Technical guideline for intra-prepontine cisternal drug delivery via spinal puncture through subarachnoid catheterization / 中南大学学报(医学版)

Objective:The distribution characteristics of intrathecal drugs and the limitation of current catheterization techniques make traditional intrathecal analgesic treatment nearly useless for refractory craniofacial pain,such as trigemina neuralgia.This technical guideline aims to promote the widespread and standardize the application of intra-prepontine cisternal drug delivery via spinal puncture and catheterization. Methods:A modified Delphi approach was used to work for this guideline.On the issues related to the intra-prepontine cisternal targeted drug delivery technique,the working group consulted 10 experts from the field with 3 rounds of email feedback and 3 rounds of conference discussion. Results:For the efficacy and safety of the intra-prepontine cisternal targeted drug delivery technique,a consensus was formed on 7 topics(with an agreement rate of more than 80%),including the principles of the technique,indications and contraindications,patient preparation,surgical specifications for intra-prepontine cisternal catheter placement,analgesic dosage coordination,analgesic management,and prevention and treatment of complications. Conclusion:Utilizing the intra-prepontine cisternal drug infusion system to manage refractory craniofacial pain could provide advantages in terms of minimally invasive,secure,and effective treatment.This application can not only alleviate the suffering of individuals experiencing the prolonged pain but also support the maintenance of quality of life and dignity in their final moments,justifiing its widespread dissemination and standardized adoption in domestic and international professional fields.

Research progress on P2X7 receptor in cancer pain / 基础医学与临床

The activation of the P2X7 receptor as an ATP-gated ion channel,triggers the release of pro-inflammato-ry cytokines in tumor carring individuals and stimulate excitation of injury-causing neurons,thereby exacerbating the transmission of pain.In preclinical cancer pain models,it has the potential to serve as a new therapeutic target for cancer pain management.

A Case of Refractory Cancer-related Neuropathic-pain Caused by Intracranial Invasion of Left Nasal Cavity Carcinoma Successfully Treated with Goreisan

Introduction: Intracranial tumors cause various neurological symptoms and neuropathic pain, which are often refractory to opioids. In some of these cases, the combination of Kampo medicines can be effective. Case: The case was a 44-year-old patient who underwent surgery for a suspected papilloma. After resection, pathological examination revealed squamous cell carcinoma, positive for margins, and then, the left intraorbital metastasis was observed. Due to the intracranial invasion of the tumor, he had pain in the second and third branches of the trigeminal nerve in the left face and paresthesia in the second branch of the trigeminal nerve bilaterally (Numerical Rating Scale: NRS 10/10). Hydromorphone was introduced, and the pain was relieved, but the paresthesia remained (NRS 8/10). Both paresthesia and pain worsened during the course of chemotherapy, but MRI showed no tumor progression, thus, the cause of symptom aggravation was diagnosed edema of the tissue around the tumor. Therefore, Goreisan was started, and both paresthesia and pain were relieved. Discussion: Goreisan has been shown to be effective in cerebral edema due to its water-regulating effect by inhibiting aquaporin. In the present case, the reduction of edema in peritumoral tissues by Goreisan may have contributed to the symptomatic relief.

Endoscopic ultrasound-guided celiac plexus neurolysis in pancreatic cancer-associated pain: different technical approaches in three challenging cases

Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancerassociated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.

El cáncer de páncreas se puede presentar con dolor abdominal intenso, siendo necesario el uso de analgésicos a largo plazo en muchos de los pacientes. Sin embargo, estos medicamentos pueden tener efectos adversos que finalmente reducen la calidad de vida de los pacientes. La neurólisis del plexo celíaco guiada por ecoendoscopia es un procedimiento que controla el dolor asociado a este tipo de neoplasia y consiste en inyectar un agente neurolítico en o alrededor del plexo celíaco. Presentamos tres casos en los cuales se realizan diferentes técnicas de abordaje terapéutico.

Effects of cannabinoids on pain control, quality of life and opioid-sparing in cancer patients: systematic review / Utilização de canabinoides no controle da dor, na qualidade de vida e no efeito poupador de opioides em pacientes com câncer: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Cannabinoids, such as delta-9-tetrahydrocannabinol and cannabidiol, have several therapeutic properties that may be useful in medicine. The objective of this study was to analyze the impact of cannabinoid use on pain control, quality of life and opioid-sparing in patients with advanced cancer. CONTENTS: A systematic review of the evidence for the use of cannabinoids in patients with advanced cancer was conducted on 1) Pain control; 2) Quality of life; and 3) Opioid-sparing effect. PubMed, Web of Science and Cochrane databases were searched for articles, written in English, published between January 1, 2011, and December 31, 2022, with the filters "randomized controlled trials" and "clinical trials". Using oral formulations of cannabinoids was accepted as "intervention" and placebo as "control". Risk of bias analysis was performed with Cochrane's RoB 2 and ROBINS-I tools. This review followed the 2020 PRISMA- statement. Ten studies were included, with 1169 participants, most with moderate risk of bias. The studies were from Australia (n=4), Canada (n=1), Israel (n=1), Mexico (n=1), The United Kingdom (n=1); two were multinationals. Eight were randomized, placebo-controlled trials; two were non-randomized studies. The most used formulation was nabiximols oral spray. Cannabinoids provide a clinical improvement in pain control. Evidence of improved quality of life with cannabinoids is inconclusive. Cannabinoids do not affect the daily dose of opioids in refractory cancer pain. Cannabinoid use cannot be said to have an opioid-sparing effect. CONCLUSION: It is necessary to expand research on the prescription of cannabinoids in individuals with cancer and other progressive diseases, with several comorbidities and multiple medications, in different health contexts.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os canabinoides, como o delta-9-tetrahidrocanabinol e o canabidiol, possuem propriedades terapêuticas que podem ser úteis em pacientes oncológicos. O objetivo deste estudo foi avaliar o impacto do uso de canabinoides no controle da dor, na melhoria da qualidade de vida, e no efeito poupador de opioides em pacientes com câncer avançado. CONTEÚDO: Realizou-se uma revisão sistemática sobre a evidência da utilização de canabinoides em pacientes com câncer avançado, relativamente a: 1) Controle da dor; 2) Qualidade de vida; e 3) Efeito poupador de opioides. Foram buscados artigos na Pubmed, Web of Science e Cochrane, em inglês, publicados entre 2011 e 2022, com os filtros "randomized controlled trials" e "clinical trials". Aceitaram-se como "intervenção" qualquer uso de formulações orais de canabinoides e como "controle" o uso de placebo. Fez-se análise de viés com as ferramentas da Cochrane RoB 2 e ROBINS-I. Seguiu-se a Declaração PRISMA 2020. Foram incluídos 10 estudos, com 1169 participantes, a maioria com risco moderado de viés. Os estudos provinham de Austrália (n=4), Canadá (n=1), Israel (n=1), México (n=1), Reino Unido (n=1); dois eram multinacionais. Oito eram ensaios randomizados controlados com placebo; dois eram não randomizados. A formulação mais usada foi spray bucal de nabiximóis. Os canabinoides proporcionam uma melhoria clínica do controle da dor. A evidência da melhoria da qualidade de vida com canabinoides é inconclusiva. Os canabinoides não afetam a dose diária de opioides na dor oncológica refratária. Não se pode afirmar que o uso de canabinoides tem um efeito poupador de opioides. CONCLUSÃO: É necessário incrementar a investigação sobre a prescrição de canabinoides em indivíduos com câncer e outras doenças progressivas, com comorbilidades e polimedicação, em diferentes contextos de saúde.

Occurrence of Fatigue and Pain in Oncology Patients: Serie of Case Reports / Ocorrência de Fadiga e Dor em Pacientes Oncológicos: Série de Casos Clínicos

Fatigue is a reversible change in biological, physical and psychic functions, resulting from the imbalance of the organism. In patients with head and neck cancer (HNC), fatigue has been cited as one of the most frequent symptoms, especially in individuals with metastasis. It can significantly limit daily activities in order to be considered as a chronic condition, in particular, when associated with painful symptoms. The objective of this studt was to report the occurrence of fatigue and pain in patients with HNC. This was a series of prospective clinical cases describing the clinical history of four patients with HNC submitted to radio chemotherapeutic treatment, users of a public oncology service. To assess the degree of fatigue, the Brief Fatigue Inventory questionnaire was applied at five different moments during the antineoplastic treatment and pain analysis, an analog pain scale was used. The analysis of the questionnaires showed that fatigue was a frequent complaint and intensified with the advance of antineoplastic therapy. Its occurrence was also related to the difficulty performing daily activities. Painful symptomatology has been reported by patients to varying degrees. The occurrence of fatigue and pain in patients with HNC presents variability due to the individual's own experience, reflected by their socioeconomic and cultural context and their personal perception of the illness process.(AU)

A fadiga é uma alteração reversível das funções biológicas, físicas e psíquicas, proveniente do desequilíbrio do organismo. Em pacientes com câncer de cabeça e pescoço (CCP), a fadiga tem sido citada como um dos sintomas mais frequentes, principalmente em indivíduos com metástase. Pode limitar de forma significativa as atividades diárias, de modo a ser considerada uma condição crônica, em especial, quando associada à sintomatologia dolorosa. Este trabalho objetiva relatar a ocorrência de fadiga e dor em pacientes com CCP. Tratou-se de uma série de casos clínicos, de caráter prospectivo, que descreve a história clínica de quatro pacientes com CCP submetidos ao tratamento radioquimioterápico, usuários de um serviço de oncologia público. Para avaliação do grau de fadiga, foi aplicado o questionário Brief Fatigue Inventory em cinco momentos distintos, durante o tratamento antineoplásico e para a análise da dor, foi utilizada uma escala analógica de dor. A análise dos questionários demonstrou que a fadiga foi uma queixa frequente e se intensificou com o avanço da terapia antineoplásica. Sua ocorrência também esteve relacionada à dificuldade de execução de atividades cotidianas. A sintomatologia dolorosa foi relatada pelos pacientes em diferentes graus. A ocorrência de fadiga e dor em pacientes com CCP apresenta variabilidade em razão da experiência vivida pelo próprio indivíduo refletida pelo seu contexto socioeconômico e cultural e a sua percepção pessoal acerca do processo de adoecimento.(AU)

Interferential Current Electrotherapy is More Effective Thanthan TENS VIF in Cancer Pain Management / Corrente Interferencial é Mais Efetiva para Alívio da Dor Oncológica que a TENS VIF

Cancer diagnosis is increasing rapidly worldwide and pain is a common feature reported by cancer patients. Therapeutical approach on cancer pain is complex where less invasive methods with little side effects have been sought. The aim of this study was to compare transcutaneous electrical nerve stimulation (TENS) and interferential current (IC) therapies effects on cancer pain. Double blind study with 81 cancer pain patients. Subjects were set up into two groups: one treated with TENS VIF (n=42) and other with IC (n=39). Age, gender, duration of pain, tumor site and histology, medications, treatments, Karnofsky score and clinical state were evaluated. Pain was measured by EMADOR and McGill scores. Electroanalgesia was performed for 30 minutes, the equipments used were Neurodyn III Ibramed® and Neurovector generation 2000 Ibramed®. Electrodes were placed where there was higher intensity of pain according to what was shown by the patient through EMADOR, and each one got only one electrotherapy session. Pain intensity was significantly reduced in both groups (p<0.001) soon after and until 6th hour post electrotherapy. IC group had better results at 4th, 5th (p<0.001) and 6th hour (p=0.022). McGill score in TENS VIF group was significant until 4th hour and in the IC group was highly significant in all evaluated times (p<0.001). Analgesic effect of TENS VIF and IC electrotherapy was clinically effective, however, IC did cause better results regarding analgesia duration.(AU)

O diagnóstico de câncer está aumentando rapidamente em todo o mundo e a dor é uma característica comum relatada por pacientes com câncer. A abordagem terapêutica da dor oncológica é complexa onde métodos menos invasivos e com poucos efeitos colaterais têm sido buscados. O objetivo deste estudo foi comparar os efeitos das terapias de estimulação elétrica nervosa transcutânea (TENS) e corrente interferencial (IC) na dor oncológica. Estudo duplo-cego com 81 pacientes com dor oncológica. Os indivíduos foram divididos em dois grupos: um tratado com TENS VIF (n=42) e outro com IC (n=39). Idade, sexo, duração da dor, local do tumor e histologia, medicamentos, tratamentos, pontuação de Karnofsky e estado clínico foram avaliados. A dor foi mensurada pelos escores EMADOR e McGill. A eletroanalgesia foi realizada por 30 minutos, os equipamentos utilizados foram Neurodyn III Ibramed® e Neurovector geração 2000 Ibramed®. Os eletrodos foram colocados onde havia maior intensidade de dor de acordo com o apresentado pelo paciente através da EMADOR. A intensidade da dor foi significativamente reduzida em ambos os grupos (p<0,001) logo após e até a 6ª hora pós-eletroterapia. O grupo CI teve melhores resultados na 4ª, 5ª (p<0,001) e 6ª hora (p=0,022). O escore de McGill no grupo TENS VIF foi significativo até a 4ª hora e no grupo IC foi altamente significativo em todos os tempos avaliados (p<0,001). O efeito analgésico da TENS VIF e da eletroterapia com IC foi clinicamente eficaz, porém a IC trouxe melhores resultados quanto à duração da analgesia.(AU)

Utilización medicinal de cannabis en pacientes oncológicos de San Carlos de Bariloche: Estudio basado en una encuesta / Medicinal use of cannabis in cancer patients in San Carlos de Bariloche: a survey-based study

RESUMEN INTRODUCCIÓN El uso medicinal del cannabis en pacientes oncológicos se ha popularizado en los últimos años. Para poder brindar asesoramiento que redunde en un uso más eficaz y seguro, es necesario conocer la experiencia y expectativas de los usuarios. El objetivo fue conocer los motivos y la experiencia del uso medicinal de cannabis en adultos con enfermedades oncológicas en San Carlos de Bariloche (Río Negro). MÉTODOS Se realizó un estudio basado en una encuesta en línea autoadministrada sobre uso de cannabis, tiempo y motivo de uso, grado de satisfacción, asesoramiento profesional, vía de administración y efectos adversos. RESULTADOS Participaron 201 pacientes. Un 19% utilizaba cannabis, y el 31% lo había utilizado antes. La principal forma de uso fue el aceite. Los principales motivos fueron tratar el dolor, dormir mejor y sentirse mejor. Las experiencias fueron satisfactorias o muy satisfactorias para más del 50%, y las más favorables fueron para tratar el dolor, mejorar el ánimo, tolerar la quimioterapia y dormir mejor. Entre las razones para dejar de usarlo se mencionó falta de utilidad, efectos adversos, dudas sobre dosis, tiempo de uso y calidad del producto adquirido. Menos del 50% de los pacientes habían recibido asesoramiento profesional sobre uso de cannabis. DISCUSIÓN El 50% de los participantes utilizó cannabis. Este relevamiento ofrece un diagnóstico útil para promover políticas que reflejen las necesidades frente al uso de cannabis.

ABSTRACT INTRODUCTION The medicinal use of cannabis in cancer patients has become popular in recent years. In order to provide advice that results in a more effective and safe use, it is necessary to know the experience and expectations of users. The objective was to know the reasons and experience of the medicinal use of cannabis in adults with oncological diseases in San Carlos de Bariloche (Río Negro province). METHODS The study was based on a self-administered online survey on cannabis use, time and reason for use, degree of satisfaction, professional advice, route of administration and adverse effects. RESULTS A total of 201 patients participated, of which 19% used cannabis and 31% had previously used it. The main form of use was oil. The main reasons for use were to treat pain, sleep better and feel better. The experiences were satisfactory or very satisfactory for more than 50%, and the most favorable ones were to treat pain, improve mood, tolerate chemotherapy, and sleep better. Lack of usefulness, adverse effects, doubts about the dose, time of use and quality of the product purchased were mentioned among the reasons for the decision to stop using it. Less than 50% of the patients had received professional advice on the use of cannabis. DISCUSSION Half of the participants used cannabis. This survey provides a useful diagnosis to foster policies that reflect the needs regarding the use of cannabis.

Analysis of influencing factors for breakthrough cancer pain in patients with advanced pancreatic cancer / 中华胰腺病杂志

Objective:To investigate the influencing factors of breakthrough cancer pain (BTcP) in patients with advanced pancreatic cancer.Methods:According to the inclusion and exclusion criteria, patients with advanced pancreatic cancer who were diagnosed and followed up by outpatient service in the 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2020 were prospectively selected as the study subjects. According to whether breakthrough cancer pain occurred, all patients were divided into observation group (breakthrough cancer pain) and control group (no breakthrough cancer pain). The relevant clinical data of the included patients including age, gender, presence or absence of vomit, constipation, sleep disruption, frequency of basic pain every week, with or without regular medication, heavy physical labor, with or without vascular invasion, bone metastasis, abdominal metastasis and lung metastasis, as well as whether surgery, radiotherapy or chemotherapy were collected and the data of evaluation indicators during follow-up were recorded. Digital pain score (NRS) and visual analog score (VAS) were used as pain evaluation score. Univariate and logistic regression were used to analyze the related influencing factors of breakthrough cancer pain. Receiver operating characteristic curve (ROC) was drawn, and area under curve (AUC), sensitivity and specificity were calculated to analyze the predictive value for breakthrough cancer pain.Results:A total of 173 patients were included in the study, with 49 cases in the observation group and 124 cases in the control group. Univariate analysis showed that aged ≥50 years old, constipation, sleep disruption, frequency of basic pain ≥3 times, irregular medication, heavy physical labor, bone metastasis, lung metastasis, radiochemotherapy, high NRS score and high VAS score were the influencing factors for breakthrough cancer pain (all P value <0.05). Multivariate analysis showed that irregular medication ( OR=1.879, 95% CI 2.473-4.757, P=0.002), basal pain ≥3 times ( OR=2.067, 95% CI 1.364-6.825, P=0.004), bone metastasis ( OR=2.756, 95% CI 1.153-5.846, P<0.001), NRS score ( OR=3.787, 95% CI 2.647-5.958, P<0.001), VAS score ( OR=2.684, 95% CI 1.545-7.878, P<0.001), were the risk factors for breakthrough cancer pain. The AUC of NRS score for predicting the occurrence of breakthrough cancer pain was 0.665 (95% CI0.573-0.757, P=0.001), and the cut-off value was 2.5 score with a sensitivity of 61.2% and a specificity of 77.1%. The AUC for predicting breakthrough cancer pain by VAS score was 0.608 (95% CI0.515-0.701, P=0.028), and the cut-off value was 2.5 score with a sensitivity of 67.9% and a specificity of 63.7%. The AUC of NRS+ VAS score for predicting breakthrough cancer pain was 0.692 (95% CI0.604-0.780), and the cut-off value was 4.5 score with a sensitivity of 81.6% and a specificity of 79.8%. Conclusions:Patients with advanced pancreatic cancer have a high incidence of breakthrough cancer pain, which was related to a variety of factors. NRS combined with VAS score can effectively predict the occurrence of breakthrough cancer pain.

Effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain / 中国基层医药

Objective:To investigate the effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain.Methods:Sixty patients with refractory cancer pain who received three-step analgesic treatment in Quzhou People's Hospital from August 2018 to December 2019 and acquired poor analgesic effects were included in this study. They were randomly assigned to undergo either an intravenous patient-controlled analgesia with hydromorphone (HV group, n = 30) or an intrathecal patient-controlled analgesia with hydromorphone (HI group, n = 30) for 10 consecutive days. The analgesic efficacy in each group was evaluated using the numerical rating scale (NRS) before and 2, 4, 24, 48 hours, and 10 days after administration. The frequency of breakthrough pain (BTP) at each time point was recorded. The sedation effect of medication was evaluated using the Ramsay score. The sleep quality of patients was evaluated using the Pittsburgh sleep quality index (PSQI). The activities of CD 3+, CD 4+, and CD 4+/CD 8+ lymphocyte subsets were measured by flow cytometry at different time points. The adverse reactions within 10 days after treatment were observed and recorded. Results:Before and at each time point after treatment, there were no significant differences in NRS score, the frequency of BTP, Ramsay score, and PSQI score between the two groups (NRS score: t = 0.45, 0.91, 0.52, 1.19, 0.97, 1.92, all P > 0.05; frequency of BTP: t = 0.34, 1.88, 0.86, 1.71, 1.22, 0.76, all P > 0.05; Ramsay score: t = 0.56, 0.46, 0.63, 0.22, 0.99, 0.14, all P > 0.05; PSQI: t = 0.86, 1.25, 1.46, 1.05, 0.57, 1.93, all P > 0.05). At each time point after treatment, the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells increased in each group, and the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells in the HI group were significantly higher than those in the HV group (CD 3+: t = 3.72, 3.12, 2.85, 3.13, 2.44, all P < 0.05; CD 4+: t = 3.62, 2.45, 3.31, 3.19, 2.70; all P > 0.05; CD 4+/CD 8+: t = 3.10, 2.74, 2.83, 3.24, 3.41, all P < 0.05). The total incidence of adverse reactions was slightly, but not significantly, lower in the HI group than the HV group [14.00% (7/30) vs. 26.00% (13/30), χ2 = 2.70, P = 0.100]. Conclusion:Compared with intravenous administration of hydromorphone, intrathecal administration of hydromorphone can better effectively relieve pain, decrease the frequency of BTP, improve sleep quality, has a good sedative effect, improve immune function, and has fewer adverse reactions.

Progress in breakthrough cancer pain management / 中华全科医师杂志

Pain is one of the most frightening and unbearable symptoms in cancer patients, approximately 80% of patients with advanced cancer have pain, and a systematic review shows that the prevalence of breakthrough cancer pain (BTcP) was 59.2%. Breakthrough pain often has a significant negative effect on quality of life of patients, which is related to a direct effect (suffering) and an indirect effect (interference with activities of daily living). Clinical management of BTcP is still not satisfactory despite the availability of various effective pain relief agents. The purpose of this review is to summarize the current situation of the management of BTcP at home and abroad, and to discuss the factors that hinder the management of BTcP.

Progress of relationship between fentanyl family and immunomodulation / 肿瘤研究与临床

The abuse of opioids in the perioperative period has made the side effects of opioids increasingly prominent. So many anesthesiologists have proposed the concept of opioid-free anesthesia. Immunomodulation is an important field of modern medical research. With the introduction of the concept of enhanced recovery after surgery, the immunomodulatory effects of opioids have received increasing attention. Currently, the fentanyl family is commonly used opioid analgesics in clinical practice. This article reviews the research progress of the fentanyl family and immunomodulation, in order to provide guidance for clinicians to choose analgesic drugs.

Intrathecal administration of Maresin 1 attenuates bone cancer pain by inhibiting the glial cells acti-vation and neuroinflammation in the spinal cord / 临床麻醉学杂志

Objective To investigate the effects of intrathecal administration of Maresin 1 on pain behavior and glial cells activation in spinal dorsal horn of mice with bone cancer pain(BCP).Methods Experiment Ⅰ,twenty-eight clean male C57BL/6 mice,aged 4-6 weeks,weighing 18-22 g,were ran-domly divided into two groups:sham 1 group(group S1)and BCP 1 group(group B1),14 mice in each group.BCP model was established in group B1 by injecting PBS 20 μl containing 2 × 105 lewis lung carcino-ma cells into the intramedullary space.Group S,received PBS 20 μl without tumor cells.Six mice in each group were randomly selected to determine the mechanical withdrawal threshold(MWT)and thermal with-drawal latency(TWL)1 day before implantation,3,7,14,21 days after implantation.Four mice were randomly sacrificed on days 7,14 and 21 in group S,and group B1.The expressions of spinal glial fibrillary acidic protein(GFAP)and ionized calcium-binding adapter molecule 1(Iba1)were detected by Western blot.Experiment Ⅱ,thirty-six clean male C57BL/6 mice were randomly divided into three groups:sham 2 group(group S2),BCP 2 group(group B2),and Maresin 1 group(group M),12 mice in each group.BCP models were established in groups B2 and M while group S2 received PBS 20 μl without tumor cells.Maresin 1 50 ng/5 μl were intrathecally injected from days 14 to 16 after tumor cells implantation.Six mice in each group were randomly selected to determine the MWT and TWL on days 14 to 18 after implantation.Mice were sacrificed on day 18 after pain behavior tests.The expressions of spinal GFAP and Iba1 were de-tected by Western blot and immunofluorescence staining.The levels of spinal IL-1 β,IL-6,and TNF-α were detected by ELISA.Results Experiment Ⅰ:compared with group S1,the MWT and TWL were significantly lower on days 7,10,14,and 21 after implantation in group B,(P＜0.05),the expressions of spinal GFAP and Iba1 were upregulated on days 7,14,and 21 after implantation in group B1(P＜0.05).Experiment Ⅱ:compared with group S2,the levels of spinal GFAP,Iba1,IL-1β,IL-6,and TNF-α were increased on day 18 after implantation in group B2(P＜0.05).Compared with group B2,the MWT and TWL were significantly higher on days 15-18 after implantation while levels of spinal GFAP,Iba1,IL-1β,IL-6,and TNF-α on day 18 were decreased in group M(P＜0.05).Conclusion Intrathecal administra-tion of Maresin 1 attenuates BCP maybe by inhibiting the glial cells activation and neuroinflammation in the spinal cord.

Status and influencing factors of digital health anxiety in elderly patients with cancer pain / 中国实用护理杂志

Objective:To investigate the level of digital health anxiety in elderly patients with cancer pain outside the hospital, and to analyze the influencing factors, so as to provide valuable reference for intervention in technology anxiety and personalized digital health services.Methods:The convenience sampling method was applied to select a total of 160 elderly patients with cancer pain who were treated in the General Surgery Department of the Second Hospital of Anhui Medical University from March 2018 to October 2022 as the research objects. The general information questionnaire, Technology Anxiety Scale, Family Adaptability and Cohesion Scale and Elderly Social Network Scale were used to conduct a cross-sectional survey. Multiple linear regression method was used to analyze the influencing factors of mobile medical technology anxiety score in elderly patients with cancer pain.Results:Finally, 153 questionnaires were effectively collected. The total score of technical anxiety scale of 153 elderly patients with cancer pain was (45.24 ± 9.67) points. Multiple linear regression results showed that family per capita monthly income ( t=-2.89, P= 0.004), living conditions ( t=-2.04, P=0.043), family support ( t=-2.42, P=0.017) and social network ( t=-7.81, P<0.001) were the main influencing factors of technical anxiety scores in elderly patients with cancer pain. Conclusions:Elderly cancer pain patients with lower family income, living alone, lower family support score and lower social network score have higher scores of digital health anxiety after discharge. Individualized intervention measures should be provided for such patients to reduce their anxiety level of digital health outside the hospital.

Relationship between spinal Mas-related gene receptor C and pathophysiological mechanism of bone cancer pain in mice / 中华麻醉学杂志

Objective:To investigate the relationship between spinal Mas-related gene receptor C (MrgC) and pathophysiological mechanism of bone cancer pain in mice.Methods:Forty male C3H/HeNCrlVr mice, aged 5-7 weeks, weighing 20-25 g, were selected and divided into 4 groups ( n=10 each) using a random number table method: sham operation group (group S), bone cancer pain group (group P), bone cancer pain + MrgC agonist group (group P-agonist) and bone cancer pain + Mrg C antagonist group (group P-Ab). Preparation of the bone cancer pain model: mouse fibrosarcoma cells (NCTC2472) were injected into the upper tibia of mice in P, P-agonist and P-Ab groups, and the equal volume of D-Hanks balanced salt solution was given instead in S group. Fourteen days later cerebrospinal fluid was intrathecally injected in S and P groups, and MrgC agonist and MrgC antibody were intrathecally injected in P-agonist and P-Ab groups. The mechanical paw withdrawal threshold (MWT) to von Frey stimuli was measured before developing the model (T 0), at 7 days after developing the model (T 1), at 14 days after developing the model (before intrathecal injection, T 2), and at 4, 8 and 12 h after intrathecal injection (T 3-5). Results:Compared with group S, no significant change was found in the MWT at T 0 ( P>0.05), and the MWT was significantly decreased at T 1-T 5 in the other groups ( P<0.05). Compared with group P, the MWT was significantly increased at T 3-T 5 in group P-agonist, and the MWT was significantly decreased at T 3-T 5 in group P-Ab ( P<0.05). Conclusions:Spinal MrgC plays an endogenous protective role in the pathophysiological mechanism of bone cancer pain to a certain extent in mice.

A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.

Development of Nursing Practice Scale of Cancer Pain Management and Examination of Reliability and Validity

The aims of this study were (1) to develop and validate the scale to measure evidence-based nursing practice in cancer pain management and (2) to identify associated factors. We developed potential items based on the 2014 version of Japanese Clinical Guidelines for Cancer Pain Management and administered anonymous questionnaire for 189 oncology nurses in a designated cancer center. We conducted a re-test to test reliability.167 nurses participated in the study. As a result of item analysis and exploratory factor analysis, we developed a nursing practice scale of cancer pain management and its shortened version. This scale consists of 1 domain 50 items The Cronbach’s α coefficient showing internal consistency was 0.98 (shortened version 0.88). The intra-class correlation coefficient of reliability was 0.52 (shortened version 0.77). Concurrent validity was confirmed by the correlation between the total score of the whole scale and the total score of the practice of palliative care, knowledge, difficulty, self-confidence scale. We concluded that this scale was valid and reliable. Factors related to the nursing practice of cancer pain management were years of experience in cancer nursing, opportunities of postgraduate education, and satisfaction with postgraduate education. This scale can be used for evaluation of daily clinical practice and practice evaluation after educational efforts such as cancer pain nursing training.

A Case Where the Epidural Block Was Useful for the Differential Diagnosis of Low Back Pain in a Patient with Esophageal Cancer and Lumbar Disc Herniation

Introduction: We experienced a case in which an epidural block was useful in estimating the cause of low back pain in a patient suffering from esophageal cancer with liver and paraaortic lymph node metastases. Case: A 69-year-old male with a history of surgery for lumbar disc herniation (at the age of 20). He was diagnosed with esophageal cancer and during follow-up, he noticed low back pain, followed by epigastric pain. MRI revealed L1/2 and L2/3 intervertebral disc herniation. The thoracic epidural block was performed from Th8/9 under X-ray fluoroscopy to alleviate symptoms and identify the cause of low back pain. After confirming the analgesic effect, we conducted a splanchnic nerve block using neurolytic agent (anhydrous ethanol), resulting in total pain elimination. Subsequently, the patient passed away under good pain control without increasing the dose of analgesics. Conclusion: By confirming the effectiveness of epidural block at the thoracic level in advance, the complicated pain was thought to be derived from not lumber disc herniation, but the visceral nerves. An epidural block was useful for the selection of subsequent analgesic therapy.

Exploration of the thinking and methods in treatment of cancer pain with acupuncture and moxibustion on the base of the fascia theory / 中国针灸

There is a commonality between jingjin (muscle region of meridian) and the fascial network for coordinating the balance in the body. The occurrence and the progression of tumor may disrupt the overall coordination between the fascial network and jingjin directly or indirectly, thereby, the impairment of this coordination may result in cancer pain. Rooted on the theory of overall balance of the fascial network, and combined with understanding of pain in jingjin theory, professor HUANG Jin-chang emphasizes the importance of "relaxing the knot" in treatment of cancer pain. It is recommended to select the fascia reaction point as the target point, in accordance with the principle of balance adjustment and apply various acupuncture and moxibustion therapies, such as Fu's subcutaneous needling, small-needle scalpel therapy, fire needling, and moxibustion.

The mechanism underlying bone metastasis pain in lung cancer mediated by Gm31083/miR-450b-5p/EphB1 pathway / 中国基层医药

Objective:To investigate the mechanism underlying bone metastasis pain in lung cancer mediated by Gm31083/miR-450b-5p/EphB1 pathway.Methods:Between January 2020 and December 2021, a total of 20 healthy specific pathogen-free (SPF) grade Sprague-Dawley mice were selected and randomly divided into a sham operation group and a model group using a random number table method, with 10 mice in each group. A lung cancer bone metastasis pain model was established by injecting human lung adenocarcinoma A549 cells into the femur of each mouse in the model group. The middle part of the left plantar area of the mouse was stimulated with 2 g Von Frey fine fibers, and the mouse's foot retraction response was observed for 5-6 seconds. The pain threshold of each mouse was measured using a hot plate instrument. The expression of miR-450b-5p was determined by real-time fluorescence quantitative polymerase chain reaction. The expression of Gm31083 and EphB1 proteins was determined by western blot assay.Results:The foot contraction response rate in the model group was (31.98 ± 6.36)%, which was significantly higher than (22.78 ± 4.54)% in the sham operation group ( t = -3.72, P < 0.05). The heat pain threshold in the model group was (8.18 ± 2.53) seconds, which was significantly lower than (15.42 ± 3.97) seconds in the sham operation group ( t = 4.86, P < 0.001). The relative expression level of miR-450b-5p in the model group was (1.62 ± 0.29), which was significantly higher than (1.00 ± 0.04) in the sham operation group ( t = -6.70, P < 0.001). The grayscale values of Gm31083 and EphB1 proteins in the model group mice were (1.23 ± 0.21) and (2.73 ± 0.28), respectively, which were significantly higher than (0.67 ± 0.18) and (1.25 ± 0.24) in the sham operation group ( t = -6.40, -12.69, both P < 0.001). Conclusion:Gm31083/miR-450b-5p/EphB1 is highly expressed in mice suffering from bone metastasis pain after developing lung cancer, and may become a new biomarker for evaluating bone metastasis pain in lung cancer.