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Contralateral approach for ipsilateral target: Stimulation-guided percutaneous cordotomy for refractory cancer pain - A case report.

Percutaneous cervical cordotomy is an advanced neuroablative technique used in the management of medically refractory cancer pain, particularly in patients with unilateral body or limb pain. The procedure is based on targeting the spinothalamic tract (STT) on the side contralateral to the patient's pain, guided by clinical findings and topographic anatomy. However, standardized and reliable guidance on how to interpret ipsilateral sensory responses that may occur during intraoperative stimulation remains limited in the current literature. In this case report, we discuss an ipsilateral (pain-si…

Transcriptomic Association of COL3A1+ Fibroblasts With Mechanical Pain-Related Gene Signatures in Triple-Negative Breast Cancer.

BACKGROUND: Epidemiological data show that approximately 80% of cancer patients experience pain of varying degrees throughout the course of their disease, with nearly one-third experiencing severe pain, significantly impacting their quality of life and the effectiveness of antitumor treatment. Triple-negative (TN) breast cancer tissues typically exhibit increased stromal stiffness and abnormally elevated mechanical stress; these biomechanical alterations may amplify pain signals by activating mechanosensitive channels. Utilizing single-cell RNA sequencing analysis, this study aims to elucidate

Implementing measurement-based care in the analgesic management of cancer pain patients receiving intrathecal drug infusion.

To evaluate the efficacy and safety of a structured measurement-based care (MBC) strategy with a "Monitor-Assess-Adjust" closed-loop protocol for managing moderate-to-severe cancer pain in patients receiving intrathecal morphine patient-controlled analgesia (IT-PCA). A retrospective observational study was conducted at two pain centers, enrolling 15 patients with cancer pain (Visual Analog Scale [VAS] ≥ 7). All patients initially received intravenous patient-controlled analgesia (IV-PCA) for dose titration, followed by IT-PCA implantation. A structured MBC protocol was implemented, including t…

Complications leading to device explant in patients with chronic non-cancer pain receiving intrathecal drug delivery.

INTRODUCTION: Intrathecal drug delivery (IDD) is often used in the management of refractory chronic non-cancer pain, particularly persistent chronic low back pain in the setting of previous lumbar spine surgery (persistent spinal pain syndrome type 2 (PSPS2)). Complications of IDD leading to device explant in patients with chronic non-cancer pain have not been well characterized. This study evaluated complications leading to device explants in a large cohort of patients with chronic non-cancer pain treated with IDD. METHODS: A retrospective study was undertaken on patients with chronic non-ca…

Efficacy of Switching from Prior Nonsteroidal Anti-inflammatory Drugs to Transdermal Diclofenac in Cancer Pain Management.

BACKGROUND/AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for mild cancer pain and can be combined with opioids for moderate-to-severe pain. The efficacy of switching from prior NSAIDs to transdermal diclofenac in patients with cancer has not been fully evaluated, however. PATIENTS AND METHODS: We conducted a retrospective observational study at the Cancer Institute Hospital, Ariake, Japan, from May 21, 2021, to May 20, 2023. Hospitalized of patients with cancer who were switched from prior NSAIDs to transdermal diclofenac were included. Patients were excluded if they neve…

EGFR activation sensitizes trigeminal NMDA receptors to promote pain and morphine analgesic tolerance in oral cancer.

Pain associated with oral cancer is debilitating. Opioids are the gold standard for cancer pain management, but tolerance and side effects limit their use. Epidermal growth factor receptor (EGFR) signaling is commonly amplified in oral tumors. Here, we found that EGFR activation contributed to both oral cancer pain and opioid tolerance by sensitizing trigeminal ganglion (TG) cells, the main sensory neurons innervating the face and mouth. EGFR ligands were secreted by oral squamous cell carcinoma (OSCC) cells and by peripheral glial cells cocultured with OSCC cells. In human OSCC and an orthoto…

Development and preliminary validation of a clinician-administered Chinese-language tool for breakthrough cancer pain assessment.

OBJECTIVE: To develop a brief, clinician-administered Chinese-language Breakthrough Cancer Pain Assessment (BCPA) instrument and evaluate its content validity, inter-rater reliability, and ability to detect change in selected rescue medication-related items. METHODS: The 11-item BCPA was developed from literature review, clinical input, and three Delphi rounds with 14 experts. Inter-rater reliability was evaluated through independent physician and nurse interviews with 30 participants with cancer and breakthrough cancer pain (BTcP). In an exploratory observational phase, selected BCPA respons…

Oxycodone combined with pulsed radiofrequency for refractory cancer pain from spinal metastases: a randomized controlled study.

OBJECTIVES: To assess the clinical efficacy and safety of oxycodone combined with pulsed radiofrequency (PRF) in the treatment of refractory cancer pain (RCP) arising from spinal metastasis. METHODS: A randomized controlled trial enrolled 60 patients with RCP due to spinal metastases. Participants were randomly allocated to the oxycodone alone group (Group A, n = 30) or the oxycodone combined with PRF group (Group B, n = 30). Primary outcomes comprised pain scores on the Numerical Rating Scale (NRS) and episodes of breakthrough pain at post-treatment time points Secondary endpoints included o…

Chronic Post-Treatment Pain in Head and Neck Cancer Survivors: A Descriptive Analysis of Phenotypic Overlap.

BACKGROUND: Chronic post-treatment pain (CPTP) affects up to 42% of head and neck cancer (HNC) survivors, significantly reducing quality of life. Its diverse clinical presentations remain poorly characterized. This study aimed to delineate the distinct painful phenotypes in CPTP following curative HNC treatment. METHODS: A prospective cross-sectional study enrolled 100 adult HNC survivors presenting to the Orofacial Pain Clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan. Patients with oropharyngeal mucositis, hardware failure, infection, or refractory disease wer

Assessment and Treatment Outcomes of Pain in Cancer Patients Undergoing Chemotherapy - A Tertiary Care Centre Experience.

ObjectivesPain is a prevalent and debilitating symptom in cancer patients, significantly affecting their quality of life. This study aimed to evaluate pain severity, its management and associated factors in patients undergoing chemotherapy in a tertiary care centre.Materials and methodsA single-centre observational study was conducted at the Department of Medical Oncology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from January 2024 to June 2024. One hundred and four chemotherapy patients were assessed using the numerical rating scale to evaluate pain severity. D

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… Liang Q Zhang K Wang S Xu X Liu Y Cui S et al Acupuncture for Cancer Pain-An Adjuvant Therapy for Cancer Pain Relief Am J Chin Med 2020 48 1769 86 10.1142/S0192415X20500883 33300479 14. … Løhre ET Thronaes M Klepstad P Breakthrough Cancer Pain in 2020 Curr Opin Support Palliat Care 2020 14 94 9 10.1097/SPC.0000000000000494 32332210 21. …

Patient-reported pain severity is associated with shorter survival in older adults with newly diagnosed cancer.

PURPOSE: Pain is a prevalent and often undertreated symptom among older adults with cancer. This study examined whether self-reported pain levels are associated with overall survival (OS) in older adults newly diagnosed with cancer receiving chemotherapy. METHODS: This retrospective cohort study included patients aged ≥ 65 years with newly diagnosed lung, colorectal, or breast cancer between 2017 and 2020, identified via a cancer registry at an academic medical center. Self-reported pain using the numeric rating scale (0-10), documented within 30 days of chemotherapy initiation, was categoriz

Alterations in dynamic regional homogeneity and functional connectivity in lung cancer patients with bone metastasis pain.

BACKGROUND: Although previous neuroimaging studies have characterized static brain activity in bone metastasis pain (BMP), its dynamic functional properties remain largely unexplored. This study aimed to investigate the dynamic brain activity in BMP patients. METHODS: We analyzed dynamic regional homogeneity (dReHo) and dynamic functional connectivity (dFC) in 50 right-handed lung cancer patients with BMP(+), 36 without BMP(-), and 32 healthy controls (HCs). Spearman's correlation was used to evaluate associations with clinical variables. RESULTS: Compared to BMP(-) patients, BMP(+) patients

HLA-Region Genetic Association Analysis of Breast Cancer Patients With and Without Persistent Postsurgical Neuropathic Pain.

BACKGROUND: Surgical nerve injuries lead to persistent neuropathic pain (NP) in up to 30% of patients. Among many other factors, polymorphisms in the human leukocyte antigen (HLA) genes have been suggested to contribute to the development of neuropathic pain. METHODS: We performed a genetic association analysis of HLA class I and class II alleles in women who had been operated on for breast cancer. Patients had a surgeon-confirmed perioperative nerve injury and were examined 4-9 years after their surgery. Patients with painful (cases, n = 27) and painless (controls, n = 30) intercostobrachial

COP1 Overexpression Attenuates Nociceptive Behaviors and Neuroinflammation in Cancer-Induced Bone Pain by Suppressing c/EBPβ.

Patients with advanced cancer often have bone metastases, causing bone destruction and cancer-induced bone pain (CIBP). The CCAAT/enhancer binding protein β (c/EBPβ) mediated the regulation of various pro-inflammatory molecules in microglia. To investigate the specific effect and regulatory mechanism of c/EBPβ in CIBP, a mice model of Lewis lung cancer (LLC) cells implantation was constructed. Our data demonstrated that the c/EBPβ was remarkably elevated in the spinal cord of CIBP mice. Specific knocking down c/EBPβ relieved the mechanical allodynia and thermal hyperalgesia of CIBP mice by sup

Low-dose add-on methadone for cancer pain management: a retrospective analysis of 102 Japanese patients.

BACKGROUND: Methadone was introduced in 2013 for the treatment of intractable cancer pain in Japan and is indicated for patients receiving opioid doses ≧60 mg/day as an oral morphine equivalent. Low-dose (≦10 mg/day) add-on methadone to prior opioids has been reported from European countries to successfully relieve various types of intractable cancer pain; however, there are few reports of such use in Japan. The aim of this study was to analyze more than a hundred cases with low-dose add-on methadone to treat intractable pain in Japanese cancer patients. METHODS: All cases in which 5 or 10 mg…

Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer.

INTRODUCTION: Pain significantly affects the quality of life of lung cancer patients. We aimed to evaluate the effect of the erector spinae plane block (ESPB) on pain in these patients. METHODS: We reviewed the medical records of patients with primary lung and bronchial cancer who experienced refractory pain in the thoracic region and underwent repeated ESPBs (three blocks at 24-hour intervals) between 2019 and 2020 in this single-center retrospective study. Visual analog scale (VAS) scores recorded before the procedure and on the first day (first day after the third block) and the first and

Pain-related impairment in daily activities after lung cancer surgery: A 1-year prospective cohort study.

BACKGROUND: Persistent postsurgical pain (PPSP) following thoracic surgery affects 40%-60% of patients undergoing lung resection due to malignancies. Postoperative pain-related symptoms are common, leading to limitations in activities of daily living (ADL) and deterioration in physical function, which significantly impacts quality of life. Pain-related limitations are of interest, as postsurgical pain may present as a target for intervention to improve postoperative rehabilitation. This study aimed to evaluate the association between PPSP and ADL limitations during the first 12 postoperative m

[Mental disorders and symptoms with persistent opioid use for chronic non-cancer pain – a registry study].

BACKGROUND: Knowledge of mental disorders among patients with persistent opioid use for the treatment of chronic non-cancer pain is essential, as mental disorders and symptoms can exacerbate or perpetuate pain and impact on the ability of patients to manage their illness. We have studied the prevalence of mental disorders and symptoms, including substance use disorders, in patients with persistent opioid use in 2019. MATERIAL AND METHOD: Persons ≥ 18 years with persistent opioid use and persons ≥ 18 years with at least one registered mental disorder in the specialist healthcare service in 201…

Opioid Nonadherence Risk Prediction of Patients with Cancer-Related Pain Based on Five Machine Learning Algorithms.

OBJECTIVES: Opioid nonadherence represents a significant barrier to cancer pain treatment efficacy. However, there is currently no effective prediction method for opioid adherence in patients with cancer pain. We aimed to develop and validate a machine learning (ML) model and evaluate its feasibility to predict opioid nonadherence in patients with cancer pain. METHODS: This was a secondary analysis from a cross-sectional study that included 1195 patients from March 1, 2018, to October 31, 2019. Five ML algorithms, such as logistic regression (LR), random forest, eXtreme Gradient Boosting, mul…

How Racialized Approaches to Opioid Use Disorder and Opioid Misuse Management Hamper Pharmacoequity for Cancer Pain.

@JCO_ASCO paper focuses on racialized approaches to OUD and opioid misuse as underappreciated drivers of disparities in cancer and recs a path forward.