Relationship between morphine and radiotherapy for management of symptomatic bone metastases from lung cancer

Management of painful pelvic bone metastasis of renal cell carcinoma using embolization, radio-frequency ablation, and cementoplasty: a prospective evaluation of efficacy and safety

PURPOSE

To measure the impact on pain relief and patient quality of life using embolization radio-frequency ablation and cementoplasty (ERC) for local combination therapeutic management of painful pelvic bone metastasis of renal cell carcinoma (RCC).

MATERIALS AND METHODS

This prospective monocentric registry was approved by our Local Institutional Review Board. Between January 2008 and January 2013, all consecutive patients who fully met the inclusion criteria were enrolled in the ERC-procedure prospective registry. They were assigned to follow-up at discharge and again at 1 and 6 months. Efficacy was evaluated using a pain visual analog scale (VAS), and narcotic consumption and quality of life were assessed using the Brief Pain Inventory questionnaire.

RESULTS

Fifty-two patients were enrolled, among whom 58 lesions were treated. Technical success was obtained in all procedures. The median VAS score decreased from 7 ± 1.4 (ranges 5-10) at baseline to 3 ± 1.5 (ranges 0-6) at discharge, 2 ± 1.5 (ranges 0-5) at 1 month (p < 0.0001), and 2 ± 1.6 (ranges 0-5) at 6 months. In 28 patients (54 %), narcotic consumption was halved at discharge and halved in 40 (77 %) patients at 1 and 6 months compared with baseline. Five patients had complete pain relief at 1 month. A major improvement in quality of life, especially regarding mood and motion, was observed in all patients.

CONCLUSION

This specific approach to painful bone metastasis is efficient and safe and yields sustained results. The ERC procedure could be suggested for patients with RCC bone metastasis.

Osteoplasty: Percutaneous Bone Cement Injection beyond the Spine

Percutaneous osteoplasty, the injection of bone cement into a painful bone lesion refractory to conventional therapy (radiotherapy, chemotherapy, and narcotic analgesia), is performed to allow for immediate bone structure consolidation, reduce the risk of a pathological fracture, achieve pain regression, and improve mobility. In this article, the technique of this procedure and a review of the current literature including the author's personal large series will be described.

Scoring the effect of radiotherapy for painful bone metastases

RATIONALE

The evaluation of the analgesic effects of radiotherapy in painful bone metastases is a matter of controversies due to a lack of appropriate tools to define the outcome. An integration of competences in monitoring the pain response and modifying the opioid treatment according to changes of the clinical condition is mandatory.

PROPOSED METHOD

A meaningful score, used in previous works to monitor the global response to an analgesic intervention in advanced cancer patients, is proposed. A case report, in which opioids are first titrated and then tapered, is described as an example of application of this method.

Endogenous opiates and behavior: 2004

This paper is the 27th consecutive installment of the annual review of research concerning the endogenous opioid system, now spanning over 30 years of research. It summarizes papers published during 2004 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.