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4 results

  • The routine use of the Edmonton Classification System for Cancer Pain in an outpatient supportive care center

  • Joseph Arthur, Sriram Yennurajalingam, Linh Nguyen, Kimberson Tanco, Gary Chisholm, David Hui, Eduardo Bruera
  • Journal:
    Palliative & Supportive Care / Volume 13 / Issue 5 / October 2015
    Published online by Cambridge University Press:
    14 October 2014, pp. 1185-1192
  • Objective:

    There is no standardized and universally accepted pain classification system for the assessment and management of cancer pain in both clinical practice and research studies. The Edmonton Classification System for Cancer Pain (ECS–CP) is an assessment tool that has demonstrated value in assessing pain characteristics and response. The purpose of our study was to determine the relationship between negative ECS–CP features and some pain-related variables like pain intensity and opioid use. We also explored whether the number of negative ECS–CP features was associated with higher pain intensity.

    Method:

    The electronic charts of 100 patients at an outpatient supportive care clinic in a comprehensive cancer center were reviewed for variables like patient characteristics, initial ECS–CP assessment, morphine equivalent daily dose (MEDD), opioid rotation, Edmonton Symptom Assessment Score (ESAS), and use of adjuvant analgesics.

    Results:

    Some 91 of the 100 charts were eligible for analysis. The most common primary cancer type was gastrointestinal (22.1%). The median pain intensity was 6, and the median MEDD was 45 mg. Neuropathic pain was associated with higher median pain intensity (7 vs. 5, p = 0.007) and median MEDD requirement (83 vs. 30, p = 0.013). Psychological distress was associated with higher median pain intensity (7 vs. 5, p = 0.042). Incident pain was also associated with a trend toward higher pain intensity (6 vs. 5, p = 0.06). A higher number of negative ECS–CP features was associated with higher pain intensity (p = 0.01).

    Significance of Results:

    The ECS–CP was successfully completed in the majority of patients, demonstrating its utility in routine clinical practice. Neuropathic pain and psychological distress were associated with higher pain intensity. Also, neuropathic pain was associated with a higher MEDD. A higher sum of negative ECS–CP features was associated with higher pain intensity. Further studies will be needed to verify and explore these observations.

  • Chapter 24 - Drug synergy and therapeutic combinations

  • from Section 6 - The Management of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 290-298

  • Summary

    This chapter discusses the epidemiology, sites of strokes, clinical presentation, pathophysiology, and treatment options for central post-stroke pain (CPSP). CPSP occurs after lesions at any level of the somatosensory pathways of the brain extending from the medulla to the thalamus to the somatosensory cortex. The diagnosis of CPSP is based on a history of stroke followed by pain within an area of the body corresponding to the presumed lesion of the central nervous system with confirmation of the lesion by imaging. The pharmacological and non-pharmacological management of CPSP is challenging and is complicated by comorbid depression, anxiety, and sleep disturbances which are common in this patient population. Tricyclic antidepressants and the anticonvulsant lamotrigine are first-line analgesics in the management of CPSP. Although the prevalence of CPSP is relatively low, the pain can be resistant to treatment and can have a major impact on quality of life.

  • Chapter 27 - Impact of chronic pain upon anxiety, sleep, and mood dimensions

  • from Section 7 - The Prognosis of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 322-333

  • Summary

    Neuropathic pain is present in approximately 20-30% of cancer patients with pain. The pathological mechanisms responsible for neuropathic pain are multifactorial. Assessment of neuropathic pain is crucial to appropriate management. Several pain scales were developed for patients with cancer pain. A meticulous neurology examination is helpful to evaluate thoroughly cancer patients with neuropathic pain. The pharmacological management of neuropathic cancer pain has recently been reviewed. Tramadol, codeine, and dihydrocodeine are recommended for the treatment of mild-to-moderate cancer pain intensity. The use of an analgesic ladder should be individualized with appropriate application of supportive drugs (e.g. laxatives and antiemetics) for the prevention and treatment of opioid adverse effects. Non-pharmacological measures, such as radiotherapy and invasive procedures (nerve blockades and neurolytic blocks) should also be used as required. In patients with very severe neuropathic pain, a combination of opioids and N-methyl-D-aspartate (NMDA) receptor antagonists (e.g. ketamine) are recommended.

  • The prescription of opioid analgesics to terminal cancer patients: Impact of physicians' general attitudes and contextual factors

  • P. PERETTI-WATEL, M.K. BENDIANE, Y. OBADIA, R. FAVRE, J.M. LAPIANA, J.P. MOATTI, THE SOUTH-EASTERN FRANCE PALLIATIVE CARE GROUP
  • Journal:
    Palliative & Supportive Care / Volume 1 / Issue 4 / December 2003
    Published online by Cambridge University Press:
    01 December 2003, pp. 345-352

  • Objective: This study aimed to examine factors associated with the prescription of opioid analgesics to terminal cancer patients, including physicians' general attitudes toward morphine and contextual factors.

    Methods: A survey was conducted among a sample of French general practitioners (GPs) and oncologists. Respondents were asked to describe the last three terminally ill patients they had followed up to death.

    Results: Overall, 526 GPs and oncologists (global response rate: 57%) described 1,082 cancer patients, among whom 85.4% received opioid analgesics. Among other significant predictors (patient age, cancer type, family assistance), this prescription was less frequent for female patients followed by male physicians (OR = 0.53), and more frequent for patients followed by physicians trained in palliative care (OR = 2.70). On the other hand, physicians' attitudes toward morphine were not associated with prescription of morphine and other opioid analgesics.

    Significance of results: Although nonprescription of opioid analgesics is only a crude proxy measure for undertreatment of cancer pain, our findings suggest the need to develop training in palliative care in order to standardize practices among GPs and specialists. Our results also highlight the necessity to study pain assessment as an interaction between the physician and the patient, and to consider patients' and physicians' respective genders as a key variable within this interaction.