Daily pain and opioid administration in hospitalized patients with cancer: the importance of psychological factors, recent surgery, and current opioid use

Initial Feasibility and Acceptability of Cancer Pain 101: An Interdisciplinary, Single-Session, Telehealth Intervention for Patients With Cancer-Related Pain

INTRODUCTION

Patients with cancer have limited access to comprehensive pain treatment. We developed a 90-min, single-session, telehealth, interdisciplinary intervention that combines cancer-specific medical education and behavioral pain treatment. We evaluated the intervention's preliminary feasibility and acceptability for patients with cancer-related pain.

METHODS

Adults with cancer-related pain (≥ 4/10, average pain) who are receiving cancer treatment (< 3 months) self-enrolled or were recruited from the Stephenson Cancer Center (SCC) in Oklahoma. Patients completed a baseline survey and attended the 90-min group-based, Zoom-delivered telehealth intervention. They completed post-intervention, 2-week, and 4-week follow-up assessments and an optional debriefing interview. The feasibility benchmark was ≥ 70% attendance and 80% of acceptability items rated ≥ 4/5.

RESULTS

Seventy participants (67.5% female; mean age = 52.5 years; 25% rural-dwelling) enrolled. Forty of 70 (57%) attended the intervention. Of those, 95% completed the post-intervention survey, and 90% and 95% completed the 2-week and 4-week follow-ups, respectively. Participants reported high acceptability, understandability (97%), and relevance (90%). Most (80%) would recommend the class to others. Qualitative feedback highlighted reduced helplessness and fear regarding opioid use, adoption of behavioral pain management strategies, and appreciation for the convenience of telehealth. Exploratory analyses showed significant reductions in pain intensity (mean difference [MD] = 1.27, p = 0.001), pain interference (MD = 5.48, p = 0.017), pain catastrophizing (MD = 6.0, p = 0.003), sleep disturbance (MD = 3.64, p = 0.004), and depression (MD = 3.97, p = 0.018) at 4 weeks.

CONCLUSION

While attendance was below feasibility benchmarks, this interdisciplinary, telehealth intervention was acceptable and improved self-reported cancer pain management. Further research will identify barriers to improve attendance, and determine the optimal timing within the cancer trajectory to deliver pain self-management content. Randomized controlled trials are needed to assess intervention efficacy on patient outcomes.

N-Methyl-D-aspartate receptor antagonists for the prevention of chronic postsurgical pain: a narrative review

The N-methyl-D-aspartate receptor (NMDAR) has been linked to the development of chronic postsurgical pain (CPSP), defined as pain after surgery that does not resolve by 3 months. Once the combination of a painful stimulus and glutamate binding activates the NMDAR, calcium influx triggers signaling cascades that lead to processes like central sensitization and CPSP. Three of the most widely studied perioperative NMDAR antagonists include ketamine, magnesium, and methadone, with ketamine having garnered the greatest amount of attention. While multiple studies have found improved analgesia in the acute postoperative period, fewer studies have focused on long-term outcomes and those that have are often underpowered for CPSP or have not included those patients at highest risk. Existing meta-analyses of ketamine for CPSP are inconsistent in their findings, and studies of magnesium and methadone are even more limited. Overall, the evidence supporting NMDAR antagonists for CPSP is weak and we recommend that future studies focus on high-risk patients and potentially include combinations of NMDAR antagonists administered together for the longest duration feasible. The results of ongoing trials could have a major influence on the overall direction of the evidence supporting NMDAR antagonists in preventing CPSP.

Effect of hyperthermia combined with opioids on cancer pain control and surgical stress in patients with gastrointestinal cancer

BACKGROUND

Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors. However, these patients generally experience high levels of cancer pain, which can in turn stimulate the body's stress and undermine the effect of external surgery. Although opioid drugs have a significantly positive effect on controlling cancer pain, they can induce adverse drug reactions and potential damage to the body 's immune function. Hyperthermia therapy produces a thermal effect that shrinks tumor tissues. However, its effect on relieving the pain of middle and late stage gastrointestinal tumors but also the stress of surgical palliative surgery remains unclear.

AIM

To investigate the effect of hyperthermia combined with opioids on controlling cancer pain in patients with middle and late stage gastrointestinal cancer and evaluate its impact on surgical palliative surgical stress.

METHODS

This was a retrospective study using the data of 70 patients with middle and late stage gastrointestinal tumors who underwent cancer pain treatment and surgical palliative surgery in the Ninth People 's Hospital of Suzhou, China from January 2021 to June 2024. Patients were grouped according to different cancer pain control regimens before surgical palliative surgery, with n = 35 cases in each group, as follows: Patients who solely used opioid drugs to control cancer pain were included in Group S, while patients who received hyperthermia treatment combined with opioid drugs were included in Group L. In both groups, we compared the effectiveness of cancer pain control (pain score, burst pain score, 24-hour burst pain frequency, immune function, daily dosage of opioid drugs, and adverse reactions), surgical palliative indicators (surgery time, intraoperative bleeding, stress response), and postoperative recovery time, including first oral feeding time, postoperative hospital stay).

RESULTS

Analgesic treatment resulted in a significant decrease in the average pain score, burst pain score, and 24-hour burst pain frequency in both Groups L and S; however, these scores were statistically significantly lower in Group L than in Group S group (P < 0.001). Analgesic treatment also resulted in significant differences, namely serum CD4+ (29.18 ± 5.64 vs 26.05 ± 4.76, P = 0.014), CD8+ (26.28 ± 3.75 vs 29.23 ± 3.89, P = 0.002), CD4+/CD8+ (0.97 ± 0.12 vs 0.83 ± 0.17, P < 0.001), between Group L and Group S, respectively. The daily dosage of opioid drugs incidence of adverse reactions such as nausea, vomiting, constipation, and difficulty urinating were statistically significantly lower in Group L than those in group S (P < 0.05). Furthermore, palliative surgery time and intraoperative blood loss in Group L were slightly lower than those in Group S; however, the difference was not statistically significant (P > 0.05). On the first day after surgery, serum cortisol and C-reactive protein levels of patients in group L and group S were 161.43 ± 21.07 vs 179.35 ± 27.86 ug/L (P = 0.003) and 10.51 ± 2.05 vs 13.49 ± 2.17 mg/L (P < 0.001), respectively. Finally, the first oral feeding time and hospitalization time after surgery in group L were statistically significantly shorter than those in group S (P < 0.05).

CONCLUSION

Our findings showed that hyperthermia combined with opioids is effective in controlling cancer pain in patients with middle and late stage gastrointestinal tumors. Furthermore, this method can reduce the dosage of opioids used and minimize potential adverse drug reactions, reduce the patient's surgical palliative surgical stress response, and shorten the overall postoperative recovery time required.

Music-Based Therapy for the Treatment of Perioperative Anxiety and Pain-A Randomized, Prospective Clinical Trial

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (-0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (-0.16, 0.91)), depression on POD2 (aSMD = 0.31 (-0.23, 0.84)) and POD4 (aSMD = 0.24 (-0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (-0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing.

A secondary analysis: the impact of pre-existing chronic pain among patients with cancer presenting to the emergency department with acute pain

PURPOSE

Patients with cancer may experience pain from cancer itself or its treatment. Additionally, chronic pain (CP) predating a patient's cancer diagnosis may make the etiology of pain less clear and the management of pain more complex. In this brief report, we investigated differences in biopsychosocial characteristics, pain severity, and opioid consumption, comparing groups of cancer patients with and without a history of CP who presented to the emergency department (ED) with a complaint of cancer-related pain.

METHODS

This secondary analysis of a prospective cohort study included patients with cancer who presented to the ED with a complaint of pain (≥ 4/10). Sociodemographic, clinical, psychological, and pain characteristics were assessed in the ED and subsequent hospitalization. Mann-Whitney U-, T-, and Chi-square tests were used to compare differences between patients with and without pre-existing CP before cancer.

RESULTS

Patients with pre-existing CP had lower income (p = 0.21) and less formal education (p = 0.25) and were more likely to have a diagnosis of depression or substance use disorder (p < 0.01). Patients with pre-existing CP reported significantly greater pain severity in the ED and during hospitalization compared to those without pre-existing CP (p < 0.05), despite receiving greater amounts of opioid analgesics (p = 0.036).

CONCLUSION

Identifying a history of pre-existing CP during intake may help identify patients with cancer with difficult to manage pain, who may particularly benefit from multimodal interventions and supportive care. In addition, referral of these patients for the management of co-occurring pain disorders may help decrease the usage of the ED for undertreated pain.