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Smart Dosing, Better Outcomes: An Electronic Medical Record Intervention for Cancer Pain in the Emergency Department.

OBJECTIVES: We hypothesized that an electronic medical record (EMR)-based best practice advisory (BPA), offering individualized opioid dosing for cancer patients with high opioid tolerance, would improve pain control and reduce hospital admissions in the emergency department (ED). METHODS: We conducted a retrospective cohort study from May 2020 to May 2024 across 2 academic EDs affiliated with a National Comprehensive Cancer Network cancer center. Adult patients with active cancer, a morphine equivalent daily dose (MEDD) ≥100, and an ED opioid order were eligible. The BPA calculated MEDD-base

The contribution of stem cell factor and its receptor c-Kit to cancer-induced bone pain.

Cancer-induced bone pain (CIBP) is among the most common and debilitating symptoms in patients with bone metastasis. Current treatments are somewhat effective but have severe side effects. For the future development of safer CIBP treatments, in this study, we sought to investigate the mechanisms whereby the nerve-cancer interaction controls CIBP. We found that c-Kit, a receptor tyrosine kinase, was activated in the dorsal root ganglia (DRG) sensory neurons of mice with CIBP and that c-Kit's sole ligand, stem cell factor (SCF), was enhanced in the bone marrow with bone metastasis. When DRGs wer

C/EBPβ Contributes to Cancer-Induced Bone Pain by Inhibiting CD200/CD200R1 in the Spinal Cord.

BACKGROUND: Advanced cancer patients still suffer from devastating bone pain, with less efficacious treatments. The spinal microglia activation and neuroinflammation are the pivotal pathological processes of cancer-induced bone pain (CIBP). This study aims to explore whether c/EBPβ negatively regulates CD200R1 to induce microglia-medicated neuroinflammation in the spinal cord of CIBP mice. METHODS: The CIBP mice model was constructed by intrafemoral injection of Lewis lung cancer cells to investigate the role of CD200/CD200R1 signaling and their upstream molecule CCAAT/enhancer binding protei

Correlates of mental defeat in individuals with chronic non-cancer pain on long-term opioid therapy.

BACKGROUND: Individuals with chronic non-cancer pain (CNCP) often present with significant challenges that can impact physical, psychological, and social well-being. Mental defeat is a critical consequence of CNCP being a known predictor of suicidality. This study examines the relationships between specific psychological and coping factors and mental defeat among individuals with CNCP on long-term opioid therapy (LTOT). DESIGN: A cross-sectional study of secondary data. SETTING: Primary care, pain, and substance abuse clinics in Pennsylvania, Washington, and Utah. SUBJECTS: 744 adults with …

UK Medical Cannabis Registry: An Analysis of Clinical Outcomes of Medicinal Cannabis Therapy for Cancer Pain.

Cancer pain (CP) is a prevalent condition with limited pharmacotherapeutic options. Cannabis-based medicinal products (CBMPs) have shown analgesic effects, but their efficacy in CP remains contentious. This study aims to evaluate the change in patient-reported outcome measures (PROMs) and adverse events (AEs) in CP patients treated with CBMPs. A case series was conducted using prospectively collected clinical data from the UK Medical Cannabis Registry. Primary outcomes were the changes in the Brief Pain Inventory (BPI), pain visual analogue scale (Pain-VAS), EQ-5D-5L, Generalized Anxiety Disor…

Triple-target radiosurgery for intractable cancer pain of mixed origin: Two-centre experience in Central America.

Cancer pain is one of the most severe components of the symptom burden among cancer patients, especially those with advanced or metastatic disease. Palliative interventions are necessary to alleviate cancer pain and reduce opioid-related side effects, thereby minimizing patient suffering. Radiosurgery has been effectively used to target the medial thalamus and the hypophysis for the treatment of chronic pain syndromes. These two areas are critical for pain modulation and control, and their precise targeting with radiosurgery and its non-invasive nature can provide relief for patients suffering…

Decreasing Pain Intensity in Adult Patients With Cancer Through Music Therapy: A Complementary Non-Pharmacological Approach.

BackgroundAdequate pain management continues to be an unmet need in patients with cancer. Pain is known to impact the quality of life. It is recommended that treatment plans include pharmacological and complementary non-pharmacological methods for managing pain. Music listening therapy is an evidence-based intervention used to manage acute and chronic pain in adult patients with cancer.MethodsThis evidence-based practice project applied the use of music therapy in adult patients with cancer experiencing moderate to severe pain despite current pharmacological treatment in a rural outpatient onc

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… Led by a board-certified APRN, project staff educated patients on how music listening therapy as a complementary non-pharmacological intervention works to improve cancer pain management ( Yangöz & Özer, 2019 ). … Adult cancer pain, version 3.2019 . Journal of the National Comprehensive Cancer Network , 17 ( 8 ), 977 – 1007 . 10.6004/jnccn.2019.0038 31390582 Tang , H. K. , Chen , L. P. , Wang , Y. C. , Zhang , Y. C. , & Yang , N. ( 2021 ). …

What is cancer pain? Investigating attitudes of patients, carers, and health professionals: A cross-sectional survey.

BACKGROUND: Cancer pain is a prevalent and debilitating symptom that impacts quality of life. Pain management remains challenging; however, due to various barriers, including stigma associated with opioid use, ambiguous roles of clinicians, and diverse attitudes toward pain management among healthcare professionals, patients, and carers. OBJECTIVE: To explore the attitudes surrounding cancer pain among patients, carers, and health professionals at a tertiary cancer hospital. METHODS: A cross-sectional online survey was conducted at the Peter MacCallum Cancer Centre. The survey included demog…

Opioid prescribing trends and pain scores among adult patients with cancer in a large health system.

BACKGROUND: Opioid stewardship policies could adversely affect pain management for patients with cancer. Yet patients with cancer are also at risk for opioid-related harms. This study sought to determine trends in opioid prescribing by clinical stratum and pain for patients with cancer from 2016 to 2020. METHODS: A retrospective study was conducted of opioid-naive adults with newly diagnosed cancer from 2016 to 2020 (N = 10,232) in a large Connecticut health system. Logistic regression was used to calculate changes in the predicted probability of opioid prescribing from 2016 to 2020. Two subp

Methadone Serum Concentration Monitoring in Palliative Care Patients with Cancer-Induced Bone Pain: A Short Communication.

BACKGROUND: Therapeutic drug monitoring of methadone for opioid replacement therapy in the management of opioid dependence is well-described. However, only a few studies have described the correlation between serum methadone concentration and cancer pain during palliative care. METHODS: Patients were recruited from an exploratory randomized controlled trial (RCT) comparing methadone rotation with other opioid rotations for refractory cancer-induced bone pain. Serum methadone trough levels and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) levels on day 14 of the rotation were analyz…

Olfactory ensheathing cell transplantation alleviates cancer pain by inhibiting P2X7 receptor expression-mediated activation of microglia.

Peripheral nerve invasion can occur during cancer progress, which seriously affects the patient's quality of life and brings pain. There is currently no effective treatment method. Therefore, in this study, we established a model of breast cancer bone metastasis and transplanted olfactory sheath cells (OECs) into rats to explore a new cell therapy strategy for treating cancer pain. The results showed that compared with the cancer pain group and the vehicle group (DMEM/F12 medium solution), OEC transplantation improved tibial bone destruction and osteolytic lesions, increased the mechanical wit…

Methadone for intractable cancer pain associated with pelvic floor lesions: a retrospective analysis of 36 cases.

PURPOSE: The aim of this study was to examine the efficacy and safety of methadone for refractory cancer pain caused by pelvic floor lesions. METHODS: Between April 2016 and September 2023, we retrospectively investigated all cases in which methadone was administered by our Palliative Care Team for refractory cancer pain due to pelvic floor lesions, based on the electronic medical records. RESULTS: The extracted cases totaled 36 (21 females), and the age was 55.1 ± 15.1 years. The primary sites of malignancy were rectum, colon, and uterine cervix, each of which accounted for nine cases, and …

Managing Cancer Pain in Hospitalized Patients with Comorbid Opioid Use Disorder with Buprenorphine: A Case Series.

Data indicate that one in five patients with cancer might be at risk for nonmedical opioid use and its extreme form, opioid use disorder (OUD). Buprenorphine is one of the few medications available for the management of patients with co-occurring OUD and chronic pain. Care for these patients can be challenging and require the expertise of specialist clinicians with a deep understanding of addiction and cancer pain. Regrettably, these specialist clinicians may not always be available and accessible when patients are admitted to the hospital. Reports on how primary non-specialist clinicians with…

Medical cannabis for refractory cancer-related pain in a specialised clinical service: a cross-sectional study.

BACKGROUND AND OBJECTIVES: Cancer-related pain management in advanced stages presents a significant challenge that often requires a multidis … e to lack of effectiveness or side effects (39.7% and 34.6%, respectively). CONCLUSION: Refractory cancer pain necessitates innovative approaches. This registry highlights that MC can effectively improve symptoms in non-responsive patients, with favourable safety profiles for this vulnerable population.

Celiac plexus radiosurgery for pain management in advanced cancer: a multicentre, single-arm, phase 2 trial.

BACKGROUND: Refractory upper abdominal pain or lower back pain (retroperitoneal pain syndrome) related to celiac plexus involvement characterises pancreatic and other upper gastrointestinal malignancies and is an unmet need. We hypothesised that ablative radiation delivered to the celiac plexus would decrease pain. METHODS: This multicentre, single-arm, phase 2 study was done at eight hospitals in five countries (Israel, Poland, Canada, the USA, and Portugal). Eligible patients aged 18 years or older with an average pain level of 5-10 on the Brief Pain Inventory short form (BPI-SF), an Easter

Cost-Effectiveness Analysis Evaluating Delivery Strategies for Pain Coping Skills Training in Women With Breast Cancer.

Pain coping skills training (PCST) is efficacious in patients with cancer, but clinical access is limited. To inform implementation, as a secondary outcome, we estimated the cost-effectiveness of 8 dosing strategies of PCST evaluated in a sequential multiple assignment randomized trial among women with breast cancer and pain (N = 327). Women were randomized to initial doses and re-randomized to subsequent doses based on their initial response (ie, ≥30% pain reduction). A decision-analytic model was designed to incorporate costs and benefits associated with 8 different PCST dosing strategies. I

Intrathecal Drug Delivery Systems for Cancer Pain Control: Insights on Current Contemporary Practices in the US.

OBJECTIVES: Among patients with cancer with moderate to severe, intractable pain, intrathecal drug delivery using an intrathecal drug delivery system (IDDS) offers effective pain control. In this study, we evaluate the trends of IDDS therapy among patients with cancer, associated comorbidities, complications, and outcomes, using a large representative US administrative inpatient data base. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) data base contains data from 48 states and the District of Columbia. The NIS was used to identify patients with cancer who underwent IDDS implant

Palliative Radiofrequency Ablation Therapy for Intractable Cancer-Related Pain Due to Malignant Psoas Syndrome: Case Report.

Uncontrollable cancer pain is a highly feared and debilitating symptom. The effectiveness of radiofrequency ablation (RFA) for osseous metastases with intractable cancer-related pain refractory to pharmacological therapy has been reported previously. This case report is the first to demonstrate the use of RFA to achieve pain relief in a patient suffering severe pain caused by para-aortic lymph node metastasis. A 55-year-old male complained of intractable pain in the left groin and perineum due to malignant psoas syndrome caused by metastatic para-aortic lymph nodes. The pain was refractory to …

Schwann cell insulin-like growth factor receptor type-1 mediates metastatic bone cancer pain in mice.

Insulin growth factor-1 (IGF-1), an osteoclast-dependent osteolysis biomarker, contributes to metastatic bone cancer pain (MBCP), but the underlying mechanism is poorly understood. In mice, the femur metastasis caused by intramammary inoculation of breast cancer cells resulted in IGF-1 increase in femur and sciatic nerve, and IGF-1-dependent stimulus/non-stimulus-evoked pain-like behaviors. Adeno-associated virus-based shRNA selective silencing of IGF-1 receptor (IGF-1R) in Schwann cells, but not in dorsal root ganglion (DRG) neurons, attenuated pain-like behaviors. Intraplantar IGF-1 evoked a…

Increased quality of life in patients with breakthrough cancer pain after individualized therapy: the CAVIDIOM study.

Aim: To evaluate the quality of life (QoL) in patients with breakthrough cancer pain (BTcP) in Spanish medical oncology departments. Patients & methods: In a prospective, observational, multicenter study, we assessed QoL using the EQ-5D-5L instrument at baseline and after 15 and 30 days of individualized BTcP therapy, as well as BTcP characteristics and treatment. Results: Patients (n = 118) were mainly women, over 64 years old and with advanced cancer. QoL improved at 15 (p = 0.013) and 30 days (p = 0.011) versus baseline. Individualized BTcP therapy consisted mostly of rapid-onset opioids (t…