• Title, Summary, Keyword: refractory cancer pain

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Intravenous Flurbiprofen Axetil Enhances Analgesic Effect of Opioids in Patients with Refractory Cancer Pain by Increasing Plasma β-Endorphin

  • Wu, Ting-Ting;Wang, Zhi-Gang;Ou, Wu-Ling;Wang, Jun;Yao, Guo-Qing;Yang, Bo;Rao, Zhi-Guo;Gao, Jian-Fei;Zhang, Bi-Cheng
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10855-10860
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    • 2015
  • Background: The study aimed to investigate the analgesic effect of a combination of intravenous flurbiprofen axetil and opioids, and evaluate the relationship between refractory pain relief and plasma ${\beta}$-endorphin levels in cancer patients. Materials and Methods: A total of 120 cancer patients was randomly divided into two groups, 60 patients took orally morphine sulfate sustained-release tablets in group A, and another 60 patients receiving the combination treatment of intravenous flurbiprofen axetil and opioid drugs in group B. After 7 days, pain relief, quality of life improvement and side effects were evaluated. Furthermore, plasma ${\beta}$-endorphin levels were measured by radioimmunoassay. Results: With the combination treatment of intravenous intravenous flurbiprofen axetil and opioids, the total effective rate of pain relief rose to 91.4%, as compared to 82.1% when morphine sulfate sustained-release tablet was used alone. Compared with that of group A, the analgesic effect increased in group B (p=0.031). Moreover, satisfactory pain relief was associated with a significant increase in plasma ${\beta}$-endorphin levels. After the treatment, plasma ${\beta}$-endorphin level in group B was $62.4{\pm}13.5pg/ml$, which was higher than that in group A ($45.8{\pm}11.2pg/ml$) (p<0.05). Conclusions: Our results suggest the combination of intravenous flurbiprofen axetil and opioids can enhance the analgesic effect of opioid drugs by increasing plasma ${\beta}$-endorphin levels, which would offer a selected and reliable strategy for refractory cancer pain treatment.

Stereotactic Mesencephalotomy for Cancer - Related Facial Pain

  • Kim, Deok-Ryeong;Lee, Sang-Won;Son, Byung-Chul
    • Journal of Korean Neurosurgical Society
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    • v.56 no.1
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    • pp.71-74
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    • 2014
  • Cancer-related facial pain refractory to pharmacologic management or nondestructive means is a major indication for destructive pain surgery. Stereotactic mesencephalotomy can be a valuable procedure in the management of cancer pain involving the upper extremities or the face, with the assistance of magnetic resonance imaging (MRI) and electrophysiologic mapping. A 72-year-old man presented with a 3-year history of intractable left-sided facial pain. When pharmacologic and nondestructive measures failed to provide pain alleviation, he was reexamined and diagnosed with inoperable hard palate cancer with intracranial extension. During the concurrent chemoradiation treatment, his cancer-related facial pain was aggravated and became medically intractable. After careful consideration, MRI-based stereotactic mesencephalotomy was performed at a point 5 mm behind the posterior commissure, 6 mm lateral to and 5 mm below the intercommissural plane using a 2-mm electrode, with the temperature of the electrode raised to $80^{\circ}C$ for 60 seconds. Up until now, the pain has been relatively well-controlled by intermittent intraventricular morphine injection and oral opioids, with the pain level remaining at visual analogue scale 4 or 5. Stereotactic mesencephalotomy with the use of high-resolution MRI and electrophysiologic localization is a valuable procedure in patients with cancer-related facial pain.

Intractable Pain Management of Lung Cancer Involving in Both Brachial Plexuses (양측 상박 신경총 침범으로 불인성 통증을 동반한 폐암환자의 통증치료 경험)

  • Na, Ae-Ja;Suh, Jae-Hyun;Kim, Sung-Nyeun
    • The Korean Journal of Pain
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    • v.5 no.1
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    • pp.99-102
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    • 1992
  • Severe intractable pain with paresthesia and severe dyspnea produced by lung cancer involving both brachial plexuses, refractory to ordinary pharmacologic approaches, was managed by epidural morphine and bupivacaine administration with the continuous Baxter infusion system. Chest pain, which is somatic pain in character, was well managed with the epidural morphine and bupivacaine administrations. However paresthesia and tingling sensation of the hand and forearm were poorly controlled by epidural morphine, and were finally managed by bolus epidural injections of bupivacaine. Supportive therapy included epidural steroid injection and TENS, but the effect was not satisfactory. Severe dyspnea seemed to aggrevate cancer related pain.

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Intrathecal Catheter and Subcutaneous Access Port Implantation in Pain Management for Terminal Cancer Patient - A case report - (말기암 환자의 통증치료를 위한 지주막하강내 카테터 거치와 피하 이식형 약제 주입기 삽입 - 증례보고 -)

  • Seo, Kwi Chu;Chung, Jin Yong;Kim, Ho Young;Rho, Woon Seok;Kim, Bong Il;Song, Seok Young
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.240-245
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    • 2007
  • It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.

Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Referred Shoulder Pain due to Metastatic Liver Cancer - A case report - (전이성 간암으로 인한 어깨통증 환자에서 박동성 고주파술 경험 - 증례보고 -)

  • Kim, Hyung Tae;Jang, In Su;Han, Sang Ji;Lee, Jun Hak;Kwon, Young Eun
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.230-234
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    • 2007
  • A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.

Ascites-decreasing Effect of SB Intraperitoneal Injection to a Refractory Ascites Patient with Synchronous Colorectal Liver Metastasis and Metachronous Peritoneal Carcinomatosis : A Case Report (동시 간전이 직장 구불결장암 환자의 재발성 복수에 대한 SB 복강 주입의 복수 감소 효과 증례)

  • Jeon, Hyung-Joon;Kim, Jong-Min;Cho, Chong-Kwan;Lee, Yeon-Weol;Han, Kyun-In;Yoo, Hwa-Seung
    • The Journal of Internal Korean Medicine
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    • v.34 no.4
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    • pp.466-477
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    • 2013
  • Objectives : To report and demonstrate the effect of decreasing ascites volume by SB intraperitoneal injection to a refractory ascites patient with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis. Methods : Two cycles of intraperitoneal and intravenous SB injection were conducted. Each injection cycle was made up of 4 days. Nine vials of SB were injected to the patient every day. To compare the volume of ascites between pret- and post-treatment, follow-up computed tomography was done on June 3, 2013. To observe other therapeutic effects of SB injection, laboratory tests were conducted periodically. Results : On the follow-up computed tomography images, the amount of ascites and pleural effusion had decreased compared to the April 30, 2013 computed tomography images. The levels of aspartate transaminase, alanine aminotransferase and lactate dehydrogenase decreased significantly from May 9, to May 30, 2013. The amount of oral intake increased constantly during hospitalization. The patient's symptoms such as abdominal distension, abdominal pain and dyspnea were improving until discharge. Conclusions : Even if thiese results cannot be applied to every synchronous colorectal cancer liver metastasis patient, we demonstrated that SB intraperitoneal injection has ascites-decreasing effect to refractory ascites patients with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis.

Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

  • Yi, Yu Ri;Lee, Na Rea;Kwon, Young Suk;Jang, Ji Su;Lim, So Young
    • The Korean Journal of Pain
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    • v.29 no.1
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    • pp.53-56
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    • 2016
  • Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases.

Study of comprehensive and integrative treatment using acupuncture for cancer pain through publication review (논문 리뷰를 통한 암성통증에 대한 침을 이용한 양한방 통합치료 효과 연구)

  • Kwak, Sang Gyu;Sohn, Ki Cheul;Shin, Im Hee;Kim, Sang Gyung;Jung, Hyun-Jung;Lee, A-Jin;Cho, Yoon-Jeong;Kim, Dal Ho
    • Journal of the Korean Data and Information Science Society
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    • v.26 no.6
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    • pp.1327-1334
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    • 2015
  • Cancer pain is a very important factor in cancer patients refractory to drop the quality of life of cancer patients. The worldwide trend is an integrated effort by both the western medicine and korean traditional medicine of treatment increases to reduce cancer pain. There are many studies related to cancer pain through an integrated medicine approach. Many study was reported that acupuncture treatment is effective for fatigue, xerostomia, insomnia, anxiety and quality of life. However, despite the practical clinical effects and various case reports of acupuncture, many still disagree about the significance of an integrated treatment of pain reduction with acupuncture. Therefore, we has identified that reduce effect of comprehensive and integrative treatment using acupuncture for cancer pain through publication review. And we evaluated effect of comprehensive and integrative treatment using acupuncture through summary of values in each publication.

Palliative Sedation for Terminal Cancer Patient (말기 암 환자에서 완화적 진정 증례 토론)

  • Kim, Do-Yeun
    • The Korean Journal of Hospice and Palliative Care
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    • v.11 no.2
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    • pp.106-110
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    • 2008
  • Palliative sedation has been used in patients who undergo intractable suffering at the end of life. Its implementation, however, may be complicated due to resistance of clinicians and barrier of bioethical issues. Here, we present 50-year-old man with stomach cancer and multiple bone metastasis who was treated with palliative chemotherapy and radiotherapy. He suffered from refractory pain on the whole body even after standard analgesics and multidisplinary effort to relieve. Upon shared decision for sedation, he was given midazolam until discharge. Literature reviews reveal cases similar to the present case.

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