Looking beyond the obvious: Role of non?invasive electroanalgesia in management of cancer pain

Pain is considered as one of the most debilitating symptoms of cancer and its treatment. Owing to the limited efficacy of traditional pharmacological interventions to address cancer pain in its entirety, an avenue exists for exploration into nonpharmacological therapies. Analgesia using non?invasive electrotherapeutic modalities such as transcutaneous electrical nerve stimulation (TENS) and scrambler therapy emerges as a viable option to address cancer pain. The inability of these modalities to find a place within the recommended clinical guidelines has possibly resulted in the paucity of application of the same within the clinical setup. This perspective article aims at stimulating a discussion surrounding the inclusion of non?invasive neuromodulatory treatment techniques such as TENS and scrambler therapy to combat cancer pain and explore the benefits and pitfalls of using these techniques as an adjunct to the pre?existing treatment strategies. It is envisioned that this opinion piece will open a dialogue about a possible home for non?invasive electroanalgesia within the clinical treatment pathway for cancer pain.

Opioids for Pediatric Pain Management

Objectives: To study the efficacy and adverse effects of opioids in management of pain in children. Methods: A descriptive study was conducted in children aged below 15 years with moderate to severe pain, and response to opioids and adverse effects were assessed at 24, 48 and 72 hours after administration. Results: 100 children (68% males) with median (IQR) age of 6.5 (3.5,10) years were studied. 81% (n=81) children with moderate pain and 78.9% (n=15) with severe pain responded to opioids in 72 hours. Among children with severe pain of non-malignant origin, 80% (n=8) responded in 48 hours compared to 11.1% (n=1) with malignancy and this difference was statistically significant at 24 hours (P=0.005). Of children with severe pain 73.7% (n=14) developed adverse reactions compared to 30.9% (n=25) with moderate pain. Conclusions: Children with moderatesevere pain, either of malignant or non-malignant origin could be managed effectively with opioids without severe adverse effects.

Tratamiento del dolor en el paciente oncológico / Treatment of pain in oncological patients

RESUMEN El dolor oncológico no controlado es uno de los síntomas que afectan de forma negativa la salud física y psicológica de los pacientes con diagnóstico de cáncer. Sin dudas, representa una situación especialmente dramática. Existe evidencia sobre los beneficios del control del dolor en estos pacientes; para lograrlos, es preciso valorar las causas, localización, intensidad y duración del dolor antes y durante el tratamiento. Se plantean diferentes formas de medir la intensidad del dolor, y la escala visual analógica es una de las más comunes, además de ser la más utilizada internacionalmente respecto al resto de las escalas unidimensionales. La Organización Mundial de la Salud propone el uso de la escalera analgésica de forma pautada, con la correspondiente titulación de la necesidad de analgésicos, así como de los tratamientos coadyuvantes necesarios. Estandarizar correctamente los tratamientos y evaluar su respuesta, es imprescindible para el control del dolor. La presente revisión bibliográfica se propone un acercamiento a las directrices internacionales en el abordaje terapéutico de esta entidad, y con ello, ofrecer una actualización del tema.

ABSTRACT Uncontrolled oncological pain is one of the symptoms that negatively affect the physical and psychological health of patients diagnosed with cancer. Undoubtedly, it represents a particularly dramatic situation. There is evidence about pain control benefits of in these patients; to achieve them, it is necessary to assess the causes, location, intensity and duration of pain before and during treatment. Different ways of measuring pain intensity are proposed, and the analog visual scale is one of the most common, in addition to being the most used internationally with respect to the rest of the single-dimensional scales. The World Health Organization proposes the use of the analgesic ladder in a prescribed manner, with the corresponding titration of the analgesic need, as well as the necessary coadjutant treatments. Standardizing treatments correctly and evaluating their response, is essential for pain control. The present bibliographic review proposes an overlook to the international guidelines in the therapeutic approach of this condition, and with it, it offers an update on the topic.

Clinical analysis of palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain in non-small cell lung cancer / 肿瘤研究与临床

Objective To investigate the analgesic efficacy,quality of life,and the incidence of adverse reactions of palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain in non-small cell lung cancer (NSCLC).Methods A total of 88 NSCLC patients with metastatic bone pain at Fujian Provincial Hospital from April 2015 to April 2018 were retrospectively analyzed.According to the treatment,the patients were divided into the combined group and the control group,and 44 cases in each group.The combined group was given palliative radiotherapy combined with the principle of three-step analgesic ladder,and the control group received the principle of three-step analgesic ladder.The analgesic efficacy,changes of quality of life,and the incidence of adverse reactions were compared between the two groups.Results The total analgesic effective rate in the combined group was higher than that in the control group [84.1％ (37/44) vs.54.5 ％ (24/44)],and the difference between the two groups was statistically significant (Z =-3.227,P =0.001).For mild and moderate pain,the effective rate in the combined group and control group were 84.6 ％ (11/13) vs.57.1％ (8/14),80.0 ％ (12/15) vs.42.9 ％ (6/14) respectively,and the differences were not statistically significant (Z =-1.473,P =0.141;Z =-1.793,P =0.073).For severe pain,the effective rates in the combined group and control group were 87.5 ％ (14/16) and 62.5 ％ (10/16),and the difference was statistically significant (Z =-2.327,P =0.020).The quality of life in the combined group was better than that in the control group,and the difference between the two groups was statistically significant (Z =-2.254,P =0.024).The overall incidence rate of adverse reactions in the combined group was 36.4 ％ (16/44),which was significantly lower than that in the control group [59.1％ (26/44)],and the difference between the two groups was statistically significant (x2 =4.55,P =0.033).Conclusion Palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain of NSCLC can significantly improve the efficacy,especially for severe pain,and improve the quality of life,and reduce the incidence of adverse reactions.

Clinical Study on Acupuncture at Zusanli, Taichong and Hegu Points Combined with Three-step Analgesic Ladder for Treatment of Gastric Cancer Pain / 广州中医药大学学报

Objective To investigate the clinical effectiveness and safety of acupuncture at Zusanli (ST36),Taichong(LR3) and Hegu(LI4) points combined with three-step analgesic ladder for the treatment of gastric cancer pain.Methods Sixty patients with moderate and severe pain induced by gastric cancer were randomly divided into study group and control group,30 cases in each group.The study group was treated with acupuncture at Zusanli,Taichong and Hegu points combined with three-step analgesic ladder for gastric cancer pain management,and the control group was treated with three-step analgesic ladder only.After treatment for 7 days,the clinical effectiveness was evaluated with the average pain scores of Numerical Rating Scale(NRS),Quality of Life Scale(QOL-BREF by WHO),Self-rating Depression Scale(SDS).And the incidence of adverse reaction was also observed.Results (1) After treatment,the markedly-effective analgesic rate of the study group was higher than that of the control group (P ＜ 0.05).(2) After treatment,QOL scores of both groups were much improved as compared with those before treatment(P ＜ 0.05),and the improvement of the study group was superior to that of the control group(P ＜0.05).(3) The depression scores of both groups were much improved after treatment (P ＜ 0.05 compared with those before treatment),but the difference between the two groups was insignificant(P ＞ 0.05).(4) The incidence of adverse reaction of the study group was lower than that of the control group(P ＜ 0.05).Conclusion The effect of acupuncture at Zusanli,Taichong and Hegu points combined with three-step analgesic ladder is better than three step analgesic ladder alone for the treatment of gastric cancer pain.

Clinical Observation of External Use of Wusheng Tincture for Treatment of Cancer Pain / 广州中医药大学学报

Objective To investigate the therapeutic efficacy of Chinese medicine of Wusheng Tincture for external application in treating cancer pain, and to observe its effect on the quality of life ( QOL) of cancer patients. Methods Eighty-three cancer pain patients were randomized into treatment group (N=42) and control group (N=41). Except 5 cases dropping out for the itch of skin, a total of 78 cases finished the treatment, 40 in the treatment and 38 in the control group. The patients were given the corresponding medicine according to the classification of numerical rating scale ( NRS) scores. In the control group, the patients were treated following the three-step analgestic ladder issued by World Health Organization ( WHO). The treatment group was given external application of Wusheng Tincture on the painful regions based on the same three-step analgestie ladder treatment as that of the control group, the treatment course lasting 7 days. The rating scale NRS scores and QOL scores were observed for the assessment of therapeutic effect and QOL of the two groups. Results (1) On medication day 7, NRS scores in both groups were decreased as compared with those one day before treatment (P0.05) . (2) The total effective rate of the treatment group was 82.5%, and that of the control group was 68.4%, the difference being significant between the two groups ( P0.05) . ( 3) On medication day 7, QOL scores were much lower in both groups than those one day before medication, the difference being significant ( P0.05) . Conclusion External application of Wusheng Tincture may have certain therapeutic effect in treating patients with mild cancer pain, but fails in enhancing the effect for patients with moderate and severe pain, either in improving the QOL of cancer pain patients when used together with WHO three-step analgestic ladder.

Papel do farmacêutico no seguimento farmacoterapêutico para o controle da dor de origem oncológica / Role of the pharmacist on the pharmacotherapeutic follow-up for cancer pain control

JUSTIFICATIVA E OBJETIVOS: A dor é um sintoma frequente nas neoplasias malignas, porém na maioria das vezes o farmacêutico da farmácia hospitalar diante da enorme tarefa burocrática que o afastam do paciente, não tem contribuído significativamente na assistência ao paciente com dor oncológica. O objetivo deste estudo foi propor a inserção o profissional farmacêutico no controle da dor de origem oncológica visando o uso racional e o monitoramento das reações adversas a medicamentos. CONTEÚDO: Para o controle efetivo do quadro álgico, implementação de medidas analgésicas e avaliação da eficácia terapêutica da dor faz-se essencial o uso correto da "Guia para Tratamento da Dor no Câncer" da Organização Mundial de Saúde (OMS), o qual proporciona diretrizes para o controle da dor na maioria dos pacientes com câncer avançado, e ainda, é fundamental o relato da experiência dolorosa do paciente aos profissionais da saúde. CONCLUSÃO: As escalas de mensuração da dor aliadas ao protocolo preconizado pela OMS tem-se mostrado um instrumento essencial para o uso racional de medicamentos. O profissional farmacêutico, além de cumprir com sua atividade corrente, está capacitado para interagir nas equipes multidisciplinares, auxiliando no tratamento álgico de pacientes oncológicos, avaliando o comprimento desse protocolo estabelecido pela OMS no controle da dor.

BACKGROUND AND OBJECTIVES: Pain is a frequent cancer symptom, however most of the times pharmacists of the hospital pharmacy, due to the huge bureaucratic tasks that depart them from patients, have not significantly contributed in assisting cancer pain patients. This study aimed at proposing the insertion of pharmacists in the cancer pain control team aiming at the rational use of drugs at and monitoring patients' adverse reactions. CONTENTS: For effective pain control, implementation of analgesic measures and assessment of therapeutic efficacy, it is critical to adequately use the "Guide to Cancer Pain Management" of the World Health Organization (WHO), which establishes guidelines for controlling pain of most advanced cancer patients; it is also fundamental to report patients' painful experience to health professionals. CONCLUSION: Pain measurement scales added to WHO's recommended protocol have been shown to be a critical tool for the rational use of drugs. Pharmacists, in addition to performing their daily activities, are qualified to interact in multidisciplinary teams helping controlling cancer patients' pain, by evaluating the compliance with this WHO protocol to control pain.

Evaluación de la calidad de la atención del paciente con dolor en fase terminal: estudio descriptivo transversal / Quality of care for patients with end-stage pain: descriptive, cross-sectional study

Nuestro trabajo tiene como objetivo general el evaluar la calidad de la atención a los pacientes con dolor en etapa terminal. Específicamente, se busca determinar la intensidad del dolor aplicando La Escala Análoga Visual del Dolor; evaluar el grado de incapacidad funcional aplicando la Escala de Prolo modificada; correlacionar la intensidad dolorosa con la potencia analgésica de los fármacos utilizados, teniendo en cuenta la Escalera Analgésica de la Organización Mundial de la Salud; así como la capacidad para participar en la toma de decisiones a la hora de realizar un proceder y el real conocimiento de su enfermedad. Para ello seleccionamos 50 pacientes de un universo de 100. Los pacientes incluidos venían remitidos de las consultas de las diferentes especialidades médicas y de oncología con diagnostico de dolor por cáncer. Se les aplico una entrevista individual realizada por el especialista de la Clínica del Dolor Crónico. Se cuantificó la intensidad dolorosa, se determinó el grado de incapacidad funcional, tratamientos farmacológicos previos, información médica sobre la enfermedad, posibilidades terapéuticas, complicaciones y el uso de morfínicos. Como resultado de nuestro estudio pudimos apreciar que el 56 por ciento de los pacientes padecían dolor moderado e intenso, que el grado de incapacidad funcional era malo, que desde el punto de vista farmacológico habían sido inadecuadamente tratados y que la mayoría desconocían la causa de su dolor.

Our work has as general objective to evaluate the quality from the attention to the patients with pain in terminal stage and specifically to determine the intensity of the pain applying the similar visual scale of the pain, to evaluate the grade of functional inability applying the scale of modified PROLO, to correlate the painful intensity with the analgesic power of the used medications keeping in mind the Analgesic Stairway of OMS, as well as the capacity to participate in the taking of decisions when carrying out a to proceed and the real knowledge of its illness. For we select it 50 patients, of an universe of 100 patients, the included patients came remitted of the consultations of the medical different Specialties and of Oncology with I Diagnose of pain for cancer, he/she is applied an individual interview carried out by the specialist of the Clinic of the Chronic pain. You quantify the painful intensity, you determines the grade of functional inability, pharmacological previous treatments, Information prescribes on the illness, therapeutic possibilities, complications and the morphine use. As a result of our study we could appreciate that 56 percent of the patients suffered moderate and intense pain that the grade of functional inability was bad that you/they had been treated improperly from the pharmacological point of view, and that most ignored the cause of its pain.

Management of pain in leukemic children using the WHO analgesic ladder.

Objective. To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia. Methods. Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of Pediatrics of a medical teaching hospital during a period of 6 months, were included in the study. Results. Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step – 1 analgesia was effective in 12 (31%) children and 21 (54%) could be managed with Step – 2 analgesia. Step – 3 analgesia was required in only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain. Conclusions. WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.

Utilization of Narcotic Analgesic Drugs in Outpatients of Our Hospital During 2005～2006 / 中国药房

OBJECTIVE:To evaluate the utilization of narcotic analgesic drugs in outpatients of our hospital.METHODS:Narcotic analgesic drugs prescribed in outpatient prescriptions of our hospital from Aug.2005 to Aug.2006 were analyzed retrospectively.RESULTS:Among patients over 60 years old,the ratio of using pethidine hydrochloride injections and all narcotic analgesic drugs is significantly higher in those with cancer pain than those without(P