Pain Management in Pancreatic Cancer

Hameed, Mariam; Hameed, Haroon; Erdek, Michael

doi:10.3390/cancers3010043

Cited by 44 publications

(47 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Opium and its derivatives may be used to alleviate pain from cancer (27). To address the reverse causality between opium consumption and pancreatic cancer; we performed a sensitivity analysis excluding participants who consumed opium less than 5 years at the time of recruitment.…”

Section: Discussionmentioning

confidence: 99%

Opium Use and Risk of Pancreatic Cancer: A Prospective Cohort Study

Moossavi

Mohamadnejad

Pourshams

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background We examined the association between opium consumption and pancreatic cancer incidence in a large-scale prospective cohort of the general population in Northeast of Iran. Methods A total of 50,045 adults were systematically followed-up (median of 7.4 years) and incident cases of pancreatic cancer were identified. Self-reported data on opium consumption was collected at baseline. Cumulative use (-year) was defined as number of nokhods (a local unit, approximately 0.2 g) of opium consumed per day multiplied by number of years consuming. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between opium consumption and pancreatic cancer were calculated using Cox proportional hazards regression models. Results Overall, 54 confirmed cases of pancreatic cancer were identified. Opium use of more than 81 nokhod-years (high cumulative use), compared to never use, was strongly associated with pancreatic cancer even after adjustments for multiple potential confounding factors [HR=3.01; 95% CI 1.25-7.26]. High cumulative consumption of opium was significantly associated with risk of pancreatic cancer after adjusting for cumulative dose of cigarette smoking [HR=3.56; 95% CI 1.49-8.50]. In a sensitivity analysis, we excluded participants (including 2 pancreatic cancer cases) who were recruited within the first 5 years of starting opium consumption; high cumulative use of opium was still associated with pancreatic cancer risk [HR=2.75; 95% CI 1.14-6.64]. Conclusion Our results showed a positive association between opium consumption and pancreatic cancer. Impact This is the first prospective large-scale study to show the association of opium consumption with pancreatic cancer as a risk factor.

show abstract

Section: Discussionmentioning

confidence: 99%

Opium Use and Risk of Pancreatic Cancer: A Prospective Cohort Study

Moossavi

Mohamadnejad

Pourshams

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

show abstract

“…The analgesic choice is informed by the WHO analgesic ladder,39 starting with paracetamol and non-steroidal anti-inflammatory drugs and if these are ineffective progressing to weak, and then strong morphine-based opioids. Methadone and ketamine, two N-methyl-D-aspartate, may be prescribed if the above are ineffective, usually by palliative care physicians 40.…”

Section: Analgesiamentioning

confidence: 99%

Bridging clinic: The initial medical management of patients with newly diagnosed pancreatic cancer

Sreedharan¹,

Kumar

Jewell

et al. 2018

Frontline Gastroenterol

View full text Add to dashboard Cite

Pancreatic cancer is the 11th most common cancer in the UK and has the worst prognosis of any tumour with minimal improvements in survival over recent decades. As most patients are either ineligible for surgery or may decline chemotherapy, the emphasis is on control of symptoms and management of complications such as poor nutritional status. The time period between informing the patient of their diagnosis and commencing cancer treatments presents a valuable opportunity to proactively identify and treat symptoms to optimise patients’ overall well-being. The ‘bridging clinic’, delivered by a range of healthcare professionals from gastroenterologists to nurse practitioners, can provide this interface where patients are first informed of their diagnosis and second supportive therapies offered. In this article, we provide a structure for instituting such supportive therapies at the bridging clinic. The components of the clinic are summarised using the mnemonic INDASH (Information/Nutrition/Diabetes and Depression/Analgesia/Stenting/Hereditary) and each is discussed in detail below.

show abstract

“…9 A temporary, percutaneous catheter is often placed to assess response and help ascertain appropriate dosing of opioids and potential agents such as local anesthetics, alpha-blockers, and calcium channel blockers. If successful, the patient is ultimately surgically treated with an implantable pump and catheter system, delivering analgesic agents directly into the central nervous system and bypassing systemic administration and its inherent limitations of effect and toxicity.…”

Section: Interventionalmentioning

confidence: 99%