Reaction time in cancer patients receiving peripherally acting analgesics alone or in combination with opioids

Continuous Reaction Time (CRT) was measured in cancer patients receiving peripherally acting analgesics either alone (n = 16) or in combination with opioids (n = 16). Comparison was performed matching the patients from each group for age and performance status. Statistically significant prolongations of CRT and higher sedation scores were seen in the opioid group, while performance status did not have any influence on CRT.     

Cancer pain management

Pain occurs in more than 80% of cancer patients before death. Because of the increase in the frequency of cancer deaths worldwide, it is imperative to address cancer pain as a public health problem. Until recently, educational efforts were focused on treatment issues rather than adequate assessment. The approach to pain intensity as a multidimensional construct has helped in focusing treatments and identifying prognostic factors. Valid tools have been developed that allow multidisciplinary assessment of these prognostic factors and their complex interrelationship with the analgesic response. As a result of increased opioid exposure, patients are currently developing newer toxicities, mostly central excitability including delirium, myoclonus, grand mal seizures, and hyperalgesia. The observation that more than 80% of patients will require alternate routes for opioid delivery before death led to the development of a number of novel and effective alternate routes for delivery. Finally, in recent years it has become evident that some specific pain syndromes need to be addressed using specific assessment and management techniques. Incidental pain, somatization, neuropathic pain, and cancer pain in patients with alcoholism and drug addiction are some of these syndromes.     

Pain management of opioid-treated cancer patients in hospital settings in Denmark

Aim: To evaluate the performance and quality of cancer pain management in hospital settings. Methods: Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory. Results: In total, 59 cancer patients were included. In 49 (83%) patients pain aetiology was assessed by the physicians of the departments of oncology and surgery. In only 19 (32%) patients they assessed pain mechanisms. The median oral morphine dose was 120 mg/day (range: 10–720 mg/day). Seventy‐eight per cent of patients received opioids at adequate regular intervals according to the duration of action. In 88% of the patients supplemental short‐acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non‐neuropathic pain received adjuvant drugs. Regarding opioid side effects only constipation and nausea were treated in the majority of the patients. Average pain intensity in the last 24 h for the total number of patients (n=59) ≤5 cm was 88.1% (confidence interval 77.1–95.1). Conclusion: Cancer pain was prevalent in opioid‐treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most often adequate. However, opioid side effects were highly prevalent and most side effects were left untreated.     

心脏手术后的认知功能障碍

大脑功能障碍是指智力下降等不同程度脑功能改变。随着心脏外科的发展，有关中枢神经系统并发症日益受到重视。 1 危险因素 术前已有中风、主动脉近端硬化、贫血与老龄化、高血压和糖尿病等均可使体外循环后中风风险增加。术中发生中风的主要风险因子是体外循环时间和反复地钳夹主动脉。其他如围术期心律失常、低心排综合征等情况也会使体外循环后认知功能障碍增加。     

不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响

目的探讨不同镇痛方法对老年食管癌患者术后疼痛及认知功能的影响。方法选择拟行左进胸食管癌根治术患者60例,男31例,女29例,年龄65~80岁,ASAⅠ或Ⅱ级,随机分为A、B两组,每组30例。A组:关胸前予以0.375%罗哌卡因行肋间神经阻滞后接静脉镇痛泵,配方为舒芬太尼3μg/kg+氟比洛芬酯100mg,泵速2ml/h,自控镇痛0.5ml/按压,锁定时间15min。B组:关胸前予以舒芬太尼10μg+氟比洛芬酯50mg为负荷量后接静脉镇痛泵,配方同A组。观察两组患者术前1d、术后3、5、7d内简易精神状态量表(MMSE)评分,术后苏醒时、苏醒后4、8、12、24、48h视觉模拟疼痛(静息及运动时VAS)评分、BCS舒适评分、术后镇痛泵有效按压次数及术后认知功能障碍(POCD)的发生率。结果与B组比较,A组术后苏醒时、苏醒后4、8、12、24、48h静息及运动时VAS评分均明显降低(P0.05或P0.01);苏醒后4、8、12、24、48h的BCS评分明显升高、有效按压次数明显降低(P0.05);术后3、5、7d的MMSE评分明显升高(P0.05);术后3、5、7d的POCD发生率降低,但差异无统计学意义。结论开胸手术围术期应用肋间神经阻滞复合静脉镇痛可有效缓解患者术后疼痛,降低术后POCD的发生率,提高术后患者舒适度,有利于术后患者的快速康复。     

步行运动锻炼干预对乳腺癌患者化疗相关认知障碍的影响

目的 探讨步行运动锻炼干预对乳腺癌患者化疗相关认知障碍及睡眠质量的影响。方法 采用整群随机法将2个科室首次进行化疗的乳腺癌患者分为两组,各28例。对照组接受化疗期常规护理,干预组在对照组基础上接受步行运动锻炼干预。干预前及干预12周后采用癌症治疗功能评估-认知功能量表、蒙特利尔认知评估量表、匹兹堡睡眠质量指数量表进行效果评定。结果 两组各有26例患者完成全程研究,干预后干预组患者主观认知得分、客观认知得分显著高于对照组,睡眠质量得分显著低于对照组(均P<0.05)。结论 步行运动锻炼干预可一定程度改善乳腺癌化疗患者认知功能及睡眠质量。     

Assessing cognition and psychomotor function under long-term treatment with controlled release oxycodone in non-cancer pain patients

BACKGROUND: The therapeutic use of opioids can be associated with altered cognition and impaired psychomotor function. Several studies have demonstrated the impact of opioid therapy on psychomotor performance and cognition, but no data exist about the effect of long-term treatment with controlled release oxycodone (CRO) on driving ability. METHODS: Thirty patients suffering from chronic non-cancer pain who had been treated with stable doses of CRO where included in a prospective trial and compared with 90 healthy volunteers (matched pairs). A computerized test battery that was developed to assess the driving ability of traffic delinquents in Germany was employed. Attention reaction, visual orientation, motor coordination and vigilance were evaluated. The data from a total of 11 parameters were assessed and for each test a relevant score was defined. As the primary endpoint the sum score of the three relevant scores was determined. A weaker statistical means to assess the patients' performance is to compare the test results with an age-independent control group. Individuals performing worse than the 16th percentile of this control group are considered to be unable to drive according to German legislation. RESULTS: Significant non-inferiority could not be demonstrated for the primary endpoint. However, driving ability as defined as a result above the 16th percentile did not differ significantly between the patients receiving CRO and the age-independent control group. CONCLUSION: The use of CRO does not prohibit driving, but individual assessment is necessary.     

癌性暴发痛的诊疗

背景暴发痛(breakthrough pain,BTP)是一种突发的中到重度疼痛,在癌症患者中发生率很高。目前国际上尚缺乏对BTP统一的定义和诊断标准,临床用于BTP治疗的方法和药物不多,所以出现癌症患者身上的BTP很难得到足够的治疗。 目的文章归纳了国际上有关癌性BTP于诊治方面的最新进展,旨在为了临床治疗BTP提...     

Epidural and intrathecal analgesia for cancer pain

The three-step analgesic ladder approach developed by the World Health Organization works well in treating the vast majority (70–90%) of patients suffering from pain related to cancer. In those patients who do not get pain relief by this three-step approach, intraspinal agents can be a fourth step in managing pain of malignant origin. Although morphine is the only opioid approved by the US Food and Drug Administration for intraspinal use, many different opioid analgesics are used intraspinally, including hydromorphone, fentanyl, sufentanil, meperidine and methadone in the treatment of cancer pain. Many non-opioid agents have also been used intraspinally either alone or in combination with opioids in the treatment of intractable cancer pain. This chapter summarizes the clinical use of these agents with some practical points.     

老年骨质疏松症患者认知功能状况调查研究

目的 通过老年骨质疏松症患者认知功能状况调查研究,探讨老年骨质疏松症认知功能相关因素.方法 选择完成骨密度(BMD)检查444例骨质疏松症老年人(年龄≥60岁)为研究对象,由经过统一培训的医务人员进行问卷调查,调查问卷包括:基本情况、实验室检查项目、简易精神状况量表、临床痴呆评定量表、日常生活能力量表.采用SAS 9....     

Postural stability during long-term treatment of cancer patients with epidural opioids

Ten cancer patients treated with stable doses of epidural opioids were tested for postural stability. The postural stability was measured using a quantitative Romberg's test, performed on a computerized force-plate system. Sway tendencies in the sagittal and the transverse directions were recorded. The postural stability of the patients was compared with values obtained from healthy controls. Comparing the cancer patients with the controls, postural stability in eight out of ten patients was intact. The study suggests that long-term epidural opioid treatment has little influence on the patient's ability to stand safely.     

加速康复外科策略对肝切除术患者术后早期认知功能的影响

目的探讨加速康复外科(ERAS)策略对肝切除术患者术后早期认知功能的影响。方法筛选96例原发性肝癌择期行肝部分切除术患者,随机分为两组,每组48例。C组实施常规围术期处理及麻醉方法,ERAS组实施ERAS策略对围术期处理及麻醉方法进行优化。于术前1d(T0)、术后1d(T4)、3d(T5)、7d(T6)应用简易智能量表(MMSE)评估两组患者认知功能,于T0、术后30min(T1)、6h(T2)、12h(T3)、T4取患者静脉血检测血清S100β蛋白、神经元特异性烯醇化酶(NSE)含量和IL-1β、IL-6及TNF-α表达量。结果与C组比较,T4、T5时ERAS组MMSE评分明显升高,T1、T2时S100β蛋白、IL-1β、IL-6明显降低,T2、T3时NSE明显降低,T1~T3时TNF-α明显降低(P0.05)。与T0时比较,T4、T5时C组患者MMSE评分明显降低,T4时ERAS组MMSE评分明显降低(P0.05)。两组T1~T3时S100β蛋白明显升高,T2~T4时NSE含量明显升高,T1~T4时IL-1β、IL-6、TNF-α表达量均明显升高(P0.05)。结论 ERAS策略应用于肝癌肝切除术患者可改善患者术后认知功能,其机制可能与降低患者术后血清中S100β蛋白、NSE、IL-1β、IL-6及TNF-α的含量有关。     

Pain management in children with and without cognitive impairment following spine fusion surgery

BACKGROUND: We compared pain assessment and management practices in children with and without cognitive impairment (CI) undergoing spine fusion surgery. METHODS: The medical records of 42 children (19 with CI and 23 without) were reviewed and data related to demographics, surgery, pain assessment and management, and side-effects were recorded. RESULTS: Fewer children with CI were assessed for pain on postoperative days (POD) 0-4 compared to those without CI (P < 0.002). Self-report was used for 81% of pain assessments in children without CI, while a behavioural tool was used for 75% of assessments in cognitively impaired children. Children with CI received smaller total opioid doses on POD 1-3 compared to those without CI (P < or = 0.02). Furthermore, children without CI received patient/nurse-controlled analgesia for more postoperative days than children with CI (P=0.02). CONCLUSION: Our data demonstrate a discrepancy in pain management practices in children with and without CI following spine fusion.     

Clinical experience of long–term treatment with epidural and intrathecal opioids – a nationwide survey

Long–term use of spinal opioids to treat chronic severe pain is widely established. However, the indications, shortcomings and complications of the method have not been completely described. Experience with spinal opioids was analysed for the period 1979–1984 in a nationwide Swedish survey. Out of 93 anaesthesia departments, 69 used the method. Approximately 750 patients were treated with epidural morphine for an average duration of 124 days (3–450). Eighteen patients were treated with intrathecal morphine for an average period for 47 days (3–90). The intrathecal approach was used in all clinics because of failure of the epidural route. In only one department was the intrathecal approach used as the primary route of therapy, depending on the mechanism of pain. The highest daily morphine dose was 480 mg and 50 mg for epidural and intrathecal routes, respectively. The patients given the highest dosages were not necessarily those subjected to the longest treatment. The need for increased dosage seems to be related not only to changes in receptor sensitivity but also to changes in pain mechanisms. No case of threatening ventilatory depression was reported. Thirty–two departments had treated a few patients with chronic non–cancer pain conditions. Initial results were considered "excellent" in H departments, but at follow–up results were excellent in only one department. In addition to dislocation, occlusion of the catheters or leakage, injection pain was an obstacle to successful treatment. Pruritus, urinary retention, and local infections were not reported as significant problems, but one case of meningitis was reported.     

脑卒中后便秘患者的认知行为干预研究

目的 探索认知行为干预对脑卒中后便秘患者的作用,为临床护理干预提供依据.方法 按随机数字表法将90例脑卒中后便秘患者随机分为对照组、行为组及认知行为组各30例,对照组行常规便秘护理,行为组增加行为指导,认知行为组再增加定向力、记忆力及注意力等训练,于第1、2个疗程后评价效果.结果 干预后三组便秘症状积分及疗效显著优于干预前,组间比较差异有统计学意义（均P＜0.01）,认知行为组最好,行为组次之,对照组最差（P＜0.05,P＜0.01）;三组认知功能（MMSE）评分及日常生活能力（BI）评分显著高于干预前（均P＜0.01）;组间比较,差异无统计学意义（均P＞0.05）;便秘症状积分与MMSE、BI评分呈显著负相关（P＜0.05,P＜0.01）.结论 认知行为干预可有效改善脑卒中后便秘症状,在一定程度上提高了患者的认知能力及日常生活能力.     

Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

BACKGROUND: Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients referred to a pain centre and to assess the short-term effects of pain treatment. METHODS: Patients were assessed at referral (T(0)) and after a treatment period of 3 months (T(3)) using the visual analogue scale (VAS) of the brief pain inventory (BPI) within somatic nociceptive, neuropathic and/or visceral pain conditions, the mini mental state examination (MMSE) and the hospital anxiety and depression scale (HADS). The main treatment intervention from T(0) to T(3) was to convert short-acting oral opioids to long-acting oral opioids and to discontinue on demand and parenteral use of opioids. RESULTS: Thirty-three patients were assessed at T(0) and 27 at T(3). The prevalence of BTP declined significantly from T(0) (90%) to T(3) (70.4%). Worst, least, average and current pain intensities as well as duration of BTP were significantly reduced from T(0) to T(3.) The majority of BTPs were exacerbation of background pain assumed to be of the same pain mechanisms. High average pain intensity (BPI) was significantly associated with high scores for both anxiety and depression (HADS). CONCLUSION: BTP in chronic non-malignant pain patients seems to be surprisingly frequent and severe. Stabilizing the opioid regimen seems to reduce pain intensity in general as well as the intensity and duration of BTP. Average pain intensity was associated with anxiety and depression.     

Pain in cancer and chronic non-cancer conditions: similarities and differences

A conceptual model within which to view and compare cancer and chronic non-cancer pain is provided. Studies comparing the two are reviewed. Implications for deploying management and intervention strategies are then analyzed in terms of disease, cognitive-behavioral and social-contextual considerations.     

脑梗死血管性认知障碍患者的注意力训练

目的探讨综合注意力训练在脑梗死后血管性认知障碍恢复中的应用效果。方法将脑梗死后血管性认知障碍患者102例随机分为对照组及干预组各51例。对照组按常规行规范治疗、护理及康复训练;干预组在常规基础上实施注意力训练,包括10组训练操、家属助练、每天记录成绩等,连续15d后评价效果。结果干预组认知评分及认知康复训练效果显著优于对照组(P0.05,P0.01)。结论综合注意力训练有利于脑梗死后血管性认知障碍患者认知功能的恢复。