Base de dados : MEDLINE
Pesquisa : C23.888.592.612.212 [Categoria DeCS]
Referências encontradas : 278 [refinar]
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[PMID]:29277615
[Au] Autor:Li J; Sun Y; Ding G; Jiang F
[Ad] Endereço:Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
[Ti] Título:Persistent pain accelerates xenograft tumor growth of breast cancer in rat.
[So] Source:Biochem Biophys Res Commun;495(4):2432-2438, 2018 01 22.
[Is] ISSN:1090-2104
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pain occurs at all stages of the patients who suffer from cancer. Owing to surgery and bone metastasis, breast cancer patients were usually disturbed by persistent pain. However, the pain-relief-right has not been respected enough in clinical cancer treatment. Whether pain has any adverse effects on cancer development is still unclear. In order to uncover this question, we established two preclinical animal models to explore the effects of pain on the tumor. For the first model, we mimicked neuropathic pain by sciatic nerve ligation on rats with xenograft tumor subcutaneously. For the second model, we mimicked the bone cancer pain by injecting tumor cell suspension into the tibial medullary cavity of rats with xenograft tumor subcutaneously. The rats with persistent pain showed higher tumor volume and tumor weight compared with the group without pain. Interestingly, when the neuropathic pain and bone cancer pain were relieved by drug administration, both the tumor volume and tumor weight were lowered compared with the group without pain relief. In summary, our study indicated that persistent pain acted as a contributing factor to tumor growth. Moreover, the pain relief could weakened the accelerating role of pain in tumor growth. Thus, we should be paid more attention to the cancer patients with persistent pain as well as cancer treatment.
[Mh] Termos MeSH primário: Neoplasias da Mama/fisiopatologia
Dor do Câncer/fisiopatologia
Dor Crônica/fisiopatologia
Neuralgia/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Neoplasias da Mama/complicações
Dor do Câncer/complicações
Dor do Câncer/etiologia
Linhagem Celular Tumoral
Proliferação Celular
Dor Crônica/etiologia
Feminino
Invasividade Neoplásica
Neuralgia/etiologia
Medição da Dor
Ratos
Ratos Wistar
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:29384852
[Au] Autor:Jordan JT; Smith MJ; Walker JA; Erdin S; Talkowski ME; Merker VL; Ramesh V; Cai W; Harris GJ; Bredella MA; Seijo M; Suuberg A; Gusella JF; Plotkin SR
[Ad] Endereço:Department of Neurology.
[Ti] Título:Pain correlates with germline mutation in schwannomatosis.
[So] Source:Medicine (Baltimore);97(5):e9717, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Schwannomatosis has been linked to germline mutations in the SMARCB1 and LZTR1 genes, and is frequently associated with pain.In a cohort study, we assessed the mutation status of 37 patients with clinically diagnosed schwannomatosis and compared to clinical data, whole body MRI (WBMRI), visual analog pain scale, and Short Form 36 (SF-36) bodily pain subscale.We identified a germline mutation in LZTR1 in 5 patients (13.5%) and SMARCB1 in 15 patients (40.5%), but found no germline mutation in 17 patients (45.9%). Peripheral schwannomas were detected in 3 LZTR1-mutant (60%) and 10 SMARCB1-mutant subjects (66.7%). Among those with peripheral tumors, the median tumor number was 4 in the LZTR1 group (median total body tumor volume 30 cc) and 10 in the SMARCB1 group (median volume 85cc), (P=.2915 for tumor number and P = .2289 for volume). mutation was associated with an increased prevalence of spinal schwannomas (100% vs 41%, P = .0197). The median pain score was 3.9/10 in the LZTR1 group and 0.5/10 in the SMARCB1 group (P = .0414), and SF-36 pain-associated quality of life was significantly worse in the LZTR1 group (P = .0106). Pain scores correlated with total body tumor volume (rho = 0.32471, P = .0499), but not with number of tumors (rho = 0.23065, P = .1696).We found no significant difference in quantitative tumor burden between mutational groups, but spinal schwannomas were more common in LZTR1-mutant patients. Pain was significantly higher in LZTR1-mutant than in SMARCB1-mutant patients, though spinal tumor location did not significantly correlate with pain. This suggests a possible genetic association with schwannomatosis-associated pain.
[Mh] Termos MeSH primário: Dor do Câncer/genética
Mutação em Linhagem Germinativa
Neurilemoma/genética
Neurofibromatoses/genética
Neoplasias Cutâneas/genética
[Mh] Termos MeSH secundário: Adulto
Dor do Câncer/diagnóstico por imagem
Dor do Câncer/fisiopatologia
Estudos de Coortes
Feminino
Estudos de Associação Genética
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Neurilemoma/diagnóstico por imagem
Neurilemoma/fisiopatologia
Neurofibromatoses/diagnóstico por imagem
Neurofibromatoses/fisiopatologia
Medição da Dor
Qualidade de Vida
Proteína SMARCB1/genética
Neoplasias Cutâneas/diagnóstico por imagem
Neoplasias Cutâneas/fisiopatologia
Fatores de Transcrição/genética
Carga Tumoral
Imagem Corporal Total
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (LZTR1 protein, human); 0 (SMARCB1 Protein); 0 (SMARCB1 protein, human); 0 (Transcription Factors)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009717


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[PMID]:29272781
[Au] Autor:Oldenmenger WH; Geerling JI; Mostovaya I; Vissers KCP; de Graeff A; Reyners AKL; van der Linden YM
[Ad] Endereço:Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands. Electronic address: w.h.oldenmenger@erasmusmc.nl.
[Ti] Título:A systematic review of the effectiveness of patient-based educational interventions to improve cancer-related pain.
[So] Source:Cancer Treat Rev;63:96-103, 2018 Feb.
[Is] ISSN:1532-1967
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite existing guidelines to assess and manage pain, the management of cancer-related pain is often suboptimal with patients often being undertreated. Inadequate pain management may be due to patient-related barriers. Educating patients may decrease these barriers. However, the effect of pain education on patient-related outcomes is still unclear. This review aimed to study the effect of educational interventions on cancer-related pain. DESIGN: We performed a systematic review of randomized controlled trials (RCTs) identified from Medline and Cinahl, from 1995 to May 2017. Two reviewers independently selected trials comparing educational intervention to usual care or an active control intervention. The methodological quality was assessed and data extraction was done independently. Primary outcome measures were pain intensity and interference. Secondary outcome measures were knowledge/barriers, medication adherence and self-efficacy. RESULTS: Twenty-six RCTs totaling 4735 patients met our inclusion criteria. Compared to the control group, 31% of the studies (including 19% of all patients) reported a significant difference in pain intensity in favor of the intervention group. Twelve studies measured pain interference and four (30%) found a significant improvement. With regard to secondary endpoints, significant differences in favor of the experimental arms were found for pain knowledge or barriers (15/22 studies; 68%), medication adherence (3/6 studies; 50%) and self-efficacy (1/2 studies). CONCLUSIONS: Patient-based pain educational programs may result in improvements of relevant patient-reported outcomes. However, the interventions are heterogeneous and improvement of pain was only seen in less than one third of the studies and in less than 20% of all included patients.
[Mh] Termos MeSH primário: Dor do Câncer/terapia
Educação de Pacientes como Assunto
[Mh] Termos MeSH secundário: Seres Humanos
Adesão à Medicação
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE


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[PMID]:28741914
[Ti] Título:Study Aims to Reduce Pain for Oral Cancer Patients.
[So] Source:J Calif Dent Assoc;44(9):538, 2016 Sep.
[Is] ISSN:1043-2256
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Dor do Câncer/prevenção & controle
Neoplasias Bucais/complicações
[Mh] Termos MeSH secundário: Terapia Genética
Seres Humanos
Apoio à Pesquisa como Assunto
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE


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[PMID]:29063851
[Au] Autor:van der Velden JM; Peters M; Verlaan JJ; Versteeg AL; Zhang L; Tsao M; Danjoux C; Barnes E; van Vulpen M; Chow E; Verkooijen HM
[Ad] Endereço:Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: J.M.vanderVelden@umcutrecht.nl.
[Ti] Título:Development and Internal Validation of a Clinical Risk Score to Predict Pain Response After Palliative Radiation Therapy in Patients With Bone Metastases.
[So] Source:Int J Radiat Oncol Biol Phys;99(4):859-866, 2017 Nov 15.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. MATERIAL AND METHODS: A total of 965 patients with painful bone metastases undergoing palliative radiation therapy at a tertiary referral center between 1999 and 2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiation therapy. Pain response was defined as at least a 2-point decrease on a pain score scale of 0-10, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism. RESULTS: Overall 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response, with a corrected c-statistic of 0.63. The predicted response rates after radiation therapy increased from 37.5% for patients with the highest risk score to 79.8% for patients with the lowest risk score and were in good agreement with the observed response rates. CONCLUSIONS: A prediction score for pain response after palliative radiation therapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options.
[Mh] Termos MeSH primário: Neoplasias Ósseas/radioterapia
Neoplasias Ósseas/secundário
Dor do Câncer/radioterapia
Modelos Teóricos
Medição da Dor
Cuidados Paliativos/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Analgésicos/uso terapêutico
Neoplasias da Mama/patologia
Tomada de Decisões
Feminino
Seres Humanos
Avaliação de Estado de Karnofsky
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Neoplasias da Próstata/patologia
Risco
Neoplasias da Coluna Vertebral/radioterapia
Neoplasias da Coluna Vertebral/secundário
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Nm] Nome de substância:
0 (Analgesics)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE


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[PMID]:28926387
[Au] Autor:Lee HL; Kuo CC; Tsai JT; Chen CY; Wu MH; Chiou JF
[Ad] Endereço:1Departments of Radiation Oncology (H.-L.L. and J.-F.C.) and Orthopaedic Surgery (M.-H.W.), Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan 2The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei, Taiwan 3Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan 4Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
[Ti] Título:Magnetic Resonance-Guided Focused Ultrasound Versus Conventional Radiation Therapy for Painful Bone Metastasis: A Matched-Pair Study.
[So] Source:J Bone Joint Surg Am;99(18):1572-1578, 2017 Sep 20.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) is an alternative local therapy for patients with painful bone metastasis for whom standard conventional radiation therapy (RT) has failed. However, the therapeutic effects of MRgFUS as a first-line treatment for bone metastasis remain uncertain. METHODS: A matched-pair study was conducted to compare the therapeutic effects of MRgFUS with those of conventional RT as a first-line treatment for patients with painful bone metastasis. The MRgFUS and RT-treated groups were matched 1:2 by age, sex, primary cancer, pretreatment pain score, and treated site. RESULTS: According to the criteria for patient eligibility and matching, 21 and 42 patients (total, 63 patients) with bone metastasis treated with MRgFUS and conventional RT, respectively, were enrolled for analyses. The median ages of the MRgFUS and RT-treated patients were 59 and 61 years, respectively. Among the enrolled patients, 52% were male and 48% were female. The results showed that both MRgFUS and RT were effective. However, MRgFUS was more efficient than RT in terms of the time course of pain palliation as it yielded a significantly higher response rate at 1 week after treatment (71% versus 26%, p = 0.0009). CONCLUSIONS: MRgFUS provides a similar overall treatment response rate but faster pain relief compared with conventional RT and has the potential to serve as the first-line treatment for painful bone metastasis in selected patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Neoplasias Ósseas/secundário
Neoplasias Ósseas/terapia
Dor do Câncer/terapia
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos
Imagem por Ressonância Magnética Intervencionista
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Manejo da Dor
Cuidados Paliativos/métodos
Radioterapia/métodos
Estudos Retrospectivos
Análise de Sobrevida
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.01248


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[PMID]:28869401
[Au] Autor:Kim N; Lee H; Kim JS; Baek JG; Lee CG; Chang SK; Koom WS
[Ad] Endereço:1 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
[Ti] Título:Clinical outcomes of multileaf collimator-based CyberKnife for spine stereotactic body radiation therapy.
[So] Source:Br J Radiol;90(1079):20170523, 2017 Nov.
[Is] ISSN:1748-880X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Stereotactic body radiotherapy (SBRT) for spinal metastases is becoming a prevalent therapeutic option. We aimed to evaluate the clinical feasibility and outcomes of the recently developed multileaf collimator (MLC)-based CyberKnife (CK-M) for spine SBRT. METHODS: We reviewed 119 patients of 144 cases with 229 lesions treated with CK between November 2014 and March 2016. The lesion features, dosimetric parameters and clinical outcomes were compared between fixed cone collimator based CK (CK-F) and CK-M. RESULTS: Of 144 cases, 78 and 66 were treated with CK-F and CK-M, respectively. CK-M achieved an adequate target volume coverage that was comparable with CK-F (median 92 vs 90%; p = 0.03) even in larger targets (median 64.2 vs 46.7 cm ; p = 0.01), respectively. CK-M showed an improvement in the gradient index (p < 0.001) and no difference in conformity (p = 0.16). With CK-M, the median beam delivery time was significantly reduced by 30% (to 34 vs 48 min; p < 0.001). CK-M showed 1 year local control rates that were comparable to CK-F (77 vs 78%, respectively; p = 0.83). CONCLUSION: CK-M exhibits dosimetric data and local control that are comparable with CK-F, but with significant treatment time reduction. CK-M could be widely used in spine SBRT. Advances in knowledge: Given the recently developed MLC in CK, we aimed to evaluate the clinical feasibility and outcomes of MLC compared with fixed cone-based CK. MLC showed equivalent plan quality and significant treatment time reduction with comparable radiological control. We report here MLC as an effective and tolerable treatment option in CK.
[Mh] Termos MeSH primário: Radiocirurgia/instrumentação
Radiocirurgia/métodos
Neoplasias da Coluna Vertebral/radioterapia
Neoplasias da Coluna Vertebral/secundário
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Dor do Câncer/radioterapia
Estudos de Viabilidade
Feminino
Gadolínio
Seres Humanos
Imagem por Ressonância Magnética/métodos
Masculino
Meia-Idade
Imagem Multimodal/métodos
Dosagem Radioterapêutica
Planejamento da Radioterapia Assistida por Computador/métodos
Estudos Retrospectivos
Neoplasias da Coluna Vertebral/diagnóstico por imagem
Neoplasias da Coluna Vertebral/patologia
Tomografia Computadorizada por Raios X/métodos
Carga Tumoral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
AU0V1LM3JT (Gadolinium)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE
[do] DOI:10.1259/bjr.20170523


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[PMID]:28829910
[Au] Autor:Schmidt-Hansen M; Bennett MI; Arnold S; Bromham N; Hilgart JS
[Ad] Endereço:National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Pl, Regent's Park, London, UK, NW1 4RG.
[Ti] Título:Oxycodone for cancer-related pain.
[So] Source:Cochrane Database Syst Rev;8:CD003870, 2017 08 22.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many people with cancer experience moderate to severe pain that requires treatment with strong opioids, such as oxycodone and morphine. Strong opioids are, however, not effective for pain in all people, neither are they well-tolerated by all people. The aim of this review was to assess whether oxycodone is associated with better pain relief and tolerability than other analgesic options for adults with cancer pain. This is an updated version of the original Cochrane review published in 2015, Issue 2 on oxycodone for cancer-related pain. OBJECTIVES: To assess the effectiveness and tolerability of oxycodone by any route of administration for pain in adults with cancer. SEARCH METHODS: For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and MEDLINE In-Process (Ovid), Embase (Ovid), Science Citation Index, Conference Proceedings Citation Index - Science (ISI Web of Science), BIOSIS (ISI), and PsycINFO (Ovid) to November 2016. We also searched four trial registries, checked the bibliographic references of relevant studies, and contacted the authors of the included studies. We applied no language, date, or publication status restrictions. SELECTION CRITERIA: We included randomised controlled trials (parallel group or cross-over) comparing oxycodone (any formulation or route of administration) with placebo or an active drug (including oxycodone) for cancer background pain in adults by examining pain intensity/relief, adverse events, quality of life, and participant preference. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the included studies using standard Cochrane methodology. We meta-analysed pain intensity data using the generic inverse variance method, and adverse events using the Mantel-Haenszel method, or summarised these data narratively along with the quality of life and participant preference data. We assessed the overall quality of the evidence using GRADE. MAIN RESULTS: For this update, we identified six new studies (1258 participants) for inclusion. In total, we included 23 studies which enrolled/randomised 2648 participants, with 2144 of these analysed for efficacy and 2363 for safety. The studies examined a number of different drug comparisons.Pooled analysis of three of the four studies comparing controlled-release (CR) oxycodone to immediate-release (IR) oxycodone showed that the ability of CR and IR oxycodone to provide pain relief were similar (standardised mean difference (SMD) 0.1, 95% confidence interval (CI) -0.06 to 0.26; low quality evidence). Pooled analyses of adverse events showed no significant differences between CR and IR oxycodone for asthenia (risk ratio (RR) 0.58, 95% CI 0.2 to 1.68), confusion (RR 0.78, 95% CI 0.2 to 3.02), constipation (RR 0.71, 95% CI 0.45 to 1.13), dizziness/lightheadedness (RR 0.74, 95% CI 0.4 to 1.37), drowsiness/somnolence (RR 1.03, 95% CI 0.69 to 1.54), dry mouth (RR 1.14, 95% CI 0.48 to 2.75), insomnia (RR 1.04, 95% CI 0.31 to 3.53), nausea (RR 0.85, 95% CI 0.56 to 1.28), nervousness (RR 0.57, 95% CI 0.2 to 1.64), pruritus (RR 1.46, 95% CI 0.65 to 3.25), vomiting (RR 0.66, 95% CI 0.38 to 1.15), and discontinuation due to adverse events (RR 0.6, 95% CI 0.29 to 1.22). The quality of the evidence was very low for all these adverse events. Three of the four studies found similar results for treatment acceptability.Pooled analysis of seven of the nine studies comparing CR oxycodone to CR morphine indicated that pain relief was significantly better after treatment with CR morphine than CR oxycodone (SMD 0.14, 95% CI 0.01 to 0.27; low quality evidence). However, sensitivity analysis did not corroborate this result (SMD 0.12, 95% CI -0.02 to 0.26).Pooled analyses of adverse events showed no significant differences between CR oxycodone and CR morphine for confusion (RR 1.01 95% CI 0.78 to 1.31), constipation (RR 0.98, 95% CI 0.82 to 1.16), dizziness/lightheadedness (RR 0.76, 95% CI 0.33 to 1.76), drowsiness/somnolence (RR 0.9, 95% CI 0.75 to 1.08), dry mouth (RR 1.01, 95% CI 0.8 to 1.26), dysuria (RR 0.71, 95% CI 0.4 to 1.26), nausea (RR 1.02, 95% CI 0.82 to 1.26), pruritus (RR 0.81, 95% CI 0.51 to 1.29), vomiting (RR 0.94, 95% CI 0.68 to 1.29), and discontinuation due to adverse events (RR 1.06, 95% CI 0.43 to 2.6). However, the RR for hallucinations was significantly lower after treatment with CR oxycodone compared to CR morphine (RR 0.52, 95% CI 0.28 to 0.97). The quality of the evidence was very low for all these adverse events. There were no marked differences in treatment acceptability or quality of life ratings.The remaining studies either compared oxycodone in various formulations or compared oxycodone to different alternative opioids. None found any clear superiority or inferiority of oxycodone for cancer pain, neither as an analgesic agent nor in terms of adverse event rates and treatment acceptability.The quality of this evidence base was limited by the high or unclear risk of bias of the studies and by imprecision due to low or very low event rates or participant numbers for many outcomes. AUTHORS' CONCLUSIONS: The conclusions have not changed since the previous version of this review. The data suggest that oxycodone offers similar levels of pain relief and overall adverse events to other strong opioids including morphine. Although we identified a clinically insignificant benefit on pain relief in favour of CR morphine over CR oxycodone, this did not persist following sensitivity analysis and so we do not consider this important. However, in this updated analysis, we found that hallucinations occurred less often with CR oxycodone than with CR morphine, but the quality of this evidence was very low so this finding should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that while the reliability of the evidence base is low, given the absence of important differences within this analysis it seems unlikely that larger head to head studies of oxycodone versus morphine are justified, although well-designed trials comparing oxycodone to other strong analgesics may well be useful. For clinical purposes, oxycodone or morphine can be used as first-line oral opioids for relief of cancer pain in adults.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Dor do Câncer/tratamento farmacológico
Neoplasias/complicações
Oxicodona/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Constipação Intestinal/induzido quimicamente
Preparações de Ação Retardada
Esquema de Medicação
Feminino
Seres Humanos
Masculino
Meia-Idade
Morfina/administração & dosagem
Morfina/efeitos adversos
Morfina/uso terapêutico
Náusea/induzido quimicamente
Oxicodona/administração & dosagem
Oxicodona/efeitos adversos
Medição da Dor
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
Fases do Sono
Vômito/induzido quimicamente
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Delayed-Action Preparations); 76I7G6D29C (Morphine); CD35PMG570 (Oxycodone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170823
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD003870.pub6


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[PMID]:28807366
[Au] Autor:Garcia C; Lefkowits C; Pelkofski E; Blackhall L; Duska LR
[Ad] Endereço:Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States. Electronic address: cg5zc@virginia.edu.
[Ti] Título:Prospective screening with the validated Opioid Risk Tool demonstrates gynecologic oncology patients are at low risk for opioid misuse.
[So] Source:Gynecol Oncol;147(2):456-459, 2017 Nov.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To characterize risk for opioid misuse among gynecologic oncology patients. METHODS: The Opioid Risk Tool (ORT), a validated screen for opioid misuse risk, was administered to a convenience sample of patients with gynecologic cancer receiving opioid prescriptions in gynecologic oncology or palliative care clinics from January 2012-June 2016. Demographic and clinical information was abstracted on chart review. The primary outcome was ORT risk level (low vs. moderate or high). Chi-square tests were performed for categorical variables. RESULTS: A total of 118 women were screened. Most women were Caucasian (79%) with a median age of 57years. Ovarian cancer patients comprised 46% of the cohort with fewer endometrial (25%), cervical (23%), vulvar (4%), and vaginal (2%) cancer patients. The median ORT score was 1.0 (range, 0-10) out of a possible 26. Overall, 87% of patients were categorized as low-risk for opioid misuse, 7% as moderate-risk, and 6% as high-risk. Patients who were at moderate or high-risk of opioid misuse were significantly younger (47 vs. 58years, p=0.02), more likely to have cervical cancer (p=0.02), be smokers (p=0.01) and be uninsured or on Medicare (p=0.03). CONCLUSIONS: Most gynecologic oncology patients in our cohort were low-risk for opioid misuse (87%). Cervical cancer patients were more likely to be moderate to high-risk for misuse. Future screening efforts for opioid misuse may have the highest utility in this subset of patients.
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Neoplasias dos Genitais Femininos/tratamento farmacológico
Neoplasias dos Genitais Femininos/psicologia
Transtornos Relacionados ao Uso de Opioides/diagnóstico
[Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem
Dor do Câncer/tratamento farmacológico
Feminino
Neoplasias dos Genitais Femininos/fisiopatologia
Seres Humanos
Meia-Idade
Transtornos Relacionados ao Uso de Opioides/prevenção & controle
Valor Preditivo dos Testes
Estudos Prospectivos
Medição de Risco/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE


  10 / 278 MEDLINE  
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[PMID]:28806817
[Au] Autor:Nugent SM; Morasco BJ; O'Neil ME; Freeman M; Low A; Kondo K; Elven C; Zakher B; Motu'apuaka M; Paynter R; Kansagara D
[Ad] Endereço:From VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon.
[Ti] Título:The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review.
[So] Source:Ann Intern Med;167(5):319-331, 2017 Sep 05.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Cannabis is increasingly available for the treatment of chronic pain, yet its efficacy remains uncertain. Purpose: To review the benefits of plant-based cannabis preparations for treating chronic pain in adults and the harms of cannabis use in chronic pain and general adult populations. Data Sources: MEDLINE, Cochrane Database of Systematic Reviews, and several other sources from database inception to March 2017. Study Selection: Intervention trials and observational studies, published in English, involving adults using plant-based cannabis preparations that reported pain, quality of life, or adverse effect outcomes. Data Extraction: Two investigators independently abstracted study characteristics and assessed study quality, and the investigator group graded the overall strength of evidence using standard criteria. Data Synthesis: From 27 chronic pain trials, there is low-strength evidence that cannabis alleviates neuropathic pain but insufficient evidence in other pain populations. According to 11 systematic reviews and 32 primary studies, harms in general population studies include increased risk for motor vehicle accidents, psychotic symptoms, and short-term cognitive impairment. Although adverse pulmonary effects were not seen in younger populations, evidence on most other long-term physical harms, in heavy or long-term cannabis users, or in older populations is insufficient. Limitation: Few methodologically rigorous trials; the cannabis formulations studied may not reflect commercially available products; and limited applicability to older, chronically ill populations and patients who use cannabis heavily. Conclusion: Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk for adverse mental health effects. Primary Funding Source: U.S. Department of Veterans Affairs. (PROSPERO: CRD42016033623).
[Mh] Termos MeSH primário: Dor Crônica/tratamento farmacológico
Maconha Medicinal/uso terapêutico
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Adulto
Dor do Câncer/tratamento farmacológico
Dor Crônica/etiologia
Seres Humanos
Maconha Medicinal/efeitos adversos
Esclerose Múltipla/fisiopatologia
Neuralgia/tratamento farmacológico
Psicoses Induzidas por Substâncias/etiologia
Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Medical Marijuana)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE
[do] DOI:10.7326/M17-0155



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