Lumbalgia cronica como presentacion de mieloma múltiple de cadenas ligeras / Chronic low back pain as a presentation of multiple light chain myeloma

El mieloma múltiple es un cáncer de células plasmáticas que producen una inmunoglobulina monoclonal, las manifestaciones incluyen lesiones líticas óseas, insuficiencia renal, hipercalcemia anemia; el diagnostico exige demostrar la proteína M y/o proteinuria de cadenas ligeras y exceso de células plasmáticas en medula ósea, el tratamiento a menudo es una combinación de la quimioterapia convencional, corticoides y uno o más de los agentes nuevos. Paciente femenina de 48 años con un cuadro clínico de siete meses de evolución caracterizado por dolor en región lumbar irradiado a región sacra, el cual fue exacerbándose en el transcurso de los meses y recibió tratamiento con corticoides y analgésicos antiinflamatorios no esteroideos, catalogada como lumbalgia crónica. Se realizó TAC de columna lumbar con lesión expansiva osteolítica en el por lo cual se realiza biopsia guiada por tac, encontrándose tejido friable, con una anatomía patológica e inmunohistoquímico el cual reporta plasmocitoma óseo. En base a las normas de diagnósticos y tratamiento de la ASSUS se estratifica a la paciente con el diagnóstico de mieloma múltiple EC IIA *Durie y Salmon/IPS Esta paciente es elegible para trasplante antólogo de células madre hematopoyéticas, por el grupo etario se inicia protocolo CYBORD* y radioterapia coadyuvante para las lesiones más representativas, actualmente paciente ha cumplido 5to ciclo alcanzando una muy buena respuesta parcial, a la espera del trasplante autólogo. En la literatura médica existen pocos reportes en cuanto a la asociación entre lumbalgia como síntoma sospechoso de MM y el de cadenas ligeras es de hecho un desafío diagnóstico.

Multiple myeloma is a cancer of plasma cells that produce a monoclonal immunoglobulin, manifestations include lytic bone lesions, renal failure, hypercalcemia, anemia; Diagnosis requires demonstration of M protein and/or light chain proteinuria and excess bone marrow plasma cells. Treatment is often a combination of conventional chemotherapy, corticosteroids, and one or more of the newer agents. A 48-year-old female patient with a clinical picture of seven months of evolution characterized by pain in the lumbar region radiating to the sacral region, which was exacerbated over the months and received treatment with corticosteroids and non-steroidal anti-inflammatory analgesics, classified as chronic low back pain. Scan of the lumbar spine was performed with an expansive osteolytic lesion in which a CT-guided biopsy was performed, finding friable tissue, with a pathological and immunohistochemical anatomy which reported bone plasmacytoma. Based on the ASSUS diagnosis and treatment standards, the patient was stratified with the diagnosis of multiple myeloma CD IIA *Durie and Salmon/IPS This patient is eligible for an autologous hematopoietic stem cell transplant. Due to the age group, the CYBORD* protocol and adjuvant radiotherapy are started for the most representative lesions. Currently, the patient has completed the 5th cycle, achieving a very good partial response, waiting for the autologous transplant. There are few reports in the medical literature regarding the association between low back pain as a suspicious symptom of MM and that of light chains, which is in fact a diagnostic challenge.

Clinical efficacy of zoledronic acid combined with calcium in the treatment of primary osteoporosis / 国际生物医学工程杂志

Objective:To investigate the clinical efficacy of zoledronic acid combined with calcium in the treatment of primary osteoporosis (OP).Methods:A total of 180 patients with OP were selected and randomly divided into study group and control group. The two groups of patients were given oral calcium carbonate D3 tablets (Ⅱ), on this basis, the patients in the study group were given zoledronic acid injection. The clinical efficacy was observed after 12 months of the treatment, and the total effective rate was calculated. The bone mineral density, visual analog scale (VAS) of pain, and bone biochemical indexes, including blood calcium (Ca), blood phosphorus (P), bone γ-carboxyglutamate protein (BGP), calcitonin (hCT), collagen type I amino-terminal peptide (P1NP) and collagen type I cross-linked carboxy-terminal peptide (β-specific sequence) (β-CTX) were collected before and after the treatment.Results:The clinical efficacy of the study group was better than that of the control group ( P<0.05). After the treatment, the bone mineral density in the study group was higher ( P<0.05), and the VAS score was lower than that in the control group ( P<0.05). After the treatment, there was no significant difference in serum calcium, serum phosphorus and BGP between the control group and the study group (all P>0.05), the hCT and P1NP levels in the study group were significantly higher than those before the treatment (all P<0.01), and the β-CTX level was significantly lower than that before the treatment ( P<0.01). Conclusions:Zoledronic acid combined with calcium has a good therapeutic effect on OP.

Manejo del dolor óseo en pacientes cancerosos / Bony pain management in cancerous patients

Las metástasis óseas se desarrollan en aproximadamente 30 a 70% de todos los pacientes con cáncer. El dolor es una experiencia de la condición humana universal, y es común que las personas busquen atención médica a raíz de ello. El presente estudio tuvo como objetivo describir la eficacia y el papel de diferentes estrategias en el control del dolor óseo en pacientes cancerosos metastásicos. Se trata de un estudio observacional realizado entre el 1 de diciembre de 2018 y el 30 de diciembre de 2019. Se inscribieron exactamente 100 pacientes cancerosos. Los pacientes fueron evaluados antes de recibir las modalidades de control del dolor, al principio y al final del tratamiento. La puntuación del dolor óseo se utilizó de 0 (sin dolor) a 10 (el peor dolor). Nuestros hallazgos con respecto al sexo, hubo 51 (51%) hombres y 49 (49%) mujeres. La edad media fue de 57,3 ± 11,2 años y el grupo de edad más frecuente fue de 41-50 años, 37 (37%). Entre los tipos de cáncer, el cáncer de mama ocupa el primer lugar entre los casos estudiados en nuestra investigación 37 (37%), seguido del cáncer de próstata 24 (24%). Las vértebras de la columna fueron el sitio más representado en un 52%, seguido de los huesos pélvicos en un 36%. La mayoría de los pacientes no requirieron cirugía. Mientras que el 15% de los pacientes se sometieron a descompresión del cordón, el 13% requirió fijación interna y solo cuatro pa- LA PRENSA MÉDICA ARGENTINA Bony pain management in cancerous patients 117 V.107/Nº 2 cientes se sometieron a vertebroplastia. El dolor agudo se describió comúnmente en un 40%, seguido de naturaleza punzante en un 15%. El dolor frecuente fue más prevalente en el 60% de los pacientes, mientras que el dolor constante se presentó en el 40%. La noche fue el momento más común de sentir dolor en el 55%. Después de recibir el tratamiento, varias modalidades provocan un desplazamiento de la puntuación del dolor hacia abajo. Combinación de más de estrategias más eficientes que utilizar una opción para el manejo del dolor óseo con un mejor resultado y pronóstico.

Bone metastases develop in approximately 30­70% of all cancer patients. Pain is a universal human experience condition, and it is a common question for people to seek health care. The study aimed to describe the efficacy and roles of different strategies in the control of bony pain in metastatic cancerous patients. This is an observational study carried out, from the 1st of December 2018 to the 30th of December 2019. Exactly 100 cancerous patients were enrolled. Patients were assessed before received of pain control modalities, in the beginning, and at the end of treatment. Bone pain scoring was used from 0 (no pain) to 10 (the worst pain). Our findings regarding sex, there were 51(51%) male and 49(49%) female. The mean age was 57.3±11.2 years, and the most frequent age group was 41-50 years as 37(37%). Among cancer types, breast cancer comes in 1st rank cases studied in our research 37(37%), followed by prostate cancer 24(24%). Spine vertebrae were the most site figured 52%, followed by pelvic bones in 36%. Most patients did not require surgery. Whereas 15% of patients underwent cord decompression, 13% required internal fixation and only four patients performed for vertebroplasty. The sharp pain was commonly described by 40%, followed by stabbing nature in 15%. Frequent pain was more prevalent in 60% of patients, whereas constant pain presented in 40%. The night was the commonest timing of feeling pain in 55%. After receiving treatment, several modalities cause shifting of the pain scoring downward. Combination of more than strategies more efficient than of use one option for manage of bone pain with a better outcome, and prognosis.

Dolor óseo generalizado e hipercalcemia en un lactante mayor como síntoma inicial de linfoma linfoblástico de células B / Generalized bone pain and hypercalcemia in an infant as an initial symptom of lymphoblastic lymphoma of B cells

Resumen Introducción: Los linfomas no Hodgkin son neoplasias heterogéneas derivadas de las células linfohematopoyéticas. Es raro que se presenten antes de los 2 años de edad y la prevalencia es mayor en el sexo masculino. Caso clínico: Paciente de sexo masculino de 1 año y 11 meses que debutó con dolor en miembros inferiores y superiores, claudicación intermitente, deformidad ósea e hipotonía generalizada, por lo que se sospechaba artritis juvenil. Se trató con antiinflamatorios no esteroideos. Al no haber mejoría, ingresó a otro hospital con adenopatías y nodulaciones en la región escrotal y braquial, y hepatomegalia, por lo que se presumió la activación precoz de la pubertad con evidencia de hipercalcemia. Los estudios radiológicos indicaron una posible displasia ósea. Sin embargo, la tomografía por emisión de positrones detectó zonas compatibles con un proceso maligno. Se diagnosticó linfoma de precursores B. La hipercalcemia es una alteración metabólica que, en presencia de cáncer, se considera un síndrome paraneoplásico. Es un dato clínico excepcional que se puede observar en niños con leucemia linfoblástica aguda. Conclusiones: El dolor óseo en la edad pediátrica amerita una exploración física minuciosa para realizar un diagnóstico oportuno del cáncer infantil y mejorar el pronóstico del paciente.

Abstract Background: Non-Hodgkin lymphomas are heterogeneous neoplasms derived from lymphohematopoietic cells, which are rarely found in children < 2 years of age and have a higher prevalence in males. Case report: One-year and eleven-month-old male patient started with pain in the lower and upper limbs, intermittent claudication, bone deformity, and generalized hypotonia, for which juvenile arthritis was suspected. He received non-steroidal anti-inflammatory drug treatment. As no improvement was reported, he was admitted in a different hospital with lymph nodes and nodulations in the scrotal and brachial region and hepatomegaly. Therefore, early activation of puberty with evidence of hypercalcemia was presumed. Radiological studies indicated possible bone dysplasia; however, positron emission tomography detected areas compatible with malignant process. Precursor B lymphoma was diagnosed. Hypercalcemia is a metabolic disorder considered a paraneoplastic syndrome in the presence of cancer, which is an exceptional clinical finding in children with acute lymphoblastic leukemia. Conclusions: Bone pain in the pediatric age deserves a thorough physical examination to favor an early diagnosis of childhood cancer and a better prognosis.

Recent advances in biology and management of cancer pain / 中国基层医药

Causes of cancer pain are multifactorial and complex.It is an important challenge for the clinicians on how to control cancer pain effectively.Opioids remain the most effective analgesics used in the treatment of cancer pain.But the adverse effects and potential risks associated with chronic use have been paid attention to in clinical work.It is related to molecular discoveries of opioid action that lead to the development of new opioid analgesic on potential new targets in treating cancer pain.Meanwhile, non-pharmacological treatments such as neuromodulation and minimally invasive interventional techniques play an important role in management of cancer pain.It is summarized in this article about the recent advances in biology and management of cancer pain.

Cionbufagin attenuates bone cancer pain by blocking the activation of microglia in the spinal cord / 药学学报

Cionbufagin has anti-inflammatory and analgesic effects. It is of great value in the treatment of bone cancer pain, but its mechanism is still unclear. To generate a bone metastasis model of breast cancer, 4×105 Walker-256 cells were inoculated into the left hind limb of SD rats. The experimental protocol was approved by the Medical Laboratory Animal Ethics Committee of Medical College of China Three Gorges University. Rats were randomly divided into sham, model, cionbufagin, morphine, saline, minocycline, microglia inhibitor (RS102895) and co-treatment with cionbufagin and minocycline group. The cionbufagin (5 mL·kg-1, i.p.), morphine (8 mg·kg-1, i.p.) and co-treatment groups (included cionbufagin 5 mL·kg-1, i.p.) received continuous administration from day 9 to day 21. The saline, minocycline (2.5 μg·μL-1, 20 μL), RS102895 (1.5 μg·μL-1, 20 μL) and co-treatment groups (included minocycline 2.5 μg·μL-1, 20 μL) received continuous administration by intrathecal cannulation from day 12 to day 21. Bone destruction of the left hind limb of rats was detected by hematoxylin-eosin staining (H&E). The pain threshold before treatment and at day 2, 5, 7, 9, 12, 14, 17 and 20 was measured by behavioral indexes. Activation and expression of a microglia marker (Iba-1) was determined by immunofluorescence and Western blot. The level of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6) in rat spinal cord was measured by enzyme-linked immunosorbent assay (ELISA). H&E results showed that cionbufagin effectively inhibited the destruction of bone marrow in rats with bone cancer pain; cionbufagin treatment significantly increased the mechanical and thermal pain threshold. Immunofluorescence showed that cionbufagin effectively inhibited the activation of microglia in the spinal dorsal horn. Western blot analysis confirmed that the activation of microglia in the spinal dorsal horn was inhibited by cionbufagin treatment. It was also found that the CCL2/CCR2 pathway may be involved in the analgesic effect of cionbufagin. These results suggest that cionbufagin can effectively alleviate bone cancer pain, possibly by inhibiting the release of inflammatory factors and the activation of spinal microglia cells through the CCL2/CCR2 pathway.

Case series of pubic bone diastasis causing severe pelvic girdle pain in pregnancy

Pelvic girdle pain (PGP) is a pregnancy discomfort that causes pain and limitation of mobility and functioning in any of the three pelvic joints. The patient usually presents antenatally with persistent suprapubic pain which is exaggerated during moving, walking or climbing stairs. Intrapartum, this could be associated with disruption of sacroiliac joint, hematuria and bladder dysfunction in severe cases. Pelvic X-rays, ultrasound, and magnetic resonance imaging aid in confirmation of diagnosis by measuring the degree of separation of symphysis. Treatment modalities range from conservative management to orthopedic interventions in form of pelvic strapping, open reduction and internal fixation. Postpartum pain often masks clinicians to make the diagnosis of pubic symphysis diastasis. A case series of three cases which were diagnosed and confirmed with ultrasound and managed with orthopedic consultation. till their delivery and in post-partum period till recovery. Although there is still no specific consensus on treatment guideline, management generally of conservative management to surgical in the form of pelvic bracing or strapping. Awareness of this rare condition can help in management of pain and associated disability which improves post-delivery.

Reduced Frequency of Bone Pain Crises in Patients with Sickle Cell Disease Given an Angiotensin-converting Enzyme Inhibitor / Reducción de la frecuencia de la crisis de dolor óseo en pacientes con la enfermedad de células falciformes mediante los inhibidores de la enzima convertidora de angiotensina

ABSTRACT Objective: To determine if sickle cell disease (SCD) bone pain crisis is mitigated by use of an angiotensin-converting enzyme inhibitor (ACEI), following a case report of ACEIs preventing bone pain crisis. Methods: Patients with SCD who attended the Haematology Clinic at Jos University Teaching Hospital, Nigeria, were assessed with a questionnaire, given 2.5 mg of ramipril and followed up monthly for three months. Frequencies of bone pain crises in the month preceding enrolment and three months following treatment as well as the cardiovascular status were evaluated. Results: Thirty-five patients with complete data were reported. Blood pressure remained stable, and cumulative frequency of bone pain crises fell. The relative risk reduction for bone pain was 56.2% at one month, 63.0% at two months and 13.0% at three months. Conclusion: Vaso-occlussion-induced hypoxia, triggering bone pain crises, produces angiotensin II from angiotensin and worsens vasoconstriction. Angiotensin-converting enzyme inhibitors block this process, reducing severity or preventing bone pain crises. With these observations and a stable blood pressure profile, we recommend wider use of ACEIs in patients with SCD to cut down on the need of opioid use with attendant addiction risk, as a way of improving their quality of life.

RESUMEN Objetivo: Determinar si la crisis de dolor por la enfermedad de células falciformes (ECF) es mitigada con el uso de los inhibidores de la enzima convertidora de angiotensina (IECA), luego de un informe que reporta que IECA previene la crisis del dolor óseo. Métodos: A pacientes con ECF que asistían a la Cínica de Hematología del Hospital Docente de la Universidad de Jos, Nigeria, se les evaluó con un cuestionario, se les suministró 2.5 mg de ramipril, y se les hizo un seguimiento mensual por tres meses. Se evaluaron las frecuencias de las crisis de dolor óseo en el mes anterior al alistamiento y tres meses después del tratamiento, así como el estado cardiovascular. Resultados: Se reportaron treinta y cinco pacientes con datos completos. La presión sanguínea se mantuvo estable, en tanto que se produjo un descenso de la frecuencia cumulativa de las crisis de dolor óseo. La reducción del riesgo relativo del dolor óseo fue de 56.2% en un mes, 63.0% en dos meses, y 13.0% en tres meses. Conclusión: La hipoxia inducida por vaso-oclusión, que desencadena la crisis de dolor óseo, produce angiotensina II a partir de la angiotensina y empeora la vasoconstricción. Los inhibidores de la enzima convertidora de angiotensina bloquean este proceso, reduciendo la severidad o previniendo las crisis del dolor óseo. Con estas observaciones y un perfil de presión arterial estable, recomendamos hacer un amplio uso de IECA en pacientes con ECF para reducir la necesidad del consumo de opioides y el consiguiente riesgo de adicción, como una manera de mejorar su calidad de vida.

Effect of cinobufagin on transient outward potassium current in dorsal root ganglion cells of rats with cancer-induced bone pain / 南方医科大学学报

OBJECTIVE@#To observe the effect of cinobufagin on transient outward potassium current () 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 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 current density, an activation curve shift to the right, and an inactivation curve shift to the left. Cinobufagin treatment significantly increased the current density and reversed the changes in the activation and inactivation curves in the DRG cells.@*CONCLUSIONS@# current is decreased in DRG neurons from rats with CIBP. Cinobufagin can regulate the activation and inactivation of current in the DRG cells, which may be related to its analgesic mechanism.

Clinical observation on Qiangjin Zhuanggu Qufeng Mixture in elderly primary osteoporosis / 中草药

Objective: To observe the clinical effect of Qiangjin Zhuanggu Qufeng Mixture on treating elderly primary osteoporosis, which had the effect of formula of nourishing the liver and kidney. Method A total of 100 elderly primary osteoporosis treated in Hangzhou Hospital of Traditional Chinese Medicine were selected and randomly divided into control group and treatment group, 50 cases in each group. The control group was treated with calcium preparations, vitamin D, calcium carbonate, Vitamin D3 Chewable Tablets and Calcitriol Soft Capsules; The treatment group was treated with Qiangjin Zhuanggu Qufeng Mixture on the basis of the control group. All patients were treated for six months. The change of the Chinese medicine symptoms scores was observed, and metastatic bone pain scores and calcaneus bone density was compared. Result The effective rate of traditional Chinese medicine symptoms in the treatment group was significantly better than that in the control group. The metastatic bone pain scores of both groups mitigated after treating, and the treatment group was better. The level of calcaneus bone density improved significantly, but that in two groups had no statistically difference after treating. Conclusion:s Calcium preparations, vitamin D, calcium carbonate, Vitamin D3 Chewable Tablets, and Calcitriol Soft Capsules combined with Qiangjin Zhuanggu Qufeng Mixture could improve traditional Chinese medicine symptoms and bone density, and mitigate metastatic bone pain.

Clinical retrospective analysis of 138 cases of multiple myeloma / 中华急诊医学杂志

Objective To analysis of multiple myeloma (MM) and non-MM patients with the same clinical manifestations but significant differences in laboratory findings at the first visit to the Emergency Medicine Department suggesting that patient should be rule out the possibilities of suffering from MM by the attending physicians engaging in a specialty other than hematology as soon as possible to avoid misdiagnosis of MM.Methods Retrospective analysis of clinical features of MM cases from February 2013 to December 2016.Patients with renal dysfunction (serum creatinine ≥ 177 mmol/L),infection,bone pain and anemia were divided into four groups.The non-MM patients with the same clinical symptoms were enrolled as control group.SPSS22.0 and Medcalce 15.10 software were used for analyzing the distinct difference and diagnostic validity of routine laboratory tests in patients with MM and non-MM.Results ①The patients with serum creatinine≥ 177 mmol/L,and unexplained renal insufficiency with blood Ca2+ ＞ 2.39mmol/L,ALB ≤ 30.31 g/L and Hb≤84 g/L should be investigated the possibility of MM.②The patient with poor response to the conventional treatment and unexplained infection with IgM ＜0.42 g/L and ALB≤32.7 g/L or ESR ＞ 82 mm/h and Hb ＜ 100 g/L should be investigated the possibility of MM.③The male patients with the first symptom in bone and joint pain associated with bone damage with urinary protein and blood,and the emergence of Ca2+ ＞ 2.39 mmol/L,ALB ＜ 37.5 g/L,Hb ＜ 104 g/L and TT ＞ 19.8 s were suggested to detect MM.④The poor respose to conventional treatment,unexplained anemia (Hb≤90 g/L),IgM ＜ 0.51 g/L,ALB ＜ 34.1 g/L and GLB ＞ 46.4 g/L suggested to detect MM.Conclusions On the basis of symptoms such as renal insufficiency,infection,bone pain,anemia,routine blood laboratory findings of high calcium,low IgM,low albumin,and high globulin,it was recommended that bone marrow biopsy be made to detect MM.

Clinical observation of fentanyl transdermal system treating bone pain from metastases of lung cancer / 中国基层医药

Objective To observe the effect and adverse reaction of fentanyl ransdermal system on the cancer pain resulted from lung cancer metastasizing to bone.Methods Thirty -two patients with moderate to severe cancer pain of bone metastasis from lung cancer were treated with fentanyl transdermal system.Analgesic effect was observed.The quality of life and adverse reactions were evaluated.Results The PI evaluation were (7.62 ± 1.35)and (1.93 ±2.41)before /after treated with fentanyl ransdermal system.The differences of bone pain between before and after treated were significant(t =3.983,P <0.01).Among the thirty -two patients with moderate to severe cancer pain used by fentanyl transdermal system,complete relief was in 12 cases(37.5%),apparent relief was in 11 cases(34.3%),moderate relief was in 7 cases(21.8%),mild relief was in 2 cases(6.3%),the total relief rate was 93.7%.The adverse reactions included hypersomnia were in 13 cases,dizziness in 11 cases,nausea and vomiting in 6 cases,constipation in 5 cases,pruritus and erythra in 4 cases,dysuria in 2 cases.All above adverse reactions dis-appeared after stopping fentanyl ransdermal system and /or undergoing symptomatic treatment.Conclusion Fentanyl transdermal system is easy to use,the effect is significant,there is few adverse reactions,which can significantly improve quality of life of cancer patients.

Síndrome de compresión medular en el paciente con patologías oncológicas / Medullary Compression Syndrome in Oncological Diseases Patient

El síndrome de compresión medular es una urgencia oncológica y neurológica de mal pronóstico que se presenta de manera similar en ambos sexos y cualquier enfermedad neoplásica diseminada puede llegar a provocarlo. La búsqueda de información, para esta revisión, se realizó en las bases de datos de PubMed, EBSCO, revistas médicas cubanas, y materiales impresos de Oncología de la biblioteca del Hospital Vladimir Ilich Lenin. Se describieron aspectos como etiología, localización, fisiopatología, diagnóstico y tratamiento. Para lograr mejores resultados en el diagnóstico y tratamiento de esta enfermedad se debe educar, tanto a pacientes con enfermedades oncológicas como a sus familiares, sobre las posibles complicaciones de su enfermedad.

The medullary compression syndrome is an oncological and neurological emergency of bad prognosis. It is presented in a similar way in both sexes and any neoplasic illness disseminated can cause it. The search of information, for this review, was carried out in the databases of PubMed, EBSCO, Cuban’s medical magazines, and materials of Oncology from the library of Vladimir Ilich Lenin Hospital. Aspects like etiology, localization, phisiopatology, diagnosis and treatment were described. To achieve better results in the diagnosis and treatment of this pathology, patient with oncological illnesses and its relatives, should be educated about the possible complications of its illness.

Randomized controlled clinical study on combination of morphine and dexamethasone through intrathecal pumping injection in patients with cancer-induced bone pain / 肿瘤

Objective: To investigate the efficacy of patients with cancer-induced bone pain (CIBP) treated with morphine in combination with dexamethasone through intrathecal pumping injection and its mechanism. Methods: Seventy-six patients with CIBP undergoing implantation of an infusion port with intrathecal catheter were randomly divided into group A (n = 38, intrathecally injected with morphine alone and group B (n = 38, intrathecally injected with morphine in combination with dexamethasone). The pain relief degree by 11-Point Numeric Rating Scale (NRS-11) score, the frequency of breakthrough pain, quality of life and SF-36 scale score were evaluated before treatment and the 1st, 3rd and 7th days after the beginning of intrathecal pumping. On the 7th day after treatment, the concentrations of â-endorphin (â-EP) and motilin in plasma as well as prostaglandin E2 (PGE2), substance P (SP) and calcitonin gene-related peptide (CGRP) in cerebrospinal fluid (CSF) were determined. Results: The pain was relieved significanly in group B, and the frequencies of breakthrough pain per day were less than those in group A on the 1st, 3rd and 7th days after treatment (all P 0.05); in group B, the SF-36 scale score and quality of life were both improved significantly on the 3rd and 7th days after treatment as compared with those of group A (all P 0.05), but the motilin level in plasma in group B was significantly higher than that in group A (P < 0.05); the PGE2, SP and CGRP levels in CSF in group B were significantly lower than those in group A (all P < 0.05). Conclusion: Intrathecal pumping injection of morphine in combination with dexamethasone can be of great help in decreasing the frequency of breakthrough of CIBP, improving the quality of life, and increasing the motilin level in plasma, but decreasing PGE2, SP and CGRP levels in CSF which may contribute to alleviating the tolerance of morphine, thus enhance the analgesic effect.

Halo-vest for cervical pain in a home care patient with esophageal cancer and cervical spine metastases

Introduction：Halo-vest is usually used temporary to immobilize the cervical spine after surgery or injury. We experienced a good pain relief by halo-vest attachment in one patient with metastatic tumors of cervical spine. Case：A 76-year-old male patient was diagnosed with cervical spine metastases during chemotherapy treatment for lymph node recurrence 7 years after the first surgery for his esophageal cancer. His neck and back pain did not improve even after pain management by analgesics and radiotherapy. He also experienced strong side effects due to opioid treatment. Eventually, he became immobile. Halo-vest was applied solely for the purpose of pain control. Since then, his pain diminished, opioid stopped and his gait recovered. After moving to a hospital close to his home, he was discharged from the hospital. He could stay at home without a severe complication and opioids for 2 months. Discussion：Fixation of the cervical spine with halo-vest might be a good procedure for pain relief in patients with cervical spine metastases. However, since it could also be a stressful treatment and might cause a severe complication, thorough discussion for the use of a halo-vest is mandatory with the patient, family, and orthopedists.

Correlation between the Severity of Bone Pain and the Amount of CD34+ Cells after Peripheral Blood Stem Cell Mobilization / 대한수혈학회지

BACKGROUND: Peripheral blood stem cells (PBSCs) are mobilized by granulocyte-colony stimulating factor (G-CSF), which causes several side effects in allogeneic donors. We report on side effects of G-CSF administration and determine which side effects could be used in predicting the amount of harvested CD34+ cells. METHODS: Data from the first PBSC collections of 155 healthy donors between 2007 and 2010 were analyzed. Side effects were assessed using adverse event inventory, which was graded from 1 (mild) to 3 (severe) or 4 (disabling). RESULTS: G-CSF administration caused an elevation of WBC counts (mean 44,834/microL) and 86% of them were neutrophils. The mean mononuclear cells in apheresis products was 6.6x10(8)/kg and mean CD34+ cells was 6.0x10(6)/kg. Bone pain was reported by 151 healthy donors (97%) and severe bone pain was related to more CD34+ cells in apheresis products (P=0.041): 39 for grade 1 (5.1x10(6) CD34+cells/kg), 86 for grade 2 (6.0x10(6)), and 26 for grade 3 (7.1x10(6)). In addition, the percentage of collecting more than 5.0x10(6) CD34+cells/kg during the first leukapheresis showed correlation with the severity of bone pain. CONCLUSION: Bone pain was the most common side effect of G-CSF mobilization and more CD34+ cells were harvested in cases of severe bone pain.

Evaluation on the efficacy of pamidronate disodium in treatment of osteocarcinoma / 中国生化药物杂志

Objective To investigate the efficacy of disodium pamidronate in treatment of bone metastasis cancer .Methods 50 cases of bone metastasis cancer were divided into control group and experimental group according to different medication, 25 cases in each group.Control group was treated by chemotherapy, experimental group was treated on the basis of control group with disodium pamidronate 45 mg+0.9%sodium chloride solution 500 mL, intravenous drip.Pain maintenance time, patient pain grading and serum NTx levels were compared after treatment.ResuIts Compared with control group,pain maintenance time of experimental group was longer(P <0.05),pain level overall score was lower,NTx was lower(P <0.05). ConcIusion Disodium pamidronate can inhibit bone metastasis cancer patients with the degree of pain, reduce the levels of serum NTx.

Approach to the patient with hypophosphatemic osteomalacia / 中华内分泌代谢杂志

A 47-year-old Chinese man with hypophosphatemic osteomalacia suffered from bone pain, difficulty in walking and pseudo-fractures. Biochemical examination showed a lowered serum phosphorus level and an elevated alkaline phosphatase level. The X-ray examination showed pseudo-fractures of multiple ribs, low bone density, biconcave deformities of the lumbar vertebrae, and pseudo-fracture of the right superior ramus of the pubis. A diagnosis of hypophosphatemic osteomalacia was made. The case was treated with oral neutral phosphate solution, calcitriol and Caltrate D. After treatment for two years, biochemical indicators were improved, and pseudo-fractures healed. Clinically, hypophosphatemic osteomalacia is often overlooked or misdiagnosed. In addition, the duration and dosage of these drugs should be appropriate, in order to avoid tertiary hyperparathyroidism or poor response to treatment.

Effect of electroacupuncture treatment on pain behavior and calcitonin-gene related peptide expression in cancer induced bone pain-morphine tolerance rat model / 中华行为医学与脑科学杂志

Objective To explore the efficacy of electroacupuncture treatment in cancer induced bone pain (CIBP)-morphine tolerance rat model and the expression of calcitonin-gene related peptide(CGRP) immunohistochemisty in dorsal root ganglion (DRG).Methods Forty SD rats were divided into four groups:sham group,CIBP + morphine tolerance group (BM),CIBP + electroacupuncture group (BE),and CIBP + morphine tolerance + electroacupuncture group (BME).BM,BE and BME groups were prepared CIBP model by carcinoma cell tibia implanted.After six days,the three CIBP groups accepted treatment of morphine,electroacupuncture,and morphine combined electroacupuncture,separately,nine days continuously.Acupoints were selected Zusanli (ST36) and Sanyinjiao (SP6).50％ mechanical withdraw threshold was evaluated by mechanical stimulation.CGRP expression in dorsal root ganglion was detected by immunohistochemisty.Results After five days of electroacupuncture treatment,pain threshold was (10.9 ± 0.8) g in BME group,(8.7 ± 0.6) g in BM group and (6.2 ± 0.9) g in BE group.The results had significant statistic differences (P ＜ 0.01,separately).IOD value of CGRP expression in dorsal root ganglion was 9026.5 ± 1827.4 in BME group,compared with 14803.1 ± 2086.7 in BM group and 15730.6 ± 2712.5 in BE group (P ＜ 0.01,separately).Results Electroacupuncture can relieve CIBP-morphine tolerance rat pain behavior.The mechanism is related to inhibiting CGRP overdue expression in DRG.

Inhibition of Glial Activation in Rostral Ventromedial Medulla Attenuates Mechanical Allodynia in a Rat Model of Cancer-induced Bone Pain / 华中科技大学学报（医学）（英德文版）

Descending nociceptive modulation from the supraspinal structures plays an important role in cancer-induced bone pain (CIBP).Rostral ventromedial medulla (RVM) is a critical component of descending nociceptive facilitation circuitry,but so far the mechanisms are poorly known.In this study,we investigated the role of RVM glial activation in the descending nociceptive facilitation circuitry in a CIBP rat model.CIBP rats showed significant activation of microglia and astrocytes,and also up-regulation of phosphorylated p38 mitogen-activated protein kinase (p38 MAPK) and pro-inflammatory mediators released by glial cells (IL-1β,IL-6,TNF-a and brain-derived neurotrophic factor) in the RVM.Stereotaxic microinjection of the glial inhibitors (minocycline and fluorocitrate) into CIBP rats' RVM could reverse the glial activation and significantly attenuate mechanical allodynia in a time-dependent manner.RVM microinjection of p38 MAPK inhibitor (SB203580) abolished the activation of microglia,reversed the associated up-regulation of pro-inflammatory mediators and significantly attenuated mechanical allodynia.Taken together,these results suggest that RVM glial activation is involved in the pathogenesis of CIBP.RVM microglial p38 MAPK signaling pathway is activated and leads to the release of downstream pro-inflammatory mediators,which contribute to the descending facilitation of CIBP.