martes, 23 de febrero de 2016

Cancer Pain (PDQ)—Health Professional Version - National Cancer Institute

Cancer Pain (PDQ)—Health Professional Version - National Cancer Institute

National Cancer Institute

Cancer Pain–for health professionals (PDQ®)


Changes to This Summary (02/17/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Revised text to include risk of misuse of or addiction to pain medications as an issue to consider when determining the most appropriate treatment.
Added text to state that corticosteroid use has also been associated with the development of avascular necrosis (cited Mattano et al. as reference 27).
Revised text to state that a full assessment also reviews previously attempted pain therapies and reasons for discontinuation; other associated symptoms such as sleep difficulties, fatigue, depression, and anxiety; functional impairment; and any relevant laboratory data and diagnostic imaging.
Revised Table 3 to include acetaminophen as an agent delivered via intramuscular injection.
Revised Table 5 to include hypoglycemia as a miscellaneous adverse effect of opioid use.
Added text to state that other barriers to opioid prescribing include poor or limited formulary and reimbursement for opioids.
Revised text to include history of childhood sexual abuse as a risk factor for opioid abuse.
Revised text to state that random urine drug testing is used for patients with an inadequate response to opioid therapy and those receiving opioids long term.
Revised text to state that gabapentin and pregabalin are structurally related to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) but have no effect on GABA binding. Also added text to state that instead, gabapentin and pregabalin bind to the alpha2delta-1 subunit of voltage-gated calcium channels, which may result in decreased neuronal excitability in pain-associated sensory neurons.
Added text to state that if the decision is made to discontinue venlafaxine, a slow tapering course may help to minimize withdrawal symptoms.
Revised text to state that gabapentin can be used as monotherapy in the first-line setting for neuropathic pain.
Revised text to state that certain neuropathic syndromes may be less responsive to gabapentin and pregabalin.
Revised text to include depression and anxiety as psychosocial factors associated with postmastectomy pain (cited Schreiber et al. as reference 19).
Revised text to state that despite inconclusive trials, the authors suggest that a trial of tricyclic antidepressants, gabapentin, and topical baclofen/amitriptyline/ketamine may be reasonable in light of evidence supporting the benefit of these agents in other types of neuropathy and the relative lack of effective alternatives in this setting (cited Barton et al. as reference 39).
This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
  • Updated: February 17, 2016

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