abstract: Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy - Reeves - 2012 - Cancer - Wiley Online Library

Blogger's Opinion: since this journal is a publication of the ACS then open access should be mandated

Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy

Abstract

BACKGROUND:

Paclitaxel causes an acute pain syndrome (P-APS), occurring within days after each dose and usually abating within days. Paclitaxel also causes a more classic peripheral neuropathy, which steadily increases in severity with increasing paclitaxel total doses. Little detail is available regarding the natural history of these 2 syndromes, or any relationship between them, although a recent publication does provide natural history data about weekly paclitaxel, supporting an association between the severity of P-APS and eventual peripheral neuropathy symptoms.

METHODS:

Patients entering this study were about to receive paclitaxel and carboplatin every 3 weeks. Daily questionnaires were completed for the first week after every chemotherapy dose, and European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Chemotherapy-Induced Peripheral Neuropathy 20-item instruments were completed weekly.

RESULTS:

The P-APS severity peaked on day 4 after the initial chemotherapy dose, with 12%, 29%, 23%, and 36% of patients having maximal pain scores of 0, 1 to 4, 5 or 6, or 7 to 10 during the first week after the first dose of therapy, respectively. Patients with P-APS scores of 0 to 4 with the first dose of chemotherapy had less eventual sensory neuropathy than did patients with P-APS scores of 5 to 10 (P = 0.001). With regard to the more peripheral neuropathy, sensory neuropathy was more problematic than was either motor or autonomic neuropathy. Numbness and tingling were more common components of the sensory neuropathy than was pain.

CONCLUSIONS:

Patients with worse P-APS severities appear to have more eventual chemotherapy-induced peripheral neuropathy. This provides support for the concept that P-APS is a form of nerve pathology.

abstract: [Assessment of health-related quality of life in cancer outpatients treated with chemotherapy] Japanese study

[Assessment of health-related quality of life in cancer outpatients treated with chemotherapy].


Abstract
Purpose: 
Few studies have been conducted to elucidate the health-related quality of life(HR-QOL) of cancer outpatients treated with chemotherapy. In this study, we attempted to determine the physical and psychological distress of cancer outpatients treated with chemotherapy.

Methods:
Two-hundred and ninety-six outpatients with various malignancies, including malignant lymphoma, and esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, were investigated using the Japanese version of the M. D. Anderson symptom inventory from March through June 2010 in Tokyo Medical University Hospital.

Results:
The results of the survey questionnaire indicated that 59 patients suffered from fatigue, 56 experienced numbness or tingling, 48 felt drowsy, 39 had low moods, 40 felt distressed, 38 had no appetite, 38 had dry mouth, 37 were in pain, 37 had disturbed sleep, 31 had shortness of breath, 24 had nausea, 17 suffered from vomiting, and 13 patients had memory problems. Furthermore, these symptoms interfered with work(65 patients), walking(56 patients), mood(52 patients), life enjoyment(49 patients), general activity(49 patients), and relationships with other people(42 patients). Medications prescribed for HR-QOL control were non-steroidal anti-inflammatory drugs (93 patients), morphine(32 patients), and adjuvant analgesics(47 patients).

Conclusion:
The present findings may help in the development of management strategies for physical and psychological distress, and improve HR-QOL of cancer outpatients treated with chemotherapy.

Elderly Frequently 'Undertriaged' in Emergency Departments

Elderly Frequently 'Undertriaged' in Emergency Departments

"Finally, the authors investigated reasons for inadequate triage. The most common reason for undertriage was neglect of high-risk situations, sometimes in combination with abnormal vital signs or in combination with severe pain or distress.
The second most important reason for undertriage was inappropriate interpretation of vital signs, sometimes in combination with severe pain or distress, high-risk situations, or an altered mental status.
"[I]nadequate triage appears to be due to a lack of adherence to the Emergency Severity Index algorithm rather than to an inherent deficit of the algorithm itself," the researchers conclude."


Ann Emerg Med. Published online March 9, 2012. Abstract
Conclusion
"In our study, older patients were at risk for undertriage. However, our results suggest that the Emergency Severity Index is reliable and valid for triage of older patients."

Canada - OxyContin delisting not the answer to opioid addiction, experts say - media

OxyContin delisting is not the answer - media

"The decision by some provinces to remove public funding for OxyContin and its newer harder-to-abuse formulation, OxyNEO, is being cast by many politicians and health professionals as a significant victory in the battle against the scourge of painkiller addictions.
If it were only that simple....."

"OxyNEO will be available for those who had existing prescriptions for the old drug and for cancer and palliative-care patients.
Yet, even if provincial plans won’t cover Purdue’s notorious product, individuals whose private insurance covers the drugs will still be able to get them...."

Women Feel Pain More Intensely Than Men: Scientific American

"...But the study was large, and the findings are backed up by previous work, Fillingim said.
"I think the most [simple] explanation is that women are indeed experiencing higher levels of pain than men," Fillingim said.
The reason for this is not known, Fillingim said. Past research suggests a number of factors contribute to perceptions of pain level, including hormones, genetics and psychological factors, which may vary between men and women, Fillingim said. It's also possible the pain systems work differently in men and women, or women experience more severe forms of disease than men, he said."

Managing adult cancer pain: The latest NCCN guidelines - Chemotherapy Advisor

"Pain is common in cancer — one-third of patients undergoing treatment and three-fourths of those with advanced disease experience it — and pain is among the symptoms patients fear the most."

abstract: Interviews with patients with advanced cancer—another step towards an international cancer pain classification system - European Palliative

Conclusions

Previously identified pain domains were confirmed to be relevant to the patients; however, the ranking differed from the experts’ ranking. Sleep disturbances may be added as a domain in a future classification system.

press release: Scripps Research scientists provide new understanding of chronic pain (neuropathic pai

(In research)

Findings suggest new target for drug development

LA JOLLA, CA – January 22, 2012 – Millions of people worldwide suffer from a type of chronic pain called neuropathic pain, which is triggered by nerve damage. Precisely how this pain persists has been a mystery, and current treatments are largely ineffective. But a team led by scientists from The Scripps Research Institute, using a new approach known as metabolomics, has now discovered a major clue: dimethylsphingosine (DMS), a small-molecule byproduct of cellular membranes in the nervous system. In their new study, the scientists found that DMS is produced at abnormally high levels in the spinal cords of rats with neuropathic pain and appears to cause pain when injected. The findings suggest inhibiting this molecule may be a fruitful target for drug development.....

open access: PLoS Medicine: The Inadequate Treatment of Pain: Collateral Damage from the War on Drugs (pain)

"Current estimates suggest that upward of 80% of the world's population lacks access to basic pain relief [6]. Paradoxically, those 80% are mostly in poorer countries, and their need for pain relief is heightened by a relative absence of curative care such as surgery, or treatment for both communicable and non-communicable diseases causing pain (e.g., HIV/AIDS, cancer) [7]. There are many reasons for this disturbing health inequity (e.g., difficulties in procurement, lack of prescribing knowledge among health providers), but the fundamental, often overlooked reason is the cumbersome, restrictive drug laws and policies that exist at international, national, and local levels. We call the legal barriers “fundamental” because where laws forbid access to pain relief, that prohibition trumps all other reasons for the inequity."

"...To reject this conclusion is to continue embracing a cruel system in which persons needlessly lack treatment for pain, for the stubborn pursuit of narcotics prohibition, which others have found no longer desirable."

open access: As-Needed Morphine: Yes, but at What Dose and at What Interval?

..........Given the above-illustrated opinion conflicts, with a 10-fold variation in dose and a six-fold variation in timing interval, a search through published sources was conducted, mirroring a wide range of combinations regarding recommendations for both the PRN narcotic doses and the appropriate intervals at which they should be repeated in the event of continued pain. Data from 22 review articles and texts that review guidelines for the treatment of cancer pain, presented in Table 3, ^1-22 provided a 20-fold variation in recommended narcotic doses (1% to 20% of daily doses) along with scattered opinions, or no direction, regarding appropriate dose intervals for potential repeat doses...............

.............Specific guidelines for prescribing opioids are needed to allow practitioners to feel comfortable in administering these medications. These guidelines must include how to determine the appropriate dose for breakthrough pain, and the appropriate and safe interval that will allow for rapid pain relief, but maintain patient safety. On completion of this project, the 2004 National Comprehensive Cancer Network guidelines for cancer pain were found.²⁷ These guidelines come to similar conclusions that recommend the use of intravenous narcotic doses of 10% to 20% of the daily intravenous morphine equivalent and the use of repeat doses at 15-minute intervals, if pain is still present. The information from this project might be used to facilitate continuous-improvement projects at individual institutions. Such a project is in process locally. The incorporation of this new information regarding PRN narcotic use should better serve the needs of patients.

LIFE Before Death : The Lancet Oncology - documentary/commentary

Genesis of the LIFE Before Death project lay in remarks from WHO. “The project co-producer Mike Hill and I read a 2009 WHO statement saying that 600 million people worldwide were going to suffer in their lifetime from untreated pain due to a lack of access to medicinal opiates”, explains Australian documentary maker Sue Collins. “We found that a very alarming statistic”, she added. Here are three more alarming statistics: more than 5 billion people worldwide have no access to essential pain medicines; this year 3·6 million people will die with untreated severe pain from cancer and AIDS; and 99·9% of these deaths will be in low-income and middle-income countries.

Pharma: Pain Therapeutics - SMi Group - Event Details - UK - Overview

This conference seeks to address Recent successes and failures for new drugs in development Translational pain R&D Current human and animal pain models Pain managment methodologies Pain treatment Clinical trial design considerations

abstract: Cancer-related chronic pain - Cancer

CONCLUSIONS:

The authors extend the literature by showing that 20% of diverse cancer survivors had cancer-related CP, and 43% had experienced pain since diagnosis, revealing racial and sex disparities in cancer-related CP's incidence and impact on QOL. Having pain was related to poorer QOL in several domains and was more frequently experienced by women. Although black race was not related to pain prevalence, it was related to greater severity. This study reveals an unaddressed cancer survivorship research, clinical, and policy issue

Pain in Underserved Community-Dwelling Chinese American Cancer Patients: Demographic and Medical Correlates --- The Oncologist

Note: registration is free/access

American Academy of Neurology issues new guideline on best treatments for diabetic nerve pain (neuropathy)

Cancer Pain: An Age-Based Analysis - 2010 - Pain Medicine abstract

abstract: Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption

CONCLUSION: A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events.

Fear of Pain in Patients With Advanced Cancer or in Patients With Chronic Noncancer Pain - abstract

Acute Pain Caused by Paclitaxel (Taxol) in Patients With Cancer - Full Text View - ClinicalTrials.gov

JAMA -- Abstract: Effect of Telecare Management on Pain and Depression in Patients With Cancer: A Randomized Trial, July 14, 2010

Conclusion
Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically dispersed urban and rural oncology practices.