Recent Literature

Ghosh A, Berger A: Opioids, adjuvants, and interventional options for pain management of symptomatic metastases. Ann Palliat Med 2014;3:172–191.

Cancer pain is a complex issue that unfortunately affects a majority of cancer patients, the assessment and treatment of which are equally essential in alleviating many facets of this pain. The authors note that the objective of this article is to address the many facets of cancer pain: its assessment, management, and its varied treatment modalities. They discuss characteristics of pain; essential aspects of the patient interview; and management using opioids, adjuvants, and interventional and invasive strategies, as well as side effects of these techniques. Many of these modalities are used for palliation but may and should be used in cancer patients who experience side effects from both their cancer and their chemotherapeutics. This is an excellent review article, and highly recommended reading.

Dhiman RK, Rana B, Agrawal S, et al.: Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: A randomized, controlled trial. Gastroenterology 2014. [E-pub ahead of print.]

Little is known about whether probiotics can affect outcomes of patients with cirrhosis and hepatic encephalopathy (HE). The authors assessed the efficacy of a probiotic preparation in preventing recurrence of HE (primary outcome) and reducing number of hospitalizations and severity of liver disease in patients with cirrhosis. The double-blind trial was completed at a tertiary care hospital in India. Patients with liver cirrhosis who had recovered from an episode of HE during the previous month were randomly assigned (using computer-generated allocation) to groups given a probiotic preparation, VSL#3^®, 9x10¹¹ bacteria (CD Pharma India Pvt Ltd, New Delhi, India) (n=66) or placebo (n=64) daily for six months. Results demonstrated that there was a trend towards reduction in development of breakthrough HE among patients receiving the probiotic (34.8% in the probiotic group versus 51.6% in the placebo group; P=0.12). Fewer patients in the probiotic group were hospitalized for HE (19.7% versus 42.2%, respectively; P=0.02) or for complications of liver cirrhosis (24.2%) than in the placebo group (45.3%). End-stage liver disease scores improved significantly from baseline to six months in the probiotic group but not the placebo group. There were no adverse events related to VSL#3^®. The authors conclude that over a six-month period, daily intake of VSL#3^® significantly reduced the risk of hospitalization for HE, as well as end-stage liver disease scores, in patients with cirrhosis.

Miles TP, Allegra JC, Ezeamama A, et al.: In a longevity society, loss and grief are emerging risk factors for health care use: Findings from the Health and Retirement Survey Cohort Aged 50 to 70 Years. Am J Hosp Palliat Med 2014. [E-pub ahead of print.]

In a society of long lives, parent and child life can overlap by 60 or 70 years or more. Most children now experience the death of their parents as adults. In fact, many of the 2.5 million deaths each year in the United States are parental deaths. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, the authors estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.

Seretny M, Currie GL, Sena ES, et al.: Incidence, prevalence and predictors of chemotherapy induced peripheral neuropathy: A systematic review and meta-analysis. Pain 2014. [E-pub ahead of print.]

Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling pain condition resulting from chemotherapy for cancer. Severe acute CIPN may require chemotherapy dose reduction or cessation. There is no effective CIPN prevention strategy; treatment of established chronic CIPN is limited, and the prevalence of CIPN is not known. The authors used a systematic review to identify studies reporting the prevalence of CIPN. They searched Embase, Medline, CAB Abstracts, CINAHL, PubMed Central, Cochrane Library, and Web of Knowledge for relevant references and used random effects meta-regression to estimate overall prevalence. They assessed study quality using the CONSORT and STROBE guidelines and report findings according to PRISMA guidance. They provide a qualitative summary of factors reported to alter the risk of CIPN. Thirty-one studies with data from 4179 patients in the analysis were included. CIPN prevalence was 68.1% (57.7 to 78.4) when measured in the first month after chemotherapy, 60.0% (36.4 to 81.6) at three months, and 30.0% (6.4 to 53.5) at six months or more. Different chemotherapy drugs were associated with differences in CIPN prevalence, and there was some evidence of publication bias. Genetic risk factors were reported in four studies. Clinical risk factors, identified in 4 of 31 studies, included neuropathy at baseline, smoking, abnormal creatinine clearance, and specific sensory changes during chemotherapy. Although CIPN prevalence decreases with time, at six months 30% of patients continue to suffer from CIPN. Routine CIPN surveillance during post-chemotherapy follow-up is needed. A number of genetic and clinical risk factors were identified that require further study.

Pachman DR, Weisbrod BL, Seisler DK, et al.: Pilot evaluation of Scrambler therapy for the treatment of chemotherapy-induced peripheral neuropathy. Support Care Cancer 2014. [E-pub ahead of print.]

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy that needs better effective treatments. Preliminary data support the use of Scrambler therapy, a device which treats pain via noninvasive cutaneous electrostimulation, for the treatment of CIPN. This article reports data from a pilot trial, performed to investigate the effect of Scrambler therapy for the treatment of established CIPN. Eligible patients had CIPN symptoms of ≥1 month duration with tingling and/or pain ≥4/10 during the prior week. Patients were treated with Scrambler therapy to the affected area(s) for up to 10 daily 30-minute sessions. Symptoms were monitored using a neuropathy questionnaire consisting of numerical analog scales ranging from 0 to 10, daily before therapy as well as weekly for 10 weeks after therapy. Descriptive summary statistics formed the basis of data analysis. Thirty-seven patients were enrolled. Twenty-five patients were treated primarily on their lower extremities, while 12 were treated primarily on their upper extremities. There was a 53% reduction in pain score from baseline to day 10; a 44% reduction in tingling; and a 37% reduction in numbness. Benefit appeared to last throughout 10 weeks of follow-up. There were no substantial adverse events. Preliminary data support that Scrambler therapy may be effective for the treatment of CIPN; however, a prospective placebo-controlled clinical trial should be performed.