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Query: UMLS:C0596240 (cancer pain)
 3,066 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-six patients with chronic pain were treated with transcutaneous nerve stimulation (TNS). If there were any signs of sensory loss in the pain area, the electrodes were placed on the healthy side of the body. The effect of TNS was assessed quantitatively. After 9 months of repeated TNS, on average, the total pain score had improved by 39%. The subjective intensity of the pain, the frequency of pain and the need for analgesics had diminished by 46-47%. In those conditions in which total improvement was better than the mean (phantom limb pain, 65%; zoster neuralgia, 56%; thalamic pain, 45%), the healthy side of the body had been stimulated. In those in which the painful area had been stimulated (cancer pain, 32%; low back pain, 32%; brachialgia, 15%), the beneficial effect did not reach the mean for the whole series. This suggests that TNS of the healthy side of the body may give better long-term improvement than stimulation of the painful area. A theory of chronic pain and the mechanism of TNS is presented.
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PMID:[Placement of electrodes in transcutaneous stimulation for chronic pain]. 108 64

In the last 30 years antidepressant drugs have been used increasingly in the treatment of patients with chronic pain. This article reviews the results of some 40 placebo-controlled studies. It is difficult to make comparisons between the various studies because they often differ in terms of pain conditions, patient selection, antidepressant drug used, dosages, trial design, etc. However, in spite of this heterogeneity and other methodological problems it is clear that a wide range of pain conditions are responsive to antidepressant drug treatment, in particular: headache, migraine, facial pain, neurogenic pain, fibrositis, and probably arthritis and rheumatoid arthritis. More data need to be gathered in cancer pain, and in other conditions such as low back pain for which no, or very limited, effect has been shown. The beneficial effects of antidepressant drugs is in most cases of a mild to moderate degree, some time lag is necessary before it is completely manifest, and it tends to persist over time if drug treatment is continued in the long term. Strong evidence of efficacy is not evident for all the antidepressants, and there are probably significant differences in this respect between various drugs. The effect of a drug on pain does not seem necessarily to be related to its effect on mood. Further studies are needed to clarify this topic, and it will be necessary to examine specific pain conditions, compare different antidepressants, with reference to each other and to placebo, further investigate the role of drug plasma concentrations and control for the presence of concomitant psychiatric disturbances and for organic lesions responsible for the pain symptomatology.
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PMID:The use of antidepressants in the treatment of chronic pain. A review of the current evidence. 172 71

We examined the efficacy of systemic local anesthetics on various types of neuropathic pain in 89 patients. Lidocaine 1.5 mg.kg-1 was infused intravenously for one minute. Pain score (PS) by visual analogue scale (VAS, 0-10) was measured 1, 5, 15 and 35 min after the infusion. The efficacy of intravenous lidocaine was evaluated by PS which was lowest after infusion. PS decreased to less than 50 percent of pre-infusion value in more than 75 percent of cases of cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain, in 50-75 percent of cases of herpetic neuralgia, and in less than 50 percent of cases of cervical spondylosis, spinal cord injury, reflex sympathetic dystrophy, causalgia and psychogenic pain. This study suggests that systemic local anesthetics is effective in neuropathy due to cancer pain, postherpetic neuralgia, trigeminal neuralgia, low back pain with signs of root pain or spinal canal stenosis, peripheral nerve injury and thalamic pain.
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PMID:[The efficacy of intravenous lidocaine on various types of neuropathic pain]. 763 67

Two separate trials compared controlled-release (CR) oral oxycodone (administered every 12 hours) with immediate-release (IR) oxycodone (4 times a day) to determine whether patients with chronic pain could be titrated to stable pain control as readily with the CR as with the IR formulation. In one study, 48 patients with cancer pain were randomized to open-label titration with either CR or IR oxycodone (maximum dose, 400 mg/day) for a period of up to 21 days. In a study of similar design, 57 patients with low back pain were titrated with either CR or IR oxycodone (maximum dose, 80 mg/day) for a period of up to 10 days. The majority of patients in both studies were converted to oxycodone from other opioid analgesics. Results of both studies showed no difference between CR and IR oxycodone with respect to both the percentage of patients achieving stable pain control, the time to achieve stable pain control, and the degree of pain control achieved. Among cancer patients, 85% achieved stable analgesia, 92% with the CR formulation and 79% with the IR formulation. Among noncancer patients, 91% achieved stable pain control, 87% with the CR formulation and 96% with the IR formulation. The most commonly reported adverse effects in both studies were similar for the two formulations and were those anticipated with opioids: nausea, vomiting, constipation, somnolence, dizziness, and pruritus. Nausea and vomiting were the most frequently cited reasons for treatment discontinuations. These studies suggest that dose titration can be accomplished as readily with oral CR oxycodone as with IR oxycodone in patients with chronic, moderate to severe pain.
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PMID:Can a controlled-release oral dose form of oxycodone be used as readily as an immediate-release form for the purpose of titrating to stable pain control? 1053 67

The three-step analgesic ladder, originally proposed for cancer pain relief by the World Health Organization (WHO), is now widely employed for all types of pain, including the chronic pain of musculoskeletal disease. Tramadol, an analgesic with weak opioid receptor affinity and possessing monoaminergic activity, has proved suitable for use at Step 2 of the WHO ladder. Owing to its pharmacological properties, tramadol is more appropriate than NSAIDs for patients suffering from gastrointestinal and renal problems. Importantly, the analgesic potency of tramadol is greater than that of NSAIDs and of other weak opioids (codeine, dextropropoxyphene). It also causes fewer opioid-type adverse effects, e.g. nausea, drowsiness, vomiting, dry mouth and constipation. In chronic musculoskeletal pain it is recommended that tramadol should be given by mouth and by the clock; the initial dose should be titrated upward gradually to reach the individual level required for suitable pain control. This dosage strategy will also minimise the usual opioid-type adverse effects encountered with tramadol. Four recent publications are reviewed to illustrate the efficacy of tramadol, alone or in conjunction with an NSAID, in the management of low back pain, osteoarthritis pain and breakthrough pain.
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PMID:Tramadol in musculoskeletal pain--a survey. 1195 1

The role of the coxibs in the management of osteoarthritis and rheumatoid arthritis has been widely discussed, but there are other potential applications for the coxibs that have received less attention. Here we consider the use of the coxibs in acute pain syndromes such as primary dysmenorrhea and the pain associated with dental extraction, as well as considering their application in chronic low back pain and cancer pain. Another area where the coxibs may prove particularly beneficial is in the management of post-surgical pain. Traditional post-surgical analgesia has involved the use of non-selective NSAIDs and opioids, but these agents can be associated with side effects such as post-operative bleeding, gastrointestinal problems, nausea, and constipation. Because the coxibs do not inhibit COX-1 dependent platelet aggregation like traditional NSAIDs, the risk of post-surgical bleeding is reduced. The careful application of coxibs as part of a multi-modal approach to pain management in the perioperative period can reduce the requirement for opioid medications and thus reduce the risk of post-operative complications such as ileus. In the future, coxibs are likely to play an important role in multi-modal perioperative analgesic regimens with the aim of reducing post-operative periods of convalescence.
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PMID:Strategies in pain management: new and potential indications for COX-2 specific inhibitors. 1260 54

(1) The first-line drugs for mild to moderate pain are non opiate analgesics, namely paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs). (2) Codeine, dextropropoxyphene and tramadol are weak opiates; they are often used with paracetamol in fixed-dose combinations, in order to reinforce the analgesic effect of paracetamol. (3) These analgesic combinations have only been evaluated in a few situations associated with chronic and acute pain. And the endpoints used in clinical trials are designed more to show statistically significant differences than clear clinical differences. (4) In acute pain, available meta-analyses confirm that the first-line drug is paracetamol, or, if necessary, ibuprofen, a NSAID. (5) The paracetamol + codeine combination slightly increases the analgesic effect of paracetamol, but causes more adverse effects. Combinations of paracetamol + dextropropoxyphene and paracetamol + tramadol are even less useful. (6) The few available clinical trials fail to demonstrate that combining paracetamol with a NSAID is any more effective than either drug given alone, while adverse effects are increased. (7) Paracetamol is also the first-line treatment for chronic non cancer pain, such as low back pain or pain due to osteoarthritis of the hip. NSAIDs have no advantages over paracetamol in these settings. We found no trials of paracetamol + NSAID combinations. Combinations of paracetamol and weak opiates have been inadequately studied in this situation, and are only second-line options.
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PMID:Weak opiate analgesics: modest practical merits. 1505 24

Previous work by Serlin and colleagues [Serlin R C, Mendoza T R, Nakamura Y, Edwards K R, Cleeland C S. When is cancer pain mild, moderate, or severe? Grading pain severity by its interference with function. Pain 1995;61:277-84] established cutpoints for mild, moderate, and severe cancer pain based on the pain's level of interference with function. Recent work [Jensen M P, Smith D G, Ehde D M, Robinson L R. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain. Pain 2001;91:317-22; Zelman D C, Hoffman D L, Seifeldin R, Dukes, E. Development of a metric for a day of manageable pain control: derivation of pain severity cutpoints for low back pain and osteoarthritis. Pain 2003;106(1/2):35-42]found differences in cutpoints for pain severity for different pain-related conditions. Reasons for these discrepancies may relate to the methods used to determine the cutpoints or to differences based on the type or the cause of the pain. The purposes of this study were to determine the optimal cutpoints for mild, moderate, and severe pain based on patients' ratings of average and worst pain severity, using a larger range of potential cutpoints, and to determine if those cutpoints distinguished among the three pain severity groups on several outcome measures. Results from a homogenous sample of oncology outpatients with pain from bone metastasis confirm a non-linear relationship between cancer pain severity and interference with function and also confirm that the boundary between a mild and a moderate level of cancer pain is at 4 on a 0-10 numeric rating scale. However, this analysis did not confirm the boundary between moderate and severe cancer pain previously described by Serlin and colleagues [Serlin R C, Mendoza T R, Nakamura Y, Edwards K R, Cleeland C S. When is cancer pain mild, moderate, or severe? Grading pain severity by its interference with function. Pain 1995;61:277-84]. In addition, these results were not consistent with the cutpoints that were found for back pain, phantom limb pain, pain 'in general', or osteoarthritis pain reported by Jensen and colleagues and Zelman and colleagues [Jensen M P, Smith D G, Ehde D M, Robinson L R. Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain. Pain 2001;91:317-22; Zelman D C, Hoffman D L, Seifeldin R, Dukes, E. Development of a metric for a day of manageable pain control: derivation of pain severity cutpoints for low back pain and osteoarthritis. Pain 2003;106(1/2):35-42]. Possible explanations for these differences are discussed, as well as implications for future research.
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PMID:Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. 1562 57

Opioids are widely used as effective analgesic therapy for cancer pain. Despite years of controversy, their use has been also accepted in chronic non-cancer pain. Oxycodone alone and in combination has been used for over 80 years in the treatment of a variety of pain syndromes. As single agent, the controlled release (CR) oxycodone's market in the USA grew from 10% in 1996 to 53% in 2000 and it has become a leading opioid in the United States. Recent data showed that the fixed-combination oxycodone/acetaminophen (5 mg/325 mg) is the most often prescribed opioid across all the different chronic pain diagnoses. Compared with morphine, oxycodone has a higher oral bioavailability and is about twice as potent. Pharmacokinetic-pharmacodynamic data support oxycodone as a pharmacologically active opiod that does not require conversion to oxymoprhone for pharmacological activity. Seven studies addressed the safety and efficacy of oxycodone for the treatment of non-cancer pain (low back pain, osteoarthritis pain, and painful diabetic neuropathy). Both immediate release (IR) and CR oxycodone are equally effective and safe. Along these trials, mean daily dosage of oxycodone was approximately 40 mg, with a low incidence of intolerable typical opiate side effects. In cancer pain, oxycodone can be considered a valid alternative to oral morphine to be used for opioid rotation. No difference in analgesic efficacy between CR oxycodone and CR morphine was found. Controlled-release preparations, with a long duration of action, are attractive because they offer the advantage of longer dosing intervals and sustained analgesic effect.
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PMID:Oxycodone. Pharmacological profile and clinical data in chronic pain management. 1601 19

Pain is the most popular complaint since the appearance of the human on earth, a very unpleasant feeling sometimes difficult to be treated. Therefore, we have many patients who complain of pain in our hospitals or clinics. When a patient with pain visits our institution, first of all, we must evaluate the grade of pain, and then start to treat the pain of the patient. Of course, we have many devices available to treat the patient with pain. In the following special articles, device for evaluation of pain, spinal stimulation device, device for electrical current therapy (ECT), LASER device for chronic and acute pain, epiduroscopy for lumbago, as well as disposable infusion pump for postoperative pain and cancer pain are described. The mechanism of pain may be understood by patients themselves. However, devices in these articles are very useful for the treatment of pain, especially intractable pain. I feel very happy if these articles contribute greatly for the treatment of patients with pain.
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PMID:[Devices for the relief and evaluation of pain: preface and comments]. 1698 4


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