Sympathetic Blockade for Pain Associated With Nonaxial Bone Lesions in Patients With Cancer: An Uncontrolled Cohort.

IF 14.8 2区 医学 Q1 ONCOLOGY Journal of the National Comprehensive Cancer Network Pub Date : 2024-10-01 DOI:10.6004/jnccn.2024.7028
Carlos J Roldan, Alice L Ye, Edward Podgorski, Jonathan Song, Matthew Chung, Billy Huh
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Abstract

Background: Cancer-related bone pain remains a prevalent and frequently incapacitating ailment. Although conventional approaches effectively alleviate pain in most individuals, a subset of patients may continue to experience intractable pain. Current recommendations for treating cancer-related bone pain include oral analgesics and multimodal adjuvants, radiation therapy, and, in selected cases, intrathecal therapy. Cancer-related bone pain is mediated by a proliferation of sensory and sympathetic fibers. Thus, we believe that this pain can be successfully managed with minimally invasive sympathetic blockade (SB).

Methods: In a retrospective observational cohort, we reviewed patients who underwent single-shot SB for uncontrolled cancer-related bone pain despite receiving opiate analgesics and other interventions. We documented the Edmonton Symptom Assessment Scale (ESAS) ratings, the numeric rating scale (NRS) pain scores, and the morphine equivalent daily dose (MEDD) before and after SB.

Results: The final cohort included 43 patients (median age, 58 years [range, 23-86 years]) with a history of bone pain experienced for a median of 6 months (IQR, 3-12 months). Comparing before and after the SB, patients had pain reduction -6 (IQR, -7 to -4; P<.001), reduction of ESAS scores of -17 (IQR, -23 to -3; P<.001), and reduction of MEDD -57 mg (95% CI, -79 to -34; P<.001). The treatment was well tolerated.

Conclusions: Blockade of sympathetic afferent innervation is an effective and cost-effective modality that can be safely used to palliate intractable pain in patients with malignant bone pain.

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交感神经阻滞治疗癌症患者非轴性骨病变引起的疼痛:无对照队列
背景:与癌症相关的骨痛仍然是一种普遍存在且经常使人丧失工作能力的疾病。尽管传统方法能有效缓解大多数患者的疼痛,但仍有一部分患者可能会继续经历难以忍受的疼痛。目前治疗癌症相关骨痛的建议包括口服镇痛药和多模式辅助药物、放射治疗,以及在特定情况下的鞘内治疗。与癌症相关的骨痛是由感觉和交感神经纤维的增殖介导的。因此,我们认为这种疼痛可以通过微创交感神经阻断术(SB)得到成功控制:在一项回顾性观察队列中,我们回顾了因癌症相关骨痛无法控制而接受单次交感神经阻断术的患者,尽管他们接受了阿片类镇痛药和其他干预措施。我们记录了SB前后的埃德蒙顿症状评估量表(ESAS)评分、疼痛数字评分量表(NRS)评分和吗啡每日当量剂量(MEDD):最终的研究对象包括 43 名患者(中位年龄 58 岁[23-86 岁]),他们的骨痛病史中位数为 6 个月(IQR,3-12 个月)。对比接受 SB 治疗前后,患者的疼痛减轻了-6(IQR,-7 至-4;PC 结论:阻断交感神经传入神经支配是一种有效且具有成本效益的方法,可安全地用于缓解恶性骨痛患者的难治性疼痛。
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来源期刊
CiteScore
20.20
自引率
0.00%
发文量
388
审稿时长
4-8 weeks
期刊介绍: JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care. Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.
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