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radiological
50 (765) Impact of caregiver status and risk for depression on cancer pain management outcomes: pain severity, pain relief, pain interference, quality of life, and satisfaction C. Chau, S. Hwang, D. Hoover, Y. Alejandro, P. Osenenko, S. Srinivas, V. Chang; VA New Jersey Health Care System, East Orange, NJ The purpose of this study was to examine the associations between caregiver status (CS) and risk for depression (RD) on pain management outcomes. 189 cancer patients with worst pain ⬎ 4/10 completed the Brief Pain Inventory (BPI), Geriatric Depression Scale (GDS) and Functional Assessment of Cancer Therapy (FACT-G) at baseline, and 1 week after pain management. Karnofsky Performance Status (KPS) and CS were recorded. Four caregiver-depression groups (CDGs) were defined based on CS [yes(C⫹)/no (C-)] and RD (GDS ⬎ 5)[yes(D⫹)/no(D-)]: C⫹D(n⫽69);C⫹D⫹(n⫽63);C-D-(n⫽20);C-D⫹(n⫽37). We performed (1) One way ANOVA to compare each outcome by CDGs at each time point, (2) Wilcoxon matched-pairs signed-ranks test to assess the differences in each outcome between two time points, and (3)ANOVA to assess the significance of interaction between CS and RD to pain outcomes. The results showed: (1) On day 1, patients in C-D⫹ had the highest pain interference (p⬍0.00001) and lowest FACT-G QOL measures(p⬍0.00001) of all four CDGs. (2) At week 1, there were significant differences in all the BPI measures (p⫽0.05 to⬍0.00001), FACT-G measures (all p⬍0.0001) and satisfaction (p⫽0.0003) between the four CDGs. Except for patients in C-D⫹, there were significant improvements between day 1 and week 1 in all the BPI measures (p from 0.02 to ⬍0.00001), FACT-G physical wellbeing (p from 0.05 to 0.0007) and satisfaction (p from 0.03 to ⬍0.00001) in the other three CDGs. Patients in the C⫹D⫹ group in particular showed improvement in FACT-G emotional wellbeing(p⫽0.02), SUMQOL(p⫽0.05) and KPS(p⫽0.003). The interaction between CS and RD was significant for day 1 to week 1 changes in the worst pain (p⫽0.05) and pain interference(p⬍0.004) . Cancer pain management outcomes can be affected by CS, RD, and interaction between CS and RD. These findings highlight the importance of depression and caregiver screening and may help identify subgroups of patients at risk for poor outcomes. VAHSRD:PCC-98068.
Abstracts
D06 - Cancer Pain: Surgical/Radiological (767) Hypotestosteronemia and testosterone replacement in females with severe, persistent pain F. Tennant; Veract Palliative Care Medical Clinic, West Covina, CA Testosterone has multiple anabolic and sexual functions that are critical for impaired, pain patients. While hypotestosteronemia and benefits of testosterone replacement are recognized in male pain patients, it is unknown if the same applies to females. Thirty-five (35) adult females with severe persistent pain controlled with opioids at a morphine equivalency of 400-1000mg/d were screened for hypotestosteronemia defined as a serum concentration below 15ng/dl. If present they were given a clinical trial with 5 grams of topical 1 % testosterone gel applied daily for 30 days. Pain control, fatigue, endurance, feeling of well-being, and libido were assessed before and after the trial. Fourteen (14) of 35 (40%) females demonstrated low serum testosterone concentration below 15ng/dl. Of the 14 patients given testosterone gel, 10 (71.0%) reported increase in libido, pain control, endurance, and energy. Additionally 7 (50.0%) reported a decrease in daily opioid requirement. No side-effects were observed. Some females with severe persistent pain who are treated with opioids develop hypotestosteronemia, and they appear to benefit from testosterone replacement.
(766) Levetiracetam administered by the rectal route is effective in treating neuropathic pain
(768) Longitudinal study of pain and other symptoms after thoracic surgery for cancer
E. Dunteman; A&A Pain Institute of St. Louis, St. Louis, MO Levetiracetam is an antiepileptic drug reported to be effective for treating various pain syndromes. This study describes an experience with patients who received levetiracetam via the rectal route of administration when oral administration was prohibitive. Three patients (2 females; 1 male) from an oncology/ palliative care service or the intensive care unit were evaluated. All patients had severe pain with a neuropathic component greater than 7 on a 10-point VAS scale, despite use of intravenous (IV) opioids and other analgesics. One patient had benefited from oral levetiracetam prior to complications that prohibited the use of oral medications; the remaining patients had no prior exposure to levetiracetam. Patients received levetiracetam covered with generous portions of water-soluble lubricant and introduced rectally at a dosage of 1000 mg every 12 hours as an adjunctive analgesic. Opioid use, VAS pain scores, and 11-point Likert pain scales were periodically recorded by the nursing staff. All patients demonstrated improved pain control within hours of rectal administration of levetiracetam. VAS scores decreased at least 60% with levetiracetam treatment. Two patients were able to completely discontinue relatively high doses of opioids; the third patient demonstrated greater than 50% reduction in use of opioids. Blood samples obtained from one patient and evaluated by mass-spectrography demonstrated the levetiracetam was adequately absorbed after rectal administration. This report suggests that levetiracetam might be a candidate for the treatment of pain, including pain of neuropathic origin. Rectal delivery of levetiracetam may be considered when oral administration is not possible as there is currently no IV formulation of levetiracetam. The favorable safety, tolerability, and pharmacokinetic profiles make levetiracetam an appealing candidate for further evaluations. Additional studies of the use of levetiracetam as an analgesic are warranted.
X. Wang, J. Putnam, B. Johnson, C. Warneke, C. Cleeland; UT MD Anderrson Cancer Center, Houston, TX The purpose of this study was to longitudinally describe pain and other symptoms related to thoracic surgery, and to identify the factors having significant impact on pain severity at 1 month postsurgery. Patients who were eligible of thoracic surgery for primary or metastatic lung and esophageal cancer were recruited. Seventy-one patients completed the Brief Pain Inventory (BPI) at presurgery and at 24, 48, and 72 hours postsurgery. Thirty-four of these also completed the M. D. Anderson Symptom Inventory (MDASI)-Thoracic Model at presurgery and at 72 hours, weeks 1, 2, and 3 and months 1, 2, and 3 postsurgery. Pain was second only to fatigue in severity during the first month postsurgery. Based on prior pain research, we set a cutoff point of 5 or greater to identify moderate-to-severe symptom severity and interference with function. More than 15% of patients suffered from moderate-to-severe levels of pain, fatigue, lack of appetite, drowsiness, sleep difficulty, and distress at one month postsurgery; after 3 months, 8% of patients still reported moderate-to-severe levels of pain, fatigue, sleep problems, lack of appetite, and coughing. Loess curves for pain and other symptoms (with the exception of fatigue) appear to peak within the first week postsurgery and decrease within the first month, returning to levels slightly above baseline by 90 days. Demographic variables, preoperative health status variables, procedure-related variables, and preliminary results of linear regression models revealed the following significant predictors (F⫽4.88, P⫽0.0051) of pain on the BPI “pain worst” item at 30 days postsurgery: gender (being female, F⫽4.72, P⫽0.0351), having had a pneumonectomy (F⫽9.03, P⫽.0043), and having spent day(s) in the ICU (no admission to the ICU, F⫽6.64, P⫽.0133). Pain is a consistent and significant burden for some cancer patients undergoing thoracic surgery, while fatigue is even more distressing among multiple postoperative symptoms.
Abstracts
D06 - Cancer Pain: Surgical/Radiological (767) Hypotestosteronemia and testosterone replacement in females with severe, persistent pain F. Tennant; Veract Palliative Care Medical Clinic, West Covina, CA Testosterone has multiple anabolic and sexual functions that are critical for impaired, pain patients. While hypotestosteronemia and benefits of testosterone replacement are recognized in male pain patients, it is unknown if the same applies to females. Thirty-five (35) adult females with severe persistent pain controlled with opioids at a morphine equivalency of 400-1000mg/d were screened for hypotestosteronemia defined as a serum concentration below 15ng/dl. If present they were given a clinical trial with 5 grams of topical 1 % testosterone gel applied daily for 30 days. Pain control, fatigue, endurance, feeling of well-being, and libido were assessed before and after the trial. Fourteen (14) of 35 (40%) females demonstrated low serum testosterone concentration below 15ng/dl. Of the 14 patients given testosterone gel, 10 (71.0%) reported increase in libido, pain control, endurance, and energy. Additionally 7 (50.0%) reported a decrease in daily opioid requirement. No side-effects were observed. Some females with severe persistent pain who are treated with opioids develop hypotestosteronemia, and they appear to benefit from testosterone replacement.
(766) Levetiracetam administered by the rectal route is effective in treating neuropathic pain
(768) Longitudinal study of pain and other symptoms after thoracic surgery for cancer
E. Dunteman; A&A Pain Institute of St. Louis, St. Louis, MO Levetiracetam is an antiepileptic drug reported to be effective for treating various pain syndromes. This study describes an experience with patients who received levetiracetam via the rectal route of administration when oral administration was prohibitive. Three patients (2 females; 1 male) from an oncology/ palliative care service or the intensive care unit were evaluated. All patients had severe pain with a neuropathic component greater than 7 on a 10-point VAS scale, despite use of intravenous (IV) opioids and other analgesics. One patient had benefited from oral levetiracetam prior to complications that prohibited the use of oral medications; the remaining patients had no prior exposure to levetiracetam. Patients received levetiracetam covered with generous portions of water-soluble lubricant and introduced rectally at a dosage of 1000 mg every 12 hours as an adjunctive analgesic. Opioid use, VAS pain scores, and 11-point Likert pain scales were periodically recorded by the nursing staff. All patients demonstrated improved pain control within hours of rectal administration of levetiracetam. VAS scores decreased at least 60% with levetiracetam treatment. Two patients were able to completely discontinue relatively high doses of opioids; the third patient demonstrated greater than 50% reduction in use of opioids. Blood samples obtained from one patient and evaluated by mass-spectrography demonstrated the levetiracetam was adequately absorbed after rectal administration. This report suggests that levetiracetam might be a candidate for the treatment of pain, including pain of neuropathic origin. Rectal delivery of levetiracetam may be considered when oral administration is not possible as there is currently no IV formulation of levetiracetam. The favorable safety, tolerability, and pharmacokinetic profiles make levetiracetam an appealing candidate for further evaluations. Additional studies of the use of levetiracetam as an analgesic are warranted.
X. Wang, J. Putnam, B. Johnson, C. Warneke, C. Cleeland; UT MD Anderrson Cancer Center, Houston, TX The purpose of this study was to longitudinally describe pain and other symptoms related to thoracic surgery, and to identify the factors having significant impact on pain severity at 1 month postsurgery. Patients who were eligible of thoracic surgery for primary or metastatic lung and esophageal cancer were recruited. Seventy-one patients completed the Brief Pain Inventory (BPI) at presurgery and at 24, 48, and 72 hours postsurgery. Thirty-four of these also completed the M. D. Anderson Symptom Inventory (MDASI)-Thoracic Model at presurgery and at 72 hours, weeks 1, 2, and 3 and months 1, 2, and 3 postsurgery. Pain was second only to fatigue in severity during the first month postsurgery. Based on prior pain research, we set a cutoff point of 5 or greater to identify moderate-to-severe symptom severity and interference with function. More than 15% of patients suffered from moderate-to-severe levels of pain, fatigue, lack of appetite, drowsiness, sleep difficulty, and distress at one month postsurgery; after 3 months, 8% of patients still reported moderate-to-severe levels of pain, fatigue, sleep problems, lack of appetite, and coughing. Loess curves for pain and other symptoms (with the exception of fatigue) appear to peak within the first week postsurgery and decrease within the first month, returning to levels slightly above baseline by 90 days. Demographic variables, preoperative health status variables, procedure-related variables, and preliminary results of linear regression models revealed the following significant predictors (F⫽4.88, P⫽0.0051) of pain on the BPI “pain worst” item at 30 days postsurgery: gender (being female, F⫽4.72, P⫽0.0351), having had a pneumonectomy (F⫽9.03, P⫽.0043), and having spent day(s) in the ICU (no admission to the ICU, F⫽6.64, P⫽.0133). Pain is a consistent and significant burden for some cancer patients undergoing thoracic surgery, while fatigue is even more distressing among multiple postoperative symptoms.