Cancer pain patients have various diagnosis, stage of disease, response to pain, and treatments and individualized treatment methods are thus needed. Use of Nonopioid analgesics is the first step treatment (according to WHO ladder) for mild to moderate pain, and may be useful for second or third step treatments when combined with weak or strong opioids to reduce side effects of opioids and to create synergy between the two drugs. Acetaminophen and nonsteroidal antiinflammatory drugs(NSAIDs) are also nonopioid analgesics. NSAIDs have a ceiling effect, along with antipyretic, analgesic and antiinflammatory effects, while not producing physical and psychological dependence. Adverse effects of NSAIDs include gastrointestinal hemorrhage, coagulopathy, and deterioration of renal function.
Acetaminophen ; Analgesics ; Analgesics, Non-Narcotic ; Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Gastrointestinal Hemorrhage ; Humans ; Resin Cements

A variety of pharmacologic agents have been developed for the treatment of osteoarthritis. At present, however, none of them has been proven to prevent disease progression, and the medications are used only for symptomatic relief. Thus, non-pharmacologic conservative treatment such as education, weight reduction in the obese, and consistent exercise should be recommended first to maintain fitness and tolerance to physical activity. Medication is then indicated to better control symptoms provided non-pharmacologic measures prove inadequate, and a successful strategy most likely would entail a combination of these non-pharmacologic and pharmacologic approaches. Acetaminophen can be tried first because of its efficacy and relatively safe profile, especially in those with mild osteoarthritis. Nonselective non-steroidal anti-inflammatory drugs may be used in patients with moderate to severe pain, but long-term medication requires caution due to the increased risk of gastrointestinal and renal complications. Selective cyclooxygenase-2 inhibitors can be better tolerated, especially in patients with risk factors for gastrointestinal adverse events, but potential cardiac and cerebrovascular thrombotic events should be considered in those with preexisting cardiovascular disease. Tramadol and opioids are more potent analgesics. However, they are not recommended for routine use due to a high incidence of nausea, constipation, and drowsiness. These agents require close monitoring for those adverse effects, especially in a geriatric population. Lastly, the pharmacologic plan should be individualized according to the severity and duration of pain, age and gender of the patient, and concurrent comorbidities to maximize the benefit as well as to minimize the risk of adverse effects from medication.
Acetaminophen ; Analgesics ; Analgesics, Opioid ; Cardiovascular Diseases ; Comorbidity ; Constipation ; Cyclooxygenase 2 Inhibitors ; Disease Progression ; Education ; Humans ; Incidence ; Motor Activity ; Nausea ; Osteoarthritis* ; Risk Factors ; Sleep Stages ; Tramadol ; Weight Loss

The opioid epidemic continues to be a serious public health concern. Many have pointed to prescription drug misuse as a nidus for patients to become addicted to opioids and as such, urologists and other surgical subspecialists must critically define optimal pain management for the various procedures performed within their respective disciplines. Controlling pain following penile prosthesis implantation remains a unique challenge for urologists, given the increased pain patients commonly experience in the postoperative setting. Although most of the existing urological literature focuses on interventions performed in the operating room, there are many studies that examine the role of preoperative adjunctive pain medicine in diminishing postoperative narcotic requirements. There are relatively few studies looking at postoperative strategies for managing pain in prosthetic surgery with follow-up past the immediate hospitalization. This review assess the various strategies employed for managing pain following penile implantation through the lens of the current state of the opioid crisis, thus examining how urologists can responsibly treat pain without contributing to the growing threat of opioid addiction.
Analgesics/therapeutic use* ; Analgesics, Opioid/therapeutic use* ; Anesthetics, Local/therapeutic use* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Cyclooxygenase 2 Inhibitors/therapeutic use* ; Gabapentin/therapeutic use* ; Humans ; Intraoperative Care ; Male ; Nerve Block/methods* ; Opioid Epidemic ; Pain Management/methods* ; Pain, Postoperative/therapy* ; Penile Implantation/methods* ; Pregabalin/therapeutic use* ; Preoperative Care

A review of the literature on cancer pain revealed that many persons with cancer receive inadequate analgesia for pain control, due in part to a lack of knowledge of the control of cancer pain by both physicians and nurses. This study is composed of two parts : one is to train nurses to change their knowledge of and attitude toward the pain management of patients having cancer and to evaluate the effectiveness of this training in comparison with other non-trained group ; the other is to test the applicability of the pain management method knowledge and attitude in the levels of pain of oncology patients. General characteristics of nurses such as age, education, educational experiences of cancer pain management were not different in both groups except the clinical experience. General characteristics of cancer patients and pain-related variables such as pain, sleep, daily activities, treatment modalities, causes of pain were not different in both groups except the educational levels of patients. After an eight-hour educational program given to the experimental nurse group, the knowledge and attitude about assessment of cancer pain, pain medication, and pharmacological knowledge were significantly higher in the experimental group than in the control group, while knowledge about classification of analgesics was not significantly different. The amount of analgesics, measured by the morphine equivalent doses, used in the experimental group was significantly lower than in the control group in the first and the last days. The experimental group used more systematic ways of drug changes from non-narcotic analgesics to narcotic analgesics than the control group. This indicated that the control group used fentanyl patches more commonly than in the control group. Cancer pain scores of both group of patients were measured on an hourly bases for a week in both groups. The patients' pain scores of the first day of measurement in experimental group were not significantly higher than those of control group of patients, while those of the last day were significantly higher than those of the control group. This study supports the need for educational program for the management of cancer pain to the nurses and the doctors.
Analgesia ; Analgesics ; Analgesics, Non-Narcotic ; Classification ; Education ; Fentanyl ; Humans ; Morphine ; Narcotics ; Pain Management*

Long QT syndrome is a cardiac repolarization disorder and is associated with an increased risk of torsades de pointes. The acquired form is most often attributable to administration of specific medications and/or electrolyte imbalance. This review provides insights into the risk for QT prolongation associated with drugs frequently used in the treatment of chronic pain. In the field of pain medicine all the major drug classes (i.e. NSAIDs, opioids, anticonvulsive and antidepressant drugs, cannabinoids, muscle relaxants) contain agents that increase the risk of QT prolongation. Other substances, not used in the treatment of pain, such as proton pump inhibitors, antiemetics, and diuretics are also associated with long QT syndrome. When the possible benefits of therapy outweigh the associated risks, slow dose titration and electrocardiography monitoring are recommended.
Analgesics ; Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Antidepressive Agents ; Antiemetics ; Cannabinoids ; Chronic Pain ; Diuretics ; Electrocardiography ; Long QT Syndrome ; Muscle Relaxants, Central ; Narcotics ; Proton Pump Inhibitors ; Torsades de Pointes

OBJECTIVETo investigate the postoperative analgesic effect of parecoxib sodium in patients with posterior spinal surgery.

METHODSEighty patients undergoing posterior spinal surgery under general anesthesia were randomly divided into parecoxib sodium group and placebo group (n=40). All the patients received a single dose of m ml morphine (1.0 mg/ml) as the background analgesia immediately after the operation. The patients in parecoxib sodium group were given 40 mg parecoxib sodium intravenously, and those in the placebo group received an equivalent volume of saline instead, and at 24 and 48 h after the operation, the same dose was repeated. The visual analog pain score, patient satisfaction and adverse reactions were recorded after the administrations.

RESULTSCompared with the placebo group, the patients in parecoxib sodium group had significantly lowered VAS score at 6, 12, 24, and 48 h after the operation (P<0.05). No significant differences were noted in the patient satisfaction and adverse reactions between the two groups.

CONCLUSIONPostoperative short-term use of parecoxib sodium can can provide good postoperative analgesic effect in patients undergoing posterior spinal surgery.

Analgesics, Non-Narcotic ; therapeutic use ; Anesthesia, General ; Cyclooxygenase 2 Inhibitors ; therapeutic use ; Female ; Humans ; Injections, Intravenous ; Isoxazoles ; administration & dosage ; therapeutic use ; Male ; Pain, Postoperative ; drug therapy ; Spinal Diseases ; surgery

PURPOSE: To assess the effectiveness of a care map for a fast-track discharge program after colorectal cancer surgery. METHODS: Ninety-nine patients who underwent colorectal surgery were retrospectively analyzed: 45 patients who were placed in a conventional program (January 3 to March 13, 2013) and 44 patients who were placed in a fast-track program using the care map (July 26 to September 24, 2014). Patients in the fast-track program started eating on postoperative day 1, while those in the conventional program started eating on post-operative day 2. complications, and pain were compared between the two groups. RESULTS: A slight decrease in the average duration of hospitalization was observed for the fast-track group (5.31+/-0.98 days) compared to the conventional group (5.38+/-2.80 days), although this difference was not statistically significant. All other outcomes for the fast-track group were scored as 0. Furthermore, there was no statistically significant differences between pain, narcotics administration, and non-narcotic analgesics (aside from patient-controlled analgesia). CONCLUSION: The care map for the colorectal surgery fast-track program was effective and program validation and supplementation of the active standardization early recovery program should be performed using multi-disciplinary research.
Analgesics, Non-Narcotic ; Colorectal Neoplasms* ; Colorectal Surgery ; Eating ; Hospitalization ; Humans ; Narcotics ; Retrospective Studies

Opioids are the most effective analgesics for cancer pain treatments. But the ineffective treatment of cancer pain is often related to insufficient knowledge of opioids and fear of the addiction along with the side effects. To achieve effective treatment of cancer pain with opioids, we need a careful assessment of pain, proper use of opioids and regular review of the effectiveness of prescribed opioids. Basic principles of opioids therapy in cancer pain are 1. Oral opioids (or transdermal) if possible; 2. Combination of long-acting opioids for constant pain with short-acting opioids for breakthrough pain; 3. "Opioids rotation"in poor analgesia and significant side effects with the calculations of the morphine equivalent daily dose (MEDD) 4. Initiation of prophylactic treatment for constipation and nausea. In this review, I will describe the essential aspects of opioids therapy, pharmacology, rotation, properties of the individual opioids, and management of common side effects.
Analgesia ; Analgesics ; Analgesics, Opioid ; Constipation ; Morphine ; Nausea

Background: Surgical injury produces nociception, inflammation and hyperalgesia. Non-steroidal anti-inflammatory drugs (NSAIDs) if present at the site of surgical injury may retard or even inhibit the inflammatory response in the tissue. Meloxicam, a COX 2 preferential NSAID was chosen as the study drug because of its long elimination half life and its good tolerability with respect to local and systemic reactions Objectives: To compare the postoperative analgesia provided by a single dose oblique muscle infiltration of 15 mg Meloxicam with Meloxicam 15 mg/IM over the vastus lateralis muscle at the anterolateral thigh for patients undergoing emergency appendectomy and to determine whether there was any difference in the requirements for postoperative analgesia between the two groups Methods: 40 ASA I-II patients aged 18-65 years old with acute appendicitis scheduled for emergency appendectomy through a McBurneys incision under spinal anesthesia were included in this randomized prospective blinded study. Right after peritoneal closure, patients in DWI group (N=21) received local infiltration of meloxicam 15 mg while patients in the ATI group (N=19) received meloxicam 15 mg over the anterolateral thigh. VAS scores at different time intervals were noted at rest, upon movement by raising the shoulders off the bed, and upon coughing. A rescue dose of 10 mg/IV Nalbuphine was given as needed by the patient Results: There was no significant difference in the demographic variables between the two groups. Only the VAS scores upon movement showed statistically different results between the DWI group and the ATI group (RMANOVA, p0.05, Significant). The proportion of those patients who requested rescue analgesics and the mean amount of rescue analgesic was also statistically different between the two groups. Patients in the ATI group required rescue analgesics earlier than those in the DWI group (p0.05, Significant) Conclusion: Intramuscular wound infiltration with Meloxicam 15 mg resulted in lower VAS scores upon movement, less requirement for rescue analgesics, and longer time interval needed before the rescue analgesic is given. (Author)
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; ANALGESIA ; APPENDECTOMY ; ANTI-INFLAMMATORY AGENTS ; NON-STEROIDAL ; ANALGESICS ; ANALGESICS ; NON-NARCOTICS ; INTRAOPERATIVE COMPLICATIONS

No abstract available.
Analgesics, Opioid* ; Dexmedetomidine* ; Neuralgia*