Opioid responsiveness of nociceptive versus mixed pain in clinical cancer patients

Bechakra, Malik; Moerdijk, Floor; Rosmalen, Joost van; Koch, Birgit C. P.; Rijt, Carin C.D. van der; Jongen, Joost L.M.

doi:10.1016/j.ejca.2018.09.036

Cited by 13 publications

(7 citation statements)

References 23 publications

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“…In a prospective study of 240 cancer patients, 72.1% of patients had nociceptive pain alone and 27.9% had mixed pain. Both patients with mixed pain and purely nociceptive pain responded to opioids with significant reductions in pain intensity (69).…”

Section: Pain Types and Levelsmentioning

confidence: 97%

“…Concept such as nociceptive (somatic and/or visceral), neuropathic (peripheral and/or central), mixed and breakthrough pain are important in the assessment of cancer patients (67). While cancer pain driven by neuropathic mechanisms may be a negative predictor of pain therapy (68) and has generally been considered to be resistant to opioids or require adjuvant analgesics for controlling mixed pain (18), this notion has recently been challenged by results in patients with mixed nociceptive-neuropathic cancer pain (69). In a prospective study of 240 cancer patients, 72.1% of patients had nociceptive pain alone and 27.9% had mixed pain.…”

Section: Pain Types and Levelsmentioning

confidence: 99%

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Optimization of opioid utility in cancer pain populations

Wong

Cheung

2020

Ann Palliat Med

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In this era of crisis and controversy surrounding opioid therapy, we must remember that cancer patients entrust us with supporting them through what might be the most difficult, and oftentimes final, period of their life. The factors that affect the benefits and risks of opioid use in cancer patients and the non-cancer population are quite different. In fact, opioid-associated deaths are 10 times less likely in the former than the latter population, suggesting that a reluctance to initiate opioids in cancer patients can risk under treatment of complex pain. In this review, we outline the considerations and evidence-based practices required to manage the clinical situations that challenge the judicious use of opioids in patients with cancer.A comprehensive review that enable us to better understand and quantify the root causes of variability in pain control, as well as risks of opioid misuse or abuse, would arm healthcare providers with the tools they need to implement multi-modal approaches to treatment planning.

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Section: Pain Types and Levelsmentioning

confidence: 97%

Section: Pain Types and Levelsmentioning

confidence: 99%

Optimization of opioid utility in cancer pain populations

Wong

Cheung

2020

Ann Palliat Med

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“…Considering the particular nature of cancer pain, the presence of a nociceptive component is very common, also in patients with NCP, making it difficult to objectively determine the effect of the analgesics on the neuropathic component. [46]. For this reason, control of NCP usually requires the concurrent use of opioids and adjuvant analgesics specific for NCP [26,47].…”

Section: Opioidsmentioning

confidence: 99%

Treatment of Neuropathic Pain Directly Due to Cancer: An Update

Shkodra

Caraceni

2022

Cancers

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Neuropathic pain can be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. In this review article, with neuropathic cancer pain (NCP), we refer to pain due to nervous tissue lesions caused by the tumor or its metastases. Nervous tissue damage is the cause of cancer pain in approximately 40% of those experiencing cancer pain. Recognizing a neuropathic pathophysiology in these cases may be difficult and requires specific criteria that are not homogenously applied in clinical practice. The management of this type of pain can be challenging, requiring the use of specific non-opioid adjuvant drugs. The majority of the criteria for NCP diagnosis and management have been based mainly on results from the noncancer population, risking the failure of addressing the specific needs of this population of patients. In this review, we summarize current management options available for NCP and provide some insights on new promising treatments.

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“…The use of opioids in NP treatment is quite controversial, especially with respect to non-cancer pain [42]. On one hand, although NNT for opioids is fairly low, at 4.3 (3.4-5.8) [39], more side effects and relatively fast development of tolerance are observed during treatment compared to treatment of other types of pain [42].The best results are obtained in treatment of mixed inflammatory and neuropathic pain [43]. On the other hand, it is traditionally believed that certain opioids have specific properties which are beneficial in NP treatment.…”

Section: Treatment Of Neuropathic Painmentioning

confidence: 99%

“…Z jednej strony NNT dla opioidów jest dość niskie 4,3 (3,4-5,8) [39], jednak podczas leczenia obserwuje się więcej działań niepożądanych i stosunkowo szybki rozwój tolerancji, w porównaniu z leczeniem innych rodzajów bólu [42]. Najlepsze wyniki uzyskiwane są w leczeniu bólu o charakterze mieszanym zapalnym i neuropatycznym [43]. Z drugiej strony, tradycyjnie uważa się, że niektóre opioidy posiadają specyficzne własności korzystne w leczeniu NP.…”

Section: Leczenie Bólu Neuropatycznegounclassified

Neuropathic pain: new mechanisms of action of old drugs

Żylicz

2019

Palliat Med Pract

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Approximately 7-10% of the general population and 30% of cancer patients suffer from neuropathic pain, which is induced by the damage or disease of the neurologic structures. Sometimes neuropathic pain is caused by the pressure on a nerve but more often pain is due to the sensitization of the centers in the spinal cord and brain. Some structures become so sensitive to the peripheral pain impulses that they become totally independent of them. Recently neuropathic pain is seen as an activation process of the innate immunologic system. In this area the Toll-like receptors seems to play an important role and many drugs are able to inhibit their activation. Treatment of neuropathic pain depends on the possibility of nerve decompression. However, in many cases, the sensitization is the target for treatment. For this purpose, most useful are gabapentinoids that inhibit influx of calcium across the membrane. Antidepressants (SNRI) such as duloxetine and venlafaxine are also useful as well as tricyclic antidepressants, although the latter are characterized by significant adverse effects. In some types of neuropathic pain 8% capsaicin, as well as 5% lidocaine plasters or different opioids, are successfully used although there is still a lack of sufficient, good quality controlled clinical trials. The description of the role of Toll-like receptors in the pathophysiology of neuropathic pain is a breakthrough in thinking and hope for the future to elaborate new, more effective treatment methods.

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Opioid responsiveness of nociceptive versus mixed pain in clinical cancer patients

Cited by 13 publications

References 23 publications

Optimization of opioid utility in cancer pain populations

Optimization of opioid utility in cancer pain populations

Treatment of Neuropathic Pain Directly Due to Cancer: An Update

Neuropathic pain: new mechanisms of action of old drugs

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