Cancer Pain Management-New Therapies

AGREE II Evaluation of Clinical Practice Guidelines on Generalized Cancer Pain Management

PURPOSE

While several clinical practice guidelines (CPGs) exist to guide clinical decision-making in patients with generalized cancer pain, to date there has been no comprehensive review of their quality. Our aim was to address this deficiency via the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.

DESIGN

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline-based systematic literature search followed by AGREE II appraisal of identified CPGs.

METHODS

Embase, MEDLINE via PubMed, and Scopus were searched from inception to March 3, 2021, for relevant CPGs. Four authors (FR, AR, JN, JH) independently performed assessments and evaluations of the selected CPGs using the AGREE II instrument. Scaled domain percentage scores were calculated with 60% as the satisfactory quality threshold. Intraclass correlation coefficients (ICCs) were also calculated to assess interrater reliability.

RESULTS

Twelve guidelines were selected for inclusion. Two guidelines were classified high quality, three guidelines as average quality, and seven as low quality. Domains of clarity of presentation (82.41% ± 18.20%) and scope and purpose (56.48% ± 30.59%) received the highest mean scores, while domains of applicability (44.53% ± 26.61%) and stakeholder involvement (36.81% ± 21.24%) received the lowest. ICCs showed high consistency between reviewers (range 0.85-0.98).

CONCLUSIONS

Most CPGs for generalized cancer pain are of low quality. Future guidelines can be improved by better-defining scope and purpose, stakeholder involvement, rigor of development, applicability, and editorial independence during development.

CLINICAL IMPLICATIONS

We hope these critiques improve the quality of published guidelines to promote an improved quality of care and method to measure quality outcomes.

Emerging advances in drug delivery systems (DDSs) for optimizing cancer complications

The management and treatment of tumor complications pose continuous challenges due to the inherent complexity. However, the advent of drug delivery systems (DDSs) brings promising opportunities to address the tumor complications using innovative technological approaches. This review focuses on common oncological complications, including cancer thrombosis, malignant serous effusion, tumor-associated infections, cancer pain, and treatment-related complications. Emphasis was placed on the application and potential of DDSs in mitigating and treating these tumor complications, and we delved into the underlying mechanisms of common cancer-associated complications, discussed the limitations of conventional treatments, and outlined the current status and potential development of DDSs for various complications in this review. Moreover, we have discussed the existing challenges in DDSs research, underscoring the need for addressing issues related to biocompatibility and targeting of DDSs, optimizing drug delivery routes, and enhancing delivery efficiency and precision. In conclusion, DDSs offer promising avenues for treating cancer complications, offering the potential for the development of more effective and safer drug delivery strategies, thereby improving the quality of life and survival rates of cancer patients.

Concomitant medication effects on patients with lung cancer taking immune checkpoint inhibitors a review

In the past decade, a variety of immune checkpoint inhibitors (ICIs) are currently approved for lung cancer in the world. As a new therapeutic approach, ICIs have shown significant clinical benefits in the first-line or second-line treatment for advanced lung cancer, improving the survival and quality of life of patients. Patients need to take multiple drugs in the meantime due to their own disease or side effects during treatment. In view of drug interactions, concomitant medications have a positive or negative impact on the prognosis of lung cancer patients. In this review, we reviewed the effects of multiple drugs on the prognosis of patients with lung cancer taking ICIs. Several studies indicate that antibiotics, proton pump inhibitors (PPIs), corticosteroids, and opioid analgesics can decrease the efficacy of ICIs. Aspirin and bone-targeting drugs can enhance the efficacy of ICIs and improve the survival rate. The effects of metformin (MET), renin-angiotensin-aldosterone system inhibitors (RASI), nonsteroidal anti-inflammatory drug (NSAIDS) (except aspirin), and statins on ICIs are controversial. Future research should further explore the effects of these concomitant medications on ICIs and develop personalized prescriptions based on the specific needs of patients.

Efficacy and safety of single and double catheter intrathecal drug delivery systems in patients with refractory neck and abdominal cancer pain

Intrathecal drug delivery systems (IDDS) is a crucial for treating refractory cancer pain, but their effectiveness in patients with pain across multiple spinal segments is limited by the localized spread of pain relief medication. Our team innovatively implanted double-catheter IDDS to manage pain related to neck and abdominal cancer. While this may represent a new solution, the efficacy, safety, and cost-effectiveness remain unclear. A multi-center retrospective cohort study. Pain management and medical oncology departments of six hospitals in various regions of China. 62 patients with neck or abdominal cancer pain were enrolled from November 2019 to June 2024. Patients were divided into two groups: the double-catheter IDDS group (n = 26) and the single-catheter IDDS groups (n = 36). Propensity score matching was employed to create a balanced cohort of 48 patients. The primary outcome was pain control, assessed using Numeric Rating Scale [NRS]), breakthrough pain (BTP), and opioid consumption, including intrathecal morphine dose [IDMED] and oral daily morphine dose [ODMED]. No significant differences were observed in the NRS score and IDMED between the double-catheter and single-catheter groups prior to surgery, one day post-surgery, and at hospital discharge (p > 0.05). However, one-month post-surgery, the NRS score was significantly lower in the double-catheter group compared to the single-catheter group, while the IDMED was significantly higher compared to the single-catheter group (p < 0.05). A significantly higher number of BTP episodes and ODMED was observed in the single-catheter group compared to the two-catheter group at one day post-surgery, at hospital discharge, and one-month post-surgery (p < 0.05). The duration of hospitalization and the incidence of adverse events did not differ significantly between the two groups (p > 0.05). However, the cumulative hospitalization expenses, IDDS opioid costs per month, and refill costs calculated for a month were significantly higher in the double-catheter group compared to the single-catheter group. Conversely, the monthly oral opioid costs and total costs of analgesic were significantly lower in comparison to the single-catheter group (p < 0.05). The preliminary findings of this study, both single- and double-catheter IDDS effectively manage cancer pain in neck and abdominal cancer patients without increasing adverse events. Despite higher initial costs, double-catheter IDDS demonstrates superior long-term pain control, a reduced incidence of BTP, and lower overall monthly analgesic costs. However, due to the limitations of the study's sample size and patient survival time, further research is needed to assess the long-term benefits.

Effectiveness and safety of acupuncture for cancer-related hiccups: a systematic review and meta-analysis

Background

The use of acupuncture in cancer treatment is expanding. Nevertheless, the efficacy and safety of acupuncture in alleviating cancer-related hiccups remains uncertain and inconclusive.

Methods

We conducted a systematic search across eight databases: PubMed, China National Knowledge Infrastructure Database, WanFang, China Science and Technology Journal Database, SinoMed, Web of Science, Cochrane, and Embase, covering the period from their inception to July 2023. Literature was screened based on predefined PICOS inclusion and exclusion criteria, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Data synthesis was performed using Review Manager 5.3 software and R studio 4.4. Additionally, we conducted a frequency analysis of acupoint usage.

Results

A total of nine randomized controlled trials (RCTs) involving 580 patients were included in the analysis. The risk of bias assessment indicated a high risk of bias in all nine RCTs, primarily due to blinding of participants and personnel and random sequence generation (selection bias). The meta-analysis revealed that acupuncture significantly reduced the symptoms of cancer-related hiccups compared to pharmacological treatment (relative risk (RR) = 1.83, 95% confidence interval (CI) [1.53, 2.20], p < 0.001, I2 = 27%). In terms of onset time, acupuncture demonstrated a shorter duration of onset compared to pharmacological treatment (mean difference (MD) = -8.71, 95% CI [-23.32 5.89], p < 0.01, I2 = 100%). Furthermore, acupuncture exhibited a significant improvement in sleep, eating, and appetite scores compared to pharmacological treatment (MD = 0.68, 95% CI [0.07, 1.29], p = 0.03; MD = 0.68, 95% CI [0.07, 1.30], p = 0.03; MD = 0.66, 95% CI [0.08, 1.25, p = 0.03]). The frequency of acupoint usage was analyzed, with ST36 and PC6 being the most frequently used acupoints. Regarding adverse events, acupuncture exhibited favorable safety profiles compared to other control groups.

Conclusion

The meta-analysis results suggest that acupuncture has a positive effect on the efficacy rate for cancer-related hiccups, as well as improvements in quality of life and time to effect response. However, due to the high risk of bias and quality limitations of the included studies, no conclusive evidence currently supports the efficacy of acupuncture. High-quality, evidence-based research is still needed to confirm the effectiveness of acupuncture in treating cancer-related hiccups.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, CRD42023451403.

Pain Management in Cancer Patients: The Effectiveness of Digital Game-based Interventions: A Rapid Literature Review

OBJECTIVES

Pain is a common side effect of cancer that negatively impacts biopsychosocial well-being and quality of life. There has been increasing interest in using digital game interventions for managing pain in cancer patients. The present study aimed to consolidate and summarize knowledge regarding the role of games in reducing pain among cancer patients and enhancing their overall quality of life.

METHODS

We reviewed studies published between 2000 and April 8, 2023, from databases such as PubMed, Scopus, and Web of Science. The focus was on determining the impact of health games on pain management in cancer patients.

RESULTS

An initial search identified 2,544 studies, which were narrowed down to 10 relevant articles after removing duplicates and assessing quality. These studies examined the use of mobile and computer games across various types of cancer, including both pediatric and adult cases. The findings indicate that digital games, particularly those utilizing virtual reality technologies, can diminish pain and anxiety while enhancing treatment outcomes. Overall, the application of these technologies has the potential to improve cancer treatment.

CONCLUSIONS

Digital game interventions empower cancer patients by fostering effective communication and patient-centered approaches, which enhance perceptions, outcomes, and overall well-being. These games provide real-time feedback and facilitate interaction with healthcare professionals, which promotes self-management and boosts patient motivation and adherence to treatment protocols. As personalized educational platforms, they increase engagement through educational resources and symptom tracking, while also encouraging physical activity. Furthermore, they act as distraction tools during painful procedures, presenting new research opportunities in pain management and enhancing overall quality of life.

Ganglion Impar Neurolysis to Treat Refractory Chronic Pain From Vulvar Cancer: A Case Report

Cancer pain treatment currently consists of the administration of pain medications, radiation therapy, tumor ablation as well as neurolytic plexus blocks. Neurolytic plexus blocks target both sensory afferent fibers and sympathetic fibers innervating visceral organs. Finding the right block for a specific type and location of cancer-related pain is crucial for the successful control of pain. One such example is a ganglion impar block for perineal pain. We report a case of a patient with chronic severe perineal pain from vulvar cancer and multiple surgeries, for whom a ganglion impar block followed by neurolysis provided significant pain relief.

Advancing the integration of biosignal-based automated pain assessment methods into a comprehensive model for addressing cancer pain

BACKGROUND

Tailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address the potential correlations between subjective and APA-derived objectives variables in a cohort of cancer patients.

METHODS

A multidimensional statistical approach was employed. Demographic, clinical, and pain-related variables were examined. Objective measures included electrodermal activity (EDA) and electrocardiogram (ECG) signals. Sensitivity analysis, multiple factorial analysis (MFA), hierarchical clustering on principal components (HCPC), and multivariable regression were used for data analysis.

RESULTS

The study analyzed data from 64 cancer patients. MFA revealed correlations between pain intensity, type, Eastern Cooperative Oncology Group Performance status (ECOG), opioids, and metastases. Clustering identified three distinct patient groups based on pain characteristics, treatments, and ECOG. Multivariable regression analysis showed associations between pain intensity, ECOG, type of breakthrough cancer pain, and opioid dosages. The analyses failed to find a correlation between subjective and objective pain variables.

CONCLUSIONS

The reported pain perception is unrelated to the objective variables of APA. An in-depth investigation of APA is required to understand the variables to be studied, the operational modalities, and above all, strategies for appropriate integration with data obtained from self-reporting.

TRIAL REGISTRATION

This study is registered with ClinicalTrials.gov, number (NCT04726228), registered 27 January 2021, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT04726228?term=nct04726228&draw=2&rank=1.

Microglia Promote Inhibitory Synapse Phagocytosis in the Spinal Cord Dorsal Horn and Modulate Pain-Like Behaviors in a Murine Cancer-Induced Bone Pain Model

BACKGROUND

The microglial activation has been implicated in cancer-induced bone pain. Recent studies have revealed that microglia mediate synaptic pruning in the central nervous system, where the cluster of differentiation 47-signal regulatory protein α (CD47-SIRPα) axis creates a "don't eat me" signal and elicits an antiphagocytic effect to protect synapses against elimination. To date, the synaptic phagocytosis in microglia has never been investigated in the murine cancer-induced bone pain model. The present experiments sought to explore whether microglia phagocytize synapses in mice with bone cancer pain as well as the possible mechanisms.

METHODS

Male C3H/HeN mice were used to induce bone cancer pain. Minocycline and S-ketamine were injected into D14. The number of spontaneous flinches (NSF) and paw withdrawal mechanical thresholds (PWMT) were measured on D0, D4, D7, D10, D14, D21, and D28. Hematoxylin and eosin staining presented bone lesions. Western blotting examined the Gephyrin, CD47, and SIRPα expression. Flow cytometry evaluated the proportion of SIRPα + cells in the spine. Immunofluorescence and 3-dimensional reconstruction showed the Gephyrin puncta inside microglial lysosomes.

RESULTS

Mice embedded with tumor cells induced persistent spontaneous pain and mechanical hyperalgesia. Hematoxylin and eosin staining revealed bone destruction and tumor infiltration in marrow cavities. Microglia underwent a responsive and proliferative burst (t = -16.831, P < .001). Western blotting manifested lowered Gephyrin expression in the tumor group (D4, D7, D10, D14, D21, and D28: P < .001). Immunofluorescence and 3-dimensional reconstruction showed larger volumes of Gephyrin puncta inside microglial lysosomes (t = -23.273, P < .001; t = -27.997, P < .001). Treatment with minocycline or S-ketamine exhibited pain relief and antiphagocytic effects (t = -6.191, P < .001, t = -7.083, P < .001; t = -20.767, P < .001, t = -17.080, P < .001; t = 11.789, P < .001, t = 16.777, P < .001; t = 8.868, P < .001, t = 21.319, P < .001). Last but not least, the levels of CD47 and SIRPα proteins were downregulated (D10: P = .004, D14, D21, and D28: P < .001; D10, D14, D21, and D28: P < .001). Flow cytometry and immunofluorescence substantiated reduced microglial SIRPα (t = 11.311, P < .001; t = 12.189, P < .001).

CONCLUSIONS

Microglia-mediated GABAergic synapse pruning in the spinal cord dorsal horn in bone cancer pain mice, which might be associated with the declined CD47-SIRPα signal. Our research uncovered an innovative mechanism that highlighted microglia-mediated synaptic phagocytosis in a murine cancer-induced bone pain model.

Use of Caudal Quadratus Lumborum Block with Ropivacaine as Part of an Opioid-Free Analgesic Protocol in Dogs Undergoing Orchiectomy: A Randomized Trial

In veterinary medicine, the use of loco-regional anesthesia techniques is increasing. The Quadratus Lumborum block (QL) is an interfascial loco-regional technique that involves the release of local anesthetic (LA) between the Quadratus Lumborum and the Small Psoas (Pm) muscle. The study aims to evaluate the effect of the QL block on reducing the total amount of opioids in dogs undergoing pre-scrotal orchiectomy. A group of 36 dogs was enrolled in a randomized blinded study. The animals were divided into two groups: 18 in the experimental group (QL) and 18 in the control group (C). The QL group received 0.4 mL kg-1 of ropivacaine 0.5% for each hemiabdomen (total amount of 3 mg kg-1 of ropivacaine, 1.5 mg kg-1 per side). The C group was brought into the operating room (OR) after receiving the same clipping as the QL group. In the intraoperative period, opioid consumption in the QL group was significantly lower than in the C group. No differences were found in the post-operative phase. No side effects were reported when performing the QL technique. The QL block performed at the level of L6 appears to be a valid approach to reducing opioid use in dogs undergoing orchidectomy with a pre-scrotal surgical approach.

Effectiveness of epidural morphine for the treatment of cancer pain in patients with gastrointestinal neoplasm-a systematic review

One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.

Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: a national survey

Scope

The present investigation seeks to illuminate the current state and disparities in the knowledge, attitudes, and practices (KAP) among healthcare professionals regarding the management of lung cancer palliative care (LCPC) in China, while simultaneously assessing the prevalence and context of patient-controlled analgesia (PCA) usage in the management of cancer-related pain.

Methods

A total of 2093 healthcare practitioners from 706 hospitals across China completed a structured questionnaire that probed various facets of LCPC management. The questionnaire consisted of seven thematic sections, incorporating chi-square tests and Fisher's exact probabilities to statistically assess the discrepancies in KAP among healthcare professionals across different hospital grades. Ordered data distributions among hospital grades were compared using non-parametric Kruskal-Wallis H and Mann-Whitney U tests. Multiple-choice items were subjected to multiple-response cross-tabulation analysis, while the Spearman rank-order correlation coefficient was employed to gauge potential associations among variables.

Results

Around 84.2% of the respondents perceived anti-tumor therapy to be of equal importance to palliative care. Statistically significant differences (χ² = 27.402, P = 0.002) in satisfaction levels were observed, with participants from Tertiary hospitals demonstrating higher satisfaction compared to those from Secondary and Primary hospitals. Pain emerged as the most prevalent symptom necessitating LCPC. Major impediments to LCPC adoption included patients' and families' concerns about the safety of long-term palliative care-related drug use. 31.1% of the respondents cited the most frequent rationale for PCA use as cases involving patients who required systemic administration of large opioid doses or exhibited intolerable adverse reactions to opioids. The principal deterrents against the use of PCA for cancer pain management were (1): apprehension about adverse drug reactions due to overdose (2), concern about the potential for opioid addiction, and (3) the anticipated increase in patients' economic burdens. Over the preceding 24-month period, 33.9% of the surveyed healthcare practitioners reported no engagement in either online or offline LCPC-related training initiatives.

Conclusion

This study emphasizes the pressing need for comprehensive training in LCPC among Chinese health personnels, particularly focusing on the effective management of cancer pain symptoms.

Targeting TRPV4 Channels for Cancer Pain Relief

Despite the unique and complex nature of cancer pain, the activation of different ion channels can be related to the initiation and maintenance of pain. The transient receptor potential vanilloid 4 (TRPV4) is a cation channel broadly expressed in sensory afferent neurons. This channel is activated by multiple stimuli to mediate pain perception associated with inflammatory and neuropathic pain. Here, we focused on summarizing the role of TRPV4 in cancer etiology and cancer-induced pain mechanisms. Many studies revealed that the administration of a TRPV4 antagonist and TRPV4 knockdown diminishes nociception in chemotherapy-induced peripheral neuropathy (CIPN). Although the evidence on TRPV4 channels' involvement in cancer pain is scarce, the expression of these receptors was reportedly enhanced in cancer-induced bone pain (CIBP), perineural, and orofacial cancer models following the inoculation of tumor cells to the bone marrow cavity, sciatic nerve, and tongue, respectively. Effective pain management is a continuous problem for patients diagnosed with cancer, and current guidelines fail to address a mechanism-based treatment. Therefore, examining new molecules with potential antinociceptive properties targeting TRPV4 modulation would be interesting. Identifying such agents could lead to the development of treatment strategies with improved pain-relieving effects and fewer adverse effects than the currently available analgesics.

External treatment of traditional Chinese medicine for cancer pain: A systematic review and network meta-analysis

BACKGROUND

Cancer pain is one of the most intolerable and frightening symptoms of cancer patients. However, the clinical effect of the three-step analgesic ladder method (TSAL) is not satisfactory. The combination of external treatment of traditional Chinese medicine (TCM) can improve the clinical effect.

OBJECTIVE

This study used network meta-analysis to compare the effects of different external treatment methods of TCM combined with TSAL on cancer pain.

METHODS

Databases searched by our team included Google Scholar, Web of Science, Scopus, Embase, PubMed, and Cochrane Library. Randomized controlled trials related to the external treatment of TCM combined with TSAL for cancer pain were screened from the establishment of the database till now. The above literature extracted clinical efficacy, NRS score, KPS score, analgesic onset time, and duration as the main results after the screening. The 95% confidence interval (95% CI) of OR value and SMD value was used as the effect index to compare the difference in efficacy of different interventions, and the ranking was conducted. STATA 17.0 software was used for the statistical analysis of the above data.

RESULTS

A total of 78 studies were included, including 8 interventions and 5742 participants. Based on ranking probability, the clinical effective rate of manual acupuncture combined with TSAL was the best when the intervention time was set at 4 weeks [OR = 5.42, 95% CI (1.99,14.81)], and the improvement effect on KPS score was also the best [SMD = 0.97, 95% CI (0.61, 1.33)]. Acupoint external application was the best intervention in reducing NRS score [SMD = -1.14, 95% CI (-1.90, -0.93)]. Acupoint moxibustion combined with TSAL was considered to be the most effective intervention to prolong the duration of analgesia [SMD = 1.69, 95% CI (0.84, 2.54)] and shortening the onset time of analgesia [SMD = -3.00, 95% CI (-4.54, -1.47)].

CONCLUSIONS

TSAL combined with manual acupuncture is the best in terms of clinical efficacy and improvement of patients' functional activity status. With the extension of treatment time, the intervention of this kind of treatment on the clinical effect is more pronounced. Acupoint external application also has a unique advantage in reducing the pain level of patients. From the point of view of analgesic duration and duration of analgesia, combined acupoint moxibustion has the best effect.

Clinical Significance of Mean Platelet Volume Combined with Neutrophil-Lymphocyte Ratio in Predicting the Therapeutic Effect of Splanchnic Neurolysis

Introduction

In most cases of pain related to abdominal tumors, increasing the dosage of analgesics still makes the pain difficult to alleviate. Splanchnic neurolysis is a new treatment option. However, not all patients receiving splanchnic neurolysis treatment will achieve satisfactory results. The aim of this study is to retrospectively analyze the predictive value of preoperative serum immune indicators (white blood cells, neutrophils, lymphocytes, and platelets) for the efficacy of splanchnic neurolysis.

Methods

The abdominal cancer patients (pancreatic cancer, liver cancer, gastric cancer, colorectal cancer, cholangiocarcinoma, and renal cancer) admitted to the Department of Pain Medicine, Harbin Medical University Cancer Hospital from January 2017 to October 2020 were collected. We evaluate the efficacy of splanchnic neurolysis by assessing the dosage of opioids and Numerical Rating Scale (NRS) scores of patients 24 to 48 hr before and after splanchnic neurolysis. The predictive value of preoperative serum immune indicators on the efficacy of splanchnic neurolysis was analyzed using Receiver Operating Characteristic (ROC). Contract the Nomogram prediction model by R software.

Results

We found that Mean Platelet Volume (MPV) has statistical significance for predicting splanchnic neurolysis efficacy in digestive system tumors. MPV and Neutrophil-Lymphocyte Ratio (NLR) are independent predictors and have statistical significance in predicting splanchnic neurolysis efficacy in pancreatic cancer. The combination of MPV and NLR had satisfactory predictive value in pancreatic cancer (AUC = 0.715) and the nomogram model was constructed. Furthermore, there was a negative correlation between lymphocyte count and NRS score, and a positive correlation between Platelet-Lymphocyte Ratio (PLR) and NRS score.

Discussion

The combined detection of MPV and NLR has important clinical predictive value for the postoperative efficacy of splanchnic neurolysis in pancreatic cancer.

The Role of Ultrasound in Cancer and Cancer-Related Pain-A Bibliometric Analysis and Future Perspectives

Ultrasound has a deep penetrating ability with minimal or no tissue injury, while cancer-mediated complications during diagnosis, therapy, and surgery have become a serious challenge for clinicians and lead to the severity of the primary condition (cancer). The current study highlights the importance of ultrasound imaging and focused ultrasound therapy during cancer diagnosis, pain reduction, guidance for surgical resection of cancer, and the effectiveness of chemotherapy. We performed the bibliometric analysis on research domains involving ultrasound, cancer management, pain, and other challenges (chemotherapy, surgical guidance, and postoperative care), to observe the trend by which the research field has grown over the years and propose a possible future trend. The data was obtained from the Web of Science, processed, and exported as plain text files for analysis in the Bibliometrix R web interface using the Biblioshiny package. A total of 3248 documents were identified from 1100 journal sources. A total of 390 articles were published in 2022, with almost a 100% growth rate from previous years. Based on the various network analysis, we conclude that the outcome of the constant research in this domain will result in better patient care during the management of various diseases, including cancer and other co-morbidities.

Cancer Patients with Chronic Pain and Their Caregivers during COVID-19: A Descriptive Study

BACKGROUND

The sanitary measures imposed by COVID-19 intensified challenges in the pain management of cancer patients.

METHODS

A descriptive study was conducted in a chronic pain unit of an oncological hospital aiming to explore the experiences of cancer patients with chronic pain and their caregivers during the pandemic period, as well as identify strategies to improve care in chronic pain management. An electronic questionnaire was developed containing sociodemographic variables, the Depression, Anxiety and Stress Scale-21, and open-ended questions exploring the experiences and circumstances of pain management.

RESULTS

A total of 30 patients and 13 caregivers filled in the questionnaire. Patients revealed a higher level of depression, anxiety, and stress than caregivers, without statistically significant differences. Both groups mentioned having experienced difficulties in self-care, particularly in relation to sleep, nutrition, and recreation. In total, 83.7% patients needed pain relief medication related to uncontrolled pain. Both mentioned that they would have benefited from a digital application to ease the communication with the healthcare professionals of the chronic pain unit, as well as non-pharmacological interventions, such as therapeutic massage.

CONCLUSIONS

Recognizing that chronic pain leads to significant limitations, it is essential to implement and anticipate objective and effective responses in pain management.

Brain stimulation for chronic pain management: a narrative review of analgesic mechanisms and clinical evidence

Chronic pain constitutes one of the most common chronic complaints that people experience. According to the International Association for the Study of Pain, chronic pain is defined as pain that persists or recurs longer than 3 months. Chronic pain has a significant impact on individuals' well-being and psychosocial health and the economy of healthcare systems as well. Despite the availability of numerous therapeutic modalities, treatment of chronic pain can be challenging. Only about 30% of individuals with non-cancer chronic pain achieve improvement from standard pharmacological treatment. Therefore, numerous therapeutic approaches were proposed as a potential treatment for chronic pain including non-opioid pharmacological agents, nerve blocks, acupuncture, cannabidiol, stem cells, exosomes, and neurostimulation techniques. Although some neurostimulation methods such as spinal cord stimulation were successfully introduced into clinical practice as a therapy for chronic pain, the current evidence for brain stimulation efficacy in the treatment of chronic pain remains unclear. Hence, this narrative literature review aimed to give an up-to-date overview of brain stimulation methods, including deep brain stimulation, motor cortex stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, cranial electrotherapy stimulation, and reduced impedance non-invasive cortical electrostimulation as a potential treatment for chronic pain.

The prospect of Xihuang pill in the treatment of cancers

Background

Xihuang pill, a Traditional Chinese Medicine (TCM) prescription and a representative of Huoxuehuayu therapy (one of the TCM therapies to promote blood circulation and remove blood stasis), has been widely used in breast cancer treatments. Although some evidence suggests the efficacy and safety of the Xihuang pill in treating certain cancer, the overall efficacy of the Xihuang pill in other cancer treatment is uncertain.

Objective

This study aimed to summarize the current clinical literature and provided evidence support for addressing the research question of whether the Xihuang pill is safe and effective in the treatment of various cancers as Huoxuehuayu therapy, and possibly identify the clinical dosage range and therapeutic effect of Xihuang pills.

Method

Seven Chinese and English databases such as PubMed, CNKI, and Google Scholar were searched to collect the publications on Xihuang pill and cancer. Then the researchers extracted data from the articles that met the inclusion criteria and used SAS statistical program version 9.4 (by SAS Institute, Cary, North Carolina, USA) for statistical statistics.

Results

Our search identified 78 studies, including 69 RCTs (randomized control trials), 6 NRCCs (non-randomized concurrent control trials), and 3 BAS (before-after study), evaluating 3151 patients in total. The daily doses of Xihuang pills/capsule were between 2 g and 60 g, and duration between 2 weeks and 5 years, mostly used in the middle or late stage of cancer. The therapeutic effect of the Xihuang pill was mainly reflected in improving Complete Response (CR, a term from The Response Evaluation Criteria In Solid Tumors) or Partial Response (PR, a term from The Response Evaluation Criteria In Solid Tumors), reducing adverse reactions, promoting quality of life (QoL), regulating immunity, alleviating pain, prolonging survival, reducing metastasis and recurrence, reducing inflammation, regulating estrogen levels, decreasing hypercoagulative status, and reducing tumor markers.

Conclusion

Xihuang pill representing Huoxuehuayu therapy has a good prospect in the treatment of cancer.

Adherence to Analgesic Drugs and its Associated Factors among Patients with Cancer Pain: A Crosssectional Study in China

Objectives: Pain is one of the most common and distressing symptoms co-occurring with cancer progression and treatment, and medication adherence plays an important role in achieving good pain control. However, research on medication adherence and influential factors among individuals with cancer pain (CP) is limited in China. The present study aimed to investigate the adherence to analgesics in patients with CP in China and to identify factors that may influence adherence. Methods: A cross-sectional study was conducted from June 2020 to February 2021. Study instruments consisted of a set of validated questionnaires, 5 measurement instruments including the numerical rating scale (NRS), ID-Pain, Morisky Medication Adherence Scale-Chinese validated version (MMAS-C), Beliefs about Medicines Questionnaire (BMQ) - Specific, and the Hospital Anxiety and Depression Scale (HADS). Results: A total of 141 participants with CP including 71 males (50.4%), aged 54.5±15.5 years were surveyed in this study. Overall, 83 patients (58.9%) showed adherence, but 58 patients (41.1%) showed non-adherence to analgesics. The univariate analysis showed that analgesic adherence was associated with pain duration of>3 months, outbreaks of pain in the last 24 hours, presence of side effects, getting analgesics in time, presence of neuropathic pain, stopping analgesics or adjusting dosage by themselves, presence of anxiety and depression, and beliefs about medicines. Moreover, the multivariate logistic regression showed that getting analgesic drugs in time (odds ratio [OR]=5.218, 95% confidence interval [CI] 1.691-16.100) and high BMQ-Necessity (OR=1.907, 95% CI 1.418-2.565) were associated with high adherence, stopping analgesics or adjusting dosage by themselves (OR=7.958, 95% CI 2.443-25.926) and high BMQ-Concern (OR=0.760, 95% CI 0.600-0.964) were more likely to be associated with non-adherence. Conclusion: In view of our findings, it may be critical for individuals to have a better understanding and strong beliefs about their prescribed analgesic drugs. Pain education, counseling and follow-up of patients and their caregivers, and removal of barriers to accessing analgesic drugs could be considered in further intervention strategies.