cancer pain
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Abstract Background The current study sought to explore whether cancer pain (CP) already exists in patients at colorectal cancer (CRC) diagnosis before treatment compared with patients with colorectal cancer (CRC) after treatment and a healthy matched control group. The study also sought to examine whether factors related to physical health status could enhance pain processes. Methods An observational cross-sectional study was conducted following the STROBE checklist. Twenty-nine newly diagnosed and forty post-treatment patients with CRC and 40 healthy age/sex-matched controls were included for comparison. Pain, local muscle function, and body composition outcomes were assessed by a physiotherapist with > 3 years of experience. ANCOVA and Kruskal–Wallis tests were performed, with Bonferroni and Dunn-Bonferroni post hoc analyses and Cohen’s d and Hedge’s effect size, as appropriate. Results The analysis detected lower values of pressure pain threshold (PPT) points, the PPT index, and abdominal strength and higher values of self-reported abdominal pain in newly diagnosed patients, with even more marked results observed in the post-treatment patients, where lower lean mass and skeletal muscle index values were also found than those in the healthy matched controls (p < 0.05). In the post-treatment and healthy matched control groups, positive associations were observed between the PPT lumbar dominant side points and abdominal isometric strength and lean mass, and negative associations were observed between the lumbar dominant side points and body fat (p < 0.05). Conclusion Upon diagnosis, patients with CRC already show signs of hyperalgesia and central sensitization and deteriorated physical conditions and body composition, and this state could be aggravated by subsequent treatments.

Cancer is one of the leading causes of morbidity in the globe, with more than half of patients reporting pain as a result of the disease. By reducing cancer-related pain, dance has the potential to redefine the life of patients independently of their cure prognosis. This review investigated the benefits of dance as adjuvant, non-pharmacological therapy for cancer treatment. To identify studies related to this topic, we searched the Cochrane Library, PUBMED, Scielo, BVS, Embase, CINAHL, and PsycINFO databases. However, we found few published systematic reports investigating the effects of dance in cancer treatment. The numbers are even smaller when we considered the relationship between dance and cancer pain. Although there is a small number of publications on this theme, we reviewed studies that indicate that there is a positive relationship between dance practice and cancer pain management. Moreover, we found that the decline of pain contributed to the better life quality of patients with cancer. We concluded that dance is a physical practice that may improve patients’ quality of life. Regarding the estimations of cancer diagnosis and pain during disease development and therapy, it is fundamental new studies and clinical trials that integrate dance as adjuvant therapy for improving cancer pain and patient’s life quality.

Abstract Background This study aims to develop an evidence-based clinical practice guideline of acupuncture in the treatment of patients with moderate and severe cancer pain. Methods The development of this guideline was triggered by a systematic review published in JAMA Oncology in 2020. We searched databases and websites for evidence on patient preferences and values, and other resources of using acupuncture for treatment of cancer pain. Recommendations were developed through a Delphi consensus of an international multidisciplinary panel including 13 western medicine oncologists, Chinese medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient preferences and values, resources, and other factors were fully considered in formulating the recommendations. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the certainty of evidence and the strength of recommendations. Results The guideline proposed three recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia. Conclusion This proposed guideline provides recommendations for the management of patients with cancer pain. The small sample sizes of evidence limit the strength of the recommendations and highlights the need for additional research.

Abstract The pro-inflammatory (M1) and anti-inflammatory (M2) status of microglial determines the outcome of neuroinflammation, which contributes to the pathogenesis of chronic morphine tolerance. Studies report that α2-adrenoceptor agonist dexmedetomidine exerts anti-inflammatory effects in inhibiting morphine tolerance in normal and neuropathic pain animals, which has not been studied in cancer pain. Therefore, we investigate the effect of intrathecal DEX on morphine tolerance in cancer pain, and whether dexmedetomidine functions via modulating microglial activation and M1/M2 polarization. 54 Wistar rats with intrathecal catheterization were treated by morphine for 10 days. Test groups received intrathecal α2-adrenoceptor agonist dexmedetomidine or antagonist MK-467. The mRNA levels of TLR4 and NF-κB were tested by RT-PCR. The protein levels of TLR4, NF-κB, Iba-1, iNOS, CD206 were quantifed using Western blotting, and IL-10 and TNF-α were examined by ELISA. Dexmedetomidine attenuates mechanical threshold and thermal latency, and increased the expression of TLR4 and NF-κB in morphine tolerance of cancer pain. Dexmedetomidine attenuates mechanical and thermal nociception in morphine tolerance in cancer pain rats. Intrathecal DEX pre-treatment significantly increased the protein levels of microglia maker Iba-1, M2 marker CD206 and anti-inflammatory factor IL-10, while had no evident influence on the pro-inflammatory factor TNF-α and M1 marker iNOS in morphine tolerance. Our findings suggest that intrathecal dexmedetomidine attenuates morphine tolerance in cancer pain via α2-adrenoceptor pathway. Furthermore, dexmedetomidine upregulates TLR4/NF-κB pathway and induces microglia activation in chronic morphine tolerance of cancer pain. The anti-inflammatory effect of dexmedetomidine might be exerted by inducing microglia M2 polarization and increasing anti-inflammatory factor IL-10.

Abstract Background: Bone cancer pain (BCP) is a common chronic pain that is caused by a primary or metastatic bone tumor. It is refractory to currently available clinical treatment owing to its complicated underlying mechanisms. Methods: In this study, we used proteomics approaches to investigate expressional changes of the rat spinal cord proteome from 7 to 21 d after inoculation. Proteins from the rat L4-6 spinal cord homogenates of BCP and Sham animals were fractionated by two-dimensional (2-DE) gel electrophoresis to produce a high-resolution map of the spinal cord soluble proteins. Proteins showing altered expression levels between BCP and Sham were selected. Results: A total of 60 spots were obtained, and isolated proteins were in-gel trypsin-digested and the resulting peptides were analyzed by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry. Using the mass spectrometric data, 34 differentially expressed proteins (DEPs) were identified. GO analysis of the identified proteins allowed us to explore the function of the represented proteins. Conclusions: Based on these results, the identified proteins may contribute to the maintenance of BCP, and may provided new or valuable information in the discovery of new therapeutic targets for BCP.

Abstract Purpose: This study was to investigate the clinical efficacy of tapentadol extended-release (ER) on pain control and the quality of life of patients with moderate to severe chronic cancer pain in clinical practice in Korea.Methods: In this prospective, open-label, multicenter trial, patients with sustained cancer pain as well as chronic pain, using or not using other analgesics were enrolled. Thirteen centers recorded a total of 752 patients, during the 6-month observation period, based on the tapentadol ER dose and tolerability, prior and concomitant analgesic treatment, pain intensity, type of pain, adverse effects, and clinical global impression change (CGI-C). A total of 752 patients were screened, 688 were enrolled, and 650 completed the study for efficacy and adverse drug reactions; among them 349 were cancer patients.Results: In total, 752 patients were screened, 688 were enrolled and 650 were completed the study for efficacy and adverse drug reactions, 349 of whom were cancer patients. Tapentadol ER significantly reduced the mean pain intensity including neuropathic pain during the observation period by 2.9 points (from a mean 7±0.87 to 4.1±2.02). Furthermore, the quality of life was observed to be significantly improved based on an objective observation, such as the CGI-C.Conclusion: This study showed that tapentadol ER was effective in patients with moderate to severe cancer pain and was also effective in neuropathic pain, and therefore it significantly improved the patients’ quality of life.