Pregabalin for the Prevention of Oxaliplatin-Induced Painful Neuropathy: A Randomized, Double-Blind Trial.

LESSONS LEARNED: Pregabalin is a medication that can decrease neuronal hyperexcitability, relieve neuropathic pain, and reach stable plasma levels after a titration period of only a few days.Its use during oxaliplatin infusions was not able to decrease the incidence of chronic, oxalipaltin-related neuropathic pain, compared with placebo. BACKGROUND: Patients with colorectal cancer (CRC) receiving oxaliplatin (OXA) develop acute and chronic painful oxaliplatin-induced peripheral neuropathy (OXAIPN). Acute and chronic OXA-related neuropathies have different pathophysiological bases, but both lead to a common phenomenon: central sensitization (CS) of nociceptive neuronal networks, leading to increased sensitivity (hyperlgesia, allodynia) in the somatosensory system, the common ground of chronic neuropathic pain. Because CS is related to increased risk of painful OXAIPN, we hypothesized that preemptive use of the anti-hyperalgesic drug pregabaline (known to decrease CS) during OXA infusions would decrease the incidence of chronic OXAIPN. METHODS: Pain-free, chemotherapy-naïve CRC patients receiving at least one cycle of modified-FLOX [5-FU(500 mg/m2)+leucovorin(20 mg/m2)/week for] 6 weeks+oxaliplatin(85 mg/m2) at weeks 1-3-5 every 8 weeks] were randomized (1:1) into the study. Patients received either pregabalin or placebo for 3 days before and 3 days after each OXA infusion and were followed for up to 6 months. Clinical assessments were performed at baseline, at the end of chemotherapy, and after the follow-up period. The main outcome was average pain at the last visit assessed by the visual analogic scale (0-10) item of the Brief Pain Inventory (BPI). Secondary endpoints were presence of neuropathic pain according to the Douleur Neuropathique-4 (DN-4), pain dimensions (short- form McGill Pain Questionnaire [MPQ]), Neuropathic Pain Symptom Inventory (NPSI), and changes in nerve conduction studies (NCS) and side effect profile. RESULTS: One hundred ninety-nine patients (57.0 ± 10.7 years old, 98 female, 101 male) were randomized. Data from 56 patients were not included in the analyses (as they did not receive at least one full cycle of modified FLOX). Data from 78 patients in the pregabalin group and 65 patients in the placebo group were retained for analyses. At the last visit, pain intensity in the pregabalin group was 1.03 (95% confidence interval [CI] = 0.79-1.26), and 0.85 (95% CI = 0.64-1.06) in the placebo group, which did not reach significance. Scores from the BPI, MPQ, DN-4, NPSI, and NCS and side-effect profiles and incidence of death did not differ between groups. Quality of life (QoL) score did not differ between groups (placebo = 76.9 ± 23.1, pregabalin group 79.4 ± 20.6). Mood scores were not significantly different between groups (placebo 9.7 [8.1-11.2]; pregabalin 6.8 [5.6-8.0]). CONCLUSION: The preemptive use of pregabalin during OXA infusions was safe, but did not decrease the incidence of chronic pain related to OXAIPN.

Mirror peripheral neuropathy and unilateral chronic neuropathic pain: insights from asymmetric neurological patterns in leprosy.

ABSTRACT: Leprosy-related multiple mononeuropathy offers a pattern of impairment where neuropathy with and without neuropathic pain (NeP) are present in the same individual, thus allowing to investigate peripheral sensory and innervation in both conditions. This cross-sectional study collected data on clinical and neurological examination, pain assessment questionnaires, quantitative sensory test, and intraepidermal nerve fiber density of patients with leprosy and divided the cohort into 2 groups: with NeP (P+) and without NeP (P-). Furthermore, we assessed mirror body areas in the same NeP individuals with bilateral neuropathy also presenting unilateral NeP. Pain-free patients having unilateral neuropathy were controls. A total of 37 P+ and 22 P- patients were evaluated. Limb areas with NeP had signs of C-fiber dysfunction and hyperesthesia on quantitative sensory testing compared with limb areas having neuropathy without NeP. Skin denervation was found in all patients with leprosy. Comparisons of limbs with and without neuropathy and with and without NeP revealed that higher heat pain thresholds (HPTs) were associated with neuropathic pain areas, whereas less altered HPT was correlated with higher fiber density. Furthermore, a relationship was found between time of leprosy treatment termination and more intense neuropathy, expressed by HPT increasing 0.03°C each month. As expected, interindividual comparisons failed to show differences in intraepidermal nerve fiber density and subepidermal plexus areas between P+ and P- patients ( P = 0.2980, P = 0.9044; respectively). Higher HPT and lower mechanical detection threshold were related to NeP. This study pointed out the relevance of intraindividual comparisons including mirror areas when assessing local changes in peripheral NeP.

[The dietary risk factors for colorectal cancer related to meat consumption]. / Os fatores de riscos alimentares para câncer colorretal relacionado ao consumo de carnes.

The integrative review is one of the methodologies used for evidence-based practice which, in this study, had the objective of surveying and synthesizing the evidence available in the literature regarding the dietary risks for colorectal cancer related to the consumption of meat. The search was made using the LILACS, MEDLINE, CINAHL, and COCHRANE Library databases, and six studies considered pertinent to the consumption of meat were found. Meta-analyses showed that there is an association between the consumption of red meat and an increased risk for colorectal cancer from 28% to 35%, whereas processed meats are associated with a rise in risk from 20% to 49%. Evidence shows that the consumption of red meat, processed meat, and total meat consumption are risk factors for developing polyps and colorectal cancer. The search did not yield any studies referring to the consumption of chicken or fish as risk factors.

The outcomes of visualization and acupuncture on the quality of life of adult cancer patients receiving chemotherapy.

BACKGROUND: The use of complementary and alternative medicine (CAM) to treat cancer patients has increased around the world, and its benefits have been described. These therapies represent an important theme in oncology and have been used in parallel with conventional therapies. OBJECTIVE: This study aimed to assess the outcomes of using relaxation with visualization and acupuncture on the quality of life of cancer patients undergoing chemotherapy treatment and to compare these outcomes with patients who did not choose to receive the intervention. METHODS: Participants chose to be in either the intervention group (IG) or control group (CG). They completed the Quality of Life Questionnaire-Core 30 at the start and end of chemotherapy. The IG was chosen by 38 patients with different types of cancer who completed weekly relaxation with visualization and acupuncture sessions, whereas the CG was composed of 37 patients who did not receive the intervention. RESULTS: Statistically significant results evidenced an increase in global health and emotional and social functions and a decrease in fatigue and loss of appetite for the IG, and an increase in global health for the CG (P< or =.05). A highly significant difference was found when comparing the post-chemotherapy scores of the Quality of Life Questionnaire-Core 30 in the global health domain between the CG and the IG (P< or =.001), indicating positive outcomes of the CAM intervention. CONCLUSION: Adults with cancer are able to choose between involvement or not with this kind of CAM intervention. Global health could be improved by participating in this type of intervention.

Os fatores de riscos alimentares para câncer colorretal relacionado ao consumo de carnes / The dietary risk factors for colorectal cancer related to meat consumption / Factores de riesgo alimentario para cáncer colorrectal relacionado al consumo de carnes

Uma das estratégias metodológicas para realizar a prática baseada em evidências é a revisão integrativa, que neste estudo teve como objetivo buscar e sintetizar as evidências disponíveis na literatura científica sobre os fatores de riscos alimentares para o câncer colorretal relacionado ao consumo de carnes. As bases de dados LILACS, MEDLINE, CINAHL e COCHRANE Library foram consultadas e os estudos pertinentes ao consumo de carnes somaram seis. As metanálises demonstraram que a ingestão de carne vermelha está relacionada com o aumento do risco para câncer colorretal em 28% a 35%, enquanto a carne processada está associada ao risco elevado de 20% a 49%. As evidências apontam a carne vermelha, a carne processada e o total de carne consumida como fatores de risco para o desenvolvimento de pólipos e câncer colorretal. Não foi identificado estudo que indicasse a ingestão de frango e peixe como fatores de risco.

The integrative review is one of the methodologies used for evidence-based practice which, in this study, had the objective of surveying and synthesizing the evidence available in the literature regarding the dietary risks for colorectal cancer related to the consumption of meat. The search was made using the LILACS, MEDLINE, CINAHL, and COCHRANE Library databases, and six studies considered pertinent to the consumption of meat were found. Meta-analyses showed that there is an association between the consumption of red meat and an increased risk for colorectal cancer from 28% to 35%, whereas processed meats are associated with a rise in risk from 20% to 49%. Evidence shows that the consumption of red meat, processed meat, and total meat consumption are risk factors for developing polyps and colorectal cancer. The search did not yield any studies referring to the consumption of chicken or fish as risk factors.

Una de las estrategias metodológicas para realizar la práctica basada en evidencias es la revisión integradora, que en este estudio objetivó buscar y sintetizar las evidencias disponibles en literatura científica sobre factores de riesgo alimentario para desarrollar cáncer colorrectal en relación al consumo de carne. Se consultaron las bases de datos LILACS, MEDLINE, CINAHL y COCHRANE Library, y los estudios pertinentes al consumo de carnes sumaron seis. Los metanálisis demostraron que la ingestión de carne roja está relacionada con el aumento de riesgo de cáncer colorrectal en 28% a 35%, mientras que la carne procesada se relaciona con un riesgo aumentado entre 20% y 49%. Las evidencias exponen a la carne roja, la carne procesada y al total de carne consumida como factores de riesgo para desarrollo de pólipos y cáncer colorrectal. No existió evidencia que relacionara la ingesta de pollo y pescado como factores de riesgo.

Qualidade de vida nos pacientes oncológicos: revisão integrativa da literatura latino-americana / Quality of life in cancer patients: integrative review of Latin American literature / Calidad de vida en pacientes con cáncer: revisión integral de la literatura hispanoamericana

O constructo subjetivo e multidimensional Qualidade de Vida (QV) consolida-se entre os estudiosos na década de 90. Identificar, mensurar e avaliar os domínios afetados pela doença tem sido a proposta de diversos estudos com delineamentos qualitativos e quantitativos. Os objetivos foram caracterizar a produção científica latinoamericana sobre QV em pacientes oncológicos adultos; identificar aspectos relacionados à QV nesta população; identificar os instrumentos utilizados para avaliar a QV. Uma das estratégias metodológicas para realizar a prática baseada em evidências é a revisão integrativa. A amostra resultou em 25 artigos, nos quais havia uma alta concentração de estudos na subcategoria QV nos diferentes tipos de câncer de cabeça e pescoço (32%), que nos faz refletir sobre os inúmeros efeitos colaterais e secundários do tratamento, como as mutilações, alterações funcionais e estéticas que interferem nas atividades de vida diária dos pacientes. Verificamos uma prevalência na aplicação do instrumento EORTC QLQ-C30 sendo que este explora sintomas específicos do câncer. Considera-se que tais estudos não apresentaram fortes evidências para aplicação clínica. Correspondendo a prática baseada em evidências, concluímos a importância no desenvolvimento de estudos com intervenções efetivas para subsidiar a prática de enfermagem e garantir uma assistência qualificada e consequentemente melhorar QV aos pacientes oncológicos.

The subjective and multidimensional construct Quality of Life (QoL) is consolidated among researchers in the 90s. Identify ,to measure and assess the areas affected by the disease has been the proposal of several studies of qualitative and quantitative designs. The aims of this study were to characterize the scientific literature on QoL in Latin Adult cancer patients, to identify aspects of QoL in this population, to identify the instruments used to evaluate QoL. One of the methodological strategies to achieve the evidence-based practice is an integrative review. The sample resulted in 25 studies, which had a high concentration of studies on QoL in the different sub-types of head and neck cancer (32%), that makes us reflect on the numerous side and secondary effects of treatment such as mutilation, functional and esthetic changes that interfere with daily activities of patients. We found a prevalence of the EORTC QLQ-C30 instrument, since it explores specific symptoms of cancer. It is considered that these studies did not show strong evidence for clinical application. In response to the evidence-based practice, we conclude the importance in the development of studies of effective interventions to support nursing practice and ensure quality care and therefore improve QoL for cancer patients.

El concepto subjetivo y multidimensional, Calidad de Vida (CV), se consolidó entre los estudiosos en los años 90. Identificar, medir y evaluar los dominios afectados por la enfermedad fue la propuesta de varios estudios cualitativos y cuantitativos. Los objetivos fueron caracterizar la producción científica latino americana sobre CV en pacientes oncológicos adultos, identificar los aspectos relacionados a CV en esta población y identificar los instrumentos utilizados para esta evaluación. Una de las estrategias metodológicas de práctica basada en evidencias, es la revisión integradora. La muestra resultó en 25 artículos, en los cuales había alta concentración de estudios sobre CV de diferentes sub-tipos de cáncer de cabeza y cuello (32%), lo que nos hace reflexionar sobre los numerosos efectos colaterales y secundarios del tratamiento, como mutilaciones, alteraciones funcionales y estéticas que interfieren en las actividades diarias de los pacientes. Encontramos que prevalece la aplicación del instrumento EORTC QLQ-C30, siendo que éste explora síntomas específicos del cáncer. Se considera que estos estudios no presentaron fuertes evidencias para aplicación clínica. Correspondiendo a la práctica basada en evidencias, concluimos por la importancia del desarrollo de estudios con intervenciones efectivas para auxiliar la práctica de enfermería garantizando atención especializada, y consecuentemente mejorar la CV de pacientes oncológicos.