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Cancer Journal (Sudbury, Mass.) 2019Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice,... (Review)
Review
Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been studied for their roles in pain management. Data from randomized controlled trials support the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not reduce pain per se, can relieve anxiety and mood changes, which are commonly associated with pain. In clinical practice, one should also consider burdens and risks to patients, patient preference, and the presence or absence of better alternatives when making decisions on whether an integrative medicine therapy is of clinical value.
Topics: Acupuncture; Cancer Pain; Combined Modality Therapy; Complementary Therapies; Disease Management; Humans; Integrative Medicine; Mind-Body Therapies; Neoplasms; Pain Management
PubMed: 31567462
DOI: 10.1097/PPO.0000000000000399 -
The Oncologist Jun 2021Pain is highly prevalent in patients with pancreas cancer and contributes to the morbidity of the disease. Pain may be due to pancreatic enzyme insufficiency,... (Review)
Review
Pain is highly prevalent in patients with pancreas cancer and contributes to the morbidity of the disease. Pain may be due to pancreatic enzyme insufficiency, obstruction, and/or a direct mass effect on nerves in the celiac plexus. Proper supportive care to decrease pain is an important aspect of the overall management of these patients. There are limited data specific to the management of pain caused by pancreatic cancer. Here we review the literature and offer recommendations regarding multiple modalities available to treat pain in these patients. The dissemination and adoption of these best supportive care practices can improve quantity and quality of life for patients with pancreatic cancer. IMPLICATIONS FOR PRACTICE: Pain management is important to improve the quality of life and survival of a patient with cancer. The pathophysiology of pain in pancreas cancer is complex and multifactorial. Despite tumor response to chemotherapy, a sizeable percentage of patients are at risk for ongoing cancer-related pain and its comorbid consequences. Accordingly, the management of pain in patients with pancreas cancer can be challenging and often requires a multifaceted approach.
Topics: Cancer Pain; Celiac Plexus; Humans; Pain Management; Palliative Care; Pancreas; Pancreatic Neoplasms; Quality of Life
PubMed: 33885205
DOI: 10.1002/onco.13796 -
Oncology (Williston Park, N.Y.) Sep 2022Opioid use disorder (OUD) is increasingly recognized and co-present in patients with cancer. Unfortunately, OUD is not addressed or treated adequately in oncology... (Review)
Review
Opioid use disorder (OUD) is increasingly recognized and co-present in patients with cancer. Unfortunately, OUD is not addressed or treated adequately in oncology settings. In addition, patients with cancer-related pain treated with narcotic pain medications are at risk for nonmedical opioid use (NMOU). More than two-thirds of patients with advanced cancer have pain. Both OUD and NMOU need to be concomitantly addressed alongside cancer-related pain management to avoid complications such as overdose. We review the approach to identifying and treating OUD and NMOU in patients with cancer and cancer-related pain.
Topics: Analgesics, Opioid; Cancer Pain; Humans; Neoplasms; Opioid-Related Disorders; Pain
PubMed: 36107782
DOI: 10.46883/2022.25920973 -
BMJ Supportive & Palliative Care Sep 2021Pain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients... (Review)
Review
BACKGROUND
Pain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.
OBJECTIVE
To critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.
METHODS
Multiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.
RESULTS
Five studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.
CONCLUSIONS
Acupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.
Topics: Acupuncture Therapy; Cancer Pain; Humans; Neoplasms; Pain Management; Palliative Care; Reproducibility of Results
PubMed: 33441387
DOI: 10.1136/bmjspcare-2020-002638 -
Seminars in Oncology Nursing Jun 2019To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain. (Review)
Review
OBJECTIVE
To review literature on the relationship of pain, spirituality, and suffering as it relates to the patient with cancer who is experiencing pain.
DATA SOURCES
Peer-reviewed articles, textbooks, internet.
CONCLUSION
Pain and suffering are distinct and yet closely related in patients with cancer. Oncology nurses are important in assessing a patient's pain, including dimensions of spirituality and suffering.
IMPLICATIONS FOR NURSING PRACTICE
Oncology nurses are the front line of pain management for patients. This includes recognizing existential distress and suffering and responding to suffering.
Topics: Cancer Pain; Female; Humans; Male; Middle Aged; Spirituality
PubMed: 31053393
DOI: 10.1016/j.soncn.2019.04.013 -
CA: a Cancer Journal For Clinicians May 2018Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this... (Review)
Review
Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182-196. © 2018 American Cancer Society.
Topics: Acupuncture Therapy; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents; Cancer Pain; Delayed-Action Preparations; Healthcare Disparities; Humans; Injections, Epidural; Injections, Spinal; Medical Marijuana; Mindfulness; Nerve Block; Pain Measurement; Prescription Drug Misuse; Quality of Life; Radiotherapy; Substance-Related Disorders
PubMed: 29603142
DOI: 10.3322/caac.21453 -
The Korean Journal of Internal Medicine Nov 2018Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the... (Review)
Review
Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.
Topics: Analgesics; Cancer Pain; Humans; Neuralgia; Pain Management; Pain Measurement; Pain Perception; Pain Threshold; Prevalence; Quality of Life; Risk Factors; Treatment Outcome
PubMed: 29929349
DOI: 10.3904/kjim.2018.162 -
JAMA Oncology Feb 2020Research into acupuncture and acupressure and their application for cancer pain has been growing, but the findings have been inconsistent. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Research into acupuncture and acupressure and their application for cancer pain has been growing, but the findings have been inconsistent.
OBJECTIVE
To evaluate the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain.
DATA SOURCES
Three English-language databases (PubMed, Embase, and CINAHL) and 4 Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from database inception through March 31, 2019.
STUDY SELECTION
Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included.
DATA EXTRACTION AND SYNTHESIS
Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects modeling was used to calculate the effect sizes of included RCTs. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.
MAIN OUTCOMES AND MEASURES
The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.
RESULTS
A total of 17 RCTs (with 1111 patients) were included in the systematic review, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity (mean difference [MD], -1.38 points; 95% CI, -2.13 to -0.64 points; I2 = 81%). A favorable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity (MD, -1.44 points; 95% CI, -1.98 to -0.89; I2 = 92%) and in 2 RCTs for reducing opioid dose (MD, -30.00 mg morphine equivalent daily dose; 95% CI, -37.5 mg to -22.5 mg). The evidence grade was moderate because of the substantial heterogeneity among studies.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.
Topics: Acupressure; Acupuncture Therapy; Cancer Pain; Humans; Randomized Controlled Trials as Topic
PubMed: 31855257
DOI: 10.1001/jamaoncol.2019.5233 -
Journal of Advanced Research Jan 2022Cancer-induced Bone Pain (CIBP) is an important factor affecting their quality of life of cancer survivors. In addition, current clinical practice and scientific... (Review)
Review
BACKGROUND
Cancer-induced Bone Pain (CIBP) is an important factor affecting their quality of life of cancer survivors. In addition, current clinical practice and scientific research suggest that neuropathic pain is a representative component of CIBP. However, given the variability of cancer conditions and the complexity of neuropathic pain, related mechanisms have been continuously supplemented but have not been perfected.
AIM OF REVIEW
Therefore, the current review highlights the latest progress in basic research on the field and proposes potential therapeutic targets, representative drugs and upcoming therapies.
KEY SCIENTIFIC CONCEPTS OF REVIEW
Notably, factors such as central sensitization, neuroinflammation, glial cell activation and an acidic environment are considered to be related to neuropathic pain in CIBP. Nonetheless, further research is needed to ascertain the mechanism of CIBP in order to develop highly effective drugs. Moreover, more attention needs to be paid to the care of patients with advanced cancer.
Topics: Bone Neoplasms; Bone and Bones; Cancer Pain; Humans; Neuroinflammatory Diseases; Quality of Life
PubMed: 35003797
DOI: 10.1016/j.jare.2021.06.006 -
BMJ Supportive & Palliative Care Mar 2020There is increased interest in cannabinoids for cancer pain management and legislative changes are in progress in many countries. This study aims to determine the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
There is increased interest in cannabinoids for cancer pain management and legislative changes are in progress in many countries. This study aims to determine the beneficial and adverse effects of cannabis/cannabinoids compared with placebo/other active agents for the treatment of cancer-related pain in adults.
METHODS
Systematic review and meta-analysis to identify randomised controlled trials of cannabinoids compared with placebo/other active agents for the treatment of cancer-related pain in adults to determine the effect on pain intensity (primary outcome) and adverse effects, including dropouts. Searches included Embase, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov, Cochrane and grey literature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
RESULTS
We identified 2805 unique records, of which six randomised controlled trials were included in this systematic review (n=1460 participants). Five studies were included in the meta-analysis (1442 participants). All had a low risk of bias. There was no difference between cannabinoids and placebo for the difference in the change in average Numeric Rating Scale pain scores (mean difference -0.21 (-0.48 to 0.07, p=0.14)); this remained when only phase III studies were meta-analysed: mean difference -0.02 (-0.21 to 0.16, p=0.80). Cannabinoids had a higher risk of adverse events when compared with placebo, especially somnolence (OR 2.69 (1.54 to 4.71), p<0.001) and dizziness (OR 1.58 (0.99 to 2.51), p=0.05). No treatment-related deaths were reported. Dropouts and mortality rates were high.
CONCLUSIONS
Studies with a low risk of bias showed that for adults with advanced cancer, the addition of cannabinoids to opioids did not reduce cancer pain.
TRIAL REGISTRATION NUMBER
CRD42018107662.
Topics: Adult; Cancer Pain; Cannabinoids; Female; Humans; Male; Medical Marijuana; Middle Aged; Pain Management
PubMed: 31959586
DOI: 10.1136/bmjspcare-2019-002032