Incorporating Music Therapy With Acupuncture in Managing Cancer Pain at an Acupuncture Practice.

BACKGROUND: Complementary and alternative medicine encompasses various nonpharmacologic interventions for managing pain, such as acupuncture and music therapy. Few studies have combined these two interventions in the management of cancer-related pain. OBJECTIVES: The purpose of this evidence-based project was to compare acupuncture-only therapy versus dual therapy (acupuncture and music therapy) on pain intensity scores in patients with cancer. METHODS: This evidence-based project included 102 participants at a private acupuncture practice. One group had acupuncture only for six weeks, and another had six weeks of acupuncture and music therapy. The Numeric Pain Rating Scale was used to assess pain before and after the interventions. FINDINGS: Findings showed that both groups had clinically and statistically significant improvements in pain intensity scores. Although a significant difference was not noted between the two groups, acupuncture and music therapy were each found to be effective for managing cancer-related pain.

Lucid Dreams Associated with Pregabalin: Implications for Clinical Practice.

Here, we describe a case of a patient with multiple myeloma who reported symptoms of lucid dreams. This patient was taking methadone for neoplasm related pain. The patient was also taking pregabalin which was initially started at dosing of 50 mg taken orally three times a day. Five days after initiation of pregabalin, the dosing was increased to 100 mg taken orally three times daily. The patient developed lucid dreams during a hospital stay and methadone was initially thought to be the cause of her lucid dreams. Methadone dosing was decreased with no success, and her lucid dreams persisted. On the patient's thirteenth day of hospital admission, the pregabalin dose was decreased from 100 mg three times a day to 75 mg twice daily. Five days later, the pregabalin was decreased from 75 mg twice daily to 50 mg twice daily. Pregabalin was continued for five more days and then discontinued. Resolution of the lucid dreams occurred following discontinuation of pregabalin. To our knowledge, this is the first reported case of an association between pregabalin and lucid dreams. Given that pregabalin is a widely used medication, we found this case to be relevant to describe this unique presentation.

Neurologic Complications: Effects of Ipilimumab and Nivolumab Therapy in Patients With Metastatic Melanoma.

Checkpoint inhibitors are a form of immunotherapy that have revolutionized treatment for malignant melanoma, resulting in longer survival and better disease control. Multiple autoimmune disorders can occur with the use of checkpoint inhibitors, including severe, potentially fatal neurologic complications. Although neurologic complications are uncommon, their early recognition and treatment is required. The purpose of this article is to present information on neurologic complications of ipilimumab and nivolumab to inform nursing practice. Recommendations for evaluation and treatment of neurologic complications are reviewed.

Opioid-Induced Hyperalgesia: Clinical Implications for Advanced Practice Nurses in Oncology.

Opioid-induced hyperalgesia (OIH) is a key factor in the clinical management of patients experiencing pain. However, limited knowledge exists regarding the specific mechanisms involved in OIH and its treatment. A thorough assessment is usually required, and clinical diagnosis is mainly determined by exclusion in medical practice. Patients who are taking opioids should receive ongoing, comprehensive assessment by a clinician. Early identification of OIH will lead to improved patient outcomes.
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5-Fluorouracil toxicity and dihydropyrimidine dehydrogenase enzyme: implications for practice.

5-fluorouracil (5-FU) is a fluorinated pyrimidine analog, which is commonly used in combination chemotherapy for treating solid tumors. Dihydropyrimidine dehydrogenase plays an important role in catabolism and clearance of 5-FU. Any alteration in that sequence of enzymatic activity can lead to toxicity and even death in some patients. The most common loss of a functional allele of the dihydropyrimidine gene is the splice-site mutation c.1905+1G>A, which leads to deficiency of the enzyme. However, because of the small percentage of the population in which the deficiency occurs, routine screening is not recommended, and commercial testing is costly. Treatment measures for 5-FU toxicity are mainly supportive, including palliation of symptoms. Good patient assessment and education are imperative to early treatment of 5-FU-induced toxicity. Advanced oncology practitioners and oncology nurses should thoroughly educate patients and their caregivers on both the common and adverse side effects of 5-FU-based therapy and when it may be necessary to immediately contact their healthcare provider.

Improving pain management at the nursing education level: evaluating knowledge and attitudes.

Unmanaged pain is a prevalent problem faced by many cancer patients. One part of this problem centers on a lack of emphasis on pain management in the undergraduate nursing curriculum. This study examined the knowledge and attitudes of 41 undergraduate nursing students regarding pain management. Students voluntarily completed a demographic data form, the Nurses' Attitude Survey, and the Pain Management Principles Assessment Tool. A mean score of 19.4 out of a possible 31 was achieved on the knowledge test, whereas a mean score of 17.0 was achieved on the Nurses' Attitude Survey. A weak-to-moderate relationship between knowledge and attitudes was found. Although students had positive attitudes regarding pain management, many still lacked the fundamental knowledge essential for adequately managing pain. The sample size was relatively small and not demographically diverse, but the response from the sample was sufficient to provide statistically meaningful data. In the quest to improve patient outcomes, these findings suggest the need to develop specific strategies to effectively teach undergraduate nursing students about pain management.