ABSTRACT
To guide the treatment of malignant neuropathic pain (MNP) in clinical practice, by inoculating MADB-106 breast cancer cells into the right L4 nerve root in Sprague-Dawley rats, a rat model of MNP was established, providing basic conditions for the study of neuropathic pain and development and application of therapeutic drugs. As the tumor grew over time, it pressed the nerve roots, causing nerve damage. The spinal nerve ligation (SNL) model, which is a neuropathic pain model widely used in rats, was compared with the L4 nerve root SNL model, and histologic examination of the nerve tissue of both models was performed by electron microscopy. In addition to the infiltration and erosion of the L4 nerve by tumor cells, the tumor tissue gradually grew and compressed the L4 nerve roots, resulting in hyperalgesia of the rat's posterior foot on the operative side. Some spontaneous pain phenomena were also observed, such as constant lifting or licking of the posterior foot on the operative side under quiet conditions. Electron microscopy images showed that nerve injury was due to progressive compression by the tumor, cells of which were visualized, but the injury was lighter than that in SNL rats. Imaging showed a paravertebral tumor near the L4 nerve root in the carcinomatous neuropathic pain model rat. These results suggest that progressive compression of the nerve by a malignant tumor leads to nerve damage similar to the behavioral changes associated with chronic compression injury resulting from a loose ligature of the nerve. The cancer neuropathologic pain model at the L4 nerve root was successfully established in Sprague-Dawley rats.
Subject(s)
Neoplasms , Neuralgia , Rats , Animals , Rats, Sprague-Dawley , Neuralgia/pathology , Spinal Nerves/pathology , Hyperalgesia/complications , Neoplasms/complications , Ganglia, Spinal/pathology , Ligation/adverse effectsABSTRACT
Objective:To improve the safety, rationality and efficacy of medication for cancer patients accompanied with malignant neuropathic pain by the participation of clinical pharmacists in the therapy. Methods:Clinical pharmacists participated in the therapy for one neurilemmoma cancer patient with malignant neuropathic pain, and provided a rational and individualized therapeutic regimen according to the drug experience of clinical pharmacists as well as the relevant medical guides and literatures. Results: According to the nature and degree of pain, clinical pharmacists adjusted the type and dosage of opioids and non opioid drugs. The pain was well controlled with pain score at 1-2 points. Besides, the adverse effects were alleviated to ensure the sustained drug treatment. Conclu-sion:The participation of clinical pharmacists in therapeutic practice can improve the normalization of pharmacotherapy for neurilem-moma cancer patients with malignant neuropathic pain, which also can provide ideas and methods for treating the similar patients.
ABSTRACT
Objective:To improve the safety, rationality and efficacy of medication for cancer patients accompanied with malignant neuropathic pain by the participation of clinical pharmacists in the therapy. Methods:Clinical pharmacists participated in the therapy for one neurilemmoma cancer patient with malignant neuropathic pain, and provided a rational and individualized therapeutic regimen according to the drug experience of clinical pharmacists as well as the relevant medical guides and literatures. Results: According to the nature and degree of pain, clinical pharmacists adjusted the type and dosage of opioids and non opioid drugs. The pain was well controlled with pain score at 1-2 points. Besides, the adverse effects were alleviated to ensure the sustained drug treatment. Conclu-sion:The participation of clinical pharmacists in therapeutic practice can improve the normalization of pharmacotherapy for neurilem-moma cancer patients with malignant neuropathic pain, which also can provide ideas and methods for treating the similar patients.
ABSTRACT
Objective To observe the effect of Oxycontin combined with Gabapentin for treatment of malignant neuropathic pain.Methods Sixty-three cases of malignant neuropathic pain in Jinshan Hospital Affiliated to Fudan University were randomly divided into group A, B and C.Patients of which were given Oxycontin, Gabapentin, Oxycontin combined with Gabapentin respectively for pain treatment.The analgesic effects, toxic reaction side effects, quality of life, and immune function were all compared in three groups.Results Compared with pretherapy, the cancer pain score (NRS), quality of life (QOL) and karnofsky performance status(KPS) scores in all groups were changed significantly after drugs therapy(F=375.852,154.612, 151.838,P＜0.05).The levels of CD3,CD4, CD4/CD8 and NK cells in all groups were higher than before therapy(F=158.935,108.145,366.973,92.090,P＜0.05).After treatment,the NRS, QOL and KPS scores in group C were 2.00± 0.86,44.80± 6.07, 84.50± 6.05, in group A were 3.35 ± 0.67,37.35 ± 5.71,74.50 ±10.99,and in group B were 4.05±0.94,35.85±5.90,72.00±8.34, and the different were significant (F =3.250,10.499,3.465,P＜0.05).The levels of CD3, CD4, CD4/CD8and NK cells in group C were (72.94 ±5.63)％,(41.52±4.19)％, 1.86±0.30, (27.57±6.86)％,in group A were (62.84±5.27)％, (33.84 ±5.40)％,1.35±0.37, (20.49±6.67) ％,and in group B were (62.22±8.10)％, (33.19±6.90)％, 1.32 ± ±0.41, (20.32±5.63) ％, and the different were significant (F =3.377,3.344,3.352,3.386, P＜ 0.05).The patient in group C had less adverse effects than those in group A and B.Conclusion Oxycontin and Gabapentin in treatment of malignant neuropathic pain is effective.
ABSTRACT
Objective To observe the clinical efficacy of duloxetine in the treatment of malignant neuropathic pain with depression.Methods 60 patients were randomly divided into two groups as study group(30 cases) and contrdl group(30 cases) and treated for 4 weeks.The patients of study group were treated with duloxetine and oxycontin,and the patients of control group were treated with oxycontin only.Numberical rating scale (NRS) on pain,criteria of pain relief and Hamilton depression scale(HAMD,17 items) score were used to assess the therapeutic effect before and after treatment.Results By the end of the fourth week of treatment,the average usage of oxycontin of the study group was significantly less than control group((45.6±8.5) mg vs (88.2±5.2)mg,P＜0.05).The effective rate of pain relief in the study group was significantly higher than that in control group (93.3％ vs 73.3％,P＜0.05).Comparing pre-treatment,the score of HAMD of the study group had a remarkable decrease ((11.45±4.56) vs (23.07±5.47),P＜0.01).In comparison to the score of control group,study group had a significant effect ((11.45±4.56) vs (18.75±4.21),P＜0.01).Conclusion Duloxetine is one of effective agents in the treatment of malignant neuropathic pain with depression,which can alleviate depression and relieve pain.Duloxetine have mild adverse effects and good tolerance.
ABSTRACT
Objective:To observe the effect of transdermal fentanyl combined with gabapentin for the treatment of malignant neu-ropathic pain (MNP). Methods:A total of 60 patients with MNP were randomly divided into two groups. A total of 30 cases in the con-trol group received transdermal fentanyl according to the dosages of opioid medicine that patients used. Such dosages were gradually in-creased until the pain relief visual analogue scale (VAS) fell below 3 or until the times of breakthrough pain became less than 3. For the combined group, gabapentin was co-administered with transdermal fentanyl, similar to the control group. Initially, 100 mg of gabapen-tin was administered thrice a day. This dosage was gradually increased until pain relief. However, gabapentin dosages were kept below 2,400 mg a day. VAS, quality of life (QOL), degree of pain relief, dosages of fentanyl and morphine, and side effects were evaluated be-fore treatment and at one, two, three, and four weeks after the treatment. Results:Both groups exhibited lower VAS after treatment (P<0.05), but the difference was observed to be more significant in the combined group than that in the control group (P<0.05). Both groups exhibited improved QOL (P<0.05), which was observed to be more significant in the combined group than in the control group (P<0.05). The effective rate was 96.7%in the combined group and 83.3%in the control group. The dosage of opioid medicine and the side effects in the combined group were less than those in the control group. Conclusion:Transdermal fentanyl combined with gabapen-tin is effective for the treatment of malignant neuropathic pain.
