Current opinion in supportive and palliative care
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The purpose of this review is to provide the reader with an up-to-date overview on the biopsychosocial model in cancer pain. ⋯ The biopsychosocial model is a helpful way to comprehensively approach the conceptualization and treatment of pain in cancer patients at all stages of the disease process. We currently have an established base of research on the importance of biopsychosocial model in cancer pain. Our ability to treat patients with cancer pain effectively will improve as we gain a better understanding of which treatments work for which patients.
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Adequate cancer pain assessment using valid and reliable tools is essential for proper cancer pain management. Because cancer pain can be a complex construct, assessment of its many domains should be conducted using multidimensional tools. Furthermore, there is a need to develop a standard, consensus classification system for prognosis of cancer pain. ⋯ Many pain and symptom assessment tools exist for use in the cancer patient, including the Brief Pain Inventory, the McGill Pain Questionnaire, the MD Anderson Symptom Inventory, and the Edmonton Symptom Assessment System, among others. Recent literature reveals the move toward translating these and other tools to electronic applications. Further study is also underway to create a standard, prognostic classification system for cancer pain.
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Curr Opin Support Palliat Care · Jun 2014
ReviewPhenotyping neuropathic pain patients: implications for individual therapy and clinical trials.
The sensory phenotype can be used as a surrogate marker of underlying mechanisms of pain generation and is assessed by tools like the Quantitative Sensory Testing, Patient Reported Outcomes or the Capsaicin Response Test. In order to establish an individualized, mechanism-based treatment of pain, it has to be demonstrated that subgroups of patients with a distinct sensory phenotype respond differently to a certain treatment. ⋯ The discussed trials show the importance of the development of an individualized pain therapy. Up to now, no clinical trial has prospectively used the sensory phenotype as an inclusion or stratification criterion. Academic researchers and pharmaceutical industry should be encouraged to implement this approach in future trial designs.
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Curr Opin Support Palliat Care · Jun 2014
ReviewDescending pain modulation and chronification of pain.
Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain 'chronification'. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. ⋯ Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain 'chronification'. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain.
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To review how common cancers such as breast, lung, and prostate cancers drive significant and frequently life-altering pain when the cells metastasize to bones. ⋯ There is both a nociceptive and neuropathic component of bone cancer pain. In bone cancer pain, there is frequently a continual afferent drive of sensory nerve fibers that induces a peripheral and central sensitization. These mechanistic insights have begun to lead to advances in not only how we understand bone cancer pain but to the development of new therapies to treat bone cancer pain.