Opioids in cancer-related pain: current situation and outlook

George, Brigitte; Minello, Christian; Allano, Gilles; Maindet, Caroline; Burnod, Alexis; Lemaire, Antoine

doi:10.1007/s00520-019-04828-8

Cited by 37 publications

(34 citation statements)

References 120 publications

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“…The high incidence of NPC in males versus females was due to differences in living habits and occupations that tend to be more frequent in contact with carcinogenic causes. Living habits such as smoking, exposure to steam, dust fumes and chemical gases in the workplace increase the risk of NPC 2-6 times 15 .…”

Section: Discussionmentioning

confidence: 99%

Correlation between IL-10 Expression with Histopathology Type on Nasopharyngeal Carcinoma Patients

2020

MLU

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Background: Nasopharyngeal carcinoma (NPC) is a malignancy derived from lymphoepithelial tissue and nasopharyngeal epithelial cells. The response therapy of NPC evaluated from histopathological type, but in some patients with the same type was illustrated a different response of therapy. IL-10 expression expects to predict a better response therapy of NPC. IL-10 expression by immunohistochemical examination associated with the differentiation of tumors. Method:The study was analytic observational with the cross-sectional approach. Samples were collected by consecutive sampling and formalin-fixed, paraffin-embedded biopsy specimens were obtained. Result:The result of IL-10 expression in Nasopharyngeal carcinoma (NPC) patients with histopathological World health organization (WHO) type I was obtained; From all the samples, there were 36.36% of strong positive expression and 63.64% of frail positive expression. There were increases in the number of cells that give a strong expression on WHO type III. Statistical analysis using Fisher's exact test was obtained p = 0.040 with a contingency coefficient of 0.384. Conclusion:There was a moderate correlation between IL-10 expression and histopathological type in NPC patients.

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Section: Discussionmentioning

confidence: 99%

Correlation between IL-10 Expression with Histopathology Type on Nasopharyngeal Carcinoma Patients

2020

MLU

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“…Genetic variation in receptors contributes to the various responses to opioids within or between individuals (8). Individual parameters including the source of the pain, age, gender, analgesics including opioids, pharmacokinetics and pharmacodynamics, genetic polymorphism, physiology, comorbidities, environmental factors, medication interference, and treatment adherence are all associated with the degree of efficacy and the gradual loss of response (9). A patient's prior exposure to opioids, current medications that interact with or augment the effect of an opioid, and end-organ function are relevant to the outcome of the therapy (10,11).…”

Section: Wwwpainphysicianjournalcommentioning

confidence: 99%

Establishment of an Individualized Chronotherapy, Autonomic Nervous System, and Variability-Based Dynamic Platform for Overcoming the Loss of Response to Analgesics

2021

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Background: Control of chronic pain and mainly the partial or complete loss of response to analgesics is a major unmet need. Multiple mechanisms underline the development of tolerance to analgesics in general and specifically to opioids. The autonomic nervous system (ANS) plays a role in the development of analgesic tolerance and chronobiology. Objectives: To review the mechanisms associated with the development of nonresponsiveness to analgesics. Study Design: Literature review. Setting: The review is followed by a description of a new method for overcoming resistance and improving the response to analgesics. Methods: Conducted a detailed review of the relevant studies describing the mechanisms that underlie tolerance to pain medications, and the potential roles of the ANS and chronobiology in the development of drug resistance. Results: The autonomic balance is reflected by heart rate variability, an example of a fundamental variability that characterizes biological systems. Chronotherapy, which is based on the circadian rhythm, can improve the efficacy and reduce the toxicity of chronic medications. In this article, we present the establishment of an individualized variability- and chronobiology-based therapy for overcoming the compensatory mechanisms associated with a loss of response to analgesics. We describe the premise of implementing personalized signatures associated with the ANS, and chronobiology, as well as with the pathophysiology of pain for establishing an adaptive model that could improve the efficacy of opioids, in a highly dynamic system. Limitations: The studies presented were selected based on their relevance to the subject. Conclusions: The described variability-based system may ensure prolonged effects of analgesics while reducing the toxicity associated with increasing dosages. Key words: Painkillers, opioids, drug resistance, compensatory mechanisms

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“…The genetics of pain is subject to research, and more than 400 genes are currently considered potential pain modulators (27). Normal genetic and pharmacokinetic variability may result in individual differences in both treatment responses and adverse effects of opioids (28).…”

Section: Genetic Polymorphisms and Opioidsmentioning

confidence: 99%

“…BTCP should be treated with a rescue medicine, and opioids are the medication of choice for exacerbations of cancer pain (11,29). Oral morphine is often recommended as first line therapy for moderate to strong cancer pain, with oral oxycodone or oral hydromorphone as effective alternatives (3,27). For severe cancer pain requiring rapid pain relief, parenteral approaches should be applied, with intravenous administration providing the most immediate effect (27).…”

Section: Treatment Alternativesmentioning

confidence: 99%

Breakthrough cancer pain in 2020

Løhre

Thronæs

Klepstad

2020

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of the review: An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options.Recent findings: The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases (ICD-11), the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated.Summary: All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.

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Opioids in cancer-related pain: current situation and outlook

Cited by 37 publications

References 120 publications

Correlation between IL-10 Expression with Histopathology Type on Nasopharyngeal Carcinoma Patients

Correlation between IL-10 Expression with Histopathology Type on Nasopharyngeal Carcinoma Patients

Establishment of an Individualized Chronotherapy, Autonomic Nervous System, and Variability-Based Dynamic Platform for Overcoming the Loss of Response to Analgesics

Breakthrough cancer pain in 2020

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