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Cancer pain is one of the common complications in patients with intermediate or advanced cancer, which brings severe sufferings to patients and their families, and also seriously interferes with the anti-tumor process. Acupuncture is an effective method for the treatment of cancer pain, which has the advantages of simple operation, quick effect and fewer side effects, and is widely used in clinic. In this paper, we reviewed the relevant literature on the mechanisms of acupuncture in the treatment of cancer pain both at home and abroad in recent years, and summarized the analgesic mechanisms of acupuncture for cancer pain from the peripheral level and the central level. It is found that acupuncture can relieve cancer pain by regulating immune inflammatory response, expression of ion channels and pain-related receptors, remising central sensitization, activating endogenous pain modulating system and suppressing pain transmission pathways. In addition, we also think that the use of high-throughput multi-omics techniques and neuroimaging methods to detect and analyze the brain areas or body fluids before and after acupuncture should be the focus of acupuncture analgesia research in the future.

The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based screening tool to determine an individual's risk of opioid-induced respiratory depression (OIRD) or overdose. Chronic opioid use and changes in a patient's clinical status and/or medication regimen may impact OIRD or overdose risk. This study evaluated longitudinal CIP-RIOSORD scores over three consecutive visits. Data for eighty patients with cancer encompassed two-hundred and forty visits. Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores (mean ± SD) were 16.6 ± 15.4, 20.3 ± 15.7, and 19.1 ± 15.1 at visits 1, 2, and 3, respectively. Visit 1 CIP-RIOSORD scores were similar compared to visit 2 and visit 3 ( p  = 0.14-0.31). CIP-RIOSORD intraindividual variability was low to moderate; the median (range) coefficient of variation was 22.3% (0-173%). Beyond a baseline OIRD/overdose risk assessment, reevaluation of such risk using the CIP-RIOSORD does not to be performed at each palliative care visit.

Aim: To synthesise the effectiveness of massage therapy for cancer pain, quality of life and anxiety among patients with cancer., Design: Systematic review and meta-analysis., Methods: This review was reported according to the PRISMA guidelines. Studies evaluating the effects of massage therapy on cancer pain, quality of life or anxiety in patients with cancer pain were eligible. The Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality of studies. Outcomes were pooled using standardised mean differences and narratively synthesised when meta-analysis was not possible., Data Sources: Pubmed, EMBASE, Web of Science, CINAHL, CENTRAL, Google Scholar, ProQuest Theses and Dissertations were searched for English peer-reviewed studies and grey literature published from inception to 8 January 2024., Results: Thirty-six RCTs involving 3671 participants were included. Massage therapy significantly improved pain (pooled SMD = -0.51, 95% CI -0.68 to -0.33), quality of life (pooled SMD = 0.48, 95% CI 0.19-0.78 when higher scores indicate better quality of life; pooled SMD = -0.52, 95% CI -0.88 to -0.16 when higher scores indicate poorer quality of life) and anxiety (pooled SMD = -0.38, 95% CI: -0.57 to -0.18) post-intervention. All outcomes had very low certainty of evidence. Most studies had unclear or high risk of bias., Conclusion: This review found that massage therapy is beneficial to patients with cancer in improving pain, quality of life and anxiety. Healthcare institutions and healthcare professionals should recognise the value of massage therapy to enhance the care of patients with cancer pain., Reporting Method: PRISMA guidelines., Patient or Public Contribution: No Patient or Public Contribution., Registration: PROSPERO CRD42023407311., (© 2024 John Wiley & Sons Ltd.)

Cancer is a major public health issue, with an estimated 20 million new cases and 9.7 million cancer-related deaths worldwide in 2022. Approximately 44.5% of patients experience cancer pain, significantly impacting their quality of life and causing physical and psychological burdens. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, shows potential in managing cancer pain. This review summarizes current research on rTMS for cancer pain, focusing on pain directly caused by tumors, pain from cancer treatments, postoperative pain, and cancer-related symptoms. Additionally, rTMS shows promise in improving cancer-related fatigue, anxiety, depression, and cognitive dysfunction, which can indirectly reduce cancer pain. The analgesic mechanisms of rTMS include inhibiting nociceptive signal transmission in the spinal cord, modulating hemodynamic changes in brain regions, and promoting endogenous opioid release. High-frequency stimulation of the primary motor cortex (M1) has shown significant analgesic effects, improving patients' emotional and cognitive functions and overall quality of life. rTMS has a favorable safety profile, with most studies reporting no severe adverse events. In conclusion, rTMS holds substantial potential for cancer pain management, offering a non-invasive and multifaceted therapeutic approach. Continued research and clinical application are expected to establish rTMS as an essential component of comprehensive cancer pain treatment strategies, significantly enhancing the overall well-being of patients with cancer., Competing Interests: Declarations Conflict of Interest The authors (Yanyuan Du, Yaoyuan Li, Jieqing Hu, Ruiying Fang, Yuming Liu, Liu Cai, Ying Song, Susu Ma, Jin Gao, Hanyue Zhang, Baihui Li, Hongtai Xiong, Huibo Yu, Shenglei Yang, Shuduo Zhu, Honggang Zheng) declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical Approval This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors., (© 2024. The Author(s).)

Background: Despite advances in pain management, cancer-related pain remains a critical issue for many patients. In recent years, there has been a growing interest in the use of fascial plane blocks, such as the Erector Spinae Plane Block (ESPB), for managing chronic pain, including in the oncology field. We conducted a systematic review to synthetize existing evidence on the use of ESPB for cancer pain management., Methods: We selected studies published between January 2016 to April 2024. A systematic search in Pubmed and Embase databases was performed. The search strategy included the following keywords and/or MeSH terms according to the controlled vocabulary of the databases sought: ((erector spinae plane block) OR (ESP block) OR (ESPB) AND ((cancer pain). We considered eligible Randomized, nonrandomized studies, case series and case reports reporting data on the use of ESPB in patients with cancer pain., Results: The search revealed 34 studies. Among these, we found one RCT, three retrospective studies, two case series, and 28 case reports for a total of 135 patients. Studies included described the use of ESPB for the management of various types of cancer pain across different conditions, including chronic thoracic cancer-related pain, abdominal visceral pain and pain related to bone metastases. Single-shot ESPB was performed in 26 studies while continuous ESPB and the use of a peripheral nerve catheter for continuous analgesia were described in 8 studies. Neurolytic ESPB was performed in 6 studies for a total of 10 patients There was a high clinical heterogeneity in terms of technique, drugs, and use of adjuvants. The lack of comparators was a major flaw, together with the low level of evidence in the majority of the included studies., Conclusions: The evidence supporting the use of ESPB for cancer pain management is currently scarce, heterogeneous, and of low quality. To better understand its potential and provide robust clinical guidance, future research needs to focus on rigorous comparative studies, standardization of techniques and larger sample sizes., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Adherence to pain medication is crucial for cancer patients, since non-adherence can lead to increased suffering, reduced quality of life and increased healthcare costs. Although the five-item Medication Adherence Report Scale (MARS-5) is a validated tool for assessing medication adherence, but it has not been translated and validated into the Nepalese language. This study aimed to translate, culturally adapt and validate the MARS-5 in Nepalese language for Nepalese cancer patients who were experiencing pain., Materials and Methods: The cross-sectional validation study utilized a convenience sampling method. Initially, a pre-test was conducted with 25 patients. The MARS-5 was then forward and backward translated following the EORTC QLG translation procedure. The final translated version was reviewed by experts and subjected to a second pre-test. Construct validity was assessed through principal component analysis, and internal consistency was measured using Cronbach's alpha coefficient. Inter-rater reliability was evaluated using the Intra-Class Correlation coefficient (ICC)., Results: The study included 204 cancer patients (ages 18-86, 55% female). The Nepalese version of the MARS-5 was translated without significant issues and underwent pre-testing with participants. Participants discussed the scale during these pre-tests, providing feedback on its clarity and comprehensibility. While formal assessment tools were not employed, the iterative nature of the pre-testing process allowed for the refinement of the translation based on participant feedback, indicating a robust understanding of the scale among participants. The ICC of test-retest reliability was found to be 0.860. The Kaiser Meyer Olkin's value was 0.690, and Cronbach's alpha was 0.72, indicating good construct validity and high internal consistency. The medication non-adherence rate was 11.3%., Conclusion: The MARS-5 was successfully translated, culturally adapted, and validated in Nepalese for use among Nepalese cancer patients experiencing pain. The Nepalese version of MARS-5 is a reliable tool for evaluating medication adherence in this population., Competing Interests: Professor Rob Horne is the originator and copyright holder of the MARS-5 questionnaire. The authors declare no other conflict of interest., (© 2024 Shrestha et al.)

Pain is one of the most debilitating symptoms of cancer, substantially diminishing one's quality of life. The level of pain experienced is eventually determined by the pain coping strategies adopted by patients individually. The awareness of the 'self-coping methods of pain' of individual patients would be beneficial for the multidisciplinary pain team to consider such methods when planning future interventions to manage pain., Objectives: This study explores the pain perception and coping strategies used by patients with cancer pain in Sri Lanka., Design: A descriptive qualitative study., Setting: Pain management unit, Apeksha Hospital, Maharagama, Sri Lanka., Participants: The study was conducted among purposively selected patients with cancer and registered at the pain management unit. 21 semi-structured interviews were conducted until data saturation. Data were analysed using Graneheim and Lundman's content analysis method., Results: Most participants were between 51 and 60 years old and identified as Sinhalese Buddhists. The study's findings revealed two subthemes under 'Understanding pain', namely 'Physical and emotional impact' and 'Cultural and spiritual interpretations', and five subthemes under 'Coping strategies for living with pain', namely 'Medication and self-control', 'Seeking spiritual support', 'Receiving social support', 'Exploring alternative treatments' and 'Adapting daily life'., Conclusion: Coping strategies were adopted especially in achieving essential life aspirations and participating in preferred activities. Goals or activities were often adjusted to fall within their health limits. Acceptance and progress in life were considered more important than pain control. We recommend giving due consideration to the 'self-coping strategies' of individual patients in designing interventions to mitigate cancer pain., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in oncological/oncohaematological hospitalized patients., Methods: Ambispective cohort study., Sample and Setting: Adults admitted to oncological unit in Hospital of Albacete., Intervention: Implementation of GBP recommendations., Variables: 1) Demographic data. 2)On implementation of GBP recommendations. 3) Outcome in patients: pain intensity in the first 24 h after admission and maximum intensity during admission Tools: Numeric and Visual Scales., Data Collection: indicators exported from clinical history for evaluation of the BPSO® program. Ethical aspects: anonymous data. Data analysis (SPSS®): Descriptive during periods: baseline (T0 = December 2015); initial (T1 = 2017); consolidation (T2 = 2018-2019); sustainability (T3 = 2021-2022). Measurements of central tendency and dispersion, absolute and relative frequencies. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). Statistical significance: p < 0.05., Results: Included 572 patients, 61.5% (352) men. Daily intervention of pain detection was performed in 94.6% (538) of patients (20%-T0; 98.3%-T1; 98.4%-T2; 91.2%-T3; p < 0.001), pain assessment using an appropriate scale in 97.6% (558) (0%-T0; 98.3%-T1; 99.2%-T2; 100%-T3; p < 0.001); 93.7% (535) had a care plan for assessment and management of pain (0%-T0; 98.3%-T1; 96.3%-T2; 92.3%-T3; p < 0.001). The percentage of patients who had severe pain (6-10) during the first 24 hours was reduced from T1 to T3 (5.1%-T1; 6.6%-T2; 2.1%-T3; p = 0.145), but throughout hospitalization increased from T1 to T3 (19.2%-T1; 17%-T2; 22.5%-T3; p = 0.21)., Conclusions: Implementation of recommendations has led to a statistically significant improvement over the periods in the study; however, no effectiveness has been shown to reduce pain intensity., (Copyright © 2024. Published by Elsevier España S.L.U.)

Context: Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%-20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity., Objectives: The aim of this genome-wide association study (GWAS) was to identify genetic markers of opioid toxicity, in terms of nausea-vomiting., Methods: Cancer patients receiving morphine, oxycodone, buprenorphine, and fentanyl were recruited from different European countries. Data about toxicity (nausea-vomiting score, NVS) and other relevant clinical information were collected, as well as genotyping data. Regression analysis between genotypes of 2052 patients and NVS was performed, using appropriate covariates, with REGENIE software., Results: We found 65 variants associated with NVS (P-value < 1.0×10 -5 ). Of note, 14 intronic variants on chromosome 2 were in NPAS2 gene, encoding a circadian transcription factor reported to play a role in another opioid side effect, the alteration of sleep. Some of these variants were previously identified as splicing quantitative trait loci of the NPAS2 gene., Conclusions: This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Methadone was introduced in 2013 for the treatment of intractable cancer pain in Japan and is indicated for patients receiving opioid doses ≧60 mg/day as an oral morphine equivalent. Low-dose (≦10 mg/day) add-on methadone to prior opioids has been reported from European countries to successfully relieve various types of intractable cancer pain; however, there are few reports of such use in Japan. The aim of this study was to analyze more than a hundred cases with low-dose add-on methadone to treat intractable pain in Japanese cancer patients., Methods: All cases in which 5 or 10 mg/day of methadone was added to prior opioids by the Palliative Care Team or Division of Palliative Medicine in our hospital during the period between April 2016 and September 2023 were extracted and analyzed retrospectively on electrical medical charts., Results and Conclusions: A total of 102 cases were extracted with a male-to-female ratio of 60:42, and the age (mean ± SD) was 62.8 ± 14.7 years old. Methadone was introduced in an inpatient setting to 86 patients. The major pathologies that caused intractable pain were spinal metastases in 48, pelvis or pelvic floor lesions in 29 and pleural and/or chest wall lesions in 16. The most common mechanism of pain was the mixture of somatic and neuropathic components. The major opioids administered prior to methadone included tapentadol in 46 patients, hydromorphone in 36 and oxycodone in 19. The dose of the prior opioids [median, (interquartile range: IQR)] was 97, (62.8-167.3) (range: 15-1313) mg/day of oral morphine equivalent. Radiotherapy, chemotherapy and nerve blocks were performed as concomitant therapies in 48, 22 and 11 patients, respectively (with some overlap). The number of rescue doses [median (IQR)] was significantly decreased from three (two to five) on the day before methadone to one (zero to four) after seven days from methadone initiation. The side effects leading to discontinuation of methadone were drowsiness in three cases, nausea in three cases and dizziness in one case (with some overlap). Compared with complete switching from other opioids, low-dose add-on methadone can reduce the possibility of major dose discrepancies and can be quickly adjusted by combined opioid reduction/increase. Low-dose add-on methadone can be an effective and safe method for intractable cancer pain., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Background: Cancer pain has a significant impact on patient's quality of life. Astrocytes play an important role in cancer pain signaling. The direct targeting of astrocytes can effectively suppress cancer pain, however, they can cause many side effects. Therefore, there is an urgent need to identify the specific signaling pathways or proteins involved within astrocytes in cancer pain as targets for treating pain., Methods: A neuropathic cancer pain (NCP) model was established by inoculating mouse S-180 sarcoma cells around the right sciatic nerve in C57BL/6 mice. Spontaneous persistent pain and paw withdrawal thresholds were measured using von Frey filaments. The NCP spinal cord dorsal horn (L4-L6) and mouse astrocyte cell line MA-C were used to study protein palmitoylation using acyl-biotin exchange, real-time polymerase chain reaction, ELISA, western blotting, and immunofluorescent staining., Results: In a cancer pain model, along with tumor growth, peripheral nerve tissue invasion, and cancer pain onset, astrocytes in the dorsal horn of the spinal cord were activated and palmitoyltransferase ZDHHC23 expression was upregulated, leading to increased palmitoylation levels of GFAP and increased secretion of inflammatory factors, such as (C-X-C motif) ligand (CXCL)10 (CXCL-10), interleukin 6, and granulocyte-macrophage colony-stimulating factor. These factors in turn activate astrocytes by activating the signal transducer and activator of transcription 3 (STAT3) signaling pathway. A competitive peptide targeting GFAP palmitoylations was designed to effectively alleviate morphine tolerance in cancer pain treatment as well as cancer pain signaling and inflammatory factor secretion., Conclusions: In a rodent model, targeting GFAP palmitoylation appears to be an effective strategy in relieving cancer pain and morphine tolerance. Human translational research is warranted., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Background: Cancer pain management is critical, especially at advanced stages. This is particularly important in Africa as most cancers are typically diagnosed at advanced stages. Given the central role of adequate pain management in advanced cancer care, this scoping review aims to examine the utilisation of patient-controlled analgesia (PCA) in cancer pain management within African healthcare settings., Methods and Analysis: This scoping review will apply the Arksey and O'Malley framework. A systematic search will be conducted in PubMed, African Journals Online and Google Scholar, focusing on studies conducted in Africa involving PCA and cancer pain. A two-step screening process will be used, title/abstract screening and full-text screening, with inclusion criteria emphasising relevance to cancer pain, PCA usage and African context. A thematic analysis approach will categorise data into themes related to PCA utilisation, effectiveness, barriers and outcomes. Tables and figures will be used for presentation., Ethics and Dissemination: This review will involve a secondary analysis of already published literature; therefore, ethical approval is not required. The findings of our scoping review will be published in an open-access, peer-reviewed journal on completion., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Pain management in patients with cancer is a critical aspect of oncological care, yet remains challenging with current pharmacological therapies. Non-pharmacological interventions, offering potential benefits without the adverse effects of drugs, have gained attention. However, the effectiveness of these diverse non-pharmacological interventions is not well understood, creating a gap in clinical practice. This study aims to conduct a systematic review and network meta-analysis (NMA) to evaluate the efficacy of various non-pharmacological interventions for pain management in patients with cancer, providing evidence-based guidance for clinicians and patients., Methods and Analysis: A systematic review and Bayesian NMA will be performed. To assess the efficacy of interventions for cancer pain, we will search six electronic databases: Cochrane Library, Web of Science, PubMed, EMBASE, PsycINFO and the Cumulative Index to Nursing and Allied Health Literature, focusing on identifying randomised controlled trials. Literature screening should be independently performed by two reviewers. A NMA will evaluate the efficacy of various non-pharmacological interventions for cancer pain. A second NMA will compare the efficacy of different non-pharmacological interventions in relieving pain interference in patients with cancer pain. Bayesian 95% credible intervals will be used to estimate the pooled mean effect size for each treatment, and the surface under the cumulative ranking area will be employed to rank the effectiveness of the treatments., Ethics and Dissemination: Ethical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication., Prospero Registration Number: CRD42024483025., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Anterolateral cordotomy (AL-C) is a long-established treatment for alleviating intractable cancer pain. However, AL-C has progressively fallen into desuetude, leading to the risk of a definitive loss of expertise within neurosurgical teams. Our objective was therefore to provide an update on percutaneous and open AL-C, with special emphasis on contemporary operative technique., Material and Methods: Patient selection, indications, outcomes and up-to-date operative technique are reviewed through illustrative cases, including intraoperative photographs and video., Results: Main indications are represented by unilateral, nociceptive pain refractory to best pharmacological treatment in patients with limited life expectancy. Percutaneous AL-C is performed under cooperative sedation at C1-C2 level. CT myelography guidance and intraoperative electrophysiology allow accurate targeting of the spinothalamic tract (STT). Thermocoagulation is performed at 80 °C for 60 s during a Mingazzini maneuver, in order to promptly detect the potential onset of a motor weakness. Open AL-C is performed under general anesthesia at T2-T3 level. The dentate ligament is suspended to gently rotate the spinal cord and expose the anterolateral column. Section of the STT is made with a micro scalpel blade at a depth of 4-5 mm, from the dentate ligament to the emergence of ventral rootlets. Success rate after AL-C is high and allows a marked reduction in antalgic drugs intake. Main limitations include failure in achieving long-standing pain relief and the new occurrence of spontaneous, mirror pain., Conclusion: AL-C is a safe and effective option for the management of opioid-resistant cancer pain, which should be part of the neurosurgeon's armamentarium., (Copyright © 2024. Published by Elsevier Masson SAS.)

This study aimed to investigate the effects of Standardized Training Resident on pharmacological interventions for pain management in patients with advanced lung cancer. A total of 84 patients with advanced lung cancer and associated pain were enrolled in the study from December 2019 to August 2023 and were divided into two groups based on their attending physician: a group managed by physician-ST Training Physicians (joint group) (n = 42) and physician-only group (usual group) (n = 42). The Brief Pain Inventory (BPI), oral morphine equivalent, and length of hospital stay. Furthermore, the Pain Management Index (PMI) was calculated. Health-related quality of life (HRQoL) was assessed at the 4-week follow-up using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). At week 4, compared to the usual group, the four BPI pain intensity categories were significantly lower in the joint group [worst pain: 4 (3-5) vs 8 (7-9); least pain: 1 (0-2) vs 3 (1-4); average pain: 2 (1-2) vs 5 (4-6); pain right now: 1.2 (0.7-1.9) vs 4 (3-5)] (all P > 0.05). The hospital stay duration was significantly reduced; for the seven pain interference categories, there were no significant improvements in the joint group. Significantly more patients achieved adequate pain control in the joint group than the usual group (p = .002). A reduction in OMEDD scores was observed for both cohorts, and the joint group's reduction was statistically more significant (p = 0.016). There were no significant differences in HRQoL between the two groups. Standardized Training for Radiation Oncology Physicians may lead to improved pharmacological interventions and enhanced pain relief. Recognizing the importance of these trainees in the healthcare team is crucial for achieving optimal pain management outcomes., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Objectives: While epidural anesthesia is an established technique for labor and perioperative pain, its use in the hospice setting remains limited, resulting in a reliance on oral opioids. We describe patients with intractable pain who pursued hospice enrollment with tunneled epidural analgesia for pain management. Methods: All patients who received a tunneled epidural prior to hospice enrollment between January 1, 2017, and September 20, 2023, were included. The medication infused, adverse effects, as well as changes in oral morphine equivalents (OME), pain scores, blood pressure, and heart rate were extracted from the medical record. Results: Seven patients underwent tunneled epidural placement for pain management. The average change in OME was -122.73 mg. Conclusions: Overall, tunneled epidural analgesia may be an underutilized method of pain management for patients at end-of-life with intractable pain. Further high-quality research on the subject is necessary to establish effectiveness, safety, and barriers to implementation.

Background/Objectives : The anesthetic block of the sensory branches of the superficial cervical plexus renders a specific area of the face, head, and anterior neck insensible and painless. Chronic pain in these areas can be difficult to diagnose and treat. In this report, we briefly review the existing evidence on the topic of the superficial cervical plexus block (SCPB) to set the context for our research. We then share our own clinical experience with the SCPB for managing chronic pain syndromes from both cancerous and non-cancerous etiologies. Methods : We first performed a comprehensive literature search and narrative review of clinical cases and studies that utilized the SCPB as an analgesic technique. We then conducted a retrospective case series of all patients who had received an SCPB at our pain clinic since 2020. Results : Our literature review found only a few cases reported, with most of them focusing on acute painful emergencies and perioperative pain syndromes and only very few addressing chronic pain. In our pain clinic, 14 patients received one or more SCPBs for chronic pain management. In 43% of these cases, the pain was related to cancer. The most common areas of pain corresponded to the regions supplied by the transverse cervical and great auricular nerves. The procedures were uneventful in all cases, and patients rated them as effective and worthwhile 71% of the time. Conclusions : Despite the lack of high-quality studies on SCPBs in pain management, the authors' experience suggests that it is a valid minimally invasive alternative for managing chronic face, head, and neck pain.

Intrathecal therapy with implanted devices is often reported in some recommendations.for the management of difficult cancer pain However, data is often biased by optimistic view and poor assessment. We report a case of patient in which a comprehensive and complex palliative care treatment was effective in managing a patient who was implanted a subcutaneous port for intrathecal analgesia This patient had many characteristics of a difficult pain, really defined as refractory due to various negative prognostic pain factors, such as neuropathic pain and psychological distress.. A comprehensive pain management with a balanced approach including both interventional therapy and palliative care simultaneously, allowed to achieve optimal pain control. Terms such as intractable or refractory pain, have been ambiguously used in literature to select patients as candidates for implated pumps. A meaningful evaluation and a comprehensive treatment should be mandatory when using intrathecal anlgesia in patients with very difficult pain conditions., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action., Objective: This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment., Methods: This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol., Results: The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals., Conclusions: This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice., Trial Registration: PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=382433., International Registered Report Identifier (irrid): DERR1-10.2196/55792., (©Ludmila Oliveira Ruela, Caroline de Castro Moura, Bianca Shieu, Yu-Min Cho, Chao Hsing Yeh, Franklin Fernandes Pimentel, Juliana Stefanello. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.10.2024.)

Context: The use of methadone for cancer pain management is gaining wider acceptance. However, switching to methadone treatment can still pose challenges. Consequently, there is ongoing development of its use in low doses in combination with other opioids, despite a lack of clinical evidence regarding its efficacy and safety., Objectives: This study aimed to evaluate the efficacy and tolerability of low-dose methadone in combination with another opioid in patients with moderate-to-severe cancer-related pain in a clinical setting., Patients and Methods: This was a prospective, open-label study conducted in 19 pain and/or palliative care centres treating patients with cancer-related pain. Pain intensity, patients' global impression of change, and adverse effects were assessed on day 7 and day 14. The main outcome measure was the proportion of responders., Results: The study included 92 patients. The daily dose of methadone was 3 [3-6] mg at baseline, 9 [4-10] mg on day 7 and 10 [6-15] mg on day 14. The NRS pain ratings significantly decreased from 7 [6-8] at baseline to 5 [3-6] on visit 2 (p < .0001) and 4 [3-6] on visit 3 (p < .0001). Similarly, the VRS pain ratings decreased from 3 [3-3] at baseline to 2 [2-3] on visit 2 (p = 0.026) and 2 [1-3] (p < 0.001) on visit 3. At Visits 1 and 2, half of the patients were considered Responders. Of those responders, 73.5% were High-Responders at Visit 1 and 58.7% were High-Responders at Visit 2. No adverse events related to the risk of QT prolongation, overdose, or drug interactions were reported., Conclusion: For patients experiencing moderate to severe cancer-related pain despite initial opioid treatment, our study found that low-dose methadone, when used in combination with another opioid, was both safe and effective. This supports the use of methadone as an adjunct to opioid-based treatment for cancer pain., (© 2024. The Author(s).)

Background: Intrathecal analgesia plays a key role for patients suffering refractory cancer pain. Nevertheless, intrathecal drug delivery systems (IDDS), requiring a cervical catheter tip implantation, have been poorly described in medical literature., Aims: A monocentric retrospective follow-up study was designed to evaluate results of cervical IDDS for cancer pain., Patients and Methods: From January 2010 to December 2022, all intrathecal-treated patients were prescribed a combined intrathecal analgesics regimen through a catheter placed in the cervical vertebral canal. Post-implant assessment of pain was determined using a numeric rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly. Pain scores were compared using the Wilcoxon's signed rank test., Results: Ninety-eight patients were included in this study; all received intrathecal treatments. Implanted patients suffered from severe pain (mean presurgical maximum numerical rating score 8.02±0.24 despite a mean 562.56±127.72 mg of oral morphine equivalent daily dose). Mean survival time after intrathecal treatment start was 208.48±67 days. Intrathecal drug delivery systems provided pain relief compared with initial pain score with a significant statistical difference after 1 week, 1 month, 2 and 3 months (p<0.01). A 50% reduction in initial pain level was achieved in 93% of cases during the first week of intrathecal implant., Conclusions: Results suggest that long-term intrathecal treatment using a multidrug regimen for cancer-related pain through cervical intrathecal catheters was suitable and safe in our study population. We demonstrated a clinically and statistically significant pain reduction in patients using mainly a percutaneous lumbar approach., Competing Interests: Competing interests: DD received consultations fees from Medtronic Esteve and Grunenthal., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Cancer is a global health challenge with rising incidence and mortality rates, posing significant concerns. The World Health Organization reports cancer as a leading cause of death worldwide, contributing to nearly one in six deaths. Cancer pathogenesis involves disruptions in cellular signaling pathways, resulting in uncontrolled cell growth and metastasis. Among emerging players in cancer biology, Transient Receptor Potential (TRP) channels, notably TRPV1, have garnered attention due to their altered expression in cancer cells and roles in tumorigenesis and progression. TRPV1, also known as the capsaicin receptor, is pivotal in cancer cell death and pain mediation, offering promise as a therapeutic target. Activation of TRPV1 triggers calcium influx and affects cell signaling linked to growth and death. Additionally, TRPV1 is implicated in cancer-induced pain and chemo-sensitivity, with upregulation observed in sensory neurons innervating oral cancers. Also, when capsaicin, a compound from chili peppers, interacts with TRPV1, it elicits a "hot" sensation and influences cancer processes through calcium influx. Understanding TRPV1's multifaceted roles in cancer may lead to novel therapeutic strategies for managing cancer-related symptoms and improving patient outcomes. The current review elucidates the comprehensive role of capsaicin in cancer therapy, particularly through the TRPV1 channel, highlighting its effects in various cells via different signaling pathways and discussing its limitations.

Purpose: The objectives of the study were to determine the prevalence of (uncontrolled) OIC, relevant medications / interventions employed by healthcare professionals, and the additional strategies utilised by patients, amongst European patients with cancer pain., Methods: This study was a prospective observational study conducted at 24 research sites in ten European countries. Cancer patients receiving opioid analgesics for at least a week were recruited, and asked to complete a questionnaire including background information, single question (Are you constipated?), Rome IV diagnostic criteria for OIC, Bowel Function Index (BFI), and Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL). Participants were characterised as having / not having OIC on the basis of the Rome IV diagnostic criteria., Results: 1200 participants completed the study. 59.5% met the Rome IV diagnostic criteria for OIC: only 61.5% that met these criteria self-reported constipation. 72% participants were prescribed a regular conventional laxative / peripherally acting mu-opioid receptor antagonist (PAMORA). However, only 66% took their prescribed laxatives every day. Many participants had utilised other strategies / interventions to manage their OIC. Furthermore, 27% had needed to use suppositories, 26.5% had needed to use an enema, and 8% had had a manual evacuation. The use of PAMORAs, and other novel effective medications, was relatively uncommon., Conclusion: The results of this study suggest that management in Europe is often inadequate, and this undoubtedly relates to a combination of inadequate assessment, inappropriate treatment, and inadequate reassessment., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Lead migration is a common complication of spinal cord stimulation, although anterior migration is rare. While early studies suggested that anterior stimulation may produce analgesic effects, it is thought to be poorly tolerated due to abnormal paresthesia and muscle contractions due to its proximity to the corticospinal tract. This case report presents a unique case of sustained pain relief despite anterior lead migration, which suggests that anterior column stimulation may hold clinical significance for pain management. Further studies are needed to explore its analgesic mechanisms and potential therapeutic application. Strategies to prevent lead migration, particularly in the early postoperative period, are also crucial for optimizing outcomes.

The elimination of localized cancer pain remains a globally neglected challenge. A potential solution lies in combining gas therapy with targeted interventional ablation therapy. In this study, HA-As 2 S 3 nanoparticles with controlled sizes are synthesized using different molecular weights of sodium hyaluronate (HA) as a supramolecular scaffold. Initially, HA co-assembles with arsenic ions (As 3+ ) via coordinate bonds, forming HA-As 3+ scaffold intermediates. These intermediates, varying in size, then react with sulfur ions to produce size-controlled HA-As 2 S 3 particles. This approach demonstrates that different molecular weights of HA enable precise control over the particle size of arsenic sulfide, offering a straightforward and environmentally friendly method for synthesizing metal sulfide particles. In an acidic environment, HA-As 2 S 3 nanoparticles release hydrogen sulfide(H 2 S) gas and As 3+ . The released As 3+ directly damage tumor mitochondria, leading to substantial reactive oxygen species (ROS) production from mitochondria. Concurrently, the H 2 S gas inhibits the activity of catalase (CAT) and complex IV, preventing the beneficial decomposition of ROS and disrupting electron transfer in the mitochondrial respiratory chain. Consequently, it is found that H 2 S gas significantly enhances the mitochondrial damage induced by arsenic nanodrugs, effectively killing local tumors and ultimately eliminating cancer pain in mice., (© 2024 Wiley‐VCH GmbH.)

To investigative the white matter (WM) alterations in lung cancer patients with cancer pain (CP+), and explore the correlations between damaged WM fiber tracts and clinical indicators. Twenty-six CP+, 26 lung cancer patients without CP (CP-), and 31 healthy controls (HC) were recruited. All participants underwent diffusion tensor imaging (DTI) and clinical assessments. Automated fiber quantification (AFQ) technique was performed to identify the 20 WM fiber bundles, and the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted. Intergroup comparisons of these diffusion metrics were conducted based on the entire fiber bundle level and 100 node levels along each tract. The associations between altered diffusion metrics and the numeric rating scale (NRS) scores, as well as the pain duration, were analyzed. At the entire level, the CP + group showed impaired WM structure in the right cingulum hippocampus (CH&#95;R). At the pointwise level, the CP + group exhibited extensive nodal FA reduction or MD, RD, and AD elevation. In addition, the AD of the posterior portion of the right inferior longitudinal fasciculus (ILF&#95;R, nodes 71-75) in the CP + group was positively correlated with the pain duration, and the FA of CH&#95;R (nodes 22-38) was negatively correlated with NRS score. Extensive WM microstructural damage may be a pattern of brain abnormalities in lung cancer patients with CP, and in particular, specific nodal disruption along pain-related fiber tracts may be a sensitive imaging biomarker to characterize the severity and duration of CP., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings., Objectives: The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients., Methods: This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale., Results: Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%., Conclusion: In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings., (© 2024. The Author(s).)

Objective: The aim of this study was to investigate the physicochemical stability of morphine-bupivacaine-ziconotide mixtures used in intrathecal analgesia in polypropylene syringes and intrathecal pumps., Materials and Methods: The stability study method was conceived according to International Council for Harmonisation guidelines. For propylene syringes, six different mixtures of morphine-bupivacaine and ziconotide were assessed over seven days. Two storage temperatures were tested (5 °C ± 3 °C and 25 °C ± 2 °C). For implantable pumps, nine different mixtures were assessed over 60 days and stored at 37 °C. Assays were performed using ultrahigh-pressure liquid chromatography. Turbidity and pH also were measured throughout the study., Results: Results confirmed excellent physicochemical stability for morphine and bupivacaine in the study for all conditions investigated (pumps at 37 °C, polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C). Concerning ziconotide, after seven days, our study showed that every 95% confidence interval calculated had lower bounds >90% for all mixtures stored in polypropylene syringes. In implantable pumps, a decrease of the concentration was observed in all the mixtures studied. Moreover, the appearance of a degradation product confirmed the ziconotide degradation., Conclusion: All results are in favor with a physicochemical stable preparation for six mixture profiles when stored in polypropylene syringes at 5 °C ± 3 °C and 25 °C ± 2 °C. For mixtures stored in implantable pumps, the efficacy should decrease over time owing to the degradation of ziconotide. A trade-off between high morphine concentration and increased refill interval will need to be found by clinicians., Competing Interests: Conflict of Interest The authors reported no conflict of interest., (Copyright © 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Objective: Previous cancer studies have indicated that medical marijuana addresses a significant unmet need, namely chronic pain treatment and conferring oncology supportive care. However, the clinical research evaluating medical marijuana is preliminary and requires further consideration., Data Sources: We conducted a PubMed search primarily comprising retrospective and prospective studies, systematic reviews, and randomized clinical trials (RCTs) from approximately 2020-2023. The search included specific terms that incorporated medical marijuana, cancer treatment, cancer-related symptoms, pain management, and side effects., Data Summary: A total of 40 studies were included in the review, many of which were either of acceptable or good quality. Select investigations indicated that medical marijuana was associated with decreased overall pain levels and improvements in nausea and vomiting. Alternatively, the results from RCTs have found that the benefits from a placebo were equivalent to medical marijuana in both the treatment of cancer-related pain and providing an opioid-sparing effect., Conclusions: Despite the potential cancer-related benefits derived from medical marijuana, the study design and results for many of the investigations on which the evidence is based, were neither uniform nor conducted via RCTs; hence, the efficacy and appropriateness of medical marijuana in treating cancer-related conditions remain indeterminate., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Percutaneous lateral cervical cordotomy (PLCC) is a treatment option for predominantly nociceptive pain of oncological origin that is refractory to conservative methods, with unilateral distribution, particularly in the lower trunk or lower limbs of patients with a life expectancy of less than one year., Objective: The aim of this study was to assess the analgesic efficacy and opioid utilization alteration in patients undergoing PLCC., Methods: We retrospectively collected data from patients undergoing PLCC between 2011 and 2021 at the AC Camargo Cancer Center in São Paulo, Brazil., Results: Sixty-three patients and their respective surgical outcomes were analyzed. The mean preoperative pain intensity, as assessed by the mean numerical rating scale (NRS), was 8.4 (range: 4-10), while postoperatively, it decreased to 0.78 (range: 0-8). Lower postoperative NRS scores were observed for pain in the lower limbs and abdomen compared to the lower thorax. The mean preoperative oral morphine equivalent (OME) consumption was 231.0 mg (range: 30.0-1015.2). At 30 days postoperative, the mean consumption of OME was 120.2 mg (range: 0.0-705.0). Twelve months after surgery, the average consumption of OME was 98.3 mg (range: 0.0-396.0)., Conclusion: PLCC is a valuable therapeutic intervention for patients experiencing cancer pain that is unresponsive to conservative treatments. The anticipated analgesic outcomes are generally favorable, particularly in cases where the pain is localized unilaterally in the abdomen or lower body segments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Oncologic chronic pain is often difficult to control, especially in anatomical areas with multiple and complex innervation, such as the pelvic/perineal region. The ganglion impar block (GIB) is a procedure with growing interest and varied applicability. It has been used in several benign and malignant causes of pelvic and perineal pain refractory to pharmacological treatment. We conducted a review of all articles published in PUBMED® until the 30th of October 2022 regarding GIB in oncologic pain. 19 articles were identified with a total of 278 patients. Both chronic cancer pain and chronic postcancer treatment pain patients were included. We reviewed the various techniques, approaches, and therapeutic options that were employed. No serious adverse effects were reported. GIB appears to be an effective and safe procedure that should be considered in patients with intractable perineal cancer-related pain., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Myofascial release (MFR) therapy is widely used in clinical practice to treat various musculoskeletal and pain-related conditions. However, there is a lack of comprehensive reviews that systematically evaluate its effectiveness across different medical conditions, leading to inconsistent applications and understanding of its therapeutic potential. This review aims to synthesize the current applications of myofascial release therapy in the treatment of various diseases, highlighting its efficacy and identifying areas where further research is needed. The review covers the application of myofascial release therapy in conditions such as chronic pain, fibromyalgia, post-surgical recovery, and neurological disorders. It evaluates the outcomes of existing studies, identifies gaps in the literature, and discusses the mechanisms through which myofascial release exerts its effects. Additionally, the review provides insights into the limitations of current research and suggests directions for future studies to enhance the clinical application of myofascial release therapy., Competing Interests: The authors declare that there are no conflicts of interest., (© 2024 Lv and Yin.)

Introduction: Patients with advanced cancer frequently suffer from chronic, severe disabling pain. Opioids such as morphine and fentanyl are commonly used to manage this pain. Transdermal drug delivery systems are important technologies for administering drugs in a non-invasive, continuous and controlled manner. Due to the narrow therapeutic range of fentanyl, individualised dosing is essential to avoid underdosing or overdosing. Standard clinical calculation tools for opioid rotation however do not include important patient characteristics that account for interindividual variability of opioid pharmacology., Methods and Analysis: We developed a clinical protocol to optimise individual fentanyl dosing in patients with advanced cancer switching from oral or intravenous opioids to transdermal fentanyl by using a physics-based digital twin (DT) that is fed by important clinical and physiological parameters. Individual tailoring of transdermal fentanyl therapy is an approach with the potential for personalised and effective care with an improved benefit-risk ratio. However, clinical validation of physics-based digital twins (PBDT) dosing is crucial to proving clinical benefit.Therapeutic drug monitoring will allow to validate the accuracy of PBDT predictions. Additional monitoring for breathing dynamics, sequential pain levels and fentanyl-related adverse events will contribute to evaluating the performance of PBDT-based dosing of transdermal fentanyl. The primary objective of the study is to develop an experimental protocol to validate DT-guided fentanyl dosing in patients with advanced cancer. This clinical study will bring individualised opioid dosing closer to clinical practice., Ethics and Dissemination: Study documents have been approved by the responsible Ethics Committee and study initiation is planned for late summer 2024. Data will be shared with the scientific community no more than 1 year following completion of the study and data assembly., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on using intrathecal drug delivery in chronic pain treatment. This Polyanalgesic Consensus Conference (PACC)® project's scope is to provide evidence-based guidance for clinical pharmacology and best practices for intrathecal drug delivery for cancer pain., Materials and Methods: Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus from 2017 (when the PACC last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations were based on the strength of evidence, and when evidence was scant, recommendations were based on expert consensus., Results: The PACC evaluated the published literature and established evidence- and consensus-based expert opinion recommendations to guide best practices in treating cancer pain. Additional guidance will occur as new evidence is developed in future iterations of this process., Conclusions: The PACC recommends best practices regarding the use of intrathecal drug delivery in cancer pain, with an emphasis on managing the unique disease and patient characteristics encountered in oncology. These evidence- and consensus-based expert opinion recommendations should be used as a guide to assist decision-making when clinically appropriate., Competing Interests: Conflict of Interest Shane E. Brogan acts as a paid consultant for Medtronic. Eric Buchser reports grants from the Swiss National Foundation and the Commission for Technology and Innovation; and grants, personal fees and nonfinancial support from Medtronic, during the conduct of the study. Timothy R. Deer reports no conflicts that pertain to intrathecal therapy; reports conflicts within the neuromodulation field that include consulting for Abbott, Saluda, Ethos, Nalu, PainTeq, and Cornorloc; he also holds a patent pending with Abbott; is on the advisory board of Abbott and Nalu; has stock options Saluda, Spinethera, and Nalu; and has institutional research grants from Abbott, Saluda, Vertiflex and Mainstay. Denis Dupoiron reports personal fees from Medtronic and Esteve during the conduct of the study. Amitabh Gulati reports personal fees from Medtronic, Flowonix, AIS HealthCare, SPR Therapeutics, Nalu Medical, Bausch Health, and Spark Medical, outside the submitted work. Jennifer Hah reports grants from NIH NIDA, outside the submitted work. Gladstone C. McDowell II reports personal fees and other from Medtronic Corporation; personal fees, nonfinancial support, and other from Flowonix Corporation and TerSera Therapeutics, outside the submitted work. Christophe Perruchoud reports grants and personal fees from Medtronic and Boston Scientific, during the conduct of the study; and personal fees from Medtronic and Boston Scientific, outside the submitted work. Fabian Piedimonte reports personal fees from Medtronic and Abbott, which stopped in June 2020. Julie G. Pilitsis reports grants and other from Boston Scientific, Nevro, Abbott, Medtronic, and TerSera; other from Saluda; grants from NIH 2R01CA166379-06, other from Aim Medical Robotics and Karuna Labs; and grants from NIH U44NS115111, outside the submitted work. Jason E. Pope reports other from Ethos Labs, Flowonix, Saluda, PainTeq, Aurora Spine, Thermaquil, Celeri Health, Spine Thera, AGR, NIS, Abbott, Medtronic, Biotronik, Mainstay, Muse, AIS, SPR Therapeutics, TerSera, Vertiflex, Boston Scientific, Vertos, SPARK, and WISE, outside the submitted work. Michael F. Saulino reports research grants from Medtronic and Flowonix; fellowship support from Medtronic, Piramal, and Saol. Peter S. Staats reports grants from Saluda, Nalu, AIS Therapeutics, Thermaquil, Biotronik, electroCore and Vertos, outside the scope of this work; royalties from the Averitas-Qutenza Patch, outside the scope of this work; payment or honoraria from Medtronic and SPR Therapeutics, outside the scope of this work; patents for vagus nerve and topical capsaicin products; participation in a Data Safety Monitoring or Advisory Board for Nalu and Saluda; a leadership role in the World Institute of Pain, American Society of Pain and Neuroscience, American Society of Interventional Pain Physicians, and the Florida Academy of Pain Management; and stock options in Saluda, Nalu and electroCore. Mark S. Wallace reports grants from NIH and is a consultant to TerSera. Tony L. Yaksh reports grants from NIH NINDS, other from CODA, IONIS, and Medtronic, during the conduct of the study; and grants from NIH-NINDS, IONIS, and Medtronic, outside the submitted work. The remaining authors reported no conflict of interest., (Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Background: The authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System-Physical Function (PROMIS-PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase., Methods: Adults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS-PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate-severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval., Results: Forty percent of the surveyed patients reported moderate-severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate-severe impairment (95% confidence interval, 2.393-17.769). The noncurative group was 1.5 times more likely to have moderate-severe impairment (95% confidence interval, 1.045-2.145; mean score, 43; p < .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One-third of those who reported PF impairment also had significant pain and/or fatigue., Conclusions: A sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co-occurred, particularly in the noncurative group. The PROMIS-PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors., Methods: From a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18-63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients., Results: Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients., Conclusions: Although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings., (© 2024. The Author(s).)

Background: Cancer patients frequently suffer pain as one of their symptoms. It includes acute and chronic pain and is one of the most feared symptoms for patients. About one-third of adults actively undergoing cancer treatment suffer from pain related to their condition. Cancer pain control remains suboptimal due to a lack of assessment, knowledge, and access. Fire needle therapy, a traditional Chinese medicine, offers a potentially beneficial addition to current pain management approaches. This protocol outlines a systematic review and meta-analysis to compile evidence and examine the pain-relieving effects and safety of fire needle therapy for cancer patients., Methods and Analysis: We will systematically search China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine disc (CBM), China Science and Technology Journal Database (CSTJ or VIP), PubMed, Web of Science, Embase, Cochrane Central Registry of Controlled Trials (CENTRAL), Chinese Clinical Trial Registry (Chictr), Opengrey, Worldcat, and Scopus from inception through July 2023. Random control trials (RCTs) include all types of cancer patients (age ≥ 18 years) complaining of pain. The primary outcome will be changes in pain intensity measured by Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Neuropathic Pain Scale (NPS), or Brief Pain Inventory (BPI). Secondary outcomes include quality of life (EORTC QLQ-C30 and GCQ), performance status (KPS), times of burst pain, treatment response rate, the dose reduction of analgesic drugs, and side effects rates. Utilizing the Cochrane risk bias measurement tool: Risk of Bias 2 (RoB 2), the trials' quality will be evaluated, and meta-analysis will be performed using RevMan software (version 5.4)., Discussion: This systematic review will be the first comprehensive review of the literature to provide a meta-analysis of fire needle therapy for cancer pain, including only Random control trials (RCTs). For the sake of transparency and to avoid future duplication, the publication of this protocol offers a clear illustration of the procedures utilized in this evaluation. The results of our future studies may provide a new approach and theoretical basis for the treatment of cancer pain by medical oncology professionals., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023418609., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Ren, Wu, Yuan, Wang, Tang, Zhou, Qiao and Liu.)

Study Objective: Advanced rectal cancer is a common cause of perineal pain and research on the use of radiofrequency therapy for the treatment of this pain is limited. In the present study, we aimed to compare the effectiveness and safety of conventional radiofrequency (CRF) and high-voltage long-term pulsed radiofrequency (H-PRF) of radiofrequency therapy in the management of perineal pain in advanced rectal cancer., Design: Randomized, Double-Blind Controlled Trial., Setting: Sichuan Cancer Hospital & Institute and Yanjiang District People's Hospital in Sichuan, China., Participants: A total of 72 patients with advanced rectal cancer experiencing perineal pain who were accepted for radiofrequency treatment., Interventions: Patients were assigned randomly (1:1) assigned to either the group CRF or H-PRF in a double-blind trial., Measurements and Main Results: The primary focus was on assessing perineal pain using numeric rating scales (NRS) scores at various time points. Secondary outcomes included the duration of maintaining a sitting position, depression scores, sleep quality, consumption of Oral Morphine Equivalent and Pregabalin, and the incidence of perineal numbness. A total of 57 patients (28 patients in the group CRF and 29 patients in the group H-PRF) were investigated. At all observation time points postoperatively, both groups of patients exhibited significant reductions in pain, enhancements in depression, improvements in sleep quality, and increased duration of sitting compared to their baseline measurements (P<0.05). During the 3 months and 6 months follow-up period, the group CRF exhibited significant reduction in pain, improvement in depression, sleep quality, and increased the time of keeping a sitting position compared with the group H-PRF (P<0.05). The consumption of oral morphine equivalent and Pregabalin as well as the incidence of perineal numbness were not significantly different between groups (P > 0.05)., Conclusion: Our results demonstrate that application of CRF and H-PRF in ganglion impar to reduce perineal pain and improve the quality of life of patients with advanced rectal cancer is safe and effective. However, the long-term effect of CRF is better compared with that of H-PRF., Trial Registration: https://www.chictr.org.cn/ (ChiCTR2200061800) on 02/07/2022. This study adheres to CONSORT guidelines., (© 2024. The Author(s).)

Background: Breakthrough cancer pain (BTcP) has a negative impact on patients' quality of life, general activities, and is related to worse clinical outcomes. Fentanyl inhalant is a hand-held combination drug-device delivery system providing rapid, multi-dose (25μg/dose) administration of fentanyl via inhalation of a thermally generated aerosol. This multicenter, randomized, placebo-controlled, multiple-crossover, double-blind study evaluated the efficacy, safety, and tolerability of fentanyl inhalant in treating BTcP in opioid-tolerant patients., Methods: The trial was conducted in opioid-tolerant cancer patients with 1 ~ 4 BTcP outbursts per day. Each patient was treated and observed for 6 episodes of BTcP (4 with fentanyl inhalant, 2 with placebo). During each episode of targeted BTcP, patients were allowed up to six inhalations, with an interval of at least 4 min between doses. Primary outcome was the time-weighted sum of PID (pain intensity difference) scores at 30 min (SPID30)., Results: A total of 335 BTcP episodes in 59 patients were treated. The mean SPID30 was -97.4 ± 48.43 for fentanyl inhalant-treated episodes, and -64.6 ± 40.25 for placebo-treated episodes (p < 0.001). Significant differences in PID for episodes treated with fentanyl inhalant versus placebo was seen as early as 4 min and maintained for up to 60 min. The percentage of episodes reported PI (pain intensity) scores ≤ 3, a ≥ 33% or ≥ 50% reduction in PI scores at 30 min, PR30 (pain relief scores at 30 min) and SPID60 favored fentanyl inhalant over placebo. Only 4.4% of BTcP episodes required rescue medication in fentanyl inhalant group. Most AEs were of mild or moderate severity and typical of opioid drugs., Conclusion: Treatment with fentanyl inhalant was shown to be a promising therapeutic option for BTcP, with significant pain relief starting very soon after dosing. Confirmation of effectiveness requires a larger phase III trial., Trial Registration: ClinicalTrials.gov: NCT05531422 registered on 6 September 2022 after major amendment, NCT04713189 registered on 14 January 2021., (© 2024. The Author(s).)

Background: Computed tomography (CT)-guided cordotomy has been shown to be a safe and effective method for treating cancer pain in adults in a palliative care setting. Its effectiveness has been rarely reported in children. During cordotomy, patient feedback is considered essential. Unfortunately, in this report, the featured patient's age and demeanor precluded an awake cordotomy. The authors report the first case, to their knowledge, of percutaneous cordotomy with the patient under general anesthesia., Observations: An 11-year-old boy with osteosarcoma of the right pelvis presented with medically refractory unilateral nociceptive pain. The pain prevented ambulation, interfered with sleep, was the focus of his concern, and could not be relieved without sedation. A left percutaneous CT-guided cervical cordotomy while he was under general anesthesia was performed without complication and provided sufficient pain relief to allow ambulation and restorative sleep. Pain was no longer an issue for the patient and his family., Lessons: CT-guided percutaneous cervical cordotomy can be accomplished in a pediatric patient under general anesthesia. The risks of cordotomy under general anesthesia without patient feedback must be weighed against the opportunity to improve palliative care. https://thejns.org/doi/abs/10.3171/CASE2427.

Competing Interests: MB has conducted paid consulting work for Medtronic, Phytome life sciences, Canopy, Esteve and is deputy medical director of Medefer. TC and AN declare no conflicts of interest.

Objective: Pain is the most debilitating and subjective experience of cancer patients. This study examines the severity, interference, characteristics, and associations of severe pain in Sri Lankan cancer patients., Methods: A descriptive study was conducted in Sri Lanka on 384 patients at age 18 or older who had cancer pain for 3 months or more due to the initial lesion, secondaries, radiation, or chemotherapy. Patients with non-cancerous pain or brain metastases were excluded. Data was collected using a validated Sinhala version of the Short-Form Brief Pain Inventory and the Short-Form McGill Pain Questionnaire-2. Logistic regression was used to identify severe pain correlations., Results: The mean of the "worst pain" experience was 7.97, and 73.2% reported their "worst pain" as severe. The "normal works" (62.5%) and "sleep" (58.3%) were severely influenced by pain. "Aching pain," was the most reported pain quality. A statistically significant association was shown between severe pain and male gender (adjusted odds ratio (AOR) = 1.723), being in marriage (AOR = 1.947), absence of family commitments (AOR = 1.8), and pain of 3 months or more duration (AOR = 1.76)., Conclusion: The experiences of cancer pain vary, with the majority suffering from severe pain., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Context: Strong opioids are the cornerstone in the treatment of cancer-related pain., Objectives: This study aims to compare analgesic effectiveness of different strong opioids for the treatment of cancer-related pain., Methods: PubMed and Embase were searched for RCTs that compared strong opioids for treatment of cancer-related pain against one another. A network meta-analysis was conducted and the related Surface Under the Cumulative RAnking (SUCRA)-based treatment ranks were calculated. Primary outcome was pain intensity (numerical rating scale (NRS)) and/or the percentage of patients with ≥50% pain reduction, after 1 and 2-4 weeks., Results: Sixteen RCTs (1813 patients) were included. Methadone showed, with a high certainty of evidence, increased ORs for treatment success at 1 week, compared with morphine, buprenorphine, fentanyl, and oxycodone, range 3.230-36.833. Methadone had the highest likelihood to be the treatment of preference (ToP) (SUCRA 0.9720). For fentanyl, ORs were lower, however significant and with high certainty. After 2-4 weeks, methadone again showed the highest likelihood for ToP, however, with moderate certainty and nonsignificant ORs. The combination of morphine/methadone, compared with morphine, buprenorphine, fentanyl, hydromorphone, methadone, and oxycodone achieved a treatment effect of mean NRS difference after 2-4 weeks between -1.100 and -1.528 and had the highest likelihood for ToP., Conclusion: The results suggest that methadone possibly deserves further promotion as first-line treatment for the treatment of cancer-related pain., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The management of cancer-related pain in patients with opioid use disorder (OUD) remains complex and often challenging for clinicians and patients. There is currently a paucity of data to guide best practices, and the evidence that exists is variably applied. In this hospital-based questionnaire, we sought to understand the variation in practice patterns among clinicians in palliative medicine, addiction medicine, and hospital medicine, in caring for this complex patient population. Sixty-two questionnaire responses were analyzed and variation was found in management of pain, as well as initiation or titration of buprenorphine and methadone. There was also a significant difference in postdischarge subspecialty follow-up. Furthermore, the findings suggest that buprenorphine and methadone may be underutilized in this population. Patients and clinicians may benefit from additional support and standardization of practices to best manage coexisting cancer-related pain and OUD.

Purpose of the study: The study aimed to develop and validate a holistically based follow-up pain assessment diary for patients with cancer pain in Sri Lanka. Design of the study: Mixed-method design adapted. Methods used: Developing a pain diary and testing its psychometric qualities were done in two phases. Comprehensive literature research and qualitative semistructured interviews with patients, clinical, and subject specialists created the pain diary items. Content, face, construct, criterion validity, and reliability were evaluated. Findings: The essential domains to be assessed were identified under six main categories; pain and related characteristics, physical, psychological, social, spiritual, and financial aspects. The average variance extracted from the subscales "Influence on daily life," "Gastric disturbances," and "Pain intensity" were 0.526, 0.562, and 0.696, respectively. The heterotrait-monotrait criterion values between subscales were from 0.691 to 0.44, which was lower than the threshold. Good to excellent correlation coefficients were demonstrated with the scores of reference tools. Cronbach's alpha was computed for each subscale and ranged from 0.75 to 0.92 and composite reliability from 0.921 to 0.826. Conclusions: Pain diary is a reliable and valid instrument for follow-up assessment of holistic pain experience enabling holistic nursing among patients with cancer pain in Sri Lanka.

Background: Opioid pain management in cancer survivorship is a complex and understudied topic., Methods: The authors conducted in-depth, qualitative interviews to understand clinician approaches to opioid pain management in chronic cancer pain and to generate ideas for improvement. They used a rigorous, inductive, qualitative, descriptive approach to examine clinician (n = 20) perspectives about opioid pain management in survivorship, including oncologists (n = 5), palliative care clinicians (n = 8), primary care clinicians (n = 5), and pain management specialists (n = 2)., Results: The findings indicated that no consistent medical home exists for chronic pain management in cancer survivors and that there are fundamental differences in how each subspecialty approaches chronic pain management in survivorship (e.g., "Do we think of this as noncancer pain or cancer pain?… This is in this limbo zone-this gray zone-because it's cancer-related pain, right?"). Simultaneously, clinicians are influenced by their peers' perceptions of their opioid prescribing decisions, sparking intraprofessional tension when disagreement occurs. In these instances, clinicians described overthinking and doubting their clinical decision-making as well as a sense of judgment, pressure, and/or shame. Finally, clinicians acknowledged a fear of consequences for opioid prescribing decisions. Specifically, participants cited conflict with patients, sometimes escalating to aggression and threats of violence, as well as potential disciplinary actions and/or legal consequences., Conclusions: Participants suggested that opportunities to improve chronic cancer pain care include developing clear, systematic guidance for chronic cancer pain management, facilitating clinician communication and consultation, creating tailored survivorship care plans in partnership with patients, and developing accessible, evidence-based, complementary pain treatments., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Context: Cancer pain is multidimensional and management should be individualized to patient goals. The current standard for pain goal assessment is the personal pain goal (PPG), a numeric rating for tolerable pain intensity. However, the PPG may not accurately capture a personally meaningful goal for tailoring pain management., Objectives: Identify how pain goals are used in cancer pain management and types of goals researched., Methods: CINAHL, PsychInfo, and PubMed databases and manual searching were used to locate research or scholarship about cancer pain goals. Authors reviewed titles, abstracts and full text to agree on the final sample., Results: Sixteen articles met inclusion criteria. Study designs included: quality improvement project (1), concept analysis (1), qualitative methods (5), quantitative methods (8), and mixed methods (1). Findings included: goal setting as a key attribute of pain management; achieving personal goals as the outcome of pain management work; qualitative themes discussed personal goals related to pain management; developing a patient pain management resource including a SMART goal; using motivational interviewing to set functional pain goals; PPG assessment was feasible; and achieving PPG equated to having controlled pain when compared to the clinically important difference measure used in research (≥30%). Quantitative studies reported on PPGs only., Conclusion: Currently, assessments for cancer pain goals do not include function, activities, moods, medication effects, or safety that patients wish to achieve as a pain management outcome. Development and testing of multidimensional patient pain goals assessments is warranted so that goals can be consistently assessed, documented, and personally meaningful., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Context: Naloxone nasal spray is recommended for patients with risk factors for opioid overdose. However, cancer patients' perceptions and beliefs regarding naloxone prescriptions and their self-perceived risks for overdose are understudied., Objective: To determine the proportion of cancer patients at risk for overdose who perceived naloxone as beneficial., Methods: Between July 2020 and April 2022, we surveyed 150 adult patients from the supportive care ambulatory clinic at a tertiary cancer center in the United States who received a co-prescription of naloxone nasal spray. We measured patients' knowledge of overdose risk-factors, attitudes, beliefs, and education received on naloxone. Risk-factors between beneficial vs. nonbeneficial groups were analyzed. The survey was administered on paper or via a telephone interview., Results: Of the 150 patients, 55% were male, 70% were white, and 81% had advanced cancer. The majority of patients believed naloxone was beneficial (100/150, 67%). When compared to the nonbeneficial group, more patients from the beneficial group agreed that the concurrent use of alcohol (100% vs. 90%; P = 0.004) or sedating drugs (96% vs. 85%; P = 0.04) with opioids could result in overdoses and felt safe having naloxone at home (95% vs. 60%; P <0.0001). More patients from the nonbeneficial group associated naloxone prescription with being suspected of misusing opioids (12/50 vs. 8/100; P = 0.01), and fewer had confidence in their caregivers' ability to administer naloxone (69% vs. 95%; P < 0.0001)., Conclusion: Most patients understood the benefits of naloxone and felt safe having one at home. More research is needed to identify knowledge gaps and develop educational strategies for those who find it nonbeneficial., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Pain is a challenging multifaceted symptom reported by most cancer patients. This systematic review aims to explore applications of artificial intelligence/machine learning (AI/ML) in predicting pain-related outcomes and pain management in cancer., Methods: A comprehensive search of Ovid MEDLINE, EMBASE and Web of Science databases was conducted using terms: "Cancer," "Pain," "Pain Management," "Analgesics," "Artificial Intelligence," "Machine Learning," and "Neural Networks" published up to September 7, 2023. AI/ML models, their validation and performance were summarized. Quality assessment was conducted using PROBAST risk-of-bias andadherence to TRIPOD guidelines., Results: Forty four studies from 2006 to 2023 were included. Nineteen studies used AI/ML for classifying pain after cancer therapy [median AUC 0.80 (range 0.76-0.94)]. Eighteen studies focused on cancer pain research [median AUC 0.86 (range 0.50-0.99)], and 7 focused on applying AI/ML for cancer pain management, [median AUC 0.71 (range 0.47-0.89)]. Median AUC (0.77) of models across all studies. Random forest models demonstrated the highest performance (median AUC 0.81), lasso models had the highest median sensitivity (1), while Support Vector Machine had the highest median specificity (0.74). Overall adherence to TRIPOD guidelines was 70.7%. Overall, high risk-of-bias (77.3%), lack of external validation (14%) and clinical application (23%) was detected. Reporting of model calibration was also missing (5%)., Conclusion: Implementation of AI/ML tools promises significant advances in the classification, risk stratification, and management decisions for cancer pain. Further research focusing on quality improvement, model calibration, rigorous external clinical validation in real healthcare settings is imperative for ensuring its practical and reliable application in clinical practice., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Advancements in understanding pain physiopathology have historically challenged animals' absence of pain senses. Studies have demonstrated that animals have comparable neural pain pathways, suggesting that cats and dogs likely experience pain similarly to humans. Understanding brain circuits for effective pain control has been crucial to adjusting pain management to the patient's individual responses and current condition. The refinement of analgesic strategies is necessary to better cater to the patient's demands. Cancer pain management searches to ascertain analgesic protocols that enhance patient well-being by minimizing or abolishing pain and reducing its impact on the immune system and cancer cells. Due to their ability to reduce nerve sensitivity, opioids are the mainstay for managing moderate and severe acute pain; however, despite their association with tumor progression, specific opioid agents have immune-protective properties and are considered safe alternatives to analgesia for cancer patients.