OBJECTIVES: Managing patients with refractory head and neck cancer pain is one of the more challenging issues in clinical practice, and traditional intrathecal drug delivery also fails to provide adequate analgesia. There are currently no comprehensive and effective treatment methods. This study aims to observe the efficacy and safety of treating intractable head and neck cancer pain with morphine pump via lumbar approach to the prepontine cistern. METHODS: A total of 18 patients with intractable head and neck cancer pain treated with prepontine cistern morphine pumps were selected from the Department of Pain Management, Second Xiangya Hospital, Central South University between September 2019 and July 2023. Statistical analysis was performed on patients' preoperative and postoperative (1 week, 1 month, and 2 months after surgery), Numerical Rating Scale (NRS) scores, Self-Rating Depression Scale (SDS) scores, daily oral morphine consumption, the number of daily breakthrough pain episodes, and postoperative daily intrathecal morphine dosage. RESULTS: The NRS scores, SDS scores, daily oral morphine consumption, and the number of daily breakthrough pain episodes of patients at each time point after surgery were significantly lower than before surgery (all P<0.05). With the gradual increase in the dosage of intrathecal morphine, the daily oral morphine consumption of patients at each postoperative time point was significantly reduced compared to preoperative levels (all P<0.05). The complications related to the operation were mild, including nausea in 5 cases (31.3%), headache in 2 cases (12.5%); hypotension, urine retention, hypersomnia and constipation in 1 case (6.3% each), and no serious adverse events occurred. All improved and were discharged after symptomatic treatment. CONCLUSIONS The implantation of prepontine cistern morphine pump effectively controls intractable head and neck cancer pain, demonstrating characteristics of minimal invasiveness, mild side effects, and low medication dosage under the premise of standardized procedures.
Humans ; Morphine/administration & dosage* ; Male ; Female ; Middle Aged ; Head and Neck Neoplasms/surgery* ; Analgesics, Opioid/administration & dosage* ; Cancer Pain/drug therapy* ; Pain, Intractable/etiology* ; Aged ; Adult ; Infusion Pumps, Implantable ; Pain Management/methods*

OBJECTIVETo investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain.

METHODSFrom September 2009 to September 2013, 21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients, with or without laminectomy. All patients were male, range in age from 20 to 28 years old with an average of (25.00±2.38) years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury (ASIA grade) or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, MRI, CT, X-rays were performed; denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation.

RESULTSAll patients were followed up from 8 to 32 months with an average of (17.29±6.02) months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of (2.43±2.46) points, and were obviously reduced than peroperative data (P<0.05). Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients' symptoms and VAS scores were not improved.

CONCLUSIONOld thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.

Adult ; Decompression, Surgical ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Neuralgia ; etiology ; surgery ; Pain, Intractable ; etiology ; surgery ; Spinal Fractures ; physiopathology ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Visual Analog Scale ; Young Adult

OBJECTIVE: To investigate the manifestation of ethology and the immunohistochemistry results of the 2B Subunits of N-methyl-D-aspartate receptors (NR2B) in the spinal cord dorsal horn and dorsal root ganglia (DRG) in mice with bone cancer pain and their correlation, and to discuss the role of NR2B in the generation and maintenance of bone cancer pain. METHODS: Forty-five male C57BL/6 mice were randomly divided into 3 groups: a model group (n=15), 2×10(6) cells in 10 μL D-Hank's were injected into the left femur of mice;a sham group(n=15), only 10 μL D-Hank's injected into the left femur of mice;and a normal control group(n=15), no treatment. Spontaneous lifting duration and mechanical withdrawal threshold of the hind paw of mice were measured on alternative days throughout the experiment. Bones from 5 mice in each group were stained with HE on Day 7, 15, and 23 after the inoculation and segments of lumbar spinal cord and L(4) DRG were taken to detect NR2B by immunohistochemistry. RESULTS: Bone cancer pain models were successfully established and confirmed by ethology and histology. The immunohistochemical positive indexes of NR2B were significantly higher in the model group than in the sham group and the control group. In the model group there were obvious differences either between Day 7 and Day 15, or between Day 7 and Day 23 (P<0.05). On Day 23, the immunohistochemical positive indexes of NR2B in the ipsilateral spinal cord dorsal horn of all groups, and L(4) DRG were positively correlated with the spontaneous lifting duration of ipsilateral hindpaw (r=0.976, P<0.001; r=0.882, P<0.001, respectively), negatively correlated with the mechanical withdrawal threshold of ipsilateral hindpaw (r=-0.879, P<0.001; r=-0.760, P=0.001, respectively). CONCLUSION The immunohistochemical positive indexes of NR2B are increased and significantly correlated with the manifestation of ethology. NR2B in the spinal cord and L(4) DRG may participate and mediate in forming and developing hyperalgesia in bone cancer pain.
Animals ; Bone Neoplasms ; complications ; Ganglia, Spinal ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Neoplasm Transplantation ; Pain, Intractable ; etiology ; metabolism ; Random Allocation ; Receptors, N-Methyl-D-Aspartate ; genetics ; metabolism ; Spinal Cord ; metabolism

OBJECTIVE: To set up a mouse model with bone cancer to simulate the morphine tolerance and explore its mechanism. METHODS: Forty C57BL/6 male mice were divided into 4 groups: Group 1 and Group 2 were firstly set up as bone cancer pain models. Morphine (10 mg/kg) was sequentially administered subcutaneously twice daily in Group 1 and normal saline was administered in Group 2 as the control group. Similar to Group 1 and Group 2, morphine (10 mg/kg) was administered subcutaneously twice daily in Group 3 and normal saline was administered in Group 4 as the control group. To set up morphine tolerance model, we injected morphine continuously for 7 days. From Day 1 to Day 7 after the morphine injection, we measured the mice hind paw withdrawal threshold in the von Frey hair test every other day. NMDA receptor 1 (NMDA1) and nitric oxide synthase (NOS) were measured on Day 7 after the morphine injection. RESULTS: The mice hind paw withdrawal threshold in the von Frey hair test in Group 1 increased on Day 1,3, and 5 after the morphine injection compared with the paw withdrawal threshold in Group 2 and had the same threshold as Group 2 on Day 7. The mice hind paw withdrawal threshold in the von Frey hair test in Group 3 increased on Day 1,3, and 5 after the morphine injection compared with the paw withdrawal threshold in Group 4 and had the same threshold as Group 4 on Day 7. The grey scales and integral optical density (IOD) of NMDAR1 and the level of NOS in the spinal dorsal horn were higher in Group 1, Group 2, and Group 3 compared with those in Group 4 (P<0.05 or P<0.01), and the grey scales and IOD of NMDAR1 in Group 2 was higher than that in Group 1 (P<0.05). CONCLUSION NMDA receptors and NOS may play important roles in morphine tolerance in mice with bone cancer pain.
Animals ; Bone Neoplasms ; complications ; Drug Tolerance ; Male ; Mice ; Mice, Inbred C57BL ; Morphine ; therapeutic use ; Neoplasm Transplantation ; Nitric Oxide Synthase Type I ; metabolism ; Pain, Intractable ; drug therapy ; etiology ; Random Allocation ; Receptors, N-Methyl-D-Aspartate ; metabolism ; Spinal Cord ; metabolism

Excellent outcomes were achieved with spinal cord stimulation (SCS) for 7 to 10 days on 2 patients who developed postherpetic neuralgia. Both patients were within 2 to 3 months of the onset of the condition, and nerve blocks provided only temporary pain relief and drug therapies had poor efficacy. The authors believe that limited-duration SCS for subacute postherpetic neuralgia is a useful treatment approach that may prevent the pain from progressing to chronic postherpetic neuralgia.
Aged ; Electric Stimulation Therapy ; methods ; Female ; Herpes Zoster ; complications ; Humans ; Neuralgia, Postherpetic ; etiology ; physiopathology ; therapy ; Outcome Assessment (Health Care) ; Pain, Intractable ; therapy ; Spinal Cord ; physiology

Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.
Adult ; Bone Cements/*therapeutic use ; Female ; *Fluoroscopy ; Humans ; Injections, Intralesional ; Male ; Middle Aged ; Pain, Intractable/etiology/*therapy ; Polymethyl Methacrylate/administration & dosage ; *Radiography, Interventional ; *Sacrum ; Spinal Neoplasms/complications/radiography/*secondary ; *Vertebroplasty/methods

OBJECTIVETo evaluate the efficacy and safety of zoledronic acid in the treatment of bone pain in patients with bone metastasis from solid tumor or multiple myeloma.

METHODSA randomized, double-blind, double-simulated and multi-center phase III clinical trail with pamidronate as control was conducted. Patients with moderate to severe bone pain (VAS > 50 mm) induced by solid tumor or multiple myeloma were randomized to receive intravenous zoledronic acid 4 mg or pamidronate 90 mg. Then the change of VAS and urinary NTX/Cr and CTX/Cr were observed in two groups.

RESULTSFrom July 2005 to September 2006, 228 patients with bone pain induced by bone metastasis from 15 cancer centers were randomize into two groups: 116 patients in zoledronic acid group and 112 patients in pamidronate group. The VAS value was decreased gradually after treatment in these two groups. Significant improvement in bone pain after treatment were observed both in zoledronic acid group and the control group when compared with baseline VAS on D8 (-11.77% vs. -10.87%), D15 (-24.60% vs. -21.06%) and D28 (-32.37% vs. -31.26%) (P< or =0.0001), but no significant difference existed between two groups (P =0.6587). Compared with baseline, urine NTX/Cr and CTX/Cr level were decreased rapidly after treatment in both groups, the nadir was on D8, the median decreased on D28, which was -36.9% vs. -32.1% for NTX/Cr (P = 0.7922) and -63.2% vs. -47.9% for CTX/Cr (P =0.834). The frequently observed adverse events were pyrexia (19.0% vs. 31.3%), vomiting (6.0% vs. 8.9%), nausea (4.3% vs. 4.5%), fatigue (3.4% vs. 2.7%) and constipation (2.6% vs. 1.8%) in the two groups. Compared with baseline, the serum creatinine level was not significantly increased throughout the study.

CONCLUSIONIntravenous injection of 4 mg zoledronic acid can significantly reduce bone pain and bone resorption marker in urine in the Chinese patients with bone metastasis from solid tumor or multiple myeloma, which is tolerable and also comparable to pamidronate in the efficacy and safety.

Adult ; Aged ; Analgesics ; adverse effects ; therapeutic use ; Bone Density Conservation Agents ; adverse effects ; therapeutic use ; Bone Neoplasms ; complications ; secondary ; Breast Neoplasms ; pathology ; Collagen Type I ; urine ; Colorectal Neoplasms ; pathology ; Creatinine ; urine ; Diphosphonates ; adverse effects ; therapeutic use ; Double-Blind Method ; Female ; Fever ; chemically induced ; Humans ; Imidazoles ; adverse effects ; therapeutic use ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Multiple Myeloma ; complications ; Pain Measurement ; Pain, Intractable ; drug therapy ; etiology ; urine ; Peptides ; urine ; Prospective Studies ; Vomiting ; chemically induced

OBJECTIVE: To explore the feasibility of a bone cancer pain model by injecting the Lewis lung carcinoma cells into the femur bone marrow cavity of C57BL/6 mice. METHODS: Sixty clear grade male C57BL/6 mice (body weight 18 approximately 20 g) were randomly divided into 4 groups(15 in each group). Cancer cell inoculated group: 2*10(6) Lewis lung carcinoma cells in 10 microL PBS were injected into the left femur bone marrow cavity, and the other 3 control groups were injected the heat inactivated Lewis cells, PBS, or a false operation respectively. Spontaneous lifting time and mechanical allodynia threshold of the mice hind paw were measured in the alternative days throughout the experiment. The structural damage of the femur was monitored by radiogram on the 7th,15th, and 23rd day respectively,and the pathohistological changes of the femur bones were observed by HE staining on the same days. RESULTS: Those mice that received intra-femur innoculation of Lewis lung carcinoma cells gradually developed the spontaneous pain, which was began on the 11th day after the innoculation, and followed by mechanical allodynia. The course of flinch lasted in the later experimental session. The 50% Von Frey threshold was significantly decreased on the 13th day after the innoculation, and the mechanical allodynia lasted the whole experimental period. On the 23rd day after the innoculation, X-ray film showed that the medullary cavity of ipsilateral distal femur was filled with tumor cells, and the cortical bone became thick; furthermore, the tumor cells invaded the peripheral muscles. CONCLUSION Injecting the Lewis lung carcinoma cells into the femoral medullary cavity of C57BL/6 mice can successfully establish a murine bone cancer pain model, and the murine model shows much resemblance compared with the human bone cancer pain.
Animals ; Bone Neoplasms ; complications ; Carcinoma, Lewis Lung ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL ; Neoplasm Transplantation ; Pain, Intractable ; etiology ; Random Allocation ; Tumor Cells, Cultured

OBJECTIVETo evaluate the clinical value of (89)SrCl(2) (Ke xing Inc, Shanghai) as a palliative therapy modality for cancer patients with bone metastasis.

METHODSIn 504 cancer patients with painful limitation of movement due to bony metastasis, a dose of 1.48-2.22 MBq/kg (40-60 uCi/kg) iv infusion of (89)SrCl(2) was given.

RESULTSIn 97 patients (19.2%) there was no improvement in pain and life quality, 298 patients (59.1%) showed mild to moderate improvement (moderately effective), 109 patients (21.6%) became free of pain and were subsequently fully ambulatory (markedly effective). The pain relief appeared from D1-D46 after (89)SrCl(2) administration, most frequently from D5-D14. The palliative effect could last for about 56 days to 13 months. Repeated bone scans of some patients showed that the metastatic foci in the bone became smaller or even disappeared gradually after the administration of (89)SrCl(2). Approximately 55% of patients experienced grade I approximately III bone marrow depression attributable to (89)SrCl(2), which would return to the pre-treatment level within 3 approximately 9 months.

CONCLUSION(89)SrCl(2) is effective and safe for the relief of bone pain and improvement of quality of life in cancer patients with painful bony metastasis.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; complications ; radiotherapy ; secondary ; Breast Neoplasms ; pathology ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Pain Measurement ; Pain, Intractable ; etiology ; radiotherapy ; Quality of Life ; Strontium Radioisotopes ; therapeutic use

OBJECTIVETo evaluate the efficacy and adverse effects of transdermal fentanyl in management of patients with cancer pain.

METHODSA total of 4492 patients (aged 3-90) with cancer pain were enrolled in this multicenter study. The mean age was 58.5 (3 approximately 90) years old. All patients received transdermal fentanyl. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment.

RESULTSBaseline mean pain intensity was 7.37. On days 1, 3, 6, 9, 15, and 30, the mean scores of pain were decreased to 4.04, 2.98, 2.52, 2.19, 1.85 and 1.61, respectively (P < 0.01). The effective rate was 96.8%. The mean doses of fentanyl were 32.37 microg/h (25-200 microg/h) on the initial day, 42.57 microg/h and 49.57 microg/h (25-225 microg/h) on days 15 and 30. The quality of life was significantly improved after treatment (P < 0.01). The common side effects were constipation (9.8%), nausea (13.6%), dizziness (6.5%), vomiting (3.9%), sedation (2.0%) and respiratory depression (0.2%). The incidence of constipation was related to age, and the incidence of vomiting and difficulty of urination was related to gender. The majority (84.5%) of patients preferred continuation of the treatment with transdermal fentanyl.

CONCLUSIONTransdermal fentanyl for the patients with cancer pain is effective, safe, convenient and can improve the quality of life. Transdermal fentanyl can be recommended as one of first-line drugs for the treatment of patients with moderate to severe cancer pain.

Administration, Cutaneous ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Digestive System Neoplasms ; complications ; Female ; Fentanyl ; administration & dosage ; adverse effects ; Humans ; Lung Neoplasms ; complications ; Male ; Middle Aged ; Pain Measurement ; Pain, Intractable ; drug therapy ; etiology ; Quality of Life