Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

Comment on “Accentuation of Tumor Growth Secondary to Morphine Administration: The Proneoplastic Role of Morphine besides Its Role in Pain Management”

References:

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abstract - Journal of Pain and Symptom Management - A Spicamycin Derivative (KRN5500) Provides Neuropathic Pain Relief in Patients With Advanced Cancer: A Placebo-Controlled, Proof-of-Concept Trial

ScienceDirect.com - Journal of Pain and Symptom Management - A Spicamycin Derivative (KRN5500) Provides Neuropathic Pain Relief in Patients With Advanced Cancer: A Placebo-Controlled, Proof-of-Concept Trial

Conclusion

This proof-of-concept study for KRN5500 in patients with advanced cancer and any type of neuropathic pain found gastrointestinal adverse events to be the predominant safety concern. The results also provided the first indication of clinical and statistical efficacy in reducing pain intensity.

abstract: Factors Associated With Pain Among Ambulatory Patients With Cancer With Advanced Disease at a Comprehensive Cancer Center (Center for Patient Safety, Dana-Farber Cancer Institute)

Factors Associated With Pain Among Ambulatory Patients With Cancer With Advanced Disease at a Comprehensive Cancer Center

Conclusion:
Younger age, minority race, and recent onset of advanced disease are associated with severe pain among patients with cancer. Recognizing these high-risk groups could inform targeted interventions to address pain care in ambulatory patients with advanced cancer.

abstract JCO: Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer - Sunnybrooke Health Sciences Centre, Toronto, Canada

Opioid Prescription After Pain Assessment: A Population-Based Cohort of Elderly Patients With Cancer

 Abstract

Purpose The purpose of this study was to measure opioid prescription (OP) rates in elderly cancer outpatients around the time of assessment for pain and to evaluate factors associated with receiving OPs for those with severe pain. 

Patients and Methods The cross-sectional cohort includes all patients with cancer in Ontario older than age 65 years who completed a pain assessment as part of a provincial initiative of systematic symptom screening. Patients were assigned to mutually exclusive categories by pain score severity: 0, 1 to 3 (mild), 4 to 6 (moderate), and 7 to 10 (severe). We linked multiple provincial health databases to examine the proportion of patients with an OP within 7 days after or 30 days before the assessment date. We examined factors associated with OPs for patients with pain scores of 7 to 10. 

Results The proportion of patients with an OP increased as pain score severity increased: 10% of those with no pain, 24% of those with mild pain, 45% of those with moderate pain, and 67% of those with severe pain. More specifically, for those with severe pain, 41% filled an OP within 7 days of assessment for pain, and 26% had an OP from the 30 days before assessment for pain, leaving 33% without an OP. In multivariable analysis, factors associated with OPs are younger age, male sex, comorbid illness, cancer type, and assessment at home. 

Conclusion Despite a generous time window for capturing OPs, the proportion of patients without an OP seems high. Further knowledge translation is required to maximize the impact of the symptom screening initiative in Ontario and to optimize management of cancer-related pain.

open access: Medscape - How Would Physicians Die?

How Would Physicians Die?


"How do doctors prefer to die? This question was addressed in a recent article on the Website zocalopublicsquare.org. The article suggests that physicians eschew extraordinary measures to extend life; instead they put a priority on reducing the pain and maximizing the quality of any limited time remaining. In a discussion on Medscape Physician Connect, an all-physician discussion group, doctors evaluated the accuracy of this portrait.
Overwhelmingly, the respondents agreed with sentiments expressed in the article. They sought to avoid the agony of a lingering final illness for themselves and for those they love. The results of an accompanying poll were unanimous. When completing the thought, "If I or my family were faced with a terminal illness with great potential for a terrible course and reasonable options have failed," all 27 respondents chose, "I'd want the focus to be on quality of life and comfort, no CPR." Not one expressed a preference for life-extending measures. Several physicians shared wrenching stories from personal experience...........cont'd

abstract: Adjuvant Analgesics in Cancer Pain: A Review

"Adjuvant analgesics (co-analgesics) are medications whose primary indication is the management of a medical condition with secondary effects of analgesia (pain killer). Cancer pain is multifactorial and often involves inflammatory, nociceptive, and neuropathic pain subtypes. Adjuvant analgesics used in conjunction with opioids have been found to be beneficial in the management of many cancer pain syndromes; however, they are currently underutilized. Antidepressants, anticonvulsants, local anesthetics, topical agents, steroids, bisphosphonates, and calcitonin are all adjuvants which have been shown to be effective in the management of cancer pain syndromes. When utilizing analgesic adjuvants in the treatment of cancer pain, providers must take into account the particular side effect profile of the medication. Ideally, adjuvant analgesics will be initiated at lower dosages and escalated as tolerated until efficacy or adverse effects are encountered."

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 pain effectively : The Lancet (full free access)

"Management of chronic pain has shown better results for patients with cancer, when guidelines are adhered to, but often they are not. Disturbingly, about 43% of patients with cancer receive inappropriate care for pain."