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441 PAIN MANAGEMENT BASED ON THE ETIOLOGY AND MECHANISM OF PAIN IN HEAD AND NECK CANCER
Posters / European Journal of Pain Supplements 4 (2010) 47–146
NP. During each study visit, patients rated their pain on a 0–10 point NRS and on the 0–100 point NPQ items. They also described their pain in their own words. NRS and NPQ symptom scores were summarized for the best overall response. A Wilcoxon Rank Sum test was used to assess treatment differences. Results: Twelve (12) of 19 patients received KRN5500. Baseline characteristics were consistent between the KRN5500 and Placebo treatment groups. Patients described their pain as: tingling (37%), numb (32%), burning (16%), shooting (16%), electric (11%) and freezing (5%). The correlations between baseline NRS and symptoms were significant for burning (r = 0.56) and freezing (r = 0.58). The correlation between post-treatment NRS and NPQ symptoms were significant for electric (r = 0.50), “sensitive to touch” (r = 0.58), shooting (r = 0.56) and tingling (r = 0.55). However, no treatment differences in symptoms were observed. KRN5500 treated patients showed a median decrease of 29.3% in NRS in while placebo treated patients showed no decrease (p = 0.02). Conclusions: Patient descriptions of pain were consistent with symptoms in the NPQ. While the NPQ scores appeared to be positively correlated with NRS, the symptom scoring methods were not sensitive enough to detect the efficacy of KRN5500 in this study. 440 PANCOAST TUMOR PRESENTING WITH ARM PAIN F. Koc1 , H. Bozdemir1 , S. Paydas2 . 1 Neurology, 2 Oncology, Cukurova University, Adana, Turkey Introduction: Although trauma is the main cause of the plexopathies, it may be seen by the tumoral invasion as well. Pulmonar apex tumors named Pancoast may lead to pain of the arm due to brachial plexus lower truncus invasion. Objectives: We presented 2 male patients with Pancoast tumor which first presentation was pain of the arm. Results: 45 years old male patient with the 3 months of complaint of severe right shoulder pain which is ranging to the upper arm and irresponsive to analgesics admitted to the clinic. Horner Syndrome at the right eye has been determined in neurological examination. The radiologic investigations showed tumor at the pulmonary apex at the right. Servical MRI has demonstrated a mass lesion located centerally at the right anterior mediastenum extending to lower servical levels and thereby invading plexus. 55 years old male patient with severe pain at the left arm which is irresponsive to analgesics admitted to the clinic. He reported right arm pain beginning approximatley 1 year ago and along the way syptoms of fatigue, weight loss and cough added, eventually he had a diagnosis of small cell pulmonary cancer. There were no further investigation regarding pain of the arm although it was the first symptom. Horner Syndrome at the right eye, right monoparesis at the level of 3-/5 has been observed in neurological examination. Servical MRI demonstrated brachial plexus invasion. Conclusions: Patients presenting with the pain of arm should be taken cautiously because of the pulmonary cancer and similar pathology possibility.
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medication such as antidepressants, anticonvulsants and local anesthetics were administered based on pain category (nociceptive, neuropathic or both) as well as particular characteristics. Results: Pain was mostly due to the cancer itself throughout the entire follow up. Approximately 80% of patients with head and neck cancer experience exclusively nociceptive pain and 24% experience both nociceptive and neuropathic pain. The presence of neuropathic pain was directly associated with the nerve destruction following radical neck dissection (P-value<0.001). Analgesic medication based on the WHO’s 3 step ladder. Pain intensity was greatly reduced within a week of treatment. The difference between the pain score at the beginning and the median score throughout the study, was statistically significant lower (P-value<0.001). Other symptoms like insomnia, anorexia, constipation were also statistically significantly (P-value<0.001) improved. Symptoms such as sweats, shortness of breath and nausea were transient and easily treated. Conclusions: Head and neck cancer patients experience pain in the final stages of their disease. The administration of analgesic and adjuvant medication according etiology, based on WHO’s three step analgesic ladder results in the resolution of pain. 442 THE ROLE OF KETAMINE IN THE MANAGEMENT OF NEUROPATHIC CANCER PAIN – A POLISH EXPERIENCE W. Leppert. Chair and Department of Palliative Medicine, Poznan University of Medicial Sciences, Poznan, Poland Objective: To assess analgesic efficacy and adverse effects of ketamine in the treatment of neuropathic cancer pain. Patients and methods: A retrospective evaluation of 30 patients with severe cancer neuropathic pain, which did not respond to opioid therapy. All patients were treated at the in-patient palliative medicine unit at the Chair and Department of Palliative Medicine of Poznan University. Ketamine was administered in continuous infusion subcutaneously (11 patients) or intravenously (19 patients). All patients treated with ketamine received also morphine and midazolam. Analgesia was assessed by 11-point NRS (Numerical Rating Scale: 0-no pain, 10-unbearable pain), adverse effects by verbal scale (0-none, 1-weak, 2-moderate, 3-severe). Results: The treatment time was 3–68 (median 31) days, daily doses of ketamine were 20–250 mg (median 84 mg). Good analgesia (NRS < 4) was achieved in 20 (67%), partial effect (NRS 4–5) in 9 (30%), ineffective treatment (NRS > 5) in 1 (3%) patient. No respiratory depression was observed. The tolerance of the therapy was acceptable with most frequent adverse effect reported sedation (12 patients: in 5 mild, in 6 moderate, in 1 severe, which decrease after dose reduction). Five patients experienced mild dizziness and two patients bad dreams. Conclusions: The addition of ketamine to opioid therapy increased significantly analgesic effect comparing to opioids administered alone. A close monitoring, start with low ketamine dose and the addition of midazolam may decrease adverse effects incidence and intensity.
441 PAIN MANAGEMENT BASED ON THE ETIOLOGY AND MECHANISM OF PAIN IN HEAD AND NECK CANCER E. Lampropoulou, A. Makris, V. Dimopoulou, K. Apostolopoulos. Hospital of Kalamata, Kalamata, Greece
443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS A. Vadalouca1 , E. Raptis2 , A. Moutzouri1 , E. Stavropoulou1 , I. Siafaka1 , E. Argyra1 . 1 A’ Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of Athens, 2 Pfizer Hellas, Athens, Greece
Objectives: To examine the causes and mechanisms of pain in Greek patients with he ad and neck cancer and the effectiveness of the World Health Organization (WHO) guidelines for pain management. Methods: Data were collected from 103 patients (73 male, 30 female). Particular pain syndromes were categorized based on pain etiology and mechanism. Treatment was based on the World Health Organization (WHO) “three step analgesic ladder”. Adjuvant
Introduction: Escalation of opioid dose remains a common practice for the management of inadequately controlled cancer pain. Unfortunately, in the case of neuropathic cancer pain, this practice often shows poor analgesic results and/or increased incidence of opioid-related side effects. The role of specific adjuvants has not been adequately investigated. Objectives: To examine whether the addition of pregabalin in neuropathic cancer pain resistant to a combination of opioids, NSAIDs,
NP. During each study visit, patients rated their pain on a 0–10 point NRS and on the 0–100 point NPQ items. They also described their pain in their own words. NRS and NPQ symptom scores were summarized for the best overall response. A Wilcoxon Rank Sum test was used to assess treatment differences. Results: Twelve (12) of 19 patients received KRN5500. Baseline characteristics were consistent between the KRN5500 and Placebo treatment groups. Patients described their pain as: tingling (37%), numb (32%), burning (16%), shooting (16%), electric (11%) and freezing (5%). The correlations between baseline NRS and symptoms were significant for burning (r = 0.56) and freezing (r = 0.58). The correlation between post-treatment NRS and NPQ symptoms were significant for electric (r = 0.50), “sensitive to touch” (r = 0.58), shooting (r = 0.56) and tingling (r = 0.55). However, no treatment differences in symptoms were observed. KRN5500 treated patients showed a median decrease of 29.3% in NRS in while placebo treated patients showed no decrease (p = 0.02). Conclusions: Patient descriptions of pain were consistent with symptoms in the NPQ. While the NPQ scores appeared to be positively correlated with NRS, the symptom scoring methods were not sensitive enough to detect the efficacy of KRN5500 in this study. 440 PANCOAST TUMOR PRESENTING WITH ARM PAIN F. Koc1 , H. Bozdemir1 , S. Paydas2 . 1 Neurology, 2 Oncology, Cukurova University, Adana, Turkey Introduction: Although trauma is the main cause of the plexopathies, it may be seen by the tumoral invasion as well. Pulmonar apex tumors named Pancoast may lead to pain of the arm due to brachial plexus lower truncus invasion. Objectives: We presented 2 male patients with Pancoast tumor which first presentation was pain of the arm. Results: 45 years old male patient with the 3 months of complaint of severe right shoulder pain which is ranging to the upper arm and irresponsive to analgesics admitted to the clinic. Horner Syndrome at the right eye has been determined in neurological examination. The radiologic investigations showed tumor at the pulmonary apex at the right. Servical MRI has demonstrated a mass lesion located centerally at the right anterior mediastenum extending to lower servical levels and thereby invading plexus. 55 years old male patient with severe pain at the left arm which is irresponsive to analgesics admitted to the clinic. He reported right arm pain beginning approximatley 1 year ago and along the way syptoms of fatigue, weight loss and cough added, eventually he had a diagnosis of small cell pulmonary cancer. There were no further investigation regarding pain of the arm although it was the first symptom. Horner Syndrome at the right eye, right monoparesis at the level of 3-/5 has been observed in neurological examination. Servical MRI demonstrated brachial plexus invasion. Conclusions: Patients presenting with the pain of arm should be taken cautiously because of the pulmonary cancer and similar pathology possibility.
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medication such as antidepressants, anticonvulsants and local anesthetics were administered based on pain category (nociceptive, neuropathic or both) as well as particular characteristics. Results: Pain was mostly due to the cancer itself throughout the entire follow up. Approximately 80% of patients with head and neck cancer experience exclusively nociceptive pain and 24% experience both nociceptive and neuropathic pain. The presence of neuropathic pain was directly associated with the nerve destruction following radical neck dissection (P-value<0.001). Analgesic medication based on the WHO’s 3 step ladder. Pain intensity was greatly reduced within a week of treatment. The difference between the pain score at the beginning and the median score throughout the study, was statistically significant lower (P-value<0.001). Other symptoms like insomnia, anorexia, constipation were also statistically significantly (P-value<0.001) improved. Symptoms such as sweats, shortness of breath and nausea were transient and easily treated. Conclusions: Head and neck cancer patients experience pain in the final stages of their disease. The administration of analgesic and adjuvant medication according etiology, based on WHO’s three step analgesic ladder results in the resolution of pain. 442 THE ROLE OF KETAMINE IN THE MANAGEMENT OF NEUROPATHIC CANCER PAIN – A POLISH EXPERIENCE W. Leppert. Chair and Department of Palliative Medicine, Poznan University of Medicial Sciences, Poznan, Poland Objective: To assess analgesic efficacy and adverse effects of ketamine in the treatment of neuropathic cancer pain. Patients and methods: A retrospective evaluation of 30 patients with severe cancer neuropathic pain, which did not respond to opioid therapy. All patients were treated at the in-patient palliative medicine unit at the Chair and Department of Palliative Medicine of Poznan University. Ketamine was administered in continuous infusion subcutaneously (11 patients) or intravenously (19 patients). All patients treated with ketamine received also morphine and midazolam. Analgesia was assessed by 11-point NRS (Numerical Rating Scale: 0-no pain, 10-unbearable pain), adverse effects by verbal scale (0-none, 1-weak, 2-moderate, 3-severe). Results: The treatment time was 3–68 (median 31) days, daily doses of ketamine were 20–250 mg (median 84 mg). Good analgesia (NRS < 4) was achieved in 20 (67%), partial effect (NRS 4–5) in 9 (30%), ineffective treatment (NRS > 5) in 1 (3%) patient. No respiratory depression was observed. The tolerance of the therapy was acceptable with most frequent adverse effect reported sedation (12 patients: in 5 mild, in 6 moderate, in 1 severe, which decrease after dose reduction). Five patients experienced mild dizziness and two patients bad dreams. Conclusions: The addition of ketamine to opioid therapy increased significantly analgesic effect comparing to opioids administered alone. A close monitoring, start with low ketamine dose and the addition of midazolam may decrease adverse effects incidence and intensity.
441 PAIN MANAGEMENT BASED ON THE ETIOLOGY AND MECHANISM OF PAIN IN HEAD AND NECK CANCER E. Lampropoulou, A. Makris, V. Dimopoulou, K. Apostolopoulos. Hospital of Kalamata, Kalamata, Greece
443 PREGABALIN FOR THE MANAGEMENT OF NEUROPATHIC CANCER PAIN: PRELIMINARY RESULTS A. Vadalouca1 , E. Raptis2 , A. Moutzouri1 , E. Stavropoulou1 , I. Siafaka1 , E. Argyra1 . 1 A’ Anaesthesiology Department, Pain Relief & Palliative Care Center, Aretaieion Hospital, Medical School, University of Athens, 2 Pfizer Hellas, Athens, Greece
Objectives: To examine the causes and mechanisms of pain in Greek patients with he ad and neck cancer and the effectiveness of the World Health Organization (WHO) guidelines for pain management. Methods: Data were collected from 103 patients (73 male, 30 female). Particular pain syndromes were categorized based on pain etiology and mechanism. Treatment was based on the World Health Organization (WHO) “three step analgesic ladder”. Adjuvant
Introduction: Escalation of opioid dose remains a common practice for the management of inadequately controlled cancer pain. Unfortunately, in the case of neuropathic cancer pain, this practice often shows poor analgesic results and/or increased incidence of opioid-related side effects. The role of specific adjuvants has not been adequately investigated. Objectives: To examine whether the addition of pregabalin in neuropathic cancer pain resistant to a combination of opioids, NSAIDs,