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Rollé A, Vidal E, Laguette P, Garnier Y, Delta D, Martino F, Portecop P, Etienne-Julan M, Piednoir P, De Jong A, Romana M, Bernit E. Pain Control for Sickle Cell Crisis, a Novel Approach? A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2196. [PMID: 38138299 PMCID: PMC10744599 DOI: 10.3390/medicina59122196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Pain management poses a significant challenge for patients experiencing vaso-occlusive crisis (VOC) in sickle cell disease (SCD). While opioid therapy is highly effective, its efficacy can be impeded by undesirable side effects. Local regional anesthesia (LRA), involving the deposition of a perineural anesthetic, provides a nociceptive blockade, local vasodilation and reduces the inflammatory response. However, the effectiveness of this therapeutic approach for VOC in SCD patients has been rarely reported up to now. The objective of this study was to assess the effectiveness of a single-shot local regional anesthesia (LRA) in reducing pain and consequently enhancing the management of severe vaso-occlusive crisis (VOC) in adults with sickle cell disease (SCD) unresponsive to conventional analgesic therapy. Materials and Methods: We first collected consecutive episodes of VOC in critical care (ICU and emergency room) for six months in 2022 in a French University hospital with a large population of sickle cell patients in the West Indies population. We also performed a systematic review of the use of LRA in SCD. The primary outcome was defined using a numeric pain score (NPS) and/or percentage of change in opioid use. Results: We enrolled nine SCD adults (28 years old, 4 females) for ten episodes of VOC in whom LRA was used for pain management. Opioid reduction within the first 24 h post block was -75% (50 to 96%). Similarly, the NPS decreased from 9/10 pre-block to 0-1/10 post-block. Five studies, including one case series with three patients and four case reports, employed peripheral nerve blocks for regional anesthesia. In general, local regional anesthesia (LRA) exhibited a reduction in pain and symptoms, along with a decrease in opioid consumption post-procedure. Conclusions: LRA improves pain scores, reduces opioid consumption in SCD patients with refractory pain, and may mitigate opioid-related side effects while facilitating the transition to oral analgesics. Furthermore, LRA is a safe and effective procedure.
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Affiliation(s)
- Amélie Rollé
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Elsa Vidal
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Pierre Laguette
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Yohann Garnier
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Delphine Delta
- West-Indies Faculty of Medicine, University of The French West-Indies, F-97157 Pointe à Pitre, France;
| | - Frédéric Martino
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Patrick Portecop
- Emergency Department, University Hospital of Guadeloupe, F-97100 Pointe à Pitre, France;
| | - Maryse Etienne-Julan
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
- Sickle Cell Disease Unit, Reference Centre for Sickle Cell Disease, Thalassemia and Other Red Cell Rare Diseases, CHU de la Guadeloupe, CEDEX, F-97159 Pointe à Pitre, France;
| | - Pascale Piednoir
- Anesthesiology and Intensive Care Department, University Hospital of La Guadeloupe, F-97139 Les Abymes, France; (E.V.); (P.L.); (F.M.); (P.P.)
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, 80 Avenue Augustin Fliche, CEDEX 5, F-34295 Montpellier, France;
- Phymed Exp INSERM U1046, CNRS UMR 9214, F-34295 Montpellier, France
| | - Marc Romana
- Université Paris Cité and Université des Antilles, INSERM, BIGR, F-75015 Paris, France; (Y.G.); (M.E.-J.); (M.R.)
| | - Emmanuelle Bernit
- Sickle Cell Disease Unit, Reference Centre for Sickle Cell Disease, Thalassemia and Other Red Cell Rare Diseases, CHU de la Guadeloupe, CEDEX, F-97159 Pointe à Pitre, France;
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Hsieh YL, Chen HY, Lin CR, Wang CF. Efficacy of epidural analgesia for intractable cancer pain: A systematic review. Pain Pract 2023; 23:956-969. [PMID: 37455298 DOI: 10.1111/papr.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Epidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk-of-bias tool or Newcastle-Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta-analysis reporting guideline. RESULTS Our systematic review included nine randomized controlled trials (n = 340) and 15 observational studies (n = 926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug-related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta-analysis and evidence-level determination. CONCLUSION Coadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high-quality studies are required.
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Affiliation(s)
- Yu-Lien Hsieh
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Yu Chen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ren Lin
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Fei Wang
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Fumić Dunkić L, Hostić V, Kustura A. PALLIATIVE TREATMENT OF INTRACTABLE CANCER PAIN. Acta Clin Croat 2022; 61:109-114. [PMID: 36824634 PMCID: PMC9942460 DOI: 10.20471/acc.2022.61.s2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. Neuraxial analgesia is a valid option for progressive cancer pain, and healthcare possibilities and costs call into question the utility of intrathecal infusion pumps. Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.
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Affiliation(s)
- Lidija Fumić Dunkić
- Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vedran Hostić
- Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Antonia Kustura
- Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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The pro- and anti-cancer effects of oxycodone are associated with epithelial growth factor receptor level in cancer cells. Biosci Rep 2021; 40:221926. [PMID: 31967294 PMCID: PMC7007405 DOI: 10.1042/bsr20193524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/10/2019] [Accepted: 01/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Oxycodone is an opioid medication used for the treatment of pain in cancer patients. However, little is known on the direct effects of oxycodone on cancer cells. Aim: To determine the effects and mechanisms of oxycodone in cancer cells. Materials and Methods: Proliferation, survival and migration assays were performed on multiple types of cancer cells. Epithelial growth factor receptor (EGFR)/ERK/Akt pathway and oxidative stress were investigated after oxycodone treatment. Results: Oxycodone can either stimulate growth and migration without affecting survival in MDA-468 cells or inhibit growth and survival without affecting migration in SKBR3 and Caco2 cells. In addition, oxycodone can either attenuate or stimulate efficacy of chemotherapeutic drugs in cancer, depending on the type of cancer cells and nature of action of oxycodone as single drug alone. Our mechanism studies suggest that the stimulatory and inhibitory effects of oxycodone are associated with EGFR expression levels in cancer cells. In cancer cells with high EGFR level, oxycodone activates EGFR signaling in cancer cells, leading to stimulatory effects in multiple biological activities, and this is dependent on opioid receptor. In cancer cells with low EGFR level, oxycodone induces mitochondria-mediated caspase activity and oxidative stress and damage, leading to cell death. Conclusions: Our work is the first to demonstrate systematic analysis of oxycodone’s effects and mechanism of action in cancer. The activation of EGFR signaling by oxycodone may provide a new guide in the clinical use of oxycodone, in particular for cancer patients with high EGFR levels.
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Xie P, Li Z, Yang J, Wu Y. Study on the prevention of infection in terminal cancer patients applying epidural analgesia by adding cefazolin to anesthetics: a randomized controlled trial. Jpn J Clin Oncol 2020; 50:867-872. [PMID: 32409838 DOI: 10.1093/jjco/hyaa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/14/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To observe the antibacterial effect of adding cefazolin into anesthetics in patients with terminal cancer undergoing long-term epidural analgesia. METHODS Patients undergoing epidural analgesia with terminal cancer were randomly divided into two groups: the conventional drug group (group C) and the cefazolin group (group G). Both groups were given levobupivacaine and morphine, while cefazolin was added to group G. The mean arterial pressure (MAP), heart rate (HR), respiratory rates (R), visual analogue scale (VAS) scores, satisfaction and complications of patients in the two groups were observed. 3 ml of the used analgesic was taken for bacterial culture when replacing the new analgesic case. RESULTS HR, MAP, R, VAS scores, dosages of morphine, satisfaction of the analgesic and the complications were not significantly different between the two groups (P > 0.05). The overall satisfaction of patients in group G was significantly higher than that in group C (P < 0.05). One patient's anesthetics in group C were infected with colibacillus. Four patients in group C got infected in their epidural puncture sites. There was no infection in group G (P < 0.05). CONCLUSION Adding cefazolin to local anesthetics could effectively prevent bacterial infection and ensured the safety of epidural analgesia for patients with terminal cancer.
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Affiliation(s)
- Pengcheng Xie
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Zhanfang Li
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Jingli Yang
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
| | - Yiming Wu
- Department of Anesthesiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Pudong, Shanghai, China
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Ahmad U, Abbas SA, Hamadani SM, Abbas SM, Usman S, Hafeez Z, Ur Rehman Ghafoor A. Pain Intervention for Cancer and Non-cancer Pain: A Retrospective Analysis of Tertiary Care Hospital Experience. Cureus 2020; 12:e7719. [PMID: 32431997 PMCID: PMC7234092 DOI: 10.7759/cureus.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background With the recent advancement in medicine there has been a great emphasis on the management of chronic pain which remains as one of the major contributing factors for functional limitation in patients as well as a financial burden on healthcare. Newer treatment modalities are aimed at terminating the vicious pain cycles and in this regard peripheral nerve blocks have proven to be very effective. Objectives The aim of this study is to evaluate the effectiveness of interventions for both cancer and non-cancer patients by objective assessment of the patients before and after the procedure. Materials and methods The study included 252 patients who underwent nerve block procedures in Shaukat Khanum Memorial Cancer Hospital from December 2016 to December 2018. The patients were evaluated using numerical rating scale (NRS) for pain, reduction in analgesic doses and patient satisfaction after one and four weeks post procedure. The data was analyzed using mean values and calculating percentages. Results In cancer group, 168 patients were included; mean age 50.49 ± 15.39 with 46.43% females and 53.57% males, the average pain score was 2.62 ± 1.87 post procedure compared with 6.30 ± 1.87 post procedure. 48.21% of the patients reported a reduction in analgesia while 51.79% of the patients kept on using the same analgesics doses. 74.40% of the patients were satisfied and 25.60% patients remained unsatisfied after one week whereas 66.07% were satisfied, 23.81% were not satisfied and 10.12% loss to follow up after four weeks. In non-cancer group 84 patients were included; mean age 56.49 ± 15.79 with 41.67% females and 58.33% males, the average pain score before intervention was 5.99 ± 1.21 and after intervention it was 2.43 ± 1.62. In 73.81% non-cancer patients the analgesics doses were reduced and 70.24% patients were satisfied while 29.76% were unsatisfied after one week. After four weeks 55.95% were satisfied, 22.62% were not satisfied and 21.43% loss to follow up. Conclusion The study showed decrease in pain scores in both group of patients and the importance of nerve blocks as an effective method for chronic pain management. The reduction in the use of other analgesics was also commendable in both the groups.
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Affiliation(s)
- Umair Ahmad
- Anaesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.,Internal Medicine, Ittefaq Trust Hospital, Lahore, PAK
| | - Syed A Abbas
- Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA.,Internal Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Syeda M Hamadani
- Internal Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Syed M Abbas
- Internal Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Samia Usman
- Internal Medicine, King Edward Medical College, Lahore, PAK
| | - Zeeshan Hafeez
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Ateeq Ur Rehman Ghafoor
- Anesthesia and Pain Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Morphine activates blast-phase chronic myeloid leukemia cells and alleviates the effects of tyrosine kinase inhibitors. Biochem Biophys Res Commun 2019; 520:560-565. [DOI: 10.1016/j.bbrc.2019.10.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 01/29/2023]
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Zhang K, Huang W, Chen W, Zhou Q, Zhang Q, Wu X, Xu Y, Li D, Xie T, Liu J. Morphine stimulates angiogenesis through Akt/mTOR/eIF4E activation under serum deprivation or H
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‐induced oxidative stress condition. Clin Exp Pharmacol Physiol 2019; 47:227-235. [PMID: 31612523 DOI: 10.1111/1440-1681.13191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kun Zhang
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Wei Huang
- Department of Neurology Taihe Hospital Hubei University of Medicine Shiyan China
| | - Wei Chen
- Department of Anesthesiology The First People’s Hospital of Jingzhou The First Clinical Medical College Yangtze University Jingzhou China
| | - Qian Zhou
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Qiongxia Zhang
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Xiaoqin Wu
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Yong Xu
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Dezhan Li
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Tao Xie
- Department of Anesthesiology Jingzhou Central Hospital The Second Clinical Medical College Yangtze University Jingzhou China
| | - Jie Liu
- Department of Anesthesiology Jingzhou Traditional Chinese Medicine Hospital The Third Clinical Medical College Yangtze University Jingzhou China
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Sarabia-Estrada R, Ruiz-Valls A, Guerrero-Cazares H, Ampuero AM, Jimenez-Estrada I, De Silva S, Bernhardt LJ, Goodwin CR, Ahmed AK, Li Y, Phillips NA, Gokaslan ZL, Quiñones-Hinojosa A, Sciubba DM. Metastatic human breast cancer to the spine produces mechanical hyperalgesia and gait deficits in rodents. Spine J 2017; 17:1325-1334. [PMID: 28412561 PMCID: PMC5628502 DOI: 10.1016/j.spinee.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Metastases to the spine are a common source of severe pain in cancer patients. The secondary effects of spinal metastases include pain, bone fractures, hypercalcemia, and neurological deficits. As the disease progresses, pain severity can increase until it becomes refractory to medical treatments and leads to a decreased quality of life for patients. A key obstacle in the study of pain-induced spinal cancer is the lack of reliable and reproducible spine cancer animal models. In the present study, we developed a reproducible and reliable rat model of spinal cancer using human-derived tumor tissue to evaluate neurological decline using imaging and behavioral techniques. PURPOSE The present study outlines the development and characterization of an orthotopic model of human breast cancer to the spine in immunocompromised rats. STUDY DESIGN/SETTING This is a basic science study. METHODS Female immunocompromised rats were randomized into three groups: tumor (n=8), RBC3 mammary adenocarcinoma tissue engrafted in the L5 vertebra body; sham (n=6), surgery performed but not tumor engrafted; and control (n=6), naive rats, no surgery performed. To evaluate the neurological impairment due to tumor invasion, functional assessment was done in all rodents at day 40 after tumor engraftment using locomotion gait analysis and pain response to a mechanical stimulus (Randall-Selitto test). Bioluminescence (BLI) was used to evaluate tumor growth in vivo and cone beam computed tomography (CBCT) was performed to evaluate bone changes due to tumor invasion. The animals were euthanized at day 45 and their spines were harvested and processed for hematoxylin and eosin (H&E) staining. RESULTS Tumor growth in the spine was confirmed by BLI imaging and corroborated by histological analysis. Cone beam computed tomography images were characterized by a decrease in the bone intensity in the lumbar spine consistent with tumor location on BLI. On H&E staining of tumor-engrafted animals, there was a near-complete ablation of the ventral and posterior elements of the L5 vertebra with severe tumor invasion in the bony components displacing the spinal cord. Locomotion gait analysis of tumor-engrafted rats showed a disruption in the normal gait pattern with asignificant reduction in length (p=.02), duration (p=.002), and velocity (p=.002) of right leg strides and only in duration (p=.0006) and velocity (p=.001) of left leg strides, as compared with control and sham rats. Tumor-engrafted animals were hypersensitive to pain stimulus shown as a significantly reduced response in time (p=.02) and pressure (p=.01) applied when compared with control groups. CONCLUSIONS We developed a system for the quantitative analysis of pain and locomotion in an animal model of metastatic human breast cancer of the spine. Tumor-engrafted animals showed locomotor and sensory deficits that are in accordance with clinical manifestation in patients with spine metastasis. Pain response and locomotion gait analysis were performed during follow-up. The Randall-Selitto test was a sensitive method to evaluate pain in the rat's spine. We present a model for the study of bone-associated cancer pain secondary to cancer metastasis to the spine, as well as for the study of new therapies and treatments to lessen pain from metastatic cancer to the neuroaxis.
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Affiliation(s)
| | - Alejandro Ruiz-Valls
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ana M. Ampuero
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ismael Jimenez-Estrada
- Physiology, Biophysics and Neurosciences, Research Center and Advanced Studies, IPN, Mexico City, MEXICO
| | - Samantha De Silva
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lydia J. Bernhardt
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Karim Ahmed
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuxin Li
- Department of Neurosurgery, Jinan General Hospital of PLA, Jinan, 250031, CHINA
| | - Neil A. Phillips
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University Providence, Rhode Island, USA
| | | | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Brant J, Keller L, McLeod K, Hsing Yeh C, Eaton L. Chronic and Refractory Pain: A Systematic Review of Pharmacologic Management in Oncology. Clin J Oncol Nurs 2017; 21:31-53. [DOI: 10.1188/17.cjon.s3.31-53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Effects of Patient-Controlled Epidural Analgesia and Patient-Controlled Intravenous Analgesia on Analgesia in Patients Undergoing Spinal Fusion Surgery. Am J Ther 2017; 23:e1806-e1812. [PMID: 26510183 DOI: 10.1097/mjt.0000000000000338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We compared the outcomes of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) in analgesia after spinal fusion surgery. A total of 120 patients who underwent spinal fusion surgeries between April 2013 and April 2015 at Shaanxi Provincial People's Hospital were selected for this study based on defined inclusion criteria. All patients were randomly divided into 2 groups before surgery: PCEA group (n = 65) and PCIA group (n = 55). Visual analog scales (VAS) were used to evaluate the degree of pain. Besides, the active and passive activities of patients during 1- to 3-day recovery period after surgery were recorded. Verbal rating scales were used to measure pain levels after surgery and after surgery. Adverse effects of PCEA and PCIA were monitored, which included nausea, vomiting, pruritus, drowsiness, respiratory depression, and headache. Our results showed no statistically significant differences between PCEA and PCIA in sex ratio, age, height, weight, American Society of Anesthesiologists level, surgery time, number of fusion section, surgery methods, and duration of anesthesia (all P > 0.05). The PCEA group was associated with significantly lower VAS scores, compared with the PCIA group, at 3, 6, 12, 24, and 48-hour postsurgery (all P < 0.05) when surgery-associated pain is expected to be intense. Also, compared with the PCIA group, the PCEA group showed higher frequency of recovery activities on first and second day postsurgery (all P < 0.05). The overall patient satisfaction level of analgesia in the PCEA group was significantly higher than in the PCIA group (P < 0.05). Moreover, the incidence of hypopiesia and skin itching in the PCIA group was higher than in the PCEA group (all P < 0.05). Finally, drowsiness and headache were markedly lower in the PCIA group after surgery, compared with the PCEA group, and this difference was statistically significant (all P < 0.05). Our results provide strong evidence that PCEA exhibits significantly greater efficacy than PCIA for pain management after spinal fusion surgery, with lower VAS scores, higher frequency of recovery activities, and overall higher satisfaction level.
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Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries. Arch Orthop Trauma Surg 2015; 135:1247-55. [PMID: 26119710 DOI: 10.1007/s00402-015-2263-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This meta-analysis aimed to compare the postoperative analgesic effects of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) for patients undergoing spinal fusion surgeries. METHOD Relevant articles were identified using computerized and manual search strategies. Statistical analyses were undertaken by the CMA 2.0 statistical software. RESULTS Nine cohort studies with a total of 436 patients undergoing spinal fusion surgeries were incorporated in the present meta-analysis. There were significant differences between the PCEA and PCIA groups in the visual analogue scale score of patients undergoing spinal fusion [standardized mean difference = 0.27, 95 % confidence interval (95 % CI) = 0.070-0.470, P = 0.008]. However, no obvious difference was observed in the rate of side effects between the PCIA and PCEA groups (side effects: odds ratio = 0.957, 95 % CI = 0.536-1.708, P = 0.882). CONCLUSION Our findings suggested that PCEA may be more effective in relieving pain than PCIA for patients undergoing spinal fusion surgeries.
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 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.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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14
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Gulati A, Joshi J, Baqai A. An overview of treatment strategies for cancer pain with a focus on interventional strategies and techniques. Pain Manag 2014; 2:569-80. [PMID: 24645889 DOI: 10.2217/pmt.12.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY As the incidence of cancer increases, considerations for pain treatments become more important and varied. While traditional views on pain therapy are successful in treating the majority of cancer-related pain, a continuum has developed to include interventional strategies in addition to pharmacologic management. Further improvements in understanding anatomy in the context of imaging and pathophysiology of cancer-pain syndromes direct our current interventional pain management options. We discuss the current interventional treatment options regularly used in the cancer-pain population.
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Affiliation(s)
- Amitabh Gulati
- Department of Anesthesiology & Critical Care, Board Certified in Anesthesiology & Pain Management, Memorial Sloan Kettering Cancer Center, M308, New York, NY, 10065, USA.
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15
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Koodie L, Yuan H, Pumper JA, Yu H, Charboneau R, Ramkrishnan S, Roy S. Morphine inhibits migration of tumor-infiltrating leukocytes and suppresses angiogenesis associated with tumor growth in mice. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1073-1084. [PMID: 24495739 DOI: 10.1016/j.ajpath.2013.12.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 12/02/2013] [Accepted: 12/30/2013] [Indexed: 01/12/2023]
Abstract
Tumor cells secrete factors that stimulate the migration of peripheral blood leukocytes and enhance tumor progression by affecting angiogenesis. In these studies, we investigated the effect of morphine, a known immunosuppressant, on leukocyte migration and recruitment to conditioned media derived from long-term cultures of mouse Lewis lung carcinoma cells. Our results indicate that morphine treatment reduced the migration and recruitment of tumor-infiltrating leukocytes into Matrigel plugs and polyvinyl alcohol sponges containing conditioned media derived from long-term cultures of mouse Lewis lung carcinoma cells when compared with placebo. A reciprocal increase in peripheral blood leukocytes was observed at the time of plug or sponge removal in morphine-treated mice. Decreased angiogenesis was observed in conditioned media derived from long-term cultures of mouse Lewis lung carcinoma cells Matrigel plugs taken from morphine-treated wild-type mice when compared with placebo but was abolished in morphine-treated μ-opioid receptor knockout mice. In addition, in vitro studies using trans-well and electric cell substrate impedance sensing system studies reveal for the first time morphine's inhibitory effects on leukocyte migration and their ability to transmigrate across an activated endothelial monolayer. Taken together, these studies indicate that morphine treatment can potentially decrease leukocyte transendothelial migration and reduce angiogenesis associated with tumor growth. The use of morphine for cancer pain management may be beneficial through its effects on angiogenesis.
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MESH Headings
- Animals
- Carcinoma, Lewis Lung/pathology
- Cell Line, Tumor
- Culture Media, Conditioned/pharmacology
- Female
- Humans
- Immunosuppressive Agents/pharmacology
- Lymphocytes, Tumor-Infiltrating/drug effects
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Morphine/pharmacology
- Neovascularization, Pathologic/pathology
- Receptors, Opioid, mu/deficiency
- Receptors, Opioid, mu/genetics
- Transendothelial and Transepithelial Migration/drug effects
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Affiliation(s)
- Lisa Koodie
- Department of Pharmacology, Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Department of Dentistry, Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Basic Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Hongyan Yuan
- Division of Basic Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jeffery A Pumper
- Department of Dentistry, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Haidong Yu
- Division of Basic Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Sundaram Ramkrishnan
- Department of Dentistry, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sabita Roy
- Department of Pharmacology, Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Department of Dentistry, Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Basic Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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16
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Abstract
Metastatic acetabular disease can be severely painful and may result in loss of mobility. Initial management may consist of diphosphonates, narcotic analgesics, radiation therapy, protected weight bearing, cementoplasty, and radiofrequency ablation. Patients with disease affecting large weight-bearing regions of the acetabulum and with impending failure of the hip joint are unlikely to gain much relief from nonsurgical treatment and interventional procedures. The profound osteopenia of the acetabulum, limited healing potential of the fracture, and projected patient life span and function necessitate surgical techniques that provide immediate stable fixation to reduce pain and restore ambulatory function. Current reconstructive procedures, including cemented total hip arthroplasty, the saddle or periacetabular endoprosthesis, and porous tantalum implants, are based on the quality of remaining acetabular bone as well as the patient's level of function and general health. Well-executed acetabular reconstructions can provide durable hip joints with good pain relief and function.
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