Pain characteristics and management of inpatients admitted to a comprehensive cancer centre: a cross‐sectional study

Kurita, Geana Paula; Tange, Ulla Brix; Farholt, Hanne; Sonne, N. M.; Strömgren, Annette S; Ankersen, Lena; Kristensen, L. E.; Bendixen, Lisbeth; Grøenvold, Mogens; Petersen, Morten Aagaard; Nordly, Mie; Christrup, Lona Louring; Niemann, Carsten Utoft; Sjøgren, Per

doi:10.1111/aas.12068

Cited by 26 publications

(18 citation statements)

References 24 publications

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“…Maintaining the dose of oxycodone and increasing the pregabalin dose improved pain control and reduced side effects relative to oxycodone dose titration with maintenance of pregabalin dose [56]. Despite the evidence, adjuvant medications are underutilized in practice, and in certain series, adjuvants were used in less than 50 % of patients treated for cancer pain [57][58][59]. A systematic review of eight prospective clinical studies showed that the combination of adjuvant analgesic drugs (such as antidepressants or antiepileptic) with opioids for cancer pain is not as effective as it is in non-cancer neuropathic pain [60].…”

Section: Introductionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

Support Care Cancer

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Background Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. Methods In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. Results Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p=0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8±0.8 vs. 1.0±0.7, p=0.58) or nurses (2.0±2.7 vs. 2.1±2.6, p=0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). Discussion This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. Conclusion Adjuvant agents are used in over 80 % of those treated for cancer pain.

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Section: Introductionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

Support Care Cancer

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“…3,17,18 Pain was identified as the most common problem (27.8%) that was presented by the cancer patients visiting the emergency department in northern Taiwan. 19 The inadequate pain management as measured by negative Pain Management Index (PMI) were also reported by Mitera 20 with 25% in patients with pain related to bone metastasis, and by Fisch 21 with 33% in patients with pain related to various cancer diagnosis and receiving care in ambulatory setting.…”

Section: Undertreatment Of Cancer Painmentioning

confidence: 99%

Undertreatment of caner pain

Lee

Wang

2015

Acta Anaesthesiologica Taiwanica

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Pain is a burdensome symptom that can commonly exist chronically along the cancer trajectory. Uncontrolled pain will impact on cancer patients' quality of life, even further negatively affect cancer survivors' employment. Based on systemic reviews of studies for past 10 years, the paper reported that although there is enormous advancement on the knowledge of cancer pain and pain management, studies still documented undertreatment of cancer pain globally. Additionally, pain distress a significant portion of cancer survivors. The pain in cancer survivors distinct from the pain related with cancer, instead emphasize on pain related with cancer treatment, such as neuropathic pain, muscular syndrome. Evidence-based pain management with common pain problems in cancer survivors is lacking. Further studies are needed to understand the pain in cancer survivors and to develop effective strategies in helping cancer survivors to manage their pain.

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“…[74,75] In a recent study of 134 cancer pain patients, BTP episodes were reported by 30.5%. [76] In a retrospective study of consecutive pain patients at a single center, 56.4% of patients overall reported severe BTP; in cancer pain patients, 70.3% reported severe BTP. [77] These numbers may actually under-report the phenomenon, in that the definition of BTP has recently been challenged to include "BTP-like flares" in patients who do not have chronic background pain controlled by opioids.…”

Section: The Role Of Ir Oxycodonementioning

confidence: 99%

Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

Pergolizzi

Talu

Zmponga

et al. 2015

Agri

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ÖzetAğrı tedavisine modern yaklaşım sürecin her yönüyle optimal düzeye getirilmesinden geçer. Bu SummaryThe modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic' s mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

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Pain characteristics and management of inpatients admitted to a comprehensive cancer centre: a cross‐sectional study

Cited by 26 publications

References 24 publications

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Undertreatment of caner pain

Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

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