Initial Experiences With Integration of Palliative Medicine and Specialist Pain Services in a Tertiary Cancer Care Center in India.

Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient outcomes. A prospective assessment was carried out within a collaborative clinic, uniting the realms of pain management and palliative medicine. Anonymized patient information was scrutinized to grasp the advantages of this amalgamation and identify strategies to address any inherent deficiencies. Furthermore, an illustrative case study was delineated, spotlighting the collaborative dynamics at a systemic level. During the period spanning from November 2020 to June 2021, a total of 43 patients received consultations at this collaborative clinic. Each patient was exposed to a comprehensive pain management regimen, with the most frequently conducted procedure being an intercostal nerve block, which was administered in 9.30% of cases. For the provision of effective pain relief within the palliative care context, the confluence of joint consultations from cancer pain specialists emerges as a requisite measure. This approach carries the promise of optimizing pain control and augmenting the quality of palliative care.

A Randomized Placebo-Controlled Trial Evaluating the Analgesic Effect of Salmon Calcitonin in Refractory Bone Metastasis Pain.

Injection calcitonin is a natural hormone inhibiting osteoclastic bone resorption have been used as an analgesic to control bone metastasis pain or pain due to osteoporosis or fracture. This randomized double blind placebo controlled trial was undertaken to determine the role of injection Salmon Calcitonin therapy to control refractory pain caused due to bone metastasis arising from cancer breast, lung, prostate or kidney. All patients had received palliative radiotherapy and were suffering unsatisfactory pain relief on NSAIDs and tab morphine. Fourteen days inj. calcitonin or placebo injections were administered in 23 patients initially as high dose induction dose (800 IU per day SC) followed 200 IU subcutaneous (SC) once a day. Patients were assessed for pain intensity and quality of life on EORTC QLQ-30 questionnaire 6 hourly for 2 days and on 7th and 30th day. Any incidence of hypercalcemia, bone fracture, nerve root and bone marrow compression were also noted. This study found a significant reduction in pain after SC calcitonin injection therapy at 14 and 30 days' assessment. No patients in the study group required rescue analgesia after 18 hrs. There was a statistically significant difference in rescue analgesics required between the groups during two days hospitalization. Global health as well as physical and social wellbeing was better at 30 and 90 days in the study group as compared to control group, however it could not reach a statistical significance which may be attributed to the small sample size of the study.

The Prevalence of Chronic Pain among Adults in India.

BACKGROUND: The prevalence of chronic pain (CP) is well described in Europe, America, and Australia. However, little knowledge is available of the prevalence of CP within Asia or Southeast Asia. Given the cultural and genetic variation in pain causation, manifestation, and reporting, the findings of previous western studies cannot be extrapolated to Asian countries. A prevalence study was needed to be carried out to quantify the magnitude and impact of CP in the adult population in India. METHODS: Two sets of questionnaires were designed. The first, a screening questionnaire was used telephonically to identify the prevalence of CP, and should there be CP; the second, a detailed questionnaire was administered, to characterize the features and impact of pain. The interviews were carried out face-to-face. RESULTS: A total of 4326 Indian patients were screened, and 836 completed a detailed pain questionnaire during 2006. The prevalence of CP was found to be 19.3% (n = 836). There was a higher prevalence in females (25.2%). Pain prevalence increased steeply beyond the age of 65 years old. There was a significant impact of CP on work and daily function. CONCLUSION: This Indian adults' population survey about CP found a higher prevalence of CP as compared to other Asian pain prevalence studies; however, the impact of pain was just as significant. In a rapidly aging population, CP is emerging as a significant healthcare problem which may likely to exert an increasing toll on the existing social infrastructure within the next two decades.

Acute pain services in India: A glimpse of the current scenario.

BACKGROUND AND AIMS: Acute postoperative pain is still a neglected and unresolved issue in day to day practice. Acute pain services were conceived three decades ago to form a dedicated team to monitor pain assessment and treatment as per laid down pain protocols and guidelines. The concept of acute pain service (APS) is slowly evolving in India. MATERIAL AND METHODS: This nationwide questionnaire survey was conducted to identify the status of postoperative pain, the prevalent treatment practices, and the prevalence of acute pain services in India. An electronic communication was sent to 4000 Indian Society of Anesthesiologists life members. RESULTS: We received only 146 responses mainly from faculties/consultants from few corporate hospitals or medical colleges. About 68 APSs were functioning, however, 20 APS do not have any training programs and 34 have no written protocols. Anesthesiologists were involved in postoperative pain management only when epidural analgesia was employed. CONCLUSION: This survey found that majority of anesthesiologists agree to establish an APS, however administrative issues seem to be a major barrier.

Audit of complications in post-operative epidural analgesia and adherence to acute pain service protocols at an Indian cancer center.

An audit of epidural anesthesia in an Indian teaching hospital is described. The authors reviewed Acute Pain Service (APS) documentation of epidural anesthesia and outcomes form the procedure over a 6-month period. Variances from established protocols were noted and reasons for these variances are discussed.

Patient controlled analgesia: redefining its role in an Indian cancer hospital.

This report describes a noninterventional audit of current patient-controlled analgesia (PCA) use in an Indian cancer hospital over a 1-year period. Because there appeared to be an underutilization of PCA in the authors' hospital, they performed this audit. A major reason to start PCA was inadequate analgesia despite ongoing epidural or standard PRN analgesic regimes, especially in thoracic, major abdominal, and pelvic bone surgeries. PCA was used for an average 52.13 hours. The reason to stop the PCA in 72 patients was minimal usage due to decreased need after the second postoperative day. Multiple triggers at the same time were a common problem encountered in 21 patients. A blocked intravenous (IV) line was encountered in 12 patients. Thirty-one patients ranked their pain relief with PCA as excellent and 39 patients stated it as good. Their protocols shall be suitably amended to ensure that PCA shall be used in immediate postoperative period as a principal modality of pain relief, especially in the above-mentioned group in absence of epidural analgesia.