were divided into 2 groups based on the median number of days to the initial dose increase after switching to FP. Between the early (<7.5 d) and late (≥7.5 d) increase groups, a significant difference was noted in the presence or absence of liver metastasis (LM), concomitant drugs with a high protein binding rate (CDHPBR), and the state of PC before and after switching to FP (p < 0.05). Binary logistic regression analysis showed the presence of CDHPBR, absence of LM, and poor PC after switching were risk factors for early dose increase (presence of CDHPBR: odds ratios (OR), 3.30, 95% confidence interval (CI), 1.09-9.98; presence of LM: OR, 0.31, 95% CI, 0.10-0.93; good PC: OR, 0.23, 95% CI, 0.07-0.79, respectively). The initial dose increase after switching to FP was earlier in patients with CDHPBR and/or without LM than those without CDHPBR and with LM (p < 0.05, log-rank test). It was suggested that the analgesic effect of FP after switching from OXC is likely to be insufficient in patients treated with CDHPBR and patients without LM.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor do Câncer/tratamento farmacológico , Substituição de Medicamentos , Fentanila/administração & dosagem , Oxicodona/administração & dosagem , Idoso , Relação Dose-Resposta a Droga , Interações Medicamentosas , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Ligação Proteica , Fatores de Risco , Comprimidos , Adesivo Transdérmico
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(9): 1078-1082, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31640967

RESUMO

OBJECTIVE: To observe the effect of cinobufagin on transient outward potassium current (IA) in rat dorsal root ganglion cells of cancer-induced bone pain (CIBP) and explore the possible analgesic mechanism of cinobufagin. METHODS: Whole cell patch clamp technique was used to examine the effect of cionbufagin on IA in acutely isolated dorsal root ganglion (DRG) cells from normal SD rats and rats with bone cancer pain. RESULTS: The DRG cells from rats with CIBP showed obviously decreased IA current density, an activation curve shift to the right, and an inactivation curve shift to the left. Cinobufagin treatment significantly increased the IA current density and reversed the changes in the activation and inactivation curves in the DRG cells. CONCLUSIONS: IA current is decreased in DRG neurons from rats with CIBP. Cinobufagin can regulate the activation and inactivation of IA current in the DRG cells, which may be related to its analgesic mechanism.


Assuntos
Analgésicos/farmacologia , Bufanolídeos/farmacologia , Dor do Câncer/tratamento farmacológico , Gânglios Espinais/efeitos dos fármacos , Canais de Potássio/metabolismo , Animais , Células Cultivadas , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley
14.
Medicina (Kaunas) ; 55(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547335

RESUMO

Pain can have a significantly negative impact on the quality of life of patients. Therefore, patients may resort to analgesics to relieve the pain. The struggle to manage pain in cancer patients effectively and safely has long been an issue in medicine. Analgesics are the mainstay treatment for pain management as they act through various methods on the peripheral and central pain pathways. However, the variability in the patient genotypes may influence a drug response and adverse drug effects that follow through. This review summarizes the observed effects of analgesics on UDP-glucuronosyl (UGT) 2B7 isoenzyme, cytochrome P450 (CYP) 2D6, µ-opioid receptor µ 1 (OPRM1), efflux transporter P-glycoprotein (P-gp) and ATP-binding cassette B1 ABCB1/multiple drug resistance 1 (MDR1) polymorphisms on the mechanism of action of these drugs in managing pain in cancer. Furthermore, this review article also discusses the responses and adverse effects caused by analgesic drugs in cancer pain management, due to the inter-individual variability in their genomes.


Assuntos
Analgésicos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Redes Reguladoras de Genes , Polimorfismo de Nucleotídeo Único , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Dor do Câncer/genética , Citocromo P-450 CYP2D6/genética , Glucuronosiltransferase/genética , Humanos , Manejo da Dor/métodos , Variantes Farmacogenômicos , Qualidade de Vida , Receptores Opioides mu/genética
16.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31484675

RESUMO

Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Maus-Tratos Infantis , Cuidados Paliativos/ética , Pais , Adolescente , Serviços de Proteção Infantil , Feminino , Hospitais para Doentes Terminais , Humanos , Adesão à Medicação , Autonomia Pessoal , Autoadministração/ética , Doente Terminal
17.
Dtsch Med Wochenschr ; 144(16): 1135-1137, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31416105

RESUMO

HISTORY AND CLINICAL FINDINGS: In this report, a 60-year old patient with a history of mixed nociceptive and neuropathic chronic pain after successful removal of oral squamous cell cancer is described who received outpatient pain treatment in our clinic. Moreover, the patient presented with a history of alcohol abuse as well as anorexia and weight loss. EXAMINATIONS AND DIAGNOSIS: The patient was in reduced general condition and cachectic nutritional status. In addition, he suffered from oral pain that radiated to both ears and a related loss of appetite. TREATMENT: In the light of progressive cachexia, we started regular medical cannabis (Sativex®, contains i. e. delta-9-tetrahydrocannabinol and cannabidiol). Despite good initial tolerability, medical cannabis was stopped early due to alcohol relapse of the patient. After termination of medical cannabis, the patient regained control of alcohol consumption and achieved sobriety. CONCLUSIONS: We suggest that medical cannabis only be prescribed with particular caution in patients with a history of alcohol abuse.


Assuntos
Alcoolismo/complicações , Abuso de Maconha , Maconha Medicinal , Dor do Câncer/tratamento farmacológico , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Pessoa de Meia-Idade , Neoplasias Bucais/psicologia , Neoplasias Bucais/terapia , Recidiva , Automedicação/psicologia
18.
Mayo Clin Proc ; 94(9): 1840-1851, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31447137

RESUMO

Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.


Assuntos
Dor do Câncer/tratamento farmacológico , Canabidiol/administração & dosagem , Maconha Medicinal/uso terapêutico , Guias de Prática Clínica como Assunto , Atitude do Pessoal de Saúde , Cannabis , Dor Crônica/tratamento farmacológico , Aprovação de Drogas , Feminino , Humanos , Masculino , Óleos , Estados Unidos , United States Food and Drug Administration
20.
Neurol Res ; 41(11): 972-979, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31296147

RESUMO

Objective: Bone cancer pain is characterized by moderate to severe ongoing pain that commonly requires the use of opiates. Transient receptor potential vanilloid subfamily member 1 (TRPV1), a new target of the analgesics, activated by heat, protons and capsaicin and the hot component of pepper. However, little is known of the anti-nociceptive effects of TRPV1 in cancer-induced bone pain. RNA interference (RNAi) has proven to be a powerful technique to study the function of genes by producing knock-down phenotypes. The aim of this study is to investigate the potential role of TRPV1 in rat model of bone cancer pain. Methods: Bone cancer pain animal model was created by tumor cell implantation (TCI). An AAV-mediated siRNA against TRPV1 was intrathecally delivered into the rats. Animal behaviors were measured using a set of mechanical or electronic von Frey apparatus and hot plate. mRNA and protein expression were examined by using qPCR and western blot methods. Results: Mechanical threshold and paw withdrawal latency in response to thermal stimulation were significantly elevated in rats with intrathecal administration of AAV-mediated siRNA against TRPV1. Moreover, class I histone deacetylases (HDACs), which plays a critical role in the neuro-inflammation response, and TNFα in the spinal cord were also significantly suppressed upon knockdown of TRPV1 by AAV-mediated siRNA against TRPV1 in rat spinal cord. Conclusions: Knockdown of TRPV1 effectively ameliorated mechanical allodynia and thermal hyperalgesia induced by TCI. Our data demonstrated that modulate the expression of TRPV1 in the spinal cord could be a potential therapeutic approach for bone cancer pain.


Assuntos
Dor do Câncer/tratamento farmacológico , Nociceptividade/efeitos dos fármacos , RNA Interferente Pequeno/farmacologia , Canais de Cátion TRPV/genética , Analgésicos Opioides/uso terapêutico , Animais , Dor do Câncer/genética , Modelos Animais de Doenças , Gânglios Espinais/metabolismo , Masculino , Interferência de RNA/fisiologia , RNA Interferente Pequeno/genética , Ratos Sprague-Dawley , Medula Espinal/patologia
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