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1.
J Pain Symptom Manage ; 62(5): 1041-1064, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33933619

RESUMO

CONTEXT: Breakthrough pain (BTP) is common in cancer and other conditions yet there is a lack of validated BTP measurement tools. OBJECTIVES: We aimed to identify all tools assessing or characterising BTP in patients of any age with any condition, and to critically appraise their psychometric properties. METHODS: The Cochrane Library, PROSPERO, Embase, CINAHL, Medline, PsycINFO, Web of Science, Google Scholar, ProQuest, Evidence Search and OpenGrey were searched to identify all available tools used to assess BTP. A second search identified studies that had evaluated psychometric properties of tools identified in Search 1. Databases were searched from inception to November 2020. Studies were assessed using COSMIN criteria and GRADE guidelines. RESULTS: Search 1 found 51 tools used to assess BTP. Search 2 found six tools that had a development study and/or a study evaluating a tool psychometric property. No tool had more than one study evaluating psychometric properties so a meta-analysis could not be conducted. Studies were of inadequate to very good quality. Only the Breakthrough Pain Assessment Tool (BAT) had sufficient content validity and at least low-quality evidence for sufficient internal consistency. CONCLUSION: The BAT is recommended to characterise BTP in adults with cancer; its applicability to other conditions is unknown. The remaining tools need further evaluation. Only the Breakthrough Pain Questionnaire for Children was designed for children with cancer, but no psychometric properties were evaluated. There is a need for a tool to assess and characterise BTP in children with non-cancer diagnoses and those who cannot self-report.


Assuntos
Dor Irruptiva , Adulto , Criança , Bases de Dados Factuais , Humanos , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários
2.
Palliat Med ; 35(6): 1118-1125, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33845654

RESUMO

BACKGROUND: Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed. AIM: To explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial. DESIGN/ PARTICIPANTS: Three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (n = 28), caring for children with life-limiting illnesses receiving palliative care, participated. RESULTS: Oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement. CONCLUSIONS: There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.


Assuntos
Dor Irruptiva , Neoplasias , Analgésicos Opioides , Criança , Atenção à Saúde , Estudos de Viabilidade , Fentanila , Grupos Focais , Heroína , Humanos , Morfina
4.
Eur J Oncol Nurs ; 52: 101945, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33813183

RESUMO

PURPOSE: To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS: Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS: One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (ß = 25.49, p < .001), attitude (ß = 0.98 to 2.81, p < .01), and their perceived assessment practices (ß = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS: This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.


Assuntos
Dor Irruptiva/enfermagem , Dor do Câncer/enfermagem , Educação em Enfermagem/métodos , Conhecimentos, Atitudes e Prática em Saúde , Medição da Dor/enfermagem , Adulto , Competência Clínica , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/enfermagem , Inquéritos e Questionários
5.
Support Care Cancer ; 29(11): 6335-6341, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33880639

RESUMO

BACKGROUND: Methadone is a low-cost, strong opioid that is increasingly used as a first-line treatment for pain in palliative care (PC). Its long and unpredictable half-life and slow elimination phase can make titration challenging. Evidence for titration modalities is scarce. OBJECTIVE: To describe the titration phase of the treatment with low-dose first-line methadone and the use of methadone for breakthrough pain. METHODS: Prospective study with strong opioid-naïve patients with moderate to severe cancer pain followed at a tertiary PC unit in Argentina. Starting methadone dose was 2.5-5 mg/day every 8, 12, or 24 h. Titration allowed daily dose increases from day 1, and prescription of oral methadone 2.5 mg every 2 h with a maximum of 3 rescue doses/day for breakthrough pain. Pain control, methadone stabilization dose, and adverse effects, among other variables, were daily assessed over the first 7 days (T0-T7). RESULTS: Sixty-two patients were included. Initial median (IQR) methadone dose was 5 (2.5) mg/day. Pain intensity decreased from a median (IQR) of 8 (2.3) at T0 to 4 (2.3) at T1 and remained ≤ 4 until T7 (all p < 0.0001 compared to T0). Similar results were obtained through the categorical and tolerability scales for pain. Fifty patients (81%) reached pain control, 66% in the first 48 h. Methadone daily doses at T2 and T7 were higher than that at T0: 7.5 (3) and 6.7 (5.5) versus 5 (2.5), respectively (all p < 0.05). The opioid escalation index at T7 was 1.7%. The median (IQR) number of rescues, stabilization dose, and time for stabilization was 0 (1), 5(4.5) mg, and 3(2) days, respectively. Two patients were discontinued due to delirium. All other side effects were mild. CONCLUSIONS: First-line, low-dose methadone using rescue methadone resulted in a pronounced and rapid decrease in pain, with minimal need for titration and for breakthrough doses, and no evidence of accumulation or sedation by the end of the week.


Assuntos
Dor Irruptiva , Dor do Câncer , Neoplasias , Analgésicos Opioides , Dor do Câncer/tratamento farmacológico , Relação Dose-Resposta a Droga , Humanos , Metadona , Neoplasias/complicações , Estudos Prospectivos
6.
Clin Pharmacokinet ; 60(7): 907-919, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33686630

RESUMO

BACKGROUND: Cardiac bypass surgery patients have early postoperative interventions that elicit breakthrough pain. We evaluated the use of intranasal fentanyl for breakthrough pain management in these patients. METHODS: Multimodal analgesia (paracetamol 1 g three times a day, oxycodone 2-3 mg boluses with a patient-controlled intravenous pump) was used in 16 patients (age 49-70 years, weight 59-129 kg) after cardiac bypass surgery. Intranasal fentanyl 100 µg or 200 µg was used to manage breakthrough pain on the first and third postoperative mornings in a randomised order. Blood samples were collected for up to 3 h after fentanyl administration, pain was assessed with a numeric rating scale of 0-10. Plasma fentanyl concentration was assayed using liquid chromatography-mass spectrometry. Body composition was measured with a bioelectrical impedance device. RESULTS: Bioavailability of intranasal fentanyl was high (77%), absorption half-time short (< 2 min) and an analgesic plasma concentration ≥ 0.5 ng/mL was achieved in 31 of 32 administrations. Fentanyl exposure correlated inversely with skeletal muscle mass and total body water. Fentanyl analgesia was effective both on the first postoperative morning with chest pleural tube removal and during physiotherapy on the third postoperative morning. The median time of subsequent oxycodone administration was 1.1 h after intranasal fentanyl 100 µg and 2.1 h after intranasal fentanyl 200 µg, despite similar oxycodone concentrations (median 13.8, range 5.2-35 ng/mL) in both fentanyl dose groups. CONCLUSIONS: Intranasal fentanyl 100 µg provided rapid-onset analgesia within 10 min and is an appropriate starting dose for incidental breakthrough pain in the first 3 postoperative days after cardiac bypass surgery. CLINICAL TRIAL REGISTRATION: EudraCT Number: 2018-001280-22.


Assuntos
Dor Irruptiva , Procedimentos Cirúrgicos Cardíacos , Administração Intranasal , Idoso , Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Método Duplo-Cego , Fentanila , Humanos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico
7.
Support Care Cancer ; 29(8): 4799-4807, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33533986

RESUMO

PURPOSE: The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. METHODS: A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. RESULTS: Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 µg, 100 µg, or 133 µg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001-1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227-13.873). CONCLUSION: Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.


Assuntos
Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Manejo da Dor/métodos , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Cancer Med ; 10(5): 1738-1744, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33594813

RESUMO

BACKGROUND: Pregabalin is commonly used to relieve neuropathic pain. However, data are lacking on its efficacy for the treatment of chronic cancer pain. The purpose of this study was to determine the analgesic efficacy of pregabalin combined with morphine in the management of pancreatic cancer pain. METHODS: This study reviewed patients who were prescribed morphine and 150 mg/d pregabalin between 1 January 2017 and 10 November 2018 in our institute. The primary outcomes of this study were the average pain score and dose of morphine. Secondary outcomes included characters of breakthrough cancer pain, functional interference related to pain, anxiety/depression status, and incidence of treatment-related adverse events during the study. RESULTS: A total of 240 patients with pain related to pancreatic cancer were included in the study. The results showed that patients of both combination therapy group (pregabalin+morphine) and monotherapy group (morphine) achieved similar analgesic efficacy, demonstrated by NRS (2.4 ± 0.9 vs. 2.6 ± 0.9; combination vs. monotherapy) at the end of the study. Mean daily dose of morphine used in the combination group was significant lower compared to monotherapy group (39.5 ± 16.0 mg vs. 61.5 ± 19.3 mg, net difference 23.5, 95% CI: 18.4-28.6, p < â€Š0.001). The change of functional interference score related to pain was significantly different between combination and monotherapy group (12.0 ± 0.4 vs. 9.8 ± 4.9; net difference, 2.3; 95% CI: 1.1-3.3; p < 0.001). Patients in combination therapy group had experienced shorter duration of breakthrough cancer pain than those in monotherapy group (X2 p < 0.001, Cramer's V:0.36). The incidence of somnolence, dizziness, and cognitive dysfunction were significantly higher in the combination group compared to monotherapy group. No serious treatment-related side effects were observed. CONCLUSIONS: The findings of this study supported the use of pregabalin with morphine to relieve pain in patients of pancreatic cancer.


Assuntos
Analgésicos/farmacologia , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Morfina/farmacologia , Neoplasias Pancreáticas/complicações , Pregabalina/farmacologia , Idoso , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Dor Irruptiva/etiologia , Dor do Câncer/etiologia , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/efeitos adversos , Neuralgia/tratamento farmacológico , Medição da Dor , Pregabalina/administração & dosagem , Pregabalina/efeitos adversos , Estudos Retrospectivos
9.
Daru ; 29(1): 51-59, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33475984

RESUMO

BACKGROUND: Breakthrough pain (BTP) is an important challenge in treatment and requires a rapid onset of action for pain control. BTP should be adequately controlled with a stable dose of a short-acting oral opioid. So far, no drug is available for the treatment of BTP in cancer patients in Iran, so we designed the first study in Iran to investigate the effect of sublingual fentanyl in relief of pain episodes in these patients. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of sublingual fentanyl in the treatment of breakthrough pain in cancer patients. METHOD: This study was a randomized double-blind placebo-controlled clinical trial in cancer patients with breakthrough pain (at least 1-4 episodes of acute pain with moderate to severe pain daily) referred to the pain clinic of Akhtar and Masih Daneshvari hospitals in 2019. The study consisted of two stages: 100 patients were selected by simple, non-random sampling and entered the open-label titration phase. The primary efficacy endpoint was the sum of pain intensity difference over 30 min post-administration. Secondary efficacy endpoints included pain intensity difference (PID) and pain relief (PR) throughout the 60-min post-dose assessment period. In the double-blind study, patients were randomly divided into two groups of placebo (n=50) and intervention (sublingual fentanyl tablet) (n=50). For evaluation of efficacy, 10 episodes were treated in each group and the results were recorded by the patient. (Clinical trial registration: IRCT20131124015515N8). RESULTS: A total of 100 patients entered the titration phase, primary efficacy of sublingual fentanyl was 3.5±0.6 and secondary efficacy of sublingual fentanyl (60 min, after treatment) was 0.3±0.6 which was statistically significant. In the titration phase, the treatment success rate was 100%. In the double-blind phase of the study, the pain intensity in multiple episodes showed a significant improvement at 15, 30, 45, and 60 min after drug administration (P=0.0001). The intensity of pain in each episode was significantly decreased compared to the next episode (P=0.0001). The mean frequency of pain episodes in the sublingual fentanyl group showed a significant decrease (P=0.0001). The most common adverse drug events in the titration phase were drowsiness (20%), dizziness (7%), and nausea 4%, and in the double-blind phase only drowsiness (12%). (Cancer Research Center, Shahid Beheshti University of Medical Sciences, Survey). CONCLUSION: Sublingual fentanyl appears to be effective for patients with rapid-onset analgesia, has short-acting duration, is effective medication, safe, and well tolerated. It is a suitable choice in Iranian patients with chronic cancer-related pain controlled suffering from acute pain episodes related to cancer.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Fentanila/administração & dosagem , Administração Sublingual , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Método Duplo-Cego , Feminino , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Comprimidos , Resultado do Tratamento , Adulto Jovem
10.
Ann Palliat Med ; 10(2): 1237-1243, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33040560

RESUMO

BACKGROUND: Breakthrough pain is an exacerbation of pain occurring in patients with chronic pain who receive opioid therapy every day. Breakthrough pain has not been routinely recognized, evaluated and treated. This study aimed to analyze the utilization of opiates analgesics, including dose regimentation, frequency of use, and the actual adverse effects in cancer patients with breakthrough pain. METHODS: Data were collected by the retrospective method in the period from January to December 2017. Patients involved received opioids around the clock for treating background pain and rescue medication for treating breakthrough pain. The percentage of the rescue medication dose was calculated based on the total daily opioid dose to treat background pain. Descriptive analysis was used. RESULTS: From 335 visits, there were 334 of patient visit where the patient received immediate-release morphine as a rescue medication with a dose percentage between 6.67-60%, and 1 visit where the patient received codeine with a dose percentage of 16.67%. Of 335 visits, 233 patient visits received the right proportion of opioid rescue medication doses, while 102 patient visits received a greater dose proportion than the recommended dose of 5-20%. CONCLUSIONS: Immediate-release morphine is the most commonly prescribed analgesic to treat breakthrough pain and used at 6.67-60% of daily dose with the frequency of use between 2 to 6 times a day. There were 189 (56.42%) patient visits when the patient experienced the adverse effects of the opioid. The identified actual adverse effects are constipation, nausea, and vomiting.


Assuntos
Dor Irruptiva , Neoplasias , Analgésicos Opioides/uso terapêutico , Dor Irruptiva/tratamento farmacológico , Dor Irruptiva/etiologia , Humanos , Morfina , Neoplasias/complicações , Estudos Retrospectivos
13.
Future Oncol ; 17(8): 943-954, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33289432

RESUMO

Aim: The CAVIDIOR study evaluated quality of life (QoL) in patients with breakthrough cancer pain receiving palliative radiation therapy in radiation oncology departments (RODs) in Spain. Patients & methods: Prospective observational study at 11 Spanish RODs (July 2016-November 2017). QoL was assessed using Short Form Health Survey 12. Secondary end points were sleep quality, caregiver burden and patient/perception of improvement. Results: QoL improved according to the Short Form Health Survey 12 mental component. Sleep quality and caregivers' burden improved significantly. Conclusion: Breakthrough cancer pain is highly prevalent and can be substantially reduced with appropriate diagnosis and management in RODs. Along with the QoL questionnaire, sleep quality and caregiver burden provide a more comprehensive assessment of overall health status in patients receiving radiation therapy in RODs. Clinical trial registration: NCT02836379 (ClinicalTrials.gov).


Assuntos
Dor Irruptiva/epidemiologia , Dor do Câncer/epidemiologia , Neoplasias/complicações , Cuidados Paliativos/métodos , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Irruptiva/etiologia , Dor Irruptiva/psicologia , Dor Irruptiva/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Dor do Câncer/terapia , Cuidadores/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/radioterapia , Medição da Dor/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Estudos Prospectivos , Radioterapia (Especialidade)/estatística & dados numéricos , Espanha/epidemiologia
14.
J Oncol Pharm Pract ; 27(2): 445-447, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33356990

RESUMO

The aim of this paper was to assess the drug costs of the different biotechnologies (intranasal fentanyl spray (INFS), oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablet (FBT)) in the treatment of breakthrough cancer pain (BTCP). We have calculated the mean drug costs (expressed in euros (€)) for patients treated for BTCP. INFS resulted the less expensive towards OTFC and FBT, with 697 440 €versus (vs.) 809 552 €vs. 779 662 €every 100 patients treated for BTCP, respectively. In conclusion, combining drug costs of different biotechnologies (INFS, OTFC and FBT) with the measure of efficacy represented by the reduction of BTCP avoided (incremental cost-effectiveness ratio, ICER), INFS resulted in better cost-effectiveness.


Assuntos
Analgésicos Opioides/economia , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Custos de Medicamentos , Fentanila/economia , Administração Bucal , Administração Intranasal/economia , Administração Oral , Analgésicos Opioides/administração & dosagem , Análise Custo-Benefício , Fentanila/administração & dosagem , Humanos
15.
Gan To Kagaku Ryoho ; 47(10): 1521-1523, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130755

RESUMO

Oral transmucosal fentanyl has been indicated for the management of breakthrough pain in patients with cancer. Fentanyl sublingual tablets(FST)have been approved for use in Japan since 2013. However, the optimal use of FSTs has not been well-elucidated. In this case, a 73-year-old man with rectal cancer and third lumbar vertebral metastasis was treated with 100 µg FST and 12.5 µg/h fentanyl patch every day for the management of cancer-related breakthrough pain. After receiving the fourth dose of FST, the patient was unconscious for 2 days. However, his respiration was stable. This case shows that due care should be taken while administering FSTs to patients, specifically geriatric patients with bone metastasis and hypoalbuminemia.


Assuntos
Dor Irruptiva , Neoplasias , Administração Sublingual , Idoso , Analgésicos Opioides/efeitos adversos , Dor Irruptiva/tratamento farmacológico , Estado de Consciência , Fentanila/uso terapêutico , Humanos , Japão , Masculino , Neoplasias/tratamento farmacológico , Comprimidos/uso terapêutico
16.
Rev Esp Salud Publica ; 942020 Jul 28.
Artigo em Espanhol | MEDLINE | ID: mdl-32719309

RESUMO

OBJECTIVE: Immediate-release fentanyl is indicated in the treatment of breakthrough pain in cancer patients who already receive opioids as background chronic analgesia. According to an alert issued by the Spanish Agency of Medicines, its consumption under non-authorized conditions has alarmingly increased in recent years, with a greater risk of abuse and dependence. The main objective of this study is to compare the off-label use of immediate-release fentanyl in our hospital during 2014 and 2017. METHODS: Retrospective cross-sectional descriptive study in which immediate-release fentanyl prescriptions were compared in adult patients admitted during 2014 and 2017 in a group 5 hospital. Variables were collected by the electronic medical record. The association study between qualitative variables was calculated using the χ2 test, and quantitative variables with the t-student test. RESULTS: In 2014, 0.43 immediate-release fentanyl prescriptions were made in our center for every 100 admissions, and in 2017 0.54/100 admissions. 22.1% (n=34) prescriptions were off-label in 2014, while in 2017 31.8% (n=76) (p=0.034). Both years, the most frequent off-label indications were healing of ulcers and wounds and non-cancer chronic pain. CONCLUSIONS: The use of immediate-release fentanyl in the hospital setting has considerably increased in comparison to 2014, as well as its off-label use.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Fentanila/administração & dosagem , Prescrição Inadequada/tendências , Uso Off-Label/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/etiologia , Padrões de Prática Médica/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Liberação Controlada de Fármacos , Feminino , Fentanila/uso terapêutico , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Estudos Retrospectivos , Espanha
17.
Dtsch Med Wochenschr ; 145(13): 917-925, 2020 07.
Artigo em Alemão | MEDLINE | ID: mdl-32615607

RESUMO

This review provides an overview of the basic knowledge of drug pain therapy in the palliative situation. Pain is one of the main symptoms in 60 to 90 % of cancer patients. Pain also develops with neurological and other diseases that occur in end-of-life situations. To address this symptom, a holistic strategy is required that encompasses all physical, psychological, social, and spiritual aspects of the multi-dimensional pain experience ("total pain" concept).Drug treatment for cancer pain has been based on a stepwise approach for many years, starting with non-opioid analgesics, followed by moderate and strong opioids. In contrast, today's pain management is determined more by the actual intensity of this aversive event.The pain assessment should be tailored to identify a nociceptive vs. neuropathic pain component that needs to be challenged by the most appropriate drug therapies. Non-opioid analgesics are ideal substances for relieving nociceptive pain. Antidepressants and anticonvulsants reduce the intensity of new neuropathic pain. Opioids are suitable for all types of pain, but are restricted to a second line choice. Among all opioids are tilidine and tramadol prodrugs, which only relieve pain after activation in the liver. Drug-drug interactions may also block this activation. Rapid release opioids should be used for cancer breakthrough pain. Transdermal opioid applications are recommended for swallowing disorders, but usually not to initiate pain control. An opioid switch can be performed if side effects such as hallucinations for the selected opioid are more pronounced than the pain reduction.


Assuntos
Analgésicos/uso terapêutico , Dor/tratamento farmacológico , Cuidados Paliativos/métodos , Administração Cutânea , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Dor Irruptiva/classificação , Dor Irruptiva/diagnóstico , Dor Irruptiva/tratamento farmacológico , Substituição de Medicamentos , Alucinações/induzido quimicamente , Humanos , Neoplasias/fisiopatologia , Neuralgia/classificação , Neuralgia/diagnóstico , Neuralgia/tratamento farmacológico , Dor/classificação , Dor/diagnóstico , Medição da Dor , Assistência Terminal , Tilidina/efeitos adversos , Tilidina/uso terapêutico , Tramadol/efeitos adversos , Tramadol/uso terapêutico
19.
Pain Res Manag ; 2020: 6190862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566062

RESUMO

Background: Better understanding of the episodic cancer pain (CP) spectrum, including pains that occur in addition to its conventionally defined breakthrough CP (BTcP) and incident CP (IcP) components, may inform CP assessment and management. This study aimed to determine the prevalence of episodic patient-reported CP and the prevalence and associations of study-defined BTcP (S-BTcP) and IcP (S-IcP) in patients with CP. Methods: In a cross-sectional study at their first CP clinic attendance, participants with CP had the following assessments: Brief Pain Inventory (BPI); Pain Management Index (PMI), with PMI-negative status indicating undertreatment; standardized neuropathic pain component (NPC) status; S-BTcP (no trigger identified) and S-IcP (trigger identified) status, based on a preceding 7-day history of transitory pain flares distinct from background pain, and BPI-Worst or BPI-Now pain intensity ≥ 4. Clinicodemographic variables' association with S-BTcP and S-IcP was examined in logistic regression analyses. Results: Of 371 participants, 308 (83%) had episodic CP by history alone; 140 (37.7%) and 181 (48.8%) had S-BTcP and S-IcP, respectively. Multivariable analyses demonstrated significant (p < 0.05) associations (odds ratios: 95% CIs) for 6 variables with S-BTcP: head and neck pain location (2.53; 1.20-5.37), NPC (2.39; 1.34-4.26), BPI average pain (1.64; 1.36-1.99), abdominal pain (0.324; 0.120-0.873), S-IcP (0.207; 0.116-0.369), and PMI-negative status (0.443; 0.213-0.918). Similar independent associations (p < 0.05) occurred for S-IcP with NPC, BPI average pain, and PMI-negative status, in addition to radiotherapy, S-BTcP, soft tissue pain, and sleep interference. Conclusions: Episodic or transient patient-reported CP flares often do not meet the more conventional criteria that define BTcP and IcP, the principal episodic CP types. Both BTcP and IcP occur frequently and both are associated with a NPC, higher pain intensity, and less opioid underuse in the management of CP. Further studies are warranted to both better understand the complex presentations of episodic CP and inform its classification.


Assuntos
Dor do Câncer/classificação , Dor do Câncer/epidemiologia , Adulto , Dor Irruptiva/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência
20.
Hosp. domic ; 4(2): 39-44, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193389

RESUMO

Presentamos el caso de un paciente varón de 67 años diagnosticado de adenocarcinoma de pulmón en estadio IV con dolor irruptivo oncológico (DIO) de difícil control. Durante el transcurso de la enfermedad el paciente necesitó varios ingresos por complicaciones, siendo la más común el mal control del DIO. Tras varios cambios en la pauta analgésica (rotación de opioides, cambios en tratamientos coadyuvantes y vías de administración), se consiguió buen control del dolor a pesar de progresión de la enfermedad de base. Finalmente, el paciente precisó ingreso hospitalario ante deterioro del estado general y claudicación familiar. Ante mal pronóstico, el equipo de Cuidados Paliativos y los familiares decidieron instaurar tratamiento con medidas de confort. De la relevancia del caso clínico que aportamos se concluye que es necesaria la existencia de equipos multidisciplinares formados y entrenados en este ámbito para un buen manejo terapéutico y una mejor calidad de vida en los pacientes


We present the case of a 67-year-old male with stage IV adenocarcinoma lung cancer who presented difficult control of breakthrough cancer pain. During the course of the disease, the patient had to be hospitalized several times due to complications. The most common complication was breakthrough cancer pain. After many changes in the analgesic treatment (opioid rotation, changes in coadjuvant drugs and routes of administration), good control of analgesic pain was achieved despite the progression of this underlying disease. Finally, the patient required being hospitalized due to deterioration of the general condition and family claudication. Faced with a por prognosis, the Palliative Care and Oncology team decided to establish treatment with comfort measures. We can conclude that the existence of multidisciplinary trained team is necessary for good therapeutic management and a better quality of life in patients


Assuntos
Humanos , Masculino , Idoso , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Dor do Câncer/tratamento farmacológico , Dor Irruptiva/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Estadiamento de Neoplasias
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