Impacts of radiation therapy on quality of life and pain relief in patients with bone metastases

Bone metastases(BM)are a common complication in advanced cancer patients,significantly contributing to morbidity and mortality due to their ability to cause pain,fractures,and spinal cord compression.Radiation therapy(RT)is vital in managing these complications by targeting metastatic lesions to ease pain,improve mobility,and reduce the risk of skeletal-related events such as fractures.Evidence supports the effectiveness of RT in pain relief,showing its ability to provide significant palliation and lessen the need for opioid painkillers,thereby enhancing the overall quality of life(QoL)for patients with BM.However,optimizing RT outcomes involves considerations such as the choice of radiation technique,dose fractionation schedules,and the integration of supportive care measures to mitigate treatment-related side effects like fatigue and skin reactions.These factors highlight the importance of personalized treatment planning tailored to individual patient needs and tumor characteristics.This mini-review aims to provide comprehensive insights into the multifaceted impacts of RT on pain management and QoL enhancement in BM patients,with implications for refining clinical practices and advancing patient care through the synthesis of findings from various studies.

Palliative care with adequate pain relief challenges the need for euthanasia legislation

Background:In today’s society the ongoing discussion about euthanasia triggers emotionally charged debates surrounding the delicate balance between valuing life and respecting an individual’s autonomy.With the persistence of this debate,there has been the emergence of the concept of the so-called alternative:palliative care.Positioned as a substitute for euthanasia,palliative care aims to alleviate suffering in terminally ill patients without engaging in the ethical dilemmas associated with euthanasia.Methods:This paper explores the facets of palliative care highlighting its core objectives such as providing adequate pain relief as a compassionate alternative to euthanasia.Results:By examining palliative care as a comprehensive approach to end of life support,this study challenges the perceived necessity of euthanasia and advocates,for compassionate and dignified end of life experiences.Conclusion:In conclusion,palliative care emerges as a viable and ethically sound alternative to euthanasia,emphasizing the importance of compassionate end-of-life care and pain management.

Pain relief in upper abdominal malignancy

The symptom of cancer most feared by many patients is pain. The physical and psychological distress of constant pain without relief should not be underestimated, and all complaints of pain should be actively treated. The clinician should not forget however that drugs used in the treatment of

A Randomized Longitudinal Double-Blind Clinical Trial on Long-Term Neuropathic Symptomatology Relief &Pain Analgesia

Diabetic neuropathic pain is one of the most difficult to treat with high levels of reoccurrence and a substantial increase with aging. It involves expensive hospitalizations, often resulting in an amputated lower limb. We explored a variety of methods treating neuropathic pain such as low-level laser, monochromatic near-infrared treatment, TENS, acupuncture and pulsed electromagnetic fields that demonstrated inconclusive, limited or temporary pain relief with minor or short-term improvements in mobility. Research conducted by ultra-low energy technologies reports pain relief and reduction of inflammation as a result of anti-oxidant electron donation transforming free radicals into stable molecules. We report the results of a randomized double blind one-year-long longitudinal clinical study on 10 diabetic mellitus (DM) subjects with chronic neuropathy, treated with ultra-low energy nanotechnology who experienced substantial long-term neuropathic pain relief. Importantly, pain analgesia and improvement in neuropathic symptomatology were not age-contingent. This contradicts past research postulating that age-accumulated inflammation and endothelial dysfunction can further exacerbate diabetic neuropathy. Importantly, a method offering age-independent, cost-effective, long-term neuropathic pain relief and increased mobility has major implications in reducing hospitalization time and overall expenses by offering a solution that enhances quality of life.

Investigating the Physiological Mechanisms between Resistance Training and Pain Relief in the Cancer Population: A Literature Review

This literature review examines the mechanisms of how exercise, specifically in the form of resistance training, may lead to pain relief in the cancer population. Primary data from three different cancer populations: breast, prostate, and lung, will be examined. A number of experimental studies have been conducted to confirm the effectiveness of resistance training on pain relief as well as the biochemical pathways that relate to this process. In this review, we will examine 5 randomized controlled trials. For the purposes of this review, pain is defined as physical suffering or discomfort associated with illness. Pain is the body’s natural signal, bringing attention to damage that has been sustained by tissues. However, chronic pain is common in the cancer population, and often serves no good purpose but instead will negatively impact both physical and mental health. The three types of pain: nociceptive, neuropathic, and inflammatory pathways have been investigated, and the knowledge of pain mechanisms allows for the understanding of how it is associated with pain. The purpose of this exploratory literature review is to give insight on how to maximize pain-relieving effects of resistance training. Research has indicated that resistance training modulates pain pathways by upregulating the release of pain-relieving substances including beta-endorphins, anti-inflammatory cytokines, and endocannabinoids. Understanding of the benefits of resistance training may be useful in relieving cancer pain, and reproducing effects of pain-relieving strategies while minimizing the symptoms related to cancer and its treatment.

Midwives’ utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study

Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.

Pain relief by palliative radiotherapy in patients with advanced bone metastases

Objective: To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8 Gy in single fraction, 31 given 20 Gy in 5 fractions, 43 given 40 Gy in 20 fractions. Results and Conclusion: The method of 40 Gy in 20 fractions had a higher pain relief rate and a lower pain relapse rate, suggesting that large-dose fractioned treatment regimen is more appropriate for patients with bone metastasis.

Pain Relief in Labour: How Can We Improve Intrapartum Care?

Background: Pain in labour is perceived differently for every individual. We can improve the outcomes and patient satisfaction with intrapartum care by ensuring adequate education and appropriate use of requested pain relief options. Encouraging informed personal control contributes to a women’s overall satisfaction. Aims: To assess current practice and identify improvement areas in the perception, planning and use of pain relief options, and how this impacts satisfaction of pain relief in labour. Methods: 114 retrospective anonymous patient questionnaires were returned by women delivering by spontaneous vaginal delivery, instrumental delivery or emergency caesarean section at Nambour General Hospital between April and July 2011. Data were collated and analysed using STATA. Results: 83% and 65% of women had their pain relief options explained antenatally and on admission respectively. 92% reported their pain relief was adequately provided. There was a significant difference (p Conclusions: Education of pain relief options for labour antenatally and on birth suite admission, with adequate discussion and documentation of their wishes encourages informed planning and use of pain relief. This promotes personal choice and control, resulting in improved overall satisfaction of pain relief in labour.

Evidence and explanation for the involvement of the nucleus accumbens in pain processing

The nucleus accumbens(NAc)is a subcortical brain structure known primarily for its roles in pleasure,reward,and addiction.Despite less focus on the NAc in pain research,it also plays a large role in the mediation of pain and is effective as a source of analgesia.Evidence for this involvement lies in the NAc’s cortical connections,functions,pharmacology,and therapeutic targeting.The NAc projects to and receives information from notable pain structures,such as the prefrontal cortex,anterior cingulate cortex,periaqueductal gray,habenula,thalamus,etc.Additionally,the NAc and other pain-modulating structures share functions involving opioid regulation and motivational and emotional processing,which each work beyond simply the rewarding experience of pain offset.Pharmacologically speaking,the NAc responds heavily to painful stimuli,due to its high density ofμopioid receptors and the activation of several different neurotransmitter systems in the NAc,such as opioids,dopamine,calcitonin gene-related peptide,γ-aminobutyric acid,glutamate,and substance P,each of which have been shown to elicit analgesic effects.In both preclinical and clinical models,deep brain stimulation of the NAc has elicited successful analgesia.The multi-functional NAc is important in motivational behavior,and the motivation for avoiding pain is just as important to survival as the motivation for seeking pleasure.It is possible,then,that the NAc must be involved in both pleasure and pain in order to help determine the motivational salience of positive and negative events.

Efficacy and Safety of Transdermal Fentanyl(TDF)in Treatment of Pain Caused by Interventional Embolization Therapy

Objective： Interventional embolization therapy is well accepted in cancer treatment, but patient may suffer from a moderate-to-severe pain after therapy and its quality of life （QoL） is influenced, this study is to observe the efficacy and safety of transdermal fentanyl （TDF） in the management of pain caused by interventional embolization therapy. Methods： Morphine 10mg and TDF 25μg/h were immediately used in 52 patients who had moderate-to-severe pain complicated by interventional embolization therapy, the pain intensity was evaluated by visual analogue scale （VAS）. If VAS≥4 at t2 h after treatment, the dosage of TDF added into 50 μg/h. At 0h, 12h, 24h, 72h, 1 week, 2 weeks after TD, the vas and adverse events were observed respectively. Result： There was an obvious decrease in VAS at 12h after TDF treatment in the patients of which only 9 patients used 50ug/h dosage after partial splenic embolization （PSE） therapy. Most patients got satisfactory pain relief both the TDF 25 μg/h and TDF 50 μg/h group （VAS 0-1）. The adverse events were nausea, vomiting and dizzy, especially in the TDF 50 μg/h group. No respiratory depression was observed and only one patient got retention of urine. Conclusion： TDF was effective and safe in the treatment of moderate-to-severe pain after interventional embolizafion therapy.

Effects of Pre-Operative Single Dose Gabapentin on Postoperative Pain Following Total Abdominal Hysterectomy: A Dose Finding Study

Background & Aims: The multimodal analgesia provides superior pain relief and reduces opioid consumption and its side effects. Gabapentin has been used successfully in multi-modal analgesia in different doses. We designed a double-blind randomized control trial to find the minimal effective dose of gabapentin in multimodal analgesia for postoperative pain following total abdominal hysterectomy. Material & Methods: After informed consent, total of 87 patients were randomly assigned to A, B & C groups to receive gabapentin orally 300 mg, 600 mg, and 900 mg respectively one to two hours before surgery. Postoperatively pain was managed by patient-controlled analgesia (PCA) using pethidine. Pain score, opioid consumption, and side effects of gabapentin were monitored. Rescue analgesia was given and monitored. Results: There was no statistically significant difference among the groups with respect to age, weight, height, pethidine consumption, and rescue analgesia. Mean pain scores were statistically insignificant at baseline, 8, 12, and 24 hours postoperatively. Only at 4 hours, the highest pain score (mean) was found in group A, which is statistically significant. The side effects of gabapentin like nausea, vomiting, somnolence, and dizziness were also statistically insignificant. Conclusion: A single preoperative oral gabapentin 300 mg was found to be minimal effective dose in multimodal analgesic regimen for reducing post-operative pain and analgesic requirement following total abdominal hysterectomy.

Quality Control of Postoperative Acute Pain Service

To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative anal-gesia period was conducted. Incidents were reported and analyzed in 1507 patients who received epidural postoperative analgesia, and the results of satisfaction of pain relief was compared with those of incident analysis. In this study, an incident was defined as any factor that might or had affected patient's safety during analgesia period. Our results showed that 1203 incidents were reported in 641 of 1507 patients, of which 122 incidents were critical. 78. 3 % of all incidents were detect-ed by acute pain service stuff. The most common incidents included complica-tions, insufficient analgesia and problems with delivery circuits. Human factors were involved in 28. 9 % of the incidents, most being associated with technical failure due to unskillfu1ness, poor communications between APS stuff and pa-tients and lack of cooperation with surgeons and nurses. The general satisfactionrate of the patients was 90. 8 %. There was a very significant difference between the satisfaction of the patients who suffered from incidents and who did not (P<t0.001). It is concluded that incidents affect the satisfaction of the patients who received postoperative pain relief. Incident reporting is a more effective method for quality control of acute pain service.

The Effect of Brief Mindfulness Meditation on Cold-Pressor Induced Pain Responses in Healthy Adults

We hypothesised a 10 minute mindfulness based intervention performed by a novice therapist would have a beneficial effect on pain responses in naive participants. Twenty-four participants were randomly assigned to the control group or mindfulness meditation group. The control group sat quietly for 10 minutes in between two cold pressor tasks. The mindfulness meditation intervention group practiced 10 minutes of mindfulness meditation in between cold-pressor tasks following standardised mindfulness of breathing meditation technique instructions provided by a male investigator. A significant interaction effect was found between anxiety towards pain ratings (pre-intervention vs. post-intervention) and intervention (F = 6.29, p = 0.02). There was a significant decrease (t = 4.07, p = 0.002) in anxiety towards pain ratings in the mindfulness meditation group following intervention. A significant interaction effect was found between pain threshold times (pre-intervention vs. post-intervention) and intervention (F = 18.45, p 0.001) in pain threshold times in the mindfulness meditation group following intervention. A significant interaction effect was found between pain tolerance times (pre-intervention vs. post-intervention) and intervention (F = 18.34, p < 0.001). A significant increase (t = -4.20, p = 0.001) in pain tolerance times in the mindfulness meditation group following intervention was also found. The results suggest a single 10 minute mindfulness meditation intervention administered by a novice therapist can improve pain tolerance, pain threshold and decrease anxiety towards pain in na?ve healthy university aged individuals.

Traditional Chinese non-drug therapies for cancer pain treatment

Cancer pain is the most common and serious symptom of cancer, which seriously affects the quality of life of cancer patients. the most widely used three-step analgesia has received good effects, but the toxic side effects at the same time can be ignored. As a complementary therapy increasingly accepted around the world, traditional Chinese medicine (TCM) also plays an important role in cancer pain treatment. Traditional Chinese non-drug therapy has a good effect for cancer pain. In this mini-review, the commonly used traditional Chinese non-drug therapies such as acupuncture, moxibustion, acupoint catgut embedding and injection, massage, ear point pressing with coxherb seeds therapy, traditional music therapy were introduced.

Sickness, Pain, and Suffering: Reflections on Doctors Dealing With Painful Diseases and the Death of Their Patients

Medicine consists first of all in taking care,also in those cases when it is impossible to cure the patients and to restore their good health.In fact,healthcare workers and doctors are increasingly faced with painful diseases and end-of-life situations.In these difficult circumstances,it becomes necessary for the doctor to recover a more global vision of the person of the patient,and to understand that the present illness can be read as a metaphor of his/her own existence-since the experience of an entire life manifests and redefines itself in the disease.Empathy and compassion constitute a guide to authentic and effective caring that manifests itself in the language used and in attitudes that become externalized as appropriate behaviours.The doctor must do all he/she can in order to alleviate the patient’s physical and psychological pain,using the tools of caregiving and palliative care.

穴位贴敷联合三阶梯止痛法治疗原发性肝癌疼痛疗效观察

目的探讨穴位贴敷联合三阶梯止痛法治疗原发性肝癌疼痛的临床疗效。方法回顾性分析重庆医科大学附属大足医院2017年4月至2019年12月收治的150例原发性肝癌患者的临床资料,按治疗方案的不同分为A组和B组,各75例。A组患者采用三阶梯止痛法,B组患者采用穴位贴敷联合三阶梯止痛法。结果B组患者治疗后3,5,7 d的视觉模拟评分法(VAS)评分分别为(1.35±1.85)分、(1.67±1.65)分、(1.09±0.55)分,显著低于A组患者的(2.51±3.88)分、(3.04±2.89)分、(2.57±1.08)分(P<0.05);B组患者的疼痛缓解总有效率为93.33%,显著高于A组的86.67%(P<0.05)。结论穴位贴敷联合三阶梯止痛法治疗原发性肝癌疼痛的临床疗效较好,能减轻患者的痛苦。

活血除痹汤联合膝痹止痛针法治疗膝骨性关节炎的临床疗效

目的观察活血除痹汤联合膝痹止痛针法治疗膝骨性关节炎(KOA)的临床疗效。方法将确诊为KOA患者72例随机分为治疗组和对照组,各36例。对照组采用膝痹止痛针法治疗,治疗组膝采用痹止痛针法联合活血除痹汤治疗,治疗4周后观察2组治疗前后中医症候评分、视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC Osteoarthritis Index)、日本骨科协会评估治疗分数(JOA Scores)变化,并进行组间对比。结果治疗后,2组中医症候评分、VAS评分、WOMAC评分均较治疗前降低,且治疗4周后的治疗组较对照组更低,差异有统计学意义(P<0.05);治疗后,2组JOA评分较治疗前明显增高,且治疗4周后的治疗组较对照组更高,差异有统计学意义(P<0.05);治疗组的总有效率为91.67%,对照组为72.22%,治疗组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论单纯膝痹止痛针法可缓解疼痛,联合活血除痹汤可增强其止痛疗效,并能有效改善关节肿胀及活动度,值得推广。

不同产地半夏主要药理作用分析

[目的]比较不同产地半夏主要药理作用,为半夏的质量评价和临床用药提供试验依据。[方法]分别对国内6个主产区(湖北天门、江苏南通、河南唐河、四川蓬溪、河北安国、贵州赫章)半夏进行主要药效研究,采用气管酚红排泌法、浓氨水引咳法、冰醋酸致小鼠扭体、二甲苯致小鼠耳肿胀试验方法建立痰液分泌模型、咳嗽模型、镇痛模型及炎症模型,探讨不同产地半夏的祛痰、镇咳、镇痛及抗炎作用的差异。[结果]在止咳祛痰作用方面,贵州赫章、江苏南通、四川蓬溪3个产区半夏能够明显增加小鼠气管酚红排泌量,显著减少小鼠咳嗽次数及延长咳嗽潜伏期(P<0.01);在镇痛抗炎作用方面,四川蓬溪、湖北天门、河南唐河3个产区半夏均能够明显延长疼痛潜伏期及减少扭体次数,显著降低小鼠耳肿胀度(P<0.01);贵州赫章、河北安国产半夏镇痛抗炎作用次之,江苏南通产半夏镇痛抗炎作用弱于其他产地。[结论]6个产区半夏均有不同程度的祛痰、镇咳、镇痛、抗炎作用,其中贵州赫章、江苏南通、四川蓬溪3个产区半夏在止咳祛痰作用明显优于湖北天门、河南唐河、河北安国;在镇痛抗炎作用方面,四川蓬溪、湖北天门所产半夏强于其他产地。

脐针疗法治疗气滞血瘀型急性腰扭伤临床研究

目的:观察脐针疗法治疗气滞血瘀型急性腰扭伤的临床疗效。方法:选取60例急性腰扭伤患者,按随机数字表法分为脐针组及普针组各30例,普针组采用普通针刺疗法治疗,脐针组采用脐针疗法治疗。比较2组治疗前后视觉模拟评分法(VAS)、腰椎活动障碍评分的变化,比较2组及时止痛总有效率。结果:治疗后,2组VAS评分、腰椎活动障碍评分均较治疗前下降(P<0.05),脐针组上述2项评分均低于普针组(P<0.05)。脐针组即时止痛疗效总有效率为93.3%,普针组即时止痛疗效总有效率为86.7%,2组比较,差异有统计学意义(P<0.05)。结论:脐针疗法能有效改善急性腰扭伤患者的疼痛程度及腰椎活动度,即时止痛效果较好。

膝骨关节炎糖皮质激素注射应用专家共识

膝骨关节炎(knee osteoarthritis,KOA)是一种退行性疾病,不仅致使患者身体机能下降、生活质量降低,而且给家庭、医疗体系和社会带来沉重负担。阶梯化治疗是KOA治疗的基本原则,其中,注射糖皮质激素(glucocorticoids,GCs)可快速有效缓解疼痛,已广泛应用于临床。然而,目前缺乏对GCs进行详细推荐的指南或专家共识,导致临床实践中存在使用不规范的问题。为此,国内KOA领域相关专家基于当前循证医学证据,结合我国具体临床实践编写本共识,经专家组反复讨论后共形成了23条推荐意见,涉及GCs的选择、使用时机、注射频次、操作方法、注意事项和禁忌证等,以期为临床注射GCs治疗KOA提供科学、规范的指导。