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Opioid-responsive and opioid-non-responsive pain in cancer.

Cancer pain in general responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment, successfully controlling pain in 70-90% of patients. The two major problem areas are pain associated with nerve damage, and 'incident' (movement-related) bone pain. Nerve damage pain tends not to respond well to morphine or other opioids. The difficulty with severe incident pain is that if the dose of opioid is titrated sufficiently to relieve the pain on weight-bearing or on movement and is then given regularly at this level, it is too much for the patient at rest. The patien…

Clearance of continuous intravenous morphine for severe cancer pain.

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady ser

Surgical techniques for patients with cancer-related neuropathic pain.

In this manuscript, we discuss the use of neuromodulatory techniques such as intrathecal therapy (IT) and spinal cord stimulation (SCS) for cancer pain in neuro-oncology patients. Currently, cancer pain management relies on oral opioids, which have a number of systemic side effects particularly in a chronic setting. An escalation of pain therapy for pain relief, such as neuromodulation, is necessary to improve neuro-oncology patients' quality of life. The paper highlights the need for more comprehensive pain management for patients during and after receiving cancer therapies. IT allows analges…

Postoperative Pain After Breast Cancer Surgery: Prevalence and Predictors.

We investigated the prevalence and predictors of postoperative pain severity following breast cancer surgery in Jordan. We enrolled 230 women undergoing mastectomy or partial mastectomy for breast cancer at a cancer center in Jordan. The participants provided demographic and clinical data, and we assessed their postoperative pain within 24 hours following surgery. A total of 212 patients completed the survey. Their ages ranged from 24‒84 years (M = 55.83, SD = 13.55). Among them, 73 (34%) underwent total mastectomy, and 139 (65.6%) had breast-conserving partial mastectomy. Within 24 hours afte

Dexmedetomidine for cancer pain: mechanisms and opioid-sparing effects.

BACKGROUND AND OBJECTIVE: Cancer pain treatment faces challenges such as ineffective pain management, high-dose opioid use, and insufficient analgesia. Dexmedetomidine (DEX), a novel α2 receptor agonist, is a potential adjuvant analgesic. Its analgesic mechanism involves central coeruleus cell hyperpolarization, activation of peripheral, spinal cord, and spinal α2 receptors, and regulation of cellular signaling pathways and inflammatory factors. DEX reduces harmful neurotransmitter production and pain signal transmission and enhances opioid analgesia while decreasing opioid use and tolerance. …

Mandibular Metastasis From Colon Cancer Presenting as Jaw Pain.

Colorectal cancer (CRC) may rarely present with atypical symptoms, particularly in the context of metastatic disease. While the most common sites of metastasis include the liver, lungs, peritoneum, and lymph nodes, osseous metastases are uncommon, and mandibular involvement is exceedingly rare. We report a case of a 57-year-old male who presented with several weeks of isolated jaw pain. Imaging revealed a destructive mass in the right mandible, and histopathology confirmed metastatic adenocarcinoma of colorectal origin. Abdominal imaging and colonoscopy identified a fungating, partially obstru

Opioid Use and Gut Dysbiosis in Cancer Pain Patients.

Opioids are commonly used for the management of severe chronic cancer pain. Their well-known pharmacological effects on the gastrointestinal system, particularly opioid-induced constipation (OIC), are the most common limiting factors in the optimization of analgesia, and have led to the wide use of laxatives and/or peripherally acting mu-opioid receptor antagonists (PAMORAs). A growing interest has been recently recorded in the possible effects of opioid treatment on the gut microbiota. Preclinical and clinical data, as presented in this review, showed that alterations of the gut microbiota pl…

Methadone in Cancer-Related Neuropathic Pain: A Narrative Review.

Background and Objective: Cancer-related neuropathic pain (CRNP) is often a significant burden on patients' quality of life. There are limit … fied from PubMed, Google Scholar, and Cochrane Library using the following keywords: "methadone AND cancer pain AND neuropathic pain" and "cancer-related opioid treatment". Results: Studies were included if they evaluated methadone's efficacy or safety in neuropathic pain management for patients with cancer. This review focused on randomized controlled trials …

Radiofrequency ablation for cancer pain with inadequate opioid response.

Data on the use of radiofrequency (RT) to ablate a tumor mass-causing pain have not been reported. A male in his 50s, diagnosed with a pelvic relapse of rectal cancer, was admitted for pain from the left groin to the perineum. The principal findings of contrast-enhanced computed tomography (CT) revealed the presence in the pelvic area of large solid tissue infiltrating the internal obturator muscle and eroding the vertebral column of the acetabulum. Also involving the gluteal muscles.He was poorly responsive to multiple opioids. He was treated with RT under CT guidance to ablate the pelvic mas

Increasing Provider Self-Efficacy to Manage Chronic Cancer Pain.

BACKGROUND: Aims: Pain is a significant problem for those with a cancer diagnosis. Oncology providers often use opioid therapy to manage cancer-related pain. Accessing opioid therapy has grown increasingly difficult because of the opioid epidemic. The American Society of Clinical Oncology (ASCO) released guidelines to optimize pain management for patients with oncologic diagnoses. The goal of this quality improvement project was to create an educational session and evaluate self-efficacy in providers who manage chronic cancer pain. DESIGN: The Plan-Do-Study-Act was used as the framework for t…

Nurse-Administered Auricular Point Acupressure for Cancer-Related Pain.

PurposeThe study aimed to (1) examine the feasibility of providing a training course on auricular point acupressure (APA) for clinical oncology nurses to integrate APA into real-world nursing care settings, and (2) examine the effectiveness of APA on cancer-related pain (CRP) under usual inpatient oncology ward conditions.MethodsThis was a 2-phase feasibility study. Phase 1, an in-person, 8 hour training program was provided to oncology nurses. Phase 2, a prospective and feasibility study was conducted to evaluate the integration of APA into nursing care activities to manage CRP. Oncology pati

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… Depression and survival outcomes after emergency department cancer pain visits . BMJ Support Palliat Care . 2019 ; 9 :e36. doi: 10.1136/bmjspcare-2018-001533 30171043 39 Kwekkeboom K Zhang Y Campbell T , et al . … Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: rationale, design, and methods of a prospective multisite randomized controlled trial . …

Opioid analgesics for nociceptive cancer pain: A comprehensive review.

Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite stable and adequately controlled background pain). They found a paucity of placebo-controlled trials for background cance…

Metastatic testicular cancer presenting with hematuria and flank pain.

Testicular cancer (TC) represents 1% of male neoplasms and 5% of urological tumors. Most of seminoma patients and about 55% of patients with nonseminoma TC have stage I disease at diagnosis. TC usually presents with a palpable testicular mass incidentally found by the patient himself or its partner by palpation. It shows excellent cure rates based on their chemosensitivity, especially to cisplatin-based chemotherapy, but careful staging at diagnosis, adequate early treatment based on a multidisciplinary approach and strict follow-up are necessary. We present a case of a 25-year-old male patien

TRP Channels as Molecular Targets to Relieve Cancer Pain.

Transient receptor potential (TRP) channels are critical receptors in the transduction of nociceptive stimuli. The microenvironment of diverse types of cancer releases substances, including growth factors, neurotransmitters, and inflammatory mediators, which modulate the activity of TRPs through the regulation of intracellular signaling pathways. The modulation of TRP channels is associated with the peripheral sensitization observed in patients with cancer, which results in mild noxious sensory stimuli being perceived as hyperalgesia and allodynia. Secondary metabolites derived from plant extr

Personalized Pain Goals and Responses in Advanced Cancer Patients.

OBJECTIVE: To assess the personalized pain intensity goal (PPIG), the achievement of a personalized pain goal response (PPGR), and patients' global impression (PGI) in advanced cancer patients after a comprehensive pain and symptom management. DESIGN: Prospective, longitudinal. SETTING: Acute pain relief and palliative/supportive care. SUBJECTS: 689 advanced cancer patients. METHODS: Measurement of Edmonton Symptom Assessment Score (ESAS) and personalized pain intensity goal (PPIG) at admission (T0). After a week (T7) personalized pain goal response (PPGR) and patients' global impression (

Involvement of Microglial P2Y12 Signaling in Tongue Cancer Pain.

To elucidate if microglial P2Y12 receptor (P2Y12R) mechanisms are involved in the trigeminal spinal subnucleus caudalis (Vc; also known as the medullary dorsal horn) in intraoral cancer pain, we developed a rat model of tongue cancer pain. Squamous cell carcinoma (SCC) cells were inoculated into the tongue of rats; sham control rats received the vehicle instead. Nociceptive behavior was measured as the head-withdrawal reflex threshold (HWRT) to mechanical or heat stimulation applied to the tongue under light anesthesia. On day 14 after the SCC inoculation, activated microglia and P2Y12R expres…

P2X7 receptor-mediated analgesia in cancer-induced bone pain.

Pain is a common and debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of molecular events, including mechanisms observed in inflammatory and neuropathic pain states, but also changes unique for cancer-induced bone pain. The P2X7 receptor (P2X7R) is involved in a variety of cellular functions and has been linked to both inflammatory and neuropathic pain. Here we study the analgesic potential of P2X7R antagonism in a rat model of cancer-induced bone pain. In cancer-bearing animals, the P2X7R anta