DOCSLIB.ORG

Opioids for the Management of Breakthrough Cancer Pain in Adults

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Opioids for the Management of Breakthrough Cancer Pain in Adults Review Palliative Medicine 25(5) 516–524 ! The Author(s) 2010 Opioids for the management of Reprints and permissions: sagepub.co.uk/journalsPermissions.nav breakthrough cancer pain in adults: DOI: 10.1177/0269216310385601 A systematic review undertaken as part pmj.sagepub.com of an EPCRC opioid guidelines project Giovambattista Zeppetella St Clare Hospice, UK Abstract The usual management of cancer related breakthrough pain is with supplemental doses of analgesics (commonly opioids) at a dose proportional to the total around-the-clock opioid dose. The aim of this review, undertaken as part of a European Palliative Care Research Collaborative (EPCRC) project, to update the EAPC guidelines on opioid analgesics in cancer pain was to determine the evidence for the utility of opioids in the management of breakthrough pain in patients with cancer. Randomized controlled trials of opioids used as rescue medication were identified using electronic search strategies. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, and patient satisfaction. The date of the final search was 31 July 2009. Eight studies (790 patients) met the inclusion criteria. Most studies investigated rescue medication delivery via the buccal or nasal transmucosal routes. Intravenous morphine has been compared with the transmucosal route and the two found to be effective. The oral route has not been formally tested although found to be an inferior comparator in one study. Most studies showed no meaningful relationship between the effective dose of transmucosal opioid and the around-the-clock scheduled medi- cation or the previous rescue medication, although one study found a fixed proportion of either intravenous morphine or transmucosal fentanyl to be efficacious. Keywords Neplasm, pain, opioids, breakthrough pain, transmucosal Introduction rescue medication. The dose of rescue medication is usually based on the patient’s ATC analgesia and is Breakthrough pain is a heterogeneous pain state given before or soon after breakthrough pain has first highlighted by Portenoy and Hagen in 1990.1 The started. The current European Association for term has been used to describe a phenomenon whereby Palliative Care (EAPC) recommendation is to use the pain intensity suddenly increases to ‘break through’ the same as the four-hourly dose of normal-release mor- background pain that is otherwise controlled by a fixed phine (approximately 17% of the daily dose) when nec- schedule ‘around-the-clock’ (ATC) opioid regimen. A essary.3 The aim of this review was to determine the number of definitions have appeared in the literature efficacy of opioid analgesics for the management of and the lack of consensus on a formal definition has breakthrough pain in patients with cancer. led to difficulties when comparing studies and recom- mending management strategies. Even the term ‘break- Methods through pain’ is not one that is universally agreed with.2 The usual approach to managing breakthrough pain All published randomized controlled trials, blinded is with supplemental doses of opioids, also known as and non-blinded, that assessed the management of Corresponding author: Dr G Zeppetella, FRCP, St Clare Hospice, Hastingwood, Essex CM17 9JX, UK Email: [email protected] Zeppetella 517 breakthrough pain were included. Randomization was A data collection form was used for the review and defined as studies that were described by the authors the following data was collected: anywhere in the manuscript as’ randomized’. The study population included adult patients with cancer and Publication details breakthrough pain in any setting. Participants: number subjects at baseline, gender, age All studies that compared opioid analgesics with pla- Trial quality characteristics cebo or other opioid analgesics, or both, or other active Description of intervention controls were considered regardless of the dose (single Outcome data or multiple doses) or mode of administration for the The number of patients and number of adverse effects relief of breakthrough pain. Patient reported pain and reported. adverse effects were assessed. In addition, requirements for additional rescue analgesia and patient preference In the analysis a comparison was calculated of were included in the analysis. weighted mean difference for pain intensity difference To identify studies for inclusion search strategies at either 10 or 15 minutes after drug administration. were developed for each electronic database searched. The subject search used a combination of controlled vocabulary and free text terms based on the following Results search strategy for searching MEDLINE: Identified studies (1) (breakthrough or episodic or transient or transitory Electronic searching identified 125 studies. Eleven stud- or incident or flare).mp. ies appeared to fit the inclusion criteria; however, on (2) (cancer or malignant or neoplasm or neoplasia or reading the papers it was found that two were not ran- tumor or tumour).mp. domized and one was a duplicate French version, leav- (3) pain.mp. ing eight primary references.5–12 Two studies were (4) exp PAIN randomized, double-blind dose titration studies and (5) 3 or 4 allowed only open label comparison of the investiga- (6) 1 and 2 and 5 tional drug and previous rescue medication.6,7 The (7) limit 6 to (human and (controlled clinical trial or remaining studies tested the investigational drugs meta analysis or randomized controlled trial)) either against placebo5,9,11,12 or an alternative (8) (morphine or fentanyl or hydromorphone, or oxy- opioid.8,10 codone, or pentazocine or methadone or opioid or opiate or opioids or opiates or codeine or dextro- moramide or OTFC or diamorphine or dihydroco- Oral transmucosal fentanyl citrate studies. Oral deine or dextropropoxyphene or meptazinol or transmucosal fentanyl citrate (OTFC) consists of a fen- sufentanil or alfentanil or remifentanil or nalbu- tanyl-impregnated sweetened and hardened lozenge on phine or meptazinol or dipipanone or pethidine or a plastic handle and has been designed for the manage- tramadol or buprenorphine).mp. ment of breakthrough pain. The lozenge is applied to (9) 7 and 8. the buccal mucosa and as it dissolves in the saliva a proportion (approx 25%) is absorbed across the The date of the final search was 31 July 2009 and the buccal mucosa, the remainder of the drug is swallowed abstracts of the identified studies were read. If it was and a further 25% is absorbed through the gastrointes- clear from the abstract that the study did not meet the tinal tract.13 OTFC is available in six doses; 200, 400, selection criteria it was excluded. If it was unclear from 600, 800, 1200 and 1600 mg. the abstract whether the study met the selection criteria Christie et al.6 and Portenoy et al.7 employed a ran- then it was read in full, as were all studies that appeared domized, double-blind dose titration methodology in to meet the selection criteria. Justification for excluding patients utilizing either transdermal6 or oral7 ATC opi- studies was documented. oids to identify the dose of OTFC for each patient ade- In the critical appraisal of studies the aspects of quate to treat one episode of breakthrough pain. Both quality considered were: whether the treatment was studies, which between them enrolled 252 patients, were randomized, whether the process of randomization divided into two phases. In phase 1 breakthrough pain was described, and whether withdrawals and drop- and the performance of the usual rescue medication outs were described and then appropriately handled was assessed for two consecutive days. In phase 2, in the analysis. The quality of each study was quantified patients were randomized to start with either 200 mg using a validated scoring system.4 or 400 mg of OTFC and titrated to the effective dose 518 Palliative Medicine 25(5) and the performance of the drug was then evaluated. pain relief, and presented no more than two break- During each day of phase 2 four OTFC units could be through pains per day. Patients meeting the inclusion taken sequentially (one every 30 minutes) for up to two criteria were planned to receive intravenous morphine episodes of pain. If more than one unit was necessary and OTFC for each couple of breakthrough pain epi- the investigator could order titration to the next largest sodes in random order with a wash out period between OTFC. Dose unit could also be decreased at the discre- the episodes of at least 6 hours. Patients who repeated tion of the investigator. Blinding was further enhanced the sequence on another day received the opposite by ignoring the need to increase the OTFC dose in sequence, thus serving as their own control. The ratio- one-third of instances according to a randomization nale in choosing the doses to be administered was based schedule. Data were used to examine the success of on previous studies13 and not intended to be equi- the titration process, the existence of a dose–response analgesic. relationship with OTFC, the comparison of outcomes during the two days of baseline treatment and the two days with OTFC once patients had titrated to an effec- Fentanyl buccal tablet studies. Fentanyl buccal tablet tive dose. (FBT) incorporates an effervescence reaction to Farrar et al.5 compared OTFC with placebo in a enhance fentanyl absorption through the buccal multicentre, randomized double-blind study design. mucosa and facilitate rapid systemic exposure to the One hundred and thirty patients were recruited to analgesic. Transient pH changes accompany the effer- phase 1 of the study where OTFC was substituted for vescence reaction, and increase both the rate of tablet their usual rescue medication. All patients were com- dissolution (at a lower pH) and membrane permeation menced on 200 mg of OTFC; if more than one unit was (at a higher pH) of fentanyl. Compared with OTFC, a required to successfully manage the pain a larger unit larger proportion of FBT is absorbed transmucosally was used for subsequent pains.
Load more

Recommended publications
  • Guidline for the Evidence-Informed Primary Care Management of Low Back Pain
    Guideline for the Evidence-Informed Primary Care Management of Low Back Pain 2nd Edition These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They should be used as an adjunct to sound clinical decision making. Guideline Disease/Condition(s) Targeted Specifications Acute and sub-acute low back pain Chronic low back pain Acute and sub-acute sciatica/radiculopathy Chronic sciatica/radiculopathy Category Prevention Diagnosis Evaluation Management Treatment Intended Users Primary health care providers, for example: family physicians, osteopathic physicians, chiro- practors, physical therapists, occupational therapists, nurses, pharmacists, psychologists. Purpose To help Alberta clinicians make evidence-informed decisions about care of patients with non- specific low back pain. Objectives • To increase the use of evidence-informed conservative approaches to the prevention, assessment, diagnosis, and treatment in primary care patients with low back pain • To promote appropriate specialist referrals and use of diagnostic tests in patients with low back pain • To encourage patients to engage in appropriate self-care activities Target Population Adult patients 18 years or older in primary care settings. Exclusions: pregnant women; patients under the age of 18 years; diagnosis or treatment of specific causes of low back pain such as: inpatient treatments (surgical treatments); referred pain (from abdomen, kidney, ovary, pelvis,
    [Show full text]
  • The IASP Classification of Chronic Pain for ICD-11: Chronic Cancer-Related
    Narrative Review The IASP classification of chronic pain for ICD-11: chronic cancer-related pain Michael I. Bennetta, Stein Kaasab,c,d, Antonia Barkee, Beatrice Korwisie, Winfried Riefe, Rolf-Detlef Treedef,*, The IASP Taskforce for the Classification of Chronic Pain Abstract 10/27/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3FlQBFFqx6X+GYXBy6C6D13N3BXo5wGkearAMol2nLQo= by https://journals.lww.com/pain from Downloaded Downloaded Worldwide, the prevalence of cancer is rising and so too is the number of patients who survive their cancer for many years thanks to the therapeutic successes of modern oncology. One of the most frequent and disabling symptoms of cancer is pain. In addition to from the pain caused by the cancer, cancer treatment may also lead to chronic pain. Despite its importance, chronic cancer-related pain https://journals.lww.com/pain is not represented in the current International Classification of Diseases (ICD-10). This article describes the new classification of chronic cancer-related pain for ICD-11. Chronic cancer-related pain is defined as chronic pain caused by the primary cancer itself or metastases (chronic cancer pain) or its treatment (chronic postcancer treatment pain). It should be distinguished from pain caused by comorbid disease. Pain management regimens for terminally ill cancer patients have been elaborated by the World Health Organization and other international bodies. An important clinical challenge is the longer term pain management in cancer patients by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3FlQBFFqx6X+GYXBy6C6D13N3BXo5wGkearAMol2nLQo= and cancer survivors, where chronic pain from cancer, its treatment, and unrelated causes may be concurrent. This article describes how a new classification of chronic cancer-related pain in ICD-11 is intended to help develop more individualized management plans for these patients and to stimulate research into these pain syndromes.
    [Show full text]
  • ASCO Answers: Managing Cancer-Related Pain
    Managing Cancer-Related Pain A Guide for Patients, Families, and Caregivers from the American Society of Clinical Oncology ABOUT ASCO Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to making a world of diference in cancer care. As the world’s leading organization of its kind, ASCO rep- resents nearly 45,000 oncology professionals who care for people living wizth cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO furthers its mission through Cancer.Net and Conquer Cancer, the ASCO Foundation. Cancer.Net (www.cancer.net) brings the expertise and resources of ASCO to people living with cancer and those who care for and about them. All the information and content on Cancer.Net is developed and approved by members of ASCO, making Cancer.Net an up-to-date and trusted resource for cancer information. Conquer Cancer (www.conquer.org) funds research into every facet of cancer to beneft every patient, everywhere. Conquer Cancer helps turn science into a sigh of relief for patients around the world by supporting groundbreaking research and education across cancer’s full continuum. Learn more at www.ASCO.org. Follow us on Facebook, Twitter, LinkedIn, and YouTube. MILLIONS OF PEOPLE RELY ON CANCER.NET FOR: • Information on 120+ cancer types • Information on navigating cancer care • Coping and survivorship resources GET YOUR CANCER INFORMATION IN THE FORMAT
    [Show full text]
  • Interventional Techniques for Cancer Pain
    Interventional Techniques for Cancer Pain Cancer pain may result either from primary or metastatic neoplasms or from invasive or diagnostic procedures. Cancer treatments that may cause pain include surgery, radiation, chemotherapy, immunotherapy, and hormonal therapy. The presentation of pain may depend on etiology; however, it is important to realize that patients with cancer are not immune to pain that commonly occurs in noncancer patients. Cancer pain is typically nociceptive, visceral, or neuropathic, or a combination of these. Interventional techniques targeted to control pain may be appropriate adjuvants or alternatives to oral or systemic pharmacological treatment. These techniques may also be more appropriate in patients who are unable to tolerate side effects of systemic medications. Some examples of interventional techniques are listed below. Intraspinal Analgesia Epidural • Is the most common option for spinal or radicular pain caused by primary or metastatic lesions • Causes lesions that may affect intervertebral disks, nerve roots, or spinal canal size • Provides highly selective pain relief, while producing analgesia over a large area • Targets cervical, thoracic, lumbar, or caudal levels • Allows single injections of a steroid, sometimes with a local anesthetic (e.g., lidocaine or bupivacaine) • Allows continuous infusions of an opioid with a temporary catheter Intrathecal • Provides highly selective pain relief of spinal origin • Allows for minimal side effects typically associated with higher dosages of oral medications
    [Show full text]
  • Treatment of Cancer Pain
    University of Massachusetts Medical School eScholarship@UMMS Cancer Concepts: A Guidebook for the Non- Oncologist Radiation Oncology 2016-09-21 Treatment of Cancer Pain Mark Dershwitz University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/cancer_concepts Part of the Anesthesia and Analgesia Commons, Medical Education Commons, Neoplasms Commons, and the Oncology Commons Repository Citation Dershwitz M, Pieters RS. (2016). Treatment of Cancer Pain. Cancer Concepts: A Guidebook for the Non- Oncologist. https://doi.org/10.7191/cancer_concepts.1024. Retrieved from https://escholarship.umassmed.edu/cancer_concepts/23 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Cancer Concepts: A Guidebook for the Non-Oncologist by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Treatment of Cancer Pain Citation: Dershwitz M, Pieters RS. Treatment of Cancer Pain. In: Pieters RS, Liebmann J, eds. Mark Dershwitz, MD, PhD Cancer Concepts: A Guidebook for the Non-Oncologist. Worcester, MA: University of Massachusetts Richard S. Pieters, MD Medical School; 2016. doi: 10.7191/cancer_concepts.1024. This project has been funded in whole or in part with federal funds from the National Library of Medicine, National Institutes of Health, under Contract No. HHSN276201100010C with the University of Massachusetts, Worcester. Copyright: All content in Cancer Concepts: A Guidebook for the Non-Oncologist, unless otherwise noted, is licensed under a Creative Commons Attribution-Noncommercial-Share Alike License, http://creativecommons.org/licenses/by-nc-sa/4.0/ Summary and Key Points 10.
    [Show full text]
  • Back Pain in a Cancer Patient: a Case Study Lucinda Morris Peter Gorayski Sandra Turner
    CLINICAL Back pain in a cancer patient: a case study Lucinda Morris Peter Gorayski Sandra Turner Answer 1 Keywords therapy, palliative; neoplasm metastasis; radiotherapy General inspection for cachexia, anaemia and gait assessment should be performed, as well as neurological examination of the upper and lower Case limbs. Examine the lower back for bony tenderness. A man aged 78 years presented to his general practitioner with new-onset low back Answer 2 pain. The patient had metastatic prostate The differential diagnoses include: cancer, which was diagnosed 2 years ago, • osteoarthritis and a solitary asymptomatic bone metastasis • musculoskeletal strain in the right pubic bone. To date, he had • osteoporotic crush fracture. been managed with androgen deprivation Given the history, a new bone metastasis should be therapy (goserelin) alone. His performance considered. status was good and his prostate-specific antigen (PSA) level stable. His past medical Answer 3 history included hyperlipidaemia and atrial fibrillation. He was on atorvastatin and Malignant spinal cord compression (MSCC) and cauda warfarin. He had no known allergies, was a equina syndrome should be excluded. Symptoms non-smoker and did not drink alcohol. may include worsening back pain, weakness in the He reported a 6-week history of constant, lower limbs, altered sensation and bladder or bowel burning pain in the lower lumbar region, incontinence. MSCC is an emergency and warrants which was worse at night and was 7/10 in urgent referral to a radiation oncologist within severity on the Numeric Pain Rating Scale. 12–24 hours to prevent irreversible progression to He had no relief with regular paracetamol paraplegia.1 Referral can be made directly to the or ibuprofen.
    [Show full text]
  • Cancer Pain Management in Children
    European Journal of Pain (2001) 5 (Suppl. A): 37±41 doi:10.1053/eujp.2001.0278, available online at http://www.idealibrary.com on 1 Cancer pain management in children John J. Collins Head, Pain and Palliative Care Service,The Children's Hospital at Westmead Sydney, New South Wales, Australia The World Health Organization document Cancer Pain Relief and Palliative Care in Children (WHO, 1998) advo- cates the global application of the principles of pain management and palliative care for children with cancer. The principles of pain management include the application of the WHO analgesic ladder, appropriate opioid dose escala- tion, the use of adjuvant analgesics, and the use of non-pharmacological methods of pain control. These principles of pain management should be incorporated into the treatment protocols of all children with cancer, acknowledging that treatment options may be limited for some children. # 2001 European Federation of Chapters of the Interna- tional Association for the Study of Pain KEYWORDS: treatment protocols of children with cancer, opioids, analgesics, non-pharmacological methods of pain control. INTRODUCTION one-third had experienced pain in the previous 48 hours. Over half of this group had pain severity Pain is one of the most common and one of the most in the medium to severe range, and one-third were feared symptoms of children with cancer and their highly distressed by their experience (Collins et al.). families. If current pain management techniques are Information was acquired about symptom char- utilized the majority of children can achieve ade- acteristics from a population of children with cancer quate analgesia.
    [Show full text]
  • Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain: an Educational Aid to Improve Care and Safety with Opioid Therapy 2010 Update
    Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An educational aid to improve care and safety with opioid therapy 2010 Update What is New in this Revised Guideline New data, including scientific evidence to support the 120mg MED dosing threshold Tools for calculating dosages of opioids during treatment and when tapering Validated screening tools for assessing substance abuse, mental health, and addiction Validated two-item scale for tracking function and pain Urine drug testing guidance and algorithm Information on access to mentoring and consultations (including reimbursement options) New patient education materials and resources Guidance on coordinating with emergency departments to reduce opioid abuse New clinical tools and resources to help streamline clinical care You can find this guideline and related tools at the Washington State Agency Medical Directors’ site at www.agencymeddirectors.wa.gov 1 Table of Contents Introduction ............................................. 1 Part II: Guidelines for optimizing 2010 Update ........................................................ 1 treatment when opioid doses are greater than 120mg MED/day .............. 12 How this guideline is organized ........................... 2 Assessing effects of opioid doses greater than Part I. Guidelines for initiating, 120mg MED/day ............................................... 12 transitioning, and maintaining oral How to discontinue opioids or reduce and opioids for chronic non-cancer pain .... 3 reassess at lower doses
    [Show full text]
  • Support for People with Cancer: Pain Control
    Support for People with Cancer Cancer Pain Control U.S. Department of Health & Human Services | National Institutes of Health For more information . This booklet is only one of many free booklets for people with cancer. Here are some others you and your loved ones may find useful: • Chemotherapy and You • Coping With Advanced Cancer • Eating Hints for Cancer Patients • If You Have Cancer: What You Should Know About Clinical Trials • Radiation Therapy and You • Taking Time • Thinking About Complementary and Alternative Medicine • When Cancer Returns • When Someone You Love Is Being Treated for Cancer • When Someone You Love Has Advanced Cancer • When Your Parent Has Cancer These free booklets are available from the National Cancer Institute (NCI). To order or download, call 1-800-4-CANCER (1-800-422-6237) or visit www.cancer.gov. (See page 35 of this booklet for more resources.) For information about your specific type of cancer, see NCI’s Physican Data Query (PDQ®) database at http://www.cancer.gov. Cancer Pain Control Cancer pain can be managed. Having cancer doesn’t mean that you’ll have pain. But if you do, you can manage most of your pain with medicine and other treatments. This booklet will show you how to work with your doctors, nurses, and others to find the best way to control your pain. It will discuss causes of pain, medicines, how to talk to your doctor, and other topics that may help you. As a team, you and your doctor can work together to find the best pain control plan for you.
    [Show full text]
  • Updates in Cancer Pain Management Alaa Ali M
    Archives of Anesthesiology Volume 1, Issue 1, 2018, PP: 28-37 Updates in Cancer Pain Management Alaa Ali M. Elzohry, MD1, Doaa Abd Eltwab M. Tueki, MD2, Ahmed Fetouh Abdelrahman, MD3 Bahaa Gamal Saad, MSc 4, Mohanad A. M. Abd-El-Gawad, MSc 4, Ahmed Ahmed, MBBCh, MSc 5 1Lecturer 2Lecturer 3 of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt.. 4 ecturerof Anesthesia, ICU and Pain Relief, National cancer institute, Cairo University, Egypt. 4 Lecturer of Anesthesia, ICU and Pain Relief, Faculty of Medicine, Tanta University, Egypt Assistant l of Anesthesia, ICU [email protected] Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt. Postdoctoral Fellow Anaesthesiology, the Ohio State University Wexner Medical Center, Columbus, USA. *Corresponding Author: Alaa Ali M. Elzohry, MD., Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Arab Republic of Egypt. Abstract Background: Pain is a common symptom in cancer patients and it is the most disturbing complications affecting the quality of life markedly. The incidence of pain depends on the type and stage of the cancer. There are many barriers that prevent treatment of cancer pain as fear of addiction, side effects and fear of distracting physicians from treating the cancer. The objective of this review is to illustrate different types, effects and various tools of the cancer pain control as well as a how to choose the ideal technique suitable for your pain. Conclusion: Cancer pain is multifactorial with complicated Pathophysiology, but early diagnosis, careful history and good assessment lead to ideal selection of treatment plane either medications or interventions according to WHO step ladder.
    [Show full text]
  • Mechanisms of Cancer Pain
    Mechanisms of Cancer Pain Cancer pain patients commonly experience more than one kind of pain. The pain may be constant or intermittent, or acute pain superimposed on chronic background pain. The pain may be disease-related or treatment-related. Chronic pain conditions, such as low back pain, that were present prior to the cancer may also continue to be problematic. Psychological factors such as depression, anxiety, and cognitive style may influence pain perception and contribute to the intensity of the pain. Multiple Causes of Pain in the Cancer Patient • Tumor expansion can cause pressure on surrounding organs. • Tumors secrete inflammatory and prohyperalgesic mediators. • Tumor infiltration in nerve plexuses and damage to nerve tissue can cause neuropathic pain. • Metastatic spread of cancer to bone is one of the most common causes of cancer pain [1]. • Stretching of hollow viscera, distortion of the capsule of solid organs, inflammation of the mucosa, and ischemia or necrosis activate visceral nociceptors, resulting in visceral pain. • Rapid weight loss, muscle hypercatabolism, immobilization, or increased muscular tension cause muscular pain. Bony metastases can cause painful muscle spasm. • Breakthrough pain, defined as a transitory flare of pain that occurs on a background of relatively well- controlled baseline pain [2], is prevalent. It may be due to a number of causes, such as bony metastases causing pain on movement. Treatment-Related Pain • Adverse effects of treatment include joint pain following chemotherapy and hormonal therapy, and painful mucositis due to radiotherapy and chemotherapy with certain agents. Neuropathic pain may arise in the form of postradiation plexopathies, peripheral polyneuropathy after chemotherapy, or opioid-induced hyperalgesia.
    [Show full text]
  • Low Back Pain George E
    Low back pain George E. Ehrlich1 Abstract Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. Keywords Low back pain/classification/etiology/therapy; Fibromyalgia; Risk factors; Treatment outcome (source: MeSH, NLM ). Mots clés Lombalgie/classification/étiologie/thérapeutique; Céllulalgie; Facteur risque; Evaluation résultats traitement (source: MeSH, INSERM ). Palabras clave Dolor de la región lumbar/clasificación/etiología/terapia; Fibromialgia; Factores de riesgo; Resultado del tratamiento (fuente: DeCS, BIREME ). Bulletin of the World Health Organization 2003;81:671-676.
    [Show full text]