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Pain is a common problem that affects nearly all cancer patients (Kwekkeboom, 2008). There are various factors that constitute suffering to cancer patients. Apart from physical pain, cancer patients usually experience emotional crisis and spiritual struggles (Magill, 2008). Music therapy is believed to be one of the most effective treatments for cancer patients. It provides a holistic care to patients with cancer. It will not only manage the physical sensation, but also address the psychological, social and spiritual parts of the patients (Magill, 2009). Although current studies have suggested the benefits of using music therapy in reducing pain for cancer patients, it is not a common practice in Hong Kong. As the administration rate of music therapy relies heavily on the knowledge of the nurses (Kwekkeboom, 2008). Therefore, this paper aims at providing evidence on the use of music therapy. In the hope of a clinical guideline, it can increase the administration rate of music therapy for cancer pain management in clinical setting. Apart from the clinical guideline, an implementation and evaluation plan on music therapy will also be discussed in this paper. There will be a full description from preparation to evaluation. Nurses can make use of this reference guide to provide music therapy for their cancer patients in respect to pain management. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Many common cancers, including breast, prostate and lung, have a predilection to metastasize to the bone, bringing not only bone destruction but severe pain. Although novel chemotherapeutic agents have increased life expectancy, patients are experiencing higher incidences of fracture, pain and drug-induced side effects; furthermore, recent findings suggest that patients are severely under-treated for their cancer pain. Strong analgesics, namely opiates, are the first-line therapy in alleviating cancer-related pain despite severe side effects including enhanced bone destruction with sustained administration. Bone resorption is primarily treated with bisphosphonates, which can bring highly undesirable side-effects including nephrotoxicity and osteonecrosis of the jaw. Thus novel therapeutics are needed to treat the pain of metastatic cancer patients. Animal models of cancer-induced bone pain (CIBP) have revealed that the neurochemistry of cancer has distinctive features from other chronic pain states. These include factors released from the cancer cells, tumor activated macrophages and increased osteoclast degredation of bone within the bone microenvironment, all acting to sensitize free nerve endings.One possibility of inhibiting cancer-mediated pain inducing factors includes agonism of the Cannabinoid 2 receptor agonists. Cannabinoid CB2 receptor-specific agonists have been shown to reduce bone loss and stimulate bone formation in a model of osteoporosis. CB2 agonists produce analgesia in both inflammatory and neuropathic pain models. Notably, mixed CB1/CB2 agonists also demonstrate a reduction in ErbB2-driven breast cancer progression. Osteolytic sarcoma within the femur produced spontaneous and touch evoked behavioral signs of pain within the tumor-bearing limb. The systemic administration of AM1241 both acutely and for 7 days significantly attenuated spontaneous and evoked pain in the inoculated limb. Sustained AM1241 significantly reduced bone loss and decreased the incidence of cancer-induced bone fractures. In addition, CB2 agonists significantly reduce breast cancer-induced bone pain, bone loss and breast cancer proliferation in part via cytokine/chemokine suppression. Studies utilized the spontaneously-occurring syngenic murine mammary cell line (66.1) implanted and sealed into the femur intramedullary space. Measurements were made of spontaneous pain, bone loss and cancer proliferation. The central and systemic administration of the CB2 agonist JWH015 for seven days significantly attenuates pain. Pharmacological characterization with cannabinoid 1 and 2 antagonists demonstrates that the effects JWH015 on pain were mediated by the CB2 receptor. We and others have found that bone induced cancer pain increases the expression of GFAP and Iba1 in the lumbar spinal cord which are markers of astrocytes and microglia respectively, compared to control animals. After administration of JWH015 (i.t), the release of spinal pro-inflammatory cytokines, IL-6 and TNFá, are reduced suggesting that modulation of glial cytokines may be one mechanism by which CB2 agonists can attenuate pain centrally. On the other hand, systemic administration of JWH015 reduces cancer-induced elevation of cytokines in the tumor microenvironment, suggesting a mechanism by which CB2 agonist is attenuating pain peripherally. Additionally, systemic administration improves bone modification, as demonstrated via micro-computed tomography and bone serum markers while decreasing femoral tumor burden. In vitro, JWH015 reduced cancer cell proliferation and other inflammatory mediators shown to promote pain, bone loss and proliferation. These results suggest CB2 agonists as a novel treatment for breast cancer-induced bone pain, where disease modifications include a reduction in bone loss, suppression of cancer growth, attenuation of severe bone-pain and increased survival without the major side effects of current therapeutic options. Another future therapeutic option for metastatic bone cancer pain may include cathepsin inhibitors. Cysteine cathepsins (B, C, F, H, K, L, O, L2/V, W, X/Z) are highly expressed in many human cancers and have been associated with poor patient prognosis. In the RIP1-Tag2 transgenic model of pancreatic cancer, mice treated with VBY-825, a reversible inhibitor of cathepsins S, B, V, L, K showed a significant reduction in tumor incidence and growth. Here we demonstrate the cathepsin inhibitor VBY-825 reduces cancer-induced pain behaviors. Additionally, tumor bearing animals treated with VBY-825 demonstrate a reduction in bone resorption, possibly mediated through a reduction in osteoclast activity. These results indicate that a cathepsin inhibitor targeting multiple cathepsins, such as VBY-825, could be a novel therapeutic for bone metastases.Part of the failure to palliate cancer pain is due to a poor understanding of the etiology of cancer pain. Preclinical studies have just begun to scratch the surface on how such cancers may interact with the bone microenvironment to result in pain and bone loss. Further studies are desperately needed at both the preclinical and clinical level to determine the unique molecular profile of cancer pain that may lead to the development of superior therapeutics for CIBP. The studies presented herein provide preclinical evidence that warrant the investigation of these compounds in the clinic as treatment for cancer-induced bone pain.

Chronic non-cancer pain (CNCP) affects approximately 25% of Canadians. Opioids are medications frequently prescribed for management of patients with CNCP. Concern about addiction, misuse, and diversion for illicit use led the Canadian medical regulatory bodies to release a national guideline on the safe and effective use of opioids in CNCP. This thesis used an online survey to determine how closely the self-reported practices of Canadian family physicians matched the recommendations of the Canadian Guideline. We received 710 responses suitable for analysis. Thirteen percent of respondents did not prescribe strong opioids for CNCP. Practice gaps indentified were infrequently using a management agreement and monitoring pain with a scale; incorrect choice of second line opioid for mild to moderate pain; incorrect choice of first, second, and third line opioids for severe pain, and starting fentanyl incorrectly. Findings provide baseline information for future follow-up to compare physicians’ adherence to the guideline.

Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-03Bitstream added on 2014-06-13T20:10:38Z : No. of bitstreams: 1 takeda_n_me_botfm.pdf: 264551 bytes, checksum: b4235e7228efb9f456dda6be5d8a3221 (MD5) / Fundação Pio Xii - Barretos / Estudos têm relacionado o uso de atividades terapêuticas como uma técnica nãofarmacológica efetiva para o controle da dor oncológica e de outros sintomas decorrentes da doença, contribuindo de maneira significativa na melhora da qualidade de vida. O objetivo deste estudo foi avaliar os resultados de um programa de terapia ocupacional aplicado a pacientes oncológicos sob cuidados paliativos, no que se refere à modulação da dor, qualidade de vida e sintomas emocionais. Após a aprovação do comitê de ética e assinatura do termo de consentimento livre e esclarecido, foram incluídos 59 pacientes portadores de neoplasia avançada, em cuidados paliativos e que apresentavam dor E.V.A 5 cm (Escala Visual Analógica). Foram avaliados: dor (E.V.A, questionário de McGill e consumo de opióides), qualidade de vida (questionário SF-12) e sintomas de ansiedade e depressão (questionário HADS). Os pacientes foram aleatoriamente distribuídos, por sorteio de envelopes, em dois grupos e acompanhados diariamente por 10 dias consecutivos. O grupo intervenção realizou 30 minutos de atividades terapêuticas associado a orientações quanto ao desempenho das atividades de vida diária. O grupo controle recebeu somente orientações quanto atividades de vida diária. Os grupos foram demograficamente e clinicamente semelhantes em relação: sexo, cor, religião, escolaridade, estado civil, presença de cuidador, qualidade da dor, localização da dor e topografia do câncer. O grupo intervenção apresentou redução da dor (E.V.A e questionário de McGill) durante os dez dias de estudo. O grupo controle não apresentou diminuição satisfatória da dor. A média do consumo de morfina foi semelhante quando comparado os grupos (p>0,05). Entretanto, analisando cada grupo separadamente, no grupo controle observou-se maior consumo de morfina quando comparado ao grupo que realizou atividades... / Studies have connected the use of therapeutic activities as non-pharmacological practice effective for the control of cancer pain and other passing symptoms from the disease by helping to improve the quality of life in a significative way. The aim of this study was to create a program of occupational therapy as a helping technique in the modulation of the pain in cancer patients under palliative care. After the approval of the ethics committee and signature of the free and evident consent term, 59 patients who had advanced cancer in palliative care and had VAS 5 cm (Visual Analogue Scale) pain were included. Pain (VAS, McGill questionnaire and opioids consumption), quality of life (questionnaire SF-12) and anxiety and depression symptoms (questionnaire HADS) were evaluated. The patients were aleatorically distributed, by raffle envelopes, into two groups and accompanied daily for consecutive 10 days. The intervention group performed 30 minutes of therapeutic activities associated guidance on the performance of activities of daily life. The control group received only orientations of activities of daily life. The groups were similar demographically and clinically in relation to sex, race, religion, graduation, marital status, the presence of caregiver, quality of pain, localization of the pain and topography of cancer. The intervention group presented decreasing of the pain (VAS and McGill questionnaire) during ten days of the study. The control group did not present satisfactory reduction of pain. The average of morphine consumption was similar compared to the groups (p> 0.05). However, analyzing each group separately in the control group was observed a large consumption of morphine when compared to the group which accomplished therapeutic activities. The quality of life and anxiety and depression symptoms got better in relation to the first and the last day of the study... (Complete abstract click electronic access below)

Chronic pain induced by nerve damage due to trauma or invasion of cancer to the bone elicits severe ongoing pain as well as hyperalgesia and allodynia likely reflecting adaptive changes within central circuits that amplify nociceptive signals. The present study explored the possible contribution of the mesolimbic dopaminergic circuit in promoting allodynia related to neuropathic and cancer pain. Mice with ligation of the sciatic nerve or treated with intrafemoral osteosarcoma cells showed allodynia to a thermal stimulus applied to the paw on the injured side. Patch clamp electrophysiology revealed that the intrinsic neuronal excitability of ventral tegmental area (VTA) dopamine neurons projecting to the nucleus accumbens (N.Acc.) was significantly reduced in those mice. We used tyrosine hydroxylase (TH)-cre mice that were microinjected with adeno-associated virus (AAV) to express channelrhodopsin-2 (ChR2) to allow optogenetic stimulation of VTA dopaminergic neurons in the VTA or in their N.Acc. terminals. Optogenetic activation of these cells produced a significant but transient anti-allodynic effect in nerve injured or tumor-bearing mice without increasing response thresholds to thermal stimulation in sham-operated animals. Suppressed activity of mesolimbic dopaminergic neurons is likely to contribute to decreased inhibition of N.Acc. output neurons and to neuropathic or cancer pain-induced allodynia suggesting strategies for modulation of pathological pain states.

Cancer-induced bone pain is characterized by moderate to severe ongoing pain that commonly requires the use of opiates. Even when ongoing pain is well controlled, patients can suffer breakthrough pain (BTP), episodic severe pain that "breaks through" the medication. We developed a novel model of cancer-induced BTP using female rats with mammary adenocarcinoma cells sealed within the tibia. We demonstrated previously that rats with bone cancer learn to prefer a context paired with saphenous nerve block to elicit pain relief (i.e., conditioned place preference, CPP), revealing the presence of ongoing pain. Treatment with systemic morphine abolished CPP to saphenous nerve block, demonstrating control of ongoing pain. Here, we show that pairing BTP induced by experimenter-induced movement of the tumor-bearing hindlimb with a context produces conditioned place avoidance (CPA) in rats treated with morphine to control ongoing pain, consistent with clinical observation of BTP. Preventing movement-induced afferent input by saphenous nerve block before, but not after, hindlimb movement blocked movement-induced BTP. Ablation of isolectin B4 (IB4)-binding, but not TRPV1(+), sensory afferents eliminated movement-induced BTP, suggesting that input from IB4-binding fibers mediates BTP. Identification of potential molecular targets specific to this population of fibers may allow for the development of peripherally restricted analgesics that control BTP and improve quality of life in patients with skeletal metastases.

Bakgrund: I dag lever cirka 70 000 människor i Sverige med cancer. Smärta är ett vanligt symtom vid cancersjukdom och icke-farmakologisk smärtlindring är sjuksköterskans ansvarsområde. Massage ingår normalt inte i dagens hälso- och sjukvård till följd av oklar evidens. Trots det använder var fjärde person med cancersjukdom i Sverige någon form av komplementär metod utöver den konventionella onkologiska behandlingen. Därför är det av intresse att kartlägga effekter av massage vid självskattad smärta.  Syfte: Beskriva effekter av massage på symtom och hälsorelaterad livskvalité bland personer med cancersjukdom.  Metod: Litteraturstudien innefattar 10 kvantitativa studier som granskats, analyserats och sammanställts. Studierna identifierades i databaserna Cinahl och Pubmed. Resultat: Resultatet visar att massage på kort sikt kan ha en smärtreducerande effekt hos personer med cancersjukdom. Resultatet ger vidare indikationer om att massage utöver smärta, kan ha effekt på flera fysiska och psykiska symtom som upplevs av patienter med cancersjukdom. Konklusion: Massage kan vara en smärtlindrande metod som används parallellt med farmakologisk behandling för symtomlindring hos personer med cancer. Det behövs fler randomiserade kontrollerade studier för att säkerställa god evidens till följd av variationer i existerande studiers metod. / Background: Today, about 70,000 people in Sweden live with cancer. Pain is a common symptom of cancer and non-pharmacological pain treatment is the nurse’s area of responsibility. Massage is not normally included in today’s medical care due to unclear evidence. Despite this, every fourth person with cancer in Sweden uses some form of complementary method. Therefore, it is of interest to describe the effects of massage among people with cancer who experience pain.  Aim: Describe the effects of massage on symptoms and health-related quality of life among people with cancer.  Methods: The literature review includes 10 quantitative studies reviewed, analyzed and compiled. The studies were identified in the Cinahl and Pubmed databases. Results: The results show that massage in the short term can have a pain-reducing effect in people with cancer. The results also give indications that massage, in addition to pain, could have an effect on other physical and mental symptoms. Conclusion: Massage can be a pain-relieving method used in parallel with pharmacological treatment of self-rated pain in people with cancer. More randomized controlled trials are needed to ensure good evidence as there were large variations in the methods of the already existing studies.

- / Every year in England and Wales, 105,000 people sufferfrom uncontrolled cancer pain and are rarely offered community pharmacy medicine consultations (e.g. Medicines Use Reviews -MURs)[1]. Our aim was to examine how patients with cancer pain deal with their pain medication and to investigate their experiences of and attitudes towards community pharmacy.

Yes / Background: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. Methods: We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Results: Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Conclusions: Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients. / National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG- 1010–23041).