RESUMO
Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.
Assuntos
Anestésicos Locais , Lidocaína , Síndromes da Dor Miofascial , Neoplasias , Cuidados Paliativos , Humanos , Lidocaína/uso terapêutico , Lidocaína/administração & dosagem , Masculino , Feminino , Cuidados Paliativos/métodos , Pessoa de Meia-Idade , Idoso , Síndromes da Dor Miofascial/tratamento farmacológico , Síndromes da Dor Miofascial/terapia , Método Simples-Cego , Anestésicos Locais/uso terapêutico , Anestésicos Locais/administração & dosagem , Neoplasias/complicações , Medição da Dor , Brasil , Dor do Câncer/tratamento farmacológico , Dor do Câncer/terapia , Idoso de 80 Anos ou maisRESUMO
INTRODUCTION: Pain is the second most frequent symptom reported in patients with cancer among the main reasons for consultation. The incorporation of educational modalities in pain intervention processes has been suggested. This study aims to examine the efficacy of neuroscience pain education (PNE) in relation to pain, biopsychosocial variables and functional capacity in comparison with conventional treatment. It is hypothesised that an intervention based on PNE achieves better outcomes than conventional management, in terms of pain, biopsychosocial variables and functional capacity in adults with oncological pain. METHODS AND ANALYSIS: This will be a single-blind, controlled clinical trial in which two groups will be compared using changes in pain as the primary measure. The first group will receive conventional treatment in addition to PNE, and participants will undergo an intervention of nine sessions (one session per week, for a total of 9 weeks), each lasting 30-40 min. Specifically, these sessions will teach biophysiological elements using metaphors that allow the adoption of these concepts related to pain. The second group will receive conventional treatment (pharmacological treatment). For this study, a sample size calculation was made based on the background, where 80 adults with oncological pain were required. An initial evaluation will be made to establish the baseline characteristics, and then, according to the randomisation, the assignment to the PNE group or the control group will be made and the two groups will be summoned again. Ten weeks later, for the intervention evaluation, the statistical analysis plan will be established by protocol and by intention-to-treat. ETHICS AND DISSEMINATION: This protocol complies with all ethical considerations. The authors commit to presenting the study's results. This study was approved by the ethics committees of the Universidad Santiago de Cali, Clínica de Occidente/Angiografía de Occidente. The authors commit to presenting the study's results. TRIAL REGISTRATION NUMBER: NCT05581784.
Assuntos
Dor do Câncer , Neoplasias , Humanos , Adulto , Dor do Câncer/terapia , Método Simples-Cego , Dor , Resultado do Tratamento , Neoplasias/complicações , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
CONTEXTUALIZATION: One of the biggest problems regarding the treatment of cancer patients is pain, whether due to the cancer or the treatment itself. Therefore, there is a search for treatments that aims to promote an effective treatment in this sense. PURPOSE: This article aims to verify which are the recent methods used to treat pain in cancer patients in a multidisciplinary sense, and to evaluate their effectiveness. METHODOLOGY: Systematic reviews, meta-analyses and randomized clinical trials utilizing the LILACS, NCBI, and MEDLINE platforms of the last 5 years were included. The descriptors were pain treatment in oncology, pain management, complementary therapies, and other synonyms, in Portuguese, English and Spanish. This included any technique that was effective in the treatment of cancer pain. RESULTS: The initial search found 2246 articles, of which 22 were included in the systematic review. Most of these are acupuncture treatments, opioids versus anti-inflammatories versus analgesics, radiotherapy, behavioral therapies, among others. Most articles suggest benefits with these therapies, improved quality of life for patients and tolerable side effects. CONCLUSION: This study demonstrates the effectiveness of the current methods used in the treatment of pain in cancer patients so that professionals in the area can have more options for treating cancer pain. Despite the important limitations, the guideline for further research and the situations in which treatments have shown effectiveness are present in it.
Assuntos
Dor do Câncer , Neoplasias , Humanos , Dor do Câncer/terapia , Dor do Câncer/tratamento farmacológico , Qualidade de Vida , Dor/tratamento farmacológico , Manejo da Dor , Analgésicos Opioides/uso terapêutico , Neoplasias/terapia , Neoplasias/tratamento farmacológicoRESUMO
Abdominal pain is severe in the vast majority of patients with pancreatic cancer. In some cases, chronic use of analgesics markedly reduces quality of life due to side effects. Endoscopic ultrasound-guided celiac plexus neurolysis is a procedure that controls cancer-associated pain in this population and consists of injecting a neurolytic agent around or within the celiac plexus. In this report, we present three cases with different technical approaches for celiac plexus neurolysis.
Assuntos
Dor do Câncer , Plexo Celíaco , Neoplasias Pancreáticas , Humanos , Plexo Celíaco/diagnóstico por imagem , Dor do Câncer/etiologia , Dor do Câncer/terapia , Qualidade de Vida , Endossonografia/métodos , Neoplasias Pancreáticas/complicações , Dor Abdominal/etiologia , Ultrassonografia de IntervençãoRESUMO
Objetivo: El dolor óseo por cáncer óseo o metástasis es un dolor de difícil manejo asociado a dolor incidental. Hay distintas estrategias quirúrgicas para su tratamiento, sin embargo, no todos los pacientes con metástasis óseas pueden beneficiarse de un tratamiento quirúrgico. La presente revisión bibliográfica tiene como objetivo identificar terapias intervencionales mínimamente invasivas para el control del dolor por metástasis óseas. Métodos: Revisión bibliográfica acerca de terapias intervencionales para el control del dolor por metástasis óseas utilizando la base de datos PubMed (www.pubmed.gov) y el motor de búsqueda Google (www.google.cl). Tipos de participantes: Pacientes con metástasis óseas dolorosas de cualquier tumor primario. Tipos de intervenciones: Bloqueos anestésicos, bloqueos neurolíticos, terapias ablativas, cementoplastías. Resultados: Se obtuvieron 384 resultados que incluyeron revisiones sistemáticas, revisiones bibliográficas, ensayos clínicos controlados, series de casos y reporte de casos. Todos los artículos relevantes en inglés y español se incluyeron para su análisis. Conclusión: Las metástasis óseas son un evento común en los pacientes con cáncer, y el dolor óseo es un dolor de difícil manejo asociado a dolor incidental. Se han desarrollado terapias intervencionales no invasivas o mínimamente invasivas para tratar el dolor, mejorar la calidad de vida y la funcionalidad, disminuir el consumo de fármacos, y reducir el tamaño del tumor. La gran mayoría ha demostrado ser terapias seguras y eficaces, con pocos eventos adversos y de rápida resolución, y que si son combinadas mejoran los resultados.
Objective: Bone pain from bone cancer or metastasis is a pain that is difficult to manage associated with incidental pain. There are different surgical strategies for its treatment, however, not all patients with bone metastases can benefit from a surgical treatment. This literature review aims to identify minimally invasive interventional therapies for the control of pain due to bone metastasis. Methods: Literature review of interventional therapies for the control of pain due to bone metastases was done using the PubMed database (www.pubmed.gov) and the Google search engine (www.google.cl). Types of participants: Patients with painful bone metastases from any primary tumor. Types of interventions: Anesthetic blocks, neurolytic blocks, ablative therapies, cementoplasties. Results: We obtained 384 results that included systematic reviews, literature reviews, controlled clinical trials, case series and case reports. All relevant articles in English and Spanish were included for analysis. Conclusion: Bone metastases are a common event in cancer patients, and bone pain is a difficult-to-manage pain associated with incidental pain. Non-invasive or minimally invasive interventional therapies have been developed to treat pain, improve quality of life and functionality, decrease drug use, and reduce tumor size. The vast majority therapies have been shown to be safe and effective ones, with few adverse events and rapid resolution, and that if combined they improve the outcomes.
Assuntos
Humanos , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Metástase Neoplásica/terapia , Denervação , Técnicas de Ablação , CementoplastiaRESUMO
BACKGROUND: Several clinical practice guidelines (CPGs), consensus statements, and recommendations currently exist for the diagnosis and management of breakthrough cancer pain (BTcP). These documents have considerable variability amongst them, and to date, their quality and methodologic rigor have not been appraised. AIM: We aim to identify and perform a quality appraisal of CPGs for the diagnosis and management of BTcP using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. METHODS: A comprehensive literature search was performed in MEDLINE (via PubMed), EMBASE, and SCOPUS databases up until January 1, 2021. Four reviewers independently evaluated each guideline using the AGREE II instrument. Scaled domain scores were generated and the threshold used for satisfactory quality was >60%. Additionally, intraclass correlation coefficients (ICC) were calculated to determine level of agreement between reviewers. RESULTS: Eleven guidelines were selected for final evaluation based on inclusion/exclusion criteria. Only one guideline was classified of "average" quality while the rest were classified as "low" quality. The "Editorial Independence" (70.46 ± 35.7) and "Scope and Purpose" (64.78 ± 12.5) domains received the highest mean scores, while the "Applicability" (32.58 ± 13.5) and "Rigor of Development" (35.04 ± 9.0) domains received the lowest mean scores. ICC statistical analysis showed high magnitude of agreement between reviewers with a range of (0.790-0.988). CONCLUSIONS: Reflecting upon our quality appraisal, it is evident that the quality and methodologic rigor of BTcP guidelines can be improved upon in the future. Our findings also elucidate the existing variability/discrepancies among guidelines in diagnostic criteria and management of BTcP.
Assuntos
Dor Irruptiva , Dor do Câncer , Neoplasias , Dor Irruptiva/diagnóstico , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/terapia , Bases de Dados Factuais , Humanos , Neoplasias/complicações , Guias de Prática Clínica como AssuntoRESUMO
Introdução: A Scrambler therapy é uma nova e não invasiva modalidade de eletroanalgesia com a intenção de organizar a má adaptação dos sinais elétricos de nervos periféricos. Objetivo: Avaliar o benefício clínico da Scrambler therapy no controle de intensidade da dor em pacientes oncológicos. Método: Revisão da literatura conforme a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) nas bases de dados eletrônicas LILACS, PEDro, SciELO e PubMed. Foram combinados aleatoriamente os descritores: "Scrambler therapy", "cancer", "pain", assim como o uso dos operadores booleanos AND e OR, em português, inglês e espanhol, sem limite de tempo. Resultados: Foram incluídos 15 estudos que, após avaliação crítica, demonstraram benefício clínico na redução na intensidade da dor. A Scrambler therapy é baseada em cinco neurônios artificiais controlados por um algoritmo otimizado para fornecer segurança e eficácia. O hardware recebe informações do algoritmo que cria as sequências de caracteres "não-dor" e as processa, transformando-as em fluxos potenciais de ação sintéticos (isto é, criados pela tecnologia) funcionalmente compatíveis com os potenciais endógenos. Conclusão: Os resultados positivos encontrados nos estudos preliminares com a Scrambler therapy indicam benefícios no controle da dor oncológica
Introduction: Scrambler therapy is a novel, non-invasive pain modifying technique that utilizes transcutaneous electrical stimulation of pain fibers with the intent of re-organizing maladaptive signaling pathways. Objective: Evaluate the benefits of Scrambler therapy to manage the intensity of pain in oncologic patients. Method: Integrative literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the electronic databases LILACS, PEDro, SciELO and PubMed. The descriptors "Scrambler therapy", "cancer", "pain" were randomly combined in addition to the Boolean operators AND, OR in Portuguese, English and Spanish with no time limitation. Results: For this review, 15 articles were found relevant. The Scrambler therapy machine is based on 5 artificial neurons controlled by an optimized algorithm to provide safety and effectiveness. The hardware receives information from the algorithm that creates the strings of "non-pain," and processes them by transforming into potential flows of synthetic action (i.e. created by technology) functionally compatible with endogenous flows. Pain scrambler therapy had a potential to decrease pain in cancer patients. Conclusion: The positive findings from preliminary studies with Scrambler therapy endorses the benefits this device provides to manage oncologic pain
Introducción: Scrambler therapy es una modalidad nueva y no invasiva de electroanalgesia con la intención de organizar la pobre adaptación de las señales eléctricas de los nervios periféricos. Objetivo: Estudiar si la Scrambler therapy influye en la intensidad del dolor en pacientes con cáncer. Método: Revisión integradora de la Literatura según la Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), mediante búsqueda realizada en las bases de datos LILACS, PEDro, SciELO y PubMed, utilizando las palabras clave "terapia Scrambler", "cáncer", "dolor", así como el uso de los operadores booleanos AND y OR, en portugués, inglés y español, sin límite de tiempo. Resultados: Se incluyeron 15 artículos relevantes para la revisión, que muestran una reducción en la intensidad del dolor. La Scrambler therapy se basa en cinco neuronas artificiales controladas por un algoritmo optimizado para proporcionar seguridad y eficacia. El hardware recibe información del algoritmo que crea las cadenas de "no dolor" y las procesa transformándolas en flujos de potenciales de acción sintéticos (es decir, creados por la tecnología) funcionalmente compatibles con los endógenos. Conclusión: Los resultados positivos encontrados en los estudios preliminares con la Scrambler therapy indican beneficios en el control del dolor por cáncer
Assuntos
Humanos , Masculino , Feminino , Estimulação Elétrica Nervosa Transcutânea , Manejo da Dor , Dor do Câncer/terapia , Neoplasias , Dor CrônicaRESUMO
Las metástasis óseas se desarrollan en aproximadamente 30 a 70% de todos los pacientes con cáncer. El dolor es una experiencia de la condición humana universal, y es común que las personas busquen atención médica a raíz de ello. El presente estudio tuvo como objetivo describir la eficacia y el papel de diferentes estrategias en el control del dolor óseo en pacientes cancerosos metastásicos. Se trata de un estudio observacional realizado entre el 1 de diciembre de 2018 y el 30 de diciembre de 2019. Se inscribieron exactamente 100 pacientes cancerosos. Los pacientes fueron evaluados antes de recibir las modalidades de control del dolor, al principio y al final del tratamiento. La puntuación del dolor óseo se utilizó de 0 (sin dolor) a 10 (el peor dolor). Nuestros hallazgos con respecto al sexo, hubo 51 (51%) hombres y 49 (49%) mujeres. La edad media fue de 57,3 ± 11,2 años y el grupo de edad más frecuente fue de 41-50 años, 37 (37%). Entre los tipos de cáncer, el cáncer de mama ocupa el primer lugar entre los casos estudiados en nuestra investigación 37 (37%), seguido del cáncer de próstata 24 (24%). Las vértebras de la columna fueron el sitio más representado en un 52%, seguido de los huesos pélvicos en un 36%. La mayoría de los pacientes no requirieron cirugía. Mientras que el 15% de los pacientes se sometieron a descompresión del cordón, el 13% requirió fijación interna y solo cuatro pa- LA PRENSA MÉDICA ARGENTINA Bony pain management in cancerous patients 117 V.107/Nº 2 cientes se sometieron a vertebroplastia. El dolor agudo se describió comúnmente en un 40%, seguido de naturaleza punzante en un 15%. El dolor frecuente fue más prevalente en el 60% de los pacientes, mientras que el dolor constante se presentó en el 40%. La noche fue el momento más común de sentir dolor en el 55%. Después de recibir el tratamiento, varias modalidades provocan un desplazamiento de la puntuación del dolor hacia abajo. Combinación de más de estrategias más eficientes que utilizar una opción para el manejo del dolor óseo con un mejor resultado y pronóstico.
Bone metastases develop in approximately 3070% of all cancer patients. Pain is a universal human experience condition, and it is a common question for people to seek health care. The study aimed to describe the efficacy and roles of different strategies in the control of bony pain in metastatic cancerous patients. This is an observational study carried out, from the 1st of December 2018 to the 30th of December 2019. Exactly 100 cancerous patients were enrolled. Patients were assessed before received of pain control modalities, in the beginning, and at the end of treatment. Bone pain scoring was used from 0 (no pain) to 10 (the worst pain). Our findings regarding sex, there were 51(51%) male and 49(49%) female. The mean age was 57.3±11.2 years, and the most frequent age group was 41-50 years as 37(37%). Among cancer types, breast cancer comes in 1st rank cases studied in our research 37(37%), followed by prostate cancer 24(24%). Spine vertebrae were the most site figured 52%, followed by pelvic bones in 36%. Most patients did not require surgery. Whereas 15% of patients underwent cord decompression, 13% required internal fixation and only four patients performed for vertebroplasty. The sharp pain was commonly described by 40%, followed by stabbing nature in 15%. Frequent pain was more prevalent in 60% of patients, whereas constant pain presented in 40%. The night was the commonest timing of feeling pain in 55%. After receiving treatment, several modalities cause shifting of the pain scoring downward. Combination of more than strategies more efficient than of use one option for manage of bone pain with a better outcome, and prognosis.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Dor/prevenção & controle , Neoplasias Ósseas/terapia , Dor do Câncer/terapia , Metástase Neoplásica/terapiaRESUMO
OBJECTIVE: to synthesize the knowledge and to critically evaluate the evidences arising from randomized controlled trials on the efficacy of the complementary therapies in the management of cancer pain in adult patients with cancer in palliative care. METHOD: a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search for articles in the MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane, and PsycINFO databases, as well as the manual search, selection of studies, data extraction, and methodological assessment using the Cochrane Bias Risk tool were performed independently by two reviewers. RESULTS: eight hundred and fifteen (815) studies were identified, six of them being selected and analyzed, of which three used massage therapy, one study used a combination of progressive muscle relaxation and guided imaging, and another two studies used acupuncture. Most of the studies had an uncertain risk of bias (n=4; 67%). CONCLUSION: while the evidence from the studies evaluating the use of massage therapy or the use of progressive muscle relaxation and guided imaging for the management of cancer pain in these patients demonstrated significant benefits, the other two studies that evaluated the use of acupuncture as a complementary therapy showed contradictory results, therefore, needing more research studies to elucidate such findings.