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breakthrough pain

Caterina Magnani, Diana Giannarelli, Giuseppe Casale
OBJECTIVES: To assess the prevalence of breakthrough pain (BTP) provoked by 6 common procedures in patients with advanced disease. METHODS: A prospective, cross-sectional, multicenter, national study was performed in 23 palliative care units in Italy. Patients were recruited if they were undergoing one of the following procedures as part of normal care: turning, personal hygiene care, transfer from bed to chair, bladder catheterization, pressure ulcer care, and subcutaneous drug administration...
October 20, 2016: Clinical Journal of Pain
Marcelo Epsztein Kanczuk, Nicholas Martin Barrett, Cristian Arzola, Kristi Downey, Xiang Y Ye, Jose C A Carvalho
BACKGROUND: Most studies that have compared programmed intermittent epidural bolus (PIEB) with continuous epidural infusion regimens have included patient-controlled epidural analgesia and/or manual bolus as rescue analgesia for breakthrough pain. Consequently, the optimal time interval between PIEB is yet to be determined. We designed a study to establish the optimal time interval between PIEB of 10 mL of bupivacaine 0.0625% with fentanyl 2 μg/mL to produce effective analgesia in 90% of women during first stage of labor without breakthrough pain...
October 11, 2016: Anesthesia and Analgesia
Masahiro Takita, Mina Iwanishi, Tomohiro Minami, Masashi Kono, Hirokazo Chishina, Tadaaki Arizumi, Norihisa Yada, Satoru Hagiwara, Yasunori Minami, Hiroshi Ida, Kazuomi Ueshima, Nishida Naoshi, Masatoshi Kudo
OBJECTIVE: The objective of treatment for polycystic liver disease is to reduce the liver volume and reduce or resolve compression symptoms such as abdominal fullness and abdominal pain due to hepatomegaly. Liver cysts are treated internally by puncture and aspiration of the cyst contents or hepatic artery embolization and surgically by cyst fenestration or hepatectomy, but no clear consensus has been reached concerning their selection. We introduced monoethanolamine oleate (EO) sclerotherapy therapy for liver cysts in 1999 and reported its effectiveness...
2016: Digestive Diseases
Sebastiano Mercadante, Claudio Adile, Arturo Cuomo, Federica Aielli, Franco Marinangeli, Alessandra Casuccio
OBJECTIVE: The aim of this study was to prospectively assess the efficacy and safety of low doses of sublingual fentanyl (SLF) for the treatment of breakthrough pain (BTP) in cancer patients in patients who were receiving low opioid doses for background analgesia. METHODS: A sample of cancer patients presenting BTP episodes and receiving stable low doses of opioids for background pain (less than 60 mg of oral morphine equivalents) was selected to assess the efficacy and safety of low doses of SLF (67 μg)...
October 15, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, Marilène Filbet
CONTEXT: In the European Association for Palliative Care recommendations for cancer pain management, there was no consensus regarding the indications, titration or monitoring of methadone. OBJECTIVES: This national, randomized, multicentre trial aimed to compare two methadone titration methods (stop-and-go vs progressive) in patients with cancer-related pain who were inadequately relieved by or intolerant to level 3 opioids. METHODS: The primary endpoint was the rate of success/failure at Day 4, defined as pain relief (reduction of at least two points on the visual scale and a pain score <5 for 2 consecutive days) and no overdose (Rudkin scale ≥3 and respiratory rate <8/min)...
September 29, 2016: Journal of Pain and Symptom Management
Fanny Dénommé, Marie Kroemer, Philippe Montcuquet, Gilles Nallet, Antoine Thiery-Vuillemin, Fernando Bazan, Guillaume Mouillet, Cristian Villanueva, Martin Demarchi, Ulrich Stein, Hamadi Almotlak, Loïc Chaigneau, Elsa Curtit, Nathalie Meneveau, Tristan Maurina, Erion Dobi, Thierry Nguyen Tan Hon, Laurent Cals, Laura Mansi, Clotilde Verlut, Héloïse Pana-Katatali, Mathieu Caubet, Marie-Justine Paillard, Samuel Limat, Xavier Pivot, Virginie Nerich
INTRODUCTION: Pain management is a major public health problem, especially in oncology. In order to assess professional practice, the IRFC-FC conducted a survey amongst patients with metastatic osteophilic solid tumor in Franche-Comté. The aims were to assess the pain prevalence, and its characteristics, its management and its impact on patients' quality of life in patients in pain. METHODS: An observational, prospective and multicenter survey was conducted using a self-report questionnaire...
September 29, 2016: Bulletin du Cancer
Noor Aniah Azmi, Amin Ahem, Mushawiahti Mustapha, Mae-Lynn Catherine Bastion
We report a case of enucleation for painful blind eye secondary to recurrent bleeding from choroidal neovascularisation in an eye that was irradiated following presumed metastatic breast carcinoma to the choroid. A 58-year-old woman with a history of treated breast malignancy presented with haemophthalmus and intractable glaucoma in the right eye. One year previously she had presented with right vitreous haemorrhage with subretinal mass that had been irradiated given her history of breast carcinoma. Following irradiation, vitrectomy was performed to clear the blood...
2016: BMJ Case Reports
Wei Hao, Lei Chen, Li-Fang Wu, Fan Yang, Jian-Xiang Niu, Alan D Kaye, Shi-Yuan Xu
BACKGROUND: Cancer-induced bone pain (CIBP) is a common chronic pain characterized by 2 components, ongoing pain and breakthrough pain. Tanshinone IIA (TSN IIA) is a bioactive constituent of the traditional Chinese medicine Danshen, which has been reported to have an antinociceptive effect on neuropathic and inflammatory pain through downregulation of the late proinflammatory cytokine high-mobility group protein B1 (HMGB1). OBJECTIVE: To assess the antinociceptive effect of TSN IIA on CIBP...
September 2016: Pain Physician
Jinyoung Shin, Do Yeun Kim, Juneyoung Lee, Youn Seon Choi, In Gyu Hwang, Sun Kyung Baek, Min Seok Seo, Jae Yong Shim
This study sought to explore the association between physician practice patterns and patient education, with a focus on breakthrough cancer pain (BTcP). A nationwide online survey was conducted by 92 Korean physicians. Thirteen questions on Korean physician's assessment, prescription, patient education practices, and knowledge regarding BTcP were administered. Based on their responses, physicians were divided using two methods: (1) by their patient education practices, where the "education group" always explained the distinction between background pain and BTcP and the "less education group" which explained it less frequently; and (2) by their definition of BTcP, as occurring "after control of background pain" or "regardless of background pain...
September 14, 2016: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
James Melrose
The intervertebral disc (IVD) is a major weight bearing structure that undergoes degenerative changes with aging limiting its ability to dissipate axial spinal loading in an efficient manner resulting in the generation of low back pain. Low back pain is a number one global musculoskeletal disorder with massive socioeconomic impact. The WHO has nominated development of mesenchymal stem cells and bioscaffolds to promote IVD repair as primary research objectives. There is a clear imperative for the development of strategies to effectively treat IVD defects...
October 2016: Regenerative Medicine
Arun Karyampudi, Uday C Ghoshal, Rajan Singh, Abhai Verma, Asha Misra, Vivek A Saraswat
Background/Aims: Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. Methods: Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively...
September 1, 2016: Journal of Neurogastroenterology and Motility
Bálint Botz, Kata Bölcskei, Zsuzsanna Helyes
Chronic inflammatory diseases and persistent pain of different origin represent common medical, social, and economic burden, and their pharmacotherapy is still an unresolved issue. Therefore, there is a great and urgent need to develop anti-inflammatory and analgesic agents with novel mechanisms of action, but it is a very challenging task. The main problem is the relatively large translational gap between the preclinical experimental data and the clinical results due to characteristics of the models, difficulties with the investigational techniques particularly for pain, as well as species differences in the mechanisms...
August 31, 2016: Wiley Interdisciplinary Reviews. Nanomedicine and Nanobiotechnology
Michael A Ueberall, Stefan Lorenzl, Eberhard A Lux, Raymond Voltz, Michael Perelman
OBJECTIVE: Assessment of analgesic effectiveness, safety, and tolerability of fentanyl pectin nasal spray (FPNS) in the treatment of breakthrough cancer pain (BTcP) in routine clinical practice. METHODS: A prospective, open-label, noninterventional study (4-week observation period, 3 month follow-up) of opioid-tolerant adults with BTcP in 41 pain and palliative care centers in Germany. Standardized BTcP questionnaires and patient diaries were used. Evaluation was made of patient-reported outcomes with respect to "time to first effect", "time to maximum effect", BTcP relief, as well as changes in BTcP-related impairment of daily life activities, quality-of-life restrictions, and health care resource utilization...
2016: Journal of Pain Research
Sebastiano Mercadante, Arturo Cuomo
The term "breakthrough cancer pain" (BTcP) was introduced about 25 years ago. Peaks of pain intensity reported in patients with cancer had been invariably examined in the past years, providing relevant information for a better knowledge of this phenomenon and its treatment. The aim of this critical review was to provide the golden rules, namely, the 10 commandments, for a correct diagnostic pathway of BTcP and a consequent personalized pharmacological treatment. These are as follows: 1) assessment of background analgesia, 2) drugs used for background analgesia, 3) BTcP is a frequent phenomenon, 4) characteristics of BTcP, 5) diagnosis of BTcP, 6) continuous assessment, 7) tailored pharmacological treatment of BTcP, 8) selection of BTcP medication, 9) dosing BTcP medications, and 10) education...
July 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Alexis B Peterson, R Matthew Gladden, Chris Delcher, Erica Spies, Amanda Garcia-Williams, Yanning Wang, John Halpin, Jon Zibbell, Carolyn Lullo McCarty, Jolene DeFiore-Hyrmer, Mary DiOrio, Bruce A Goldberger
In March and October 2015, the Drug Enforcement Administration (DEA) and CDC issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl (IMF), as a threat to public health and safety (1,2). IMF is pharmacologically similar to pharmaceutical fentanyl (PF), but is unlawfully produced in clandestine laboratories, obtained via illicit drug markets, and includes fentanyl analogs. Fentanyl is a synthetic opioid 50-100 times more potent than morphine and approved for the management of surgical/postoperative pain, severe chronic pain, and breakthrough cancer pain...
2016: MMWR. Morbidity and Mortality Weekly Report
Jane C Ballantyne
No abstract text is available yet for this article.
August 10, 2016: Pain
Mingkwan Wongyingsinn, Annisa Anuwongjaroen
BACKGROUND: Epidural analgesia is the recommended analgesic technique in patients having surgery with moderate to severe postoperative pain. Inadequate pain control in patients receiving epidural analgesia frequently occurred in clinical practice but the number of the success rate or the failure rate have not been reported in our university hospital. OBJECTIVE: The aim of the prospective descriptive study is to examine various data related to and evaluate the effectiveness of the postoperative epidural analgesia in Siriraj Hospital, a university hospital in Thailand...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Allison Scheetz, Richard J Ackermann
End-of-life care often involves management of pain. A patient's pain should be assessed using the Visual Analogue Scale, which uses a 0 to 10 score, with 0 indicating no pain and 10 the worst pain imaginable. Mild pain typically is managed with nonopioids (eg, acetaminophen, nonsteroidal anti-inflammatory drugs). More severe pain is managed with opioids. Opioid therapy should start with an immediate-release opioid to determine the dose needed to achieve pain control. This can be used to create a regimen with an extended-release formulation for daily pain management plus an immediate-release formulation for breakthrough pain...
August 2016: FP Essentials
Sebastiano Mercadante, Giovanna Prestia, Alessandra Casuccio
OBJECTIVES: To assess the nurses' performance in assessing, treating, and documenting breakthrough pain (BTP) in a palliative care unit where traditionally there is continuous training. METHODS: The study was performed in an acute palliative care unit. Once a week, a research nurse examined the documentation regarding all the episodes of BTP registered in a specific pain chart, designed by the institutional nurse board, as part of the routine nurse activity. RESULTS: The charts of 50 consecutive eligible patients (32 M/18 F), were analysed...
August 2, 2016: Hospital Practice (Minneapolis)
G Andrikopoulos, D Terentes-Printzios, S Tzeis, C Vlachopoulos, C Varounis, N Nikas, J Lekakis, D Stakos, S Lymperi, D Symeonidis, D Chrissos, C Kyrpizidis, D Alexopoulos, S Zombolos, S Foussas, Α Κranidis, Κ Oikonomou, V Vasilikos, P Andronikos, Α Dermitzakis, D Richter, N Fragakis, I Styliadis, S Mavridis, C Stefanadis, P Vardas
INTRODUCTION: In view of recent therapeutic breakthroughs in acute coronary syndromes (ACS) and essential demographic and socioeconomic changes in Greece, we conducted the prospective, multi-center, nationwide PHAETHON study (An Epidemiological Cohort Study of Acute Coronary Syndromes in the Greek Population) that aimed to recruit a representative cohort of ACS patients and examine current management practices and patient prognosis. METHODS: The PHAETHON study was conducted from May 2012 to February 2014...
May 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
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