Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and manageme...Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and management.Methods In this cross-sectional study,consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain(IASP)criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025.CNCP was diagnosed based on the Neuropathic Pain Special Interest Group(NeuPSIG)criteria.Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria,regardless of coexisting visceral or bone pain.Demographic,oncologic,and pain-related data were collected through standardized interviews.Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests.Logistic regression analyses were conducted to identify clinical factors associated with CNCP.Results Of 138 eligible patients with CCP,85(61.6%)were classified into the CNCP group and 53(38.4%)into the non-CNCP group.Multivariable logistic regression analysis revealed that bone metastasis(adjusted OR=2.316,95%CI:1.074-5.178,P=0.032),radiotherapy(adjusted OR=2.489,95%CI:1.119-5.803,P=0.025),and voiding dysfunction(adjusted OR=5.470,95%CI:2.150-16.396,P<0.001)were independently associated with CNCP.Pancreatic cancer was inversely associated with CNCP(OR=0.371,P=0.031).Only 5(3.6%)patients in the CNCP group received neuropathic pain-specific interventions,indicating a predominant reliance on single-modality pain management.Conclusions CNCP was present in nearly two-thirds of outpatients with CCP.The identified associations with bone metastasis,radiotherapy,and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.展开更多
In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage ...In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.展开更多
With the aging of China’s population,tumors have become a major disease affecting people’s normal life.In particular,“cancer pain”caused by tumors has a severe impact on tumor patients,not only reducing their qual...With the aging of China’s population,tumors have become a major disease affecting people’s normal life.In particular,“cancer pain”caused by tumors has a severe impact on tumor patients,not only reducing their quality of life but also exerting negative effects on their physical and mental health and emotions.Therefore,in the clinical care of tumor patients,helping them relieve“cancer pain”and improving the quality and efficiency of medical care services have become important research topics.This paper takes evidence-based nursing as the starting point,analyzes the basic concepts and practical characteristics of evidence-based nursing,and then proposes the application process and effects of evidence-based nursing in cancer pain care for tumor patients.展开更多
Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chines...Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chinese and English databases was conducted to identify relevant studies.Two researchers independently assessed the quality of included literature using the Newcastle-Ottawa Scale(NOS).Data were extracted and analyzed via Stata 14.A random-effects model was applied due to significant heterogeneity(I²>50%).Sensitivity analysis and Egger’s test were performed to assess bias.Results:12 eligible studies(2014-2024)were included.Meta-analysis demonstrated that integrated nursing interventions significantly reduced cancer pain scores compared to routine care(SMD=-1.51,95%CI:-1.90 to-1.12;I²=84.8%),with superior efficacy.Subgroup-analyses revealed enhanced effects for“Nursing modes”(SMD=-2.11)and“cancer pain education”(SMD=-2.30).Conclusion:Research-oriented integrated nursing interventions significantly improve cancer pain management in Chinese hospitalized oncology patients,particularly through synergistic effects of“Nursing modes”and“can-cer pain education.”However,implementation bias from“additive interventions”in teaching hospitals and high heterogeneity warrant attention.Future studies should optimize designs to enhance clinical applicability.展开更多
Objective To observe the clinical effect of warming-yang moxibustion combined with acupuncture in the treatment of cancer pain. Methods Thirty patients with malignant tumor accompanied with moderate or severe cancer p...Objective To observe the clinical effect of warming-yang moxibustion combined with acupuncture in the treatment of cancer pain. Methods Thirty patients with malignant tumor accompanied with moderate or severe cancer pain were treated with warming-yang moxibustion technique in combination with acupuncture. Zhōngwǎn （中脘 CV 12）, Guānyuán （关元 CV 4） and Shénquè （神阙 CV 8） were applied with warming moxibustion, Hégǔ （合谷 LI 4）, Nèiguān （内关 PC 6） Tàichōng （太冲 LR 3） and Sānyīnjiāo （三阴交 SP 6） were punctured as well as other acupoints selected according to differentiation of syndrome. The treatment was given once every day, and 10 times were one treatment course. Pain degree was assessed on the basis of visual analogue scale （VAS） and efficacy based on pain relief. Results Remarkably improvement was seen in 10 cases （33.3%）, improvement in 11 cases （36.7%）, partially improvement in 8 cases （26.7%）, ineffective in 1 case （3.3%）, and the total effective rate was 96.7%. VAS was 6.07±1.26 before the treatment and was 2.53±1.48 after the treatment. The difference was statistically significant （P0.01）. Conclusion Warming-yang moxibustion technique in combination with acupuncture is effective in the treatment of cancer pain.展开更多
Objective: Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6) with ...Objective: Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6) with cancer pain enrolled in the multicenter study from 136 institutes in China. Of them, 408 (28.8%) patients were 75 years old or older. All patients received transdermal fentanyl for the management of cancer pain. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. Results: Baseline mean of pain intensity was 7.34. On day 1, 3, 6, 9 15, and 30, the pain mean scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, 1.64 (P=0.000). The effective rate was 97.18%. The mean doses of fentanyl was 31.34 g/h (25-150 g/h) initially, and 40.59 g/h and 47.50 g/h (25-200 g/h) at day 15 and day 30. At treatment day 15, the dose of fentanyl was ranger from 25 to 50 g/h in 91.8% of patients, 75 to 100 g/h in 7.5% patients, and 125 to 200 g/h only in 0.8% patients. The fine quality of life was in 25.4% patients before treatment, and was 71.15% and 73.04% at day 15 and day 30 respectively (P=0.0000). The common side effects were constipation (10.70%), nausea (11.96%), dizzy (6.85%), vomiting (3.85%), sedation (2.40%), Respiratory depression (0.12%). 86.2% patients preferred continue treated by transdermal fentanyl. Conclusions: Transdermal fentanyl for the elderly with cancer pain is effective, safe, convenient, and can improve the quality of life. Transdermal fentanyl can be recommended as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain, and the initial doses is recommended as 25 g/h.展开更多
In the present study, the efficacy and safety of oxycodone and morphine in the treatment of cancer pain were compared in a meta-analysis with the goal of providing a reference for drug selection in clinical practice. ...In the present study, the efficacy and safety of oxycodone and morphine in the treatment of cancer pain were compared in a meta-analysis with the goal of providing a reference for drug selection in clinical practice. Electronic literature databases were searched for articles published through February 2015, including PubMed, MEDLINE, the Cochrane library, and Embase; and the China National Knowledge Intemet, VIP Databases and Wanfang Databases for studies published in Chinese. Only randomized controlled trials were selected. The primary outcome measures were efficacy and the incidence of adverse drug reactions （ADRs）. Data were extracted from the studies by two independent reviewers. A total of 15 studies containing 1338 patients were included in the analysis. The studies were divided into two subgroups according to different scoring methods. The pain relief efficacies of oxycodone and morphine were rated by the numerical rating scale （NRS） （risk ratio [RR]： 1.04; 95% confidence interval [CI]： 0.97-1.11）. Others were rated by the visual analog scale （VAS） （RR： 1.03; 95% CI： 0.97-1.10）. Five studies showed that pain intensity scores did not significantly differ between oxycodone and morphine treatments （standard mean difference [SMD] = 0.16, 95% CI： -0.01-0.33, P = 0.06）. Regarding ADRs, the incidence of constipation was lower in the oxycodone group （RR： 0.70; 95% CI： 0.58-0.85）. No statistical difference was observed among other ADRs. The efficacies of oxycodone and morphine were similar in treating cancer pain. However, the incidence of constipation was lower in patients treated with oxycodone.展开更多
To compare the effects and adverse reactions of dihydrocodeine tartrate andcodeine phosphate in treating moderate cancer pain. Methods: Sixty-nine cases of cancer patientswith moderate pain were treated with dihydroco...To compare the effects and adverse reactions of dihydrocodeine tartrate andcodeine phosphate in treating moderate cancer pain. Methods: Sixty-nine cases of cancer patientswith moderate pain were treated with dihydrocodeine tartrate or codeine phosphate respectively bydouble-blind, controlled randomized methods and the effects and adverse reactions were observed.Results: After administration of dihydrocodeine tartrate or codeine phosphate, in treatment group orcontrol group, the total effective rate was 86.6% and 93.6%, and common adverse symptoms includedconstipation (31.3%/12.9%), nausea (18.8%/19.7%), gastric trouble (18.8%/19.7%), skin pruritus(12.5%/10%), vomit (9.3% and 6.5%) with the difference being not significant. Conclusion: Theeffects of dihydrocodeine tartrate in treating moderate cancer pain are similar to codeinephosphate. Both them can be used to treat moderate cancer pain.展开更多
Background: The incidence of cancer pain in patients with malignant tumors is relatively high, and pain control is poor, which is closely related to many factors, especially the nursing way. Objective: To explore the ...Background: The incidence of cancer pain in patients with malignant tumors is relatively high, and pain control is poor, which is closely related to many factors, especially the nursing way. Objective: To explore the effect of standardized nursing model on pain control in patients with malignant tumors. Methods: 50 patients with malignant tumors treated in the Affiliated Hospital of Chengde Medical College from January to December in 2021 were randomly divided into 25 cases in the control group and 25 cases in the observation group. The pain control and medication compliance of the two groups were compared. Results: There was no difference in the corresponding score of admission pain between the two groups (P > 0.05), and the pain score of the observation group was lower than that of the control group (P P Conclusion: Standardized cancer pain nursing can ease the pain of patients, and the medication compliance is better.展开更多
Objective Our previous study showed that tumor tissue-derived formaldehyde at low concentrations plays an important role in bone cancer pain through activating transient receptor potential vanilloid subfamily member 1...Objective Our previous study showed that tumor tissue-derived formaldehyde at low concentrations plays an important role in bone cancer pain through activating transient receptor potential vanilloid subfamily member 1 （TRPV 1）. The present study further explored whether this tumor tissue-derived endogenous formaldehyde regulates TRPV1 expres- sion in a rat model of bone cancer pain, and if so, what the possible signal pathways are during the development of this type of pain. Methods A rat model of bone cancer pain was established by injecting living MRMT-1 tumor cells into the tibia. The formaldehyde levels were determined by high performance liquid chromatography, and the expression of TRPV1 was examined with Western blot and RT-PCR. In primary cultured dorsal root ganglion （DRG） neurons, the ex- pression of TRPV1 was assessed after treatment with 100 ~tmol/L formaldehyde with or without pre-addition of PD98059 [an inhibitor for extracellular signal-regulated kinase], SB203580 （a p38 inhibitor）, SP600125 [an inhibitor for c-Jun N- terminal kinase], BIM [a protein kinase C （PKC） inhibitor] or LY294002 [a phosphatidylinositol 3-kinase （PI3K） inhibi- tor]. Results In the rat model of bone cancer pain, formaldehyde concentration increased in blood plasma, bone marrow and the spinal cord. TRPV1 protein expression was also increased in the DRG. In primary cultured DRG neurons, 100 p^mol/L formaldehyde significantly increased the TRPV1 expression level. Pre-incubation with PD98059, SB203580, SP600125 or LY294002, but not BIM, inhibited the formaldehyde-induced increase of TRPV1 expression. Conclusion Formaldehyde at a very low concentration up-regulates TRPV1 expression through mitogen-activated protein kinase and PI3K, but not PKC, signaling pathways. These results further support our previous finding that TRPV1 in peripheral after- ents plays a role in bone cancer pain.展开更多
Objective: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have b...Objective: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have been obtained. This study aimed to assess the efficacy and safety of the new system in Chinese patients with moderate to severe cancer pain. Methods: A total of 474 patients with moderate to severe cancer pain were enrolled in this study and were treated with the new transdermal fentanyl matrix patch (TDF) up to 2 weeks. All the patients were asked to record pain intensity, side effects, quality of life (QOL), adherence and global satisfaction. The initial dose of fentanyl was 25 ?g/h titrated with opioid or according to National Comprehensive Cancer Network (NCCN) guidelines. Transdermal fentanyl was changed every three days. Results: After 2 weeks. The mean pain intensity of the 459 evaluated patients decreased significantly from 5.63?1.26 to 2.03?1.46 (P<0.0001). The total remission rate was 91.29%, of which moderate remission rate 53.16%, obvious remission rate 25.49% and complete remission rate 12.64%. The rate of adverse events was 33.75%, 18.78% of which were moderate and 3.80% were severe. The most frequent adverse events were constipation and nausea. No fatal events were observed. The quality of life was remarkably improved after the treatment (P<0.0001). Conclusion: The new TDF is effective and safe in treating patients with moderate to severe cancer pain, and can significantly improve the quality of life.展开更多
Background:Pain associated with cancer is one of the greatest causes of reduced quality of life in patients.Acupuncture is one of the treatments used to address this issue,with the great advantage of having little or ...Background:Pain associated with cancer is one of the greatest causes of reduced quality of life in patients.Acupuncture is one of the treatments used to address this issue,with the great advantage of having little or no side effects,especially when compared with pharmacological pain-killers.Objective:The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain.Search strategy:Six electronic databases(PubMed,EBSCO,Cochrane Library,Scielo,b-On and Scopus)were searched for relevant articles about pain relief in cancer patients from their beginning until 2022using MeSH terms such as“acupuncture,”“electroacupuncture,”“ear acupuncture,”“acupuncture analgesia,”“oncological pain,”and“cancer pain.”Inclusion criteria:Studies included were randomized controlled trials(RCTs)where acupuncture was compared with no treatment,placebo acupuncture or usual care.Data extraction and analysis:Three independent reviewers participated in data extraction and evaluation of risk of bias,and a meta-analysis was conducted.The primary outcome was pain intensity,measured with the visual analog scale,numeric rating scale,or brief pain inventory.Secondary outcomes also assessed were quality of life,functionality,xerostomia,pain interference,and analgesic consumption.Results were expressed as standardized mean difference(SMD)with 95%confidence interval(CI).Results:Sixteen RCTs with a total of 1124 participants were included in the meta-analysis,with the majority of the studies presenting a low or unclear risk of bias.Acupuncture was more effective in reducing pain than no treatment(SMD=–0.90,95%CI[–1.68,–0.12]),sham acupuncture(SMD=–1.10,95%CI[–1.59,–0.61])or usual care(SMD=–1.16,95%CI[–1.38,–0.93]).Conclusion:The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer.Despite some limitations due to the low quality and small sample size of some included studies,as well as the different types and stages of cancer,acupuncture might provide an effective and safe treatment to reduce cancer pain.展开更多
This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiar...This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiary hospitals across China,372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control.Patients'demographic data and pain control-related factors were recorded.Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control.The survey showed that the majority of the patients were more than 45 years old(76.3%),and 64.4%had an average annual income of more than 20000 RMB.One-third of the patients suffered from cancer pain for more than 3 months,and 75.1%received professional guidance during medication.The barriers to pain control for patients included preference to enduring pain and refusing analgesics(62.9%),negligence towards drug usage(28.5%),concerns about the addiction(48.2%)and adverse reaction(56.4%).The average annual family income,pro fessional guidance,knowledge of pain medication,adherence to analgesics,and concerns about addiction to analgesics were significantly correlated to the effect of patients'pain control.The study presents major barriers to optimal pain control among patients with cancer in China.Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.展开更多
Given that lysophosphatidic acid（LPA） and the tetrodotoxin-resistant sodium channel Na_v1.8 are both involved in bone cancer pain, the present study was designed to investigate whether crosstalk between the LPA rece...Given that lysophosphatidic acid（LPA） and the tetrodotoxin-resistant sodium channel Na_v1.8 are both involved in bone cancer pain, the present study was designed to investigate whether crosstalk between the LPA receptor LPA_1（also known as EDG2） and Na_v1.8 in the dorsal root ganglion（DRG） contributes to the induction of bone cancer pain. We showed that the EDG2 antagonist Ki16198 blocked the mechanical allodynia induced by intrathecal LPA in na？ve rats and attenuated mechanical allodynia in a rat model of bone cancer. EDG2 and Na_v1.8expression in L_（4-6）DRGs was upregulated following intrathecal or hindpaw injection of LPA. EDG2 and Na_v1.8expression in ipsilateral L_（4-6）DRGs increased with the development of bone cancer. Furthermore, we showed that EDG2 co-localized with Na_v1.8 and LPA remarkably enhanced Na_v1.8 currents in DRG neurons, and this was blocked by either a protein kinase C（PKC） inhibitor or a PKCe inhibitor. Overall, we demonstrated the modulation of Na_v1.8 by LPA in DRG neurons, and that this probably underlies the peripheral mechanism by which bone cancer pain is induced.展开更多
Objective:Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’physical health,psychological well-being,and quality of life(QOL).Deficiency of pain care,inade...Objective:Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’physical health,psychological well-being,and quality of life(QOL).Deficiency of pain care,inadequate pain communication,and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain.Fortunately,the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain.Methods:A two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain.Based on Orem’s self-care theory and Naylor’s transitional care theory,cancer pain self-management application“Pain-housekeeper”was developed with dual client:patient client and medical client.A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China.They are randomly assigned to the control group and the intervention group.The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App.The intervention is delivered by registered doctors,nurses,and postgraduate nursing students specialized in pain care.Effect measurements for both groups are carried out with questionnaires at baseline(T0),after 4 weeks(T1)and after 12 weeks(T2).The primary outcomes include pain condition,self-efficacy,and QOL.The secondary outcomes include pain medication adherence,satisfaction,anxiety,and depression.Compliance of data submission,economic evaluation,usage,and clinical data are also considered in the test.Data for the evaluation are gathered continuously during the study period.Discussion:This article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain.The results are used to help patients to improve cancer pain control,self-efficacy,and QOL.Conclusions:The findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.展开更多
Objective： To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain. Methods： A retrospective study was carried on in 20 patients with cancer pain ...Objective： To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain. Methods： A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003. Pain intensity, adverse reactions, and satisfaction index of patients were evaluated. Results： The pain intensity was stable in 17 patients indicating good pain-control within 1 week after conversion and unstable in 3 patients after conversion suggesting poor pain-control. Fentanyl injection could alleviate side effects and increase the satisfaction index of patients. Conclusion： The equipotent ratio for conversion of low dose morphine to fentanyl injection was established as 72：1, and for non low dose morphine a ratio less than 72：1 was proposed to get stable pain-relieving effect. But the equipotent ratio for conversion of morphine to continuous infusion of fentanyl could not be determined. We must consider the morphine dose before the confirmation of the conversing rate.展开更多
Objective: To observe the effect of slow-released morphine tablets by rectum in treating the patients of moderate to severe cancer pain with server nausea and vomiting or dysphagia. Methods: 54 cases of cancer patient...Objective: To observe the effect of slow-released morphine tablets by rectum in treating the patients of moderate to severe cancer pain with server nausea and vomiting or dysphagia. Methods: 54 cases of cancer patients with server nau- sea and vomiting symptoms or dysphagia were treated with slow-released morphine tablets by rectum, 30-90 mg/time, once every 12 hours. The drug dose was titrated by degree of pain, and the effects and adverse effects were observed. Results: The total effective rate was 81.48%, complete response rate was 51.85% (28/54), and the partial response rate was 29.63% (16/54); there were no obvious toxicities, and the common adverse symptoms included nausea (16.7%) and vomiting (9.3%). Conclusion: The treatment of slow-released morphine tablet by rectum could effectively control cancer pain, the adverse effects were slight than that by mouth. It is safe and effective to be worthy of the adhibition in clinic.展开更多
BACKGROUND Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors.However,these patients generally expe-rience high levels of cancer pain,which can in t...BACKGROUND Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors.However,these patients generally expe-rience 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 signifi-cantly 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.展开更多
Purpose: To formulate and demonstrate methods for regression modeling of probabilities and dispersions for individual-patient longitudinal outcomes taking on discrete numeric values. Methods: Three alternatives for mo...Purpose: To formulate and demonstrate methods for regression modeling of probabilities and dispersions for individual-patient longitudinal outcomes taking on discrete numeric values. Methods: Three alternatives for modeling of outcome probabilities are considered. Multinomial probabilities are based on different intercepts and slopes for probabilities of different outcome values. Ordinal probabilities are based on different intercepts and the same slope for probabilities of different outcome values. Censored Poisson probabilities are based on the same intercept and slope for probabilities of different outcome values. Parameters are estimated with extended linear mixed modeling maximizing a likelihood-like function based on the multivariate normal density that accounts for within-patient correlation. Formulas are provided for gradient vectors and Hessian matrices for estimating model parameters. The likelihood-like function is also used to compute cross-validation scores for alternative models and to control an adaptive modeling process for identifying possibly nonlinear functional relationships in predictors for probabilities and dispersions. Example analyses are provided of daily pain ratings for a cancer patient over a period of 97 days. Results: The censored Poisson approach is preferable for modeling these data, and presumably other data sets of this kind, because it generates a competitive model with fewer parameters in less time than the other two approaches. The generated probabilities for this model are distinctly nonlinear in time while the dispersions are distinctly nonconstant over time, demonstrating the need for adaptive modeling of such data. The analyses also address the dependence of these daily pain ratings on time and the daily numbers of pain flares. Probabilities and dispersions change differently over time for different numbers of pain flares. Conclusions: Adaptive modeling of daily pain ratings for individual cancer patients is an effective way to identify nonlinear relationships in time as well as in other predictors such as the number of pain flares.展开更多
In patients with advanced cancer, cancer-induced bone pain（CIBP） is a severe and common problem that is difficult to manage and explain. As c-Jun N-terminal kinase（JNK） and chemokine（C-X-C motif） ligand 1（CXCL1...In patients with advanced cancer, cancer-induced bone pain（CIBP） is a severe and common problem that is difficult to manage and explain. As c-Jun N-terminal kinase（JNK） and chemokine（C-X-C motif） ligand 1（CXCL1） have been shown to participate in several chronic pain processes, we investigated the role of JNK and CXCL1 in CIBP and the relationship between them. A rat bone cancer pain model was established by intramedullary injection of Walker 256 rat gland mammary carcinoma cells into the left tibia of Sprague-Dawley rats. As a result, intramedullary injection of Walker 256 carcinoma cells induced significant bone destruction and persistent pain. Both phosphorylated JNK1（p JNK1） and p JNK2 showed time-dependent increases in the ipsilateral spinal cord from day 7 to day 18 after tumor injection. Inhibition of JNK activation by intrathecal administration of SP600125, a selective p JNK inhibitor, attenuated mechanical allodynia and heat hyperalgesia caused by tumor inoculation. Tumor cell inoculation also induced robust CXCL1 upregulation in the ipsilateral spinal cord on day 18 after tumor injection. Inhibition of CXCL1 by intrathecal administration of CXCL1 neutralizing antibody showed a stable analgesic effect. Intrathecal administration of SP600125 reduced CXCL1 increase in the spinal cord, whereas inhibition of CXCL1 in the spinal cord showed no influence on JNK activation. Taken together, these results suggested that JNK activation in spinal cord contributed to the maintenance of CIBP, which may act through modulation of CXCL1. Inhibition of the p JNK/CXCL1 pathway may provide a new choice for treatment of CIBP.展开更多
文摘Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and management.Methods In this cross-sectional study,consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain(IASP)criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025.CNCP was diagnosed based on the Neuropathic Pain Special Interest Group(NeuPSIG)criteria.Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria,regardless of coexisting visceral or bone pain.Demographic,oncologic,and pain-related data were collected through standardized interviews.Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests.Logistic regression analyses were conducted to identify clinical factors associated with CNCP.Results Of 138 eligible patients with CCP,85(61.6%)were classified into the CNCP group and 53(38.4%)into the non-CNCP group.Multivariable logistic regression analysis revealed that bone metastasis(adjusted OR=2.316,95%CI:1.074-5.178,P=0.032),radiotherapy(adjusted OR=2.489,95%CI:1.119-5.803,P=0.025),and voiding dysfunction(adjusted OR=5.470,95%CI:2.150-16.396,P<0.001)were independently associated with CNCP.Pancreatic cancer was inversely associated with CNCP(OR=0.371,P=0.031).Only 5(3.6%)patients in the CNCP group received neuropathic pain-specific interventions,indicating a predominant reliance on single-modality pain management.Conclusions CNCP was present in nearly two-thirds of outpatients with CCP.The identified associations with bone metastasis,radiotherapy,and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.
基金Supported by the Shandong Province Medical and Health Science and Technology Development Plan Project,No.202203030713Science and Technology Program of Yantai Affiliated Hospital of Binzhou Medical University,No.YTFY2022KYQD06.
文摘In this article,we evaluate the findings of the study by Qian et al,which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors.The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients,highlighting significant benefits in pain control,reduction of opioid dosage,and minimization of adverse reactions.In our article,we not only discuss these fin-dings but also emphasize the broader implications for clinical practice,parti-cularly in enhancing patient outcomes through innovative pain management strategies.We advocate for further research to establish more robust data su-pporting this approach and to explore the mechanistic insights that enable these benefits.This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain,urging a reevaluation of current practices to incorporate these findings effectively.
文摘With the aging of China’s population,tumors have become a major disease affecting people’s normal life.In particular,“cancer pain”caused by tumors has a severe impact on tumor patients,not only reducing their quality of life but also exerting negative effects on their physical and mental health and emotions.Therefore,in the clinical care of tumor patients,helping them relieve“cancer pain”and improving the quality and efficiency of medical care services have become important research topics.This paper takes evidence-based nursing as the starting point,analyzes the basic concepts and practical characteristics of evidence-based nursing,and then proposes the application process and effects of evidence-based nursing in cancer pain care for tumor patients.
文摘Objective:To systematically evaluate the effectiveness of research-oriented integrated nursing interventions on cancer pain management in hospitalized oncology patients in China.Methods:A computerized search of Chinese and English databases was conducted to identify relevant studies.Two researchers independently assessed the quality of included literature using the Newcastle-Ottawa Scale(NOS).Data were extracted and analyzed via Stata 14.A random-effects model was applied due to significant heterogeneity(I²>50%).Sensitivity analysis and Egger’s test were performed to assess bias.Results:12 eligible studies(2014-2024)were included.Meta-analysis demonstrated that integrated nursing interventions significantly reduced cancer pain scores compared to routine care(SMD=-1.51,95%CI:-1.90 to-1.12;I²=84.8%),with superior efficacy.Subgroup-analyses revealed enhanced effects for“Nursing modes”(SMD=-2.11)and“cancer pain education”(SMD=-2.30).Conclusion:Research-oriented integrated nursing interventions significantly improve cancer pain management in Chinese hospitalized oncology patients,particularly through synergistic effects of“Nursing modes”and“can-cer pain education.”However,implementation bias from“additive interventions”in teaching hospitals and high heterogeneity warrant attention.Future studies should optimize designs to enhance clinical applicability.
文摘Objective To observe the clinical effect of warming-yang moxibustion combined with acupuncture in the treatment of cancer pain. Methods Thirty patients with malignant tumor accompanied with moderate or severe cancer pain were treated with warming-yang moxibustion technique in combination with acupuncture. Zhōngwǎn （中脘 CV 12）, Guānyuán （关元 CV 4） and Shénquè （神阙 CV 8） were applied with warming moxibustion, Hégǔ （合谷 LI 4）, Nèiguān （内关 PC 6） Tàichōng （太冲 LR 3） and Sānyīnjiāo （三阴交 SP 6） were punctured as well as other acupoints selected according to differentiation of syndrome. The treatment was given once every day, and 10 times were one treatment course. Pain degree was assessed on the basis of visual analogue scale （VAS） and efficacy based on pain relief. Results Remarkably improvement was seen in 10 cases （33.3%）, improvement in 11 cases （36.7%）, partially improvement in 8 cases （26.7%）, ineffective in 1 case （3.3%）, and the total effective rate was 96.7%. VAS was 6.07±1.26 before the treatment and was 2.53±1.48 after the treatment. The difference was statistically significant （P0.01）. Conclusion Warming-yang moxibustion technique in combination with acupuncture is effective in the treatment of cancer pain.
文摘Objective: Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6) with cancer pain enrolled in the multicenter study from 136 institutes in China. Of them, 408 (28.8%) patients were 75 years old or older. All patients received transdermal fentanyl for the management of cancer pain. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. Results: Baseline mean of pain intensity was 7.34. On day 1, 3, 6, 9 15, and 30, the pain mean scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, 1.64 (P=0.000). The effective rate was 97.18%. The mean doses of fentanyl was 31.34 g/h (25-150 g/h) initially, and 40.59 g/h and 47.50 g/h (25-200 g/h) at day 15 and day 30. At treatment day 15, the dose of fentanyl was ranger from 25 to 50 g/h in 91.8% of patients, 75 to 100 g/h in 7.5% patients, and 125 to 200 g/h only in 0.8% patients. The fine quality of life was in 25.4% patients before treatment, and was 71.15% and 73.04% at day 15 and day 30 respectively (P=0.0000). The common side effects were constipation (10.70%), nausea (11.96%), dizzy (6.85%), vomiting (3.85%), sedation (2.40%), Respiratory depression (0.12%). 86.2% patients preferred continue treated by transdermal fentanyl. Conclusions: Transdermal fentanyl for the elderly with cancer pain is effective, safe, convenient, and can improve the quality of life. Transdermal fentanyl can be recommended as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain, and the initial doses is recommended as 25 g/h.
基金Evaluation of Safe and Rational Medication and Study and Application of Interventional Technology(Grant No.2013BAI06B04)
文摘In the present study, the efficacy and safety of oxycodone and morphine in the treatment of cancer pain were compared in a meta-analysis with the goal of providing a reference for drug selection in clinical practice. Electronic literature databases were searched for articles published through February 2015, including PubMed, MEDLINE, the Cochrane library, and Embase; and the China National Knowledge Intemet, VIP Databases and Wanfang Databases for studies published in Chinese. Only randomized controlled trials were selected. The primary outcome measures were efficacy and the incidence of adverse drug reactions （ADRs）. Data were extracted from the studies by two independent reviewers. A total of 15 studies containing 1338 patients were included in the analysis. The studies were divided into two subgroups according to different scoring methods. The pain relief efficacies of oxycodone and morphine were rated by the numerical rating scale （NRS） （risk ratio [RR]： 1.04; 95% confidence interval [CI]： 0.97-1.11）. Others were rated by the visual analog scale （VAS） （RR： 1.03; 95% CI： 0.97-1.10）. Five studies showed that pain intensity scores did not significantly differ between oxycodone and morphine treatments （standard mean difference [SMD] = 0.16, 95% CI： -0.01-0.33, P = 0.06）. Regarding ADRs, the incidence of constipation was lower in the oxycodone group （RR： 0.70; 95% CI： 0.58-0.85）. No statistical difference was observed among other ADRs. The efficacies of oxycodone and morphine were similar in treating cancer pain. However, the incidence of constipation was lower in patients treated with oxycodone.
文摘To compare the effects and adverse reactions of dihydrocodeine tartrate andcodeine phosphate in treating moderate cancer pain. Methods: Sixty-nine cases of cancer patientswith moderate pain were treated with dihydrocodeine tartrate or codeine phosphate respectively bydouble-blind, controlled randomized methods and the effects and adverse reactions were observed.Results: After administration of dihydrocodeine tartrate or codeine phosphate, in treatment group orcontrol group, the total effective rate was 86.6% and 93.6%, and common adverse symptoms includedconstipation (31.3%/12.9%), nausea (18.8%/19.7%), gastric trouble (18.8%/19.7%), skin pruritus(12.5%/10%), vomit (9.3% and 6.5%) with the difference being not significant. Conclusion: Theeffects of dihydrocodeine tartrate in treating moderate cancer pain are similar to codeinephosphate. Both them can be used to treat moderate cancer pain.
文摘Background: The incidence of cancer pain in patients with malignant tumors is relatively high, and pain control is poor, which is closely related to many factors, especially the nursing way. Objective: To explore the effect of standardized nursing model on pain control in patients with malignant tumors. Methods: 50 patients with malignant tumors treated in the Affiliated Hospital of Chengde Medical College from January to December in 2021 were randomly divided into 25 cases in the control group and 25 cases in the observation group. The pain control and medication compliance of the two groups were compared. Results: There was no difference in the corresponding score of admission pain between the two groups (P > 0.05), and the pain score of the observation group was lower than that of the control group (P P Conclusion: Standardized cancer pain nursing can ease the pain of patients, and the medication compliance is better.
基金supported by grants from the National Natural Science Foundation of China (81070893, 81171042 and 31171063)Beijing Municipal Commission of Education "Grants for Outstanding Ph.D. Program Tutors"+2 种基金the "111" Project of the Ministry of Education of ChinaThe Ministry of Education(BMU20100014)the China Postdoctoral Science Foundation (20090450266)
文摘Objective Our previous study showed that tumor tissue-derived formaldehyde at low concentrations plays an important role in bone cancer pain through activating transient receptor potential vanilloid subfamily member 1 （TRPV 1）. The present study further explored whether this tumor tissue-derived endogenous formaldehyde regulates TRPV1 expres- sion in a rat model of bone cancer pain, and if so, what the possible signal pathways are during the development of this type of pain. Methods A rat model of bone cancer pain was established by injecting living MRMT-1 tumor cells into the tibia. The formaldehyde levels were determined by high performance liquid chromatography, and the expression of TRPV1 was examined with Western blot and RT-PCR. In primary cultured dorsal root ganglion （DRG） neurons, the ex- pression of TRPV1 was assessed after treatment with 100 ~tmol/L formaldehyde with or without pre-addition of PD98059 [an inhibitor for extracellular signal-regulated kinase], SB203580 （a p38 inhibitor）, SP600125 [an inhibitor for c-Jun N- terminal kinase], BIM [a protein kinase C （PKC） inhibitor] or LY294002 [a phosphatidylinositol 3-kinase （PI3K） inhibi- tor]. Results In the rat model of bone cancer pain, formaldehyde concentration increased in blood plasma, bone marrow and the spinal cord. TRPV1 protein expression was also increased in the DRG. In primary cultured DRG neurons, 100 p^mol/L formaldehyde significantly increased the TRPV1 expression level. Pre-incubation with PD98059, SB203580, SP600125 or LY294002, but not BIM, inhibited the formaldehyde-induced increase of TRPV1 expression. Conclusion Formaldehyde at a very low concentration up-regulates TRPV1 expression through mitogen-activated protein kinase and PI3K, but not PKC, signaling pathways. These results further support our previous finding that TRPV1 in peripheral after- ents plays a role in bone cancer pain.
文摘Objective: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have been obtained. This study aimed to assess the efficacy and safety of the new system in Chinese patients with moderate to severe cancer pain. Methods: A total of 474 patients with moderate to severe cancer pain were enrolled in this study and were treated with the new transdermal fentanyl matrix patch (TDF) up to 2 weeks. All the patients were asked to record pain intensity, side effects, quality of life (QOL), adherence and global satisfaction. The initial dose of fentanyl was 25 ?g/h titrated with opioid or according to National Comprehensive Cancer Network (NCCN) guidelines. Transdermal fentanyl was changed every three days. Results: After 2 weeks. The mean pain intensity of the 459 evaluated patients decreased significantly from 5.63?1.26 to 2.03?1.46 (P<0.0001). The total remission rate was 91.29%, of which moderate remission rate 53.16%, obvious remission rate 25.49% and complete remission rate 12.64%. The rate of adverse events was 33.75%, 18.78% of which were moderate and 3.80% were severe. The most frequent adverse events were constipation and nausea. No fatal events were observed. The quality of life was remarkably improved after the treatment (P<0.0001). Conclusion: The new TDF is effective and safe in treating patients with moderate to severe cancer pain, and can significantly improve the quality of life.
文摘Background:Pain associated with cancer is one of the greatest causes of reduced quality of life in patients.Acupuncture is one of the treatments used to address this issue,with the great advantage of having little or no side effects,especially when compared with pharmacological pain-killers.Objective:The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain.Search strategy:Six electronic databases(PubMed,EBSCO,Cochrane Library,Scielo,b-On and Scopus)were searched for relevant articles about pain relief in cancer patients from their beginning until 2022using MeSH terms such as“acupuncture,”“electroacupuncture,”“ear acupuncture,”“acupuncture analgesia,”“oncological pain,”and“cancer pain.”Inclusion criteria:Studies included were randomized controlled trials(RCTs)where acupuncture was compared with no treatment,placebo acupuncture or usual care.Data extraction and analysis:Three independent reviewers participated in data extraction and evaluation of risk of bias,and a meta-analysis was conducted.The primary outcome was pain intensity,measured with the visual analog scale,numeric rating scale,or brief pain inventory.Secondary outcomes also assessed were quality of life,functionality,xerostomia,pain interference,and analgesic consumption.Results were expressed as standardized mean difference(SMD)with 95%confidence interval(CI).Results:Sixteen RCTs with a total of 1124 participants were included in the meta-analysis,with the majority of the studies presenting a low or unclear risk of bias.Acupuncture was more effective in reducing pain than no treatment(SMD=–0.90,95%CI[–1.68,–0.12]),sham acupuncture(SMD=–1.10,95%CI[–1.59,–0.61])or usual care(SMD=–1.16,95%CI[–1.38,–0.93]).Conclusion:The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer.Despite some limitations due to the low quality and small sample size of some included studies,as well as the different types and stages of cancer,acupuncture might provide an effective and safe treatment to reduce cancer pain.
基金This work was financially supported by Hubei Provincial Natural Science Foundation of China(No.2016CFB678).
文摘This cross-sectional study aimed to investigate cancer patients'cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China.In seven tertiary hospitals across China,372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control.Patients'demographic data and pain control-related factors were recorded.Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control.The survey showed that the majority of the patients were more than 45 years old(76.3%),and 64.4%had an average annual income of more than 20000 RMB.One-third of the patients suffered from cancer pain for more than 3 months,and 75.1%received professional guidance during medication.The barriers to pain control for patients included preference to enduring pain and refusing analgesics(62.9%),negligence towards drug usage(28.5%),concerns about the addiction(48.2%)and adverse reaction(56.4%).The average annual family income,pro fessional guidance,knowledge of pain medication,adherence to analgesics,and concerns about addiction to analgesics were significantly correlated to the effect of patients'pain control.The study presents major barriers to optimal pain control among patients with cancer in China.Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.
基金supported by the National Natural Science Foundation of China (81200854)the Natural Science Foundation of Jiangxi Province, China (20122BAB215027)+1 种基金the Science Foundation of the Educational Committee of Jiangxi Province, China (GJJ12064)the International Postdoctoral Exchange Fellowship Program, China (20150062)
文摘Given that lysophosphatidic acid（LPA） and the tetrodotoxin-resistant sodium channel Na_v1.8 are both involved in bone cancer pain, the present study was designed to investigate whether crosstalk between the LPA receptor LPA_1（also known as EDG2） and Na_v1.8 in the dorsal root ganglion（DRG） contributes to the induction of bone cancer pain. We showed that the EDG2 antagonist Ki16198 blocked the mechanical allodynia induced by intrathecal LPA in na？ve rats and attenuated mechanical allodynia in a rat model of bone cancer. EDG2 and Na_v1.8expression in L_（4-6）DRGs was upregulated following intrathecal or hindpaw injection of LPA. EDG2 and Na_v1.8expression in ipsilateral L_（4-6）DRGs increased with the development of bone cancer. Furthermore, we showed that EDG2 co-localized with Na_v1.8 and LPA remarkably enhanced Na_v1.8 currents in DRG neurons, and this was blocked by either a protein kinase C（PKC） inhibitor or a PKCe inhibitor. Overall, we demonstrated the modulation of Na_v1.8 by LPA in DRG neurons, and that this probably underlies the peripheral mechanism by which bone cancer pain is induced.
基金This project was supported by the Xuzhou Science and Technology Plan Project(No.KC19223)Natural Science Project of Xuzhou Medical University(No.2018KJ07).
文摘Objective:Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’physical health,psychological well-being,and quality of life(QOL).Deficiency of pain care,inadequate pain communication,and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain.Fortunately,the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain.Methods:A two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain.Based on Orem’s self-care theory and Naylor’s transitional care theory,cancer pain self-management application“Pain-housekeeper”was developed with dual client:patient client and medical client.A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China.They are randomly assigned to the control group and the intervention group.The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App.The intervention is delivered by registered doctors,nurses,and postgraduate nursing students specialized in pain care.Effect measurements for both groups are carried out with questionnaires at baseline(T0),after 4 weeks(T1)and after 12 weeks(T2).The primary outcomes include pain condition,self-efficacy,and QOL.The secondary outcomes include pain medication adherence,satisfaction,anxiety,and depression.Compliance of data submission,economic evaluation,usage,and clinical data are also considered in the test.Data for the evaluation are gathered continuously during the study period.Discussion:This article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain.The results are used to help patients to improve cancer pain control,self-efficacy,and QOL.Conclusions:The findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.
基金a grant from the Japan Sasakawa Medical Scholarship.
文摘Objective： To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain. Methods： A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003. Pain intensity, adverse reactions, and satisfaction index of patients were evaluated. Results： The pain intensity was stable in 17 patients indicating good pain-control within 1 week after conversion and unstable in 3 patients after conversion suggesting poor pain-control. Fentanyl injection could alleviate side effects and increase the satisfaction index of patients. Conclusion： The equipotent ratio for conversion of low dose morphine to fentanyl injection was established as 72：1, and for non low dose morphine a ratio less than 72：1 was proposed to get stable pain-relieving effect. But the equipotent ratio for conversion of morphine to continuous infusion of fentanyl could not be determined. We must consider the morphine dose before the confirmation of the conversing rate.
文摘Objective: To observe the effect of slow-released morphine tablets by rectum in treating the patients of moderate to severe cancer pain with server nausea and vomiting or dysphagia. Methods: 54 cases of cancer patients with server nau- sea and vomiting symptoms or dysphagia were treated with slow-released morphine tablets by rectum, 30-90 mg/time, once every 12 hours. The drug dose was titrated by degree of pain, and the effects and adverse effects were observed. Results: The total effective rate was 81.48%, complete response rate was 51.85% (28/54), and the partial response rate was 29.63% (16/54); there were no obvious toxicities, and the common adverse symptoms included nausea (16.7%) and vomiting (9.3%). Conclusion: The treatment of slow-released morphine tablet by rectum could effectively control cancer pain, the adverse effects were slight than that by mouth. It is safe and effective to be worthy of the adhibition in clinic.
文摘BACKGROUND Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors.However,these patients generally expe-rience 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 signifi-cantly 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.
文摘Purpose: To formulate and demonstrate methods for regression modeling of probabilities and dispersions for individual-patient longitudinal outcomes taking on discrete numeric values. Methods: Three alternatives for modeling of outcome probabilities are considered. Multinomial probabilities are based on different intercepts and slopes for probabilities of different outcome values. Ordinal probabilities are based on different intercepts and the same slope for probabilities of different outcome values. Censored Poisson probabilities are based on the same intercept and slope for probabilities of different outcome values. Parameters are estimated with extended linear mixed modeling maximizing a likelihood-like function based on the multivariate normal density that accounts for within-patient correlation. Formulas are provided for gradient vectors and Hessian matrices for estimating model parameters. The likelihood-like function is also used to compute cross-validation scores for alternative models and to control an adaptive modeling process for identifying possibly nonlinear functional relationships in predictors for probabilities and dispersions. Example analyses are provided of daily pain ratings for a cancer patient over a period of 97 days. Results: The censored Poisson approach is preferable for modeling these data, and presumably other data sets of this kind, because it generates a competitive model with fewer parameters in less time than the other two approaches. The generated probabilities for this model are distinctly nonlinear in time while the dispersions are distinctly nonconstant over time, demonstrating the need for adaptive modeling of such data. The analyses also address the dependence of these daily pain ratings on time and the daily numbers of pain flares. Probabilities and dispersions change differently over time for different numbers of pain flares. Conclusions: Adaptive modeling of daily pain ratings for individual cancer patients is an effective way to identify nonlinear relationships in time as well as in other predictors such as the number of pain flares.
基金supported by the National Natural Science Foundation of China(No.81172150)
文摘In patients with advanced cancer, cancer-induced bone pain（CIBP） is a severe and common problem that is difficult to manage and explain. As c-Jun N-terminal kinase（JNK） and chemokine（C-X-C motif） ligand 1（CXCL1） have been shown to participate in several chronic pain processes, we investigated the role of JNK and CXCL1 in CIBP and the relationship between them. A rat bone cancer pain model was established by intramedullary injection of Walker 256 rat gland mammary carcinoma cells into the left tibia of Sprague-Dawley rats. As a result, intramedullary injection of Walker 256 carcinoma cells induced significant bone destruction and persistent pain. Both phosphorylated JNK1（p JNK1） and p JNK2 showed time-dependent increases in the ipsilateral spinal cord from day 7 to day 18 after tumor injection. Inhibition of JNK activation by intrathecal administration of SP600125, a selective p JNK inhibitor, attenuated mechanical allodynia and heat hyperalgesia caused by tumor inoculation. Tumor cell inoculation also induced robust CXCL1 upregulation in the ipsilateral spinal cord on day 18 after tumor injection. Inhibition of CXCL1 by intrathecal administration of CXCL1 neutralizing antibody showed a stable analgesic effect. Intrathecal administration of SP600125 reduced CXCL1 increase in the spinal cord, whereas inhibition of CXCL1 in the spinal cord showed no influence on JNK activation. Taken together, these results suggested that JNK activation in spinal cord contributed to the maintenance of CIBP, which may act through modulation of CXCL1. Inhibition of the p JNK/CXCL1 pathway may provide a new choice for treatment of CIBP.
