Circadian variation of breakthrough pain in cancer patients

Saini, Andrea; Tucci, Marco; Tampellini, Marco; Maina, D; Bouraouia, K; Giuliano, Pl; Termine, A; Castellano, Maurizio; Campagna, Sara; Laciura, P.; Berruti, Alfredo

doi:10.1002/j.1532-2149.2012.00184.x

Cited by 23 publications

(21 citation statements)

References 23 publications

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“…It is well known that performance status bears prognostic value; this is the first study to statistically clarify the relationship between outcomes and rest-activity rhythm. The cancer patients in this study had been hospitalized for treatment; therefore, the disruptions in their rest-activity rhythms may have been caused by the combined effects of pain, fatigue, lack of exercise and poor sleep quality (Miller et al, 2008;Saini et al, 2013). Our results indicate that the I5O of hospitalized cancer patients experiencing pain is negatively correlated to their survival, which supports the findings of previous studies (Innominato et al, 2009a(Innominato et al, , 2012Mormont et al, 2000).…”

Section: Discussionsupporting

confidence: 93%

“…Ma et al (2014) reported a positive correlation between the severity of pain among cancer patients and their rest-activity rhythm, as represented by the dichotomy index (I5O). Differences in restactivity rhythm have been observed among cancer patients with cancer pain of various severities (Mormont et al, 2000;Saini et al, 2013). Irregularities in rest-activity rhythm have been shown to be proportional to the cancer pain endured.…”

Section: Introductionmentioning

confidence: 96%

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Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

Chang

2014

Chronobiology International

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The purpose of this study was to investigate the influence of rest-activity rhythm on the survival of cancer patients. This study collected data related to cancer patients experiencing pain who had been hospitalized for treatment between August 2006 and October 2007. Data included the Karnofsky Performance Status Index as a representation of functional condition as well as the Brief Pain Inventory and the Pittsburgh Sleep Quality Index. Actigraphic methods were used to record the dichotomy index (I < O) of patients' rest-activity rhythms over periods of three consecutive days. Patients were closely followed until 31 July 2013. Results were analyzed using Kaplan-Meier survival analysis, log-rank testing and Cox proportional hazards regression analysis to evaluate whether alterations in the rest-activity rhythm affected the survival rate of the patients. Of the 68 hospitalized cancer patients experiencing pain at the time of admission, 51 subsequently died within the study period. A significant difference was observed in the survival curves between the regular I < O group and the disrupted I < O group (log rank = 7.942, p = 0.005). A multivariable proportional hazard model was used for analysis of overall survival, revealing that the risk of death within the study period among patients with disrupted I < O was 4.59 times higher than that of patients with regular I < O (95% CI: 1.92-10.96, p = 0.001). Among patients with poor performance status, the risk of death among patients with disrupted I < O was 8.68 times higher than that of patients with regular I < O (95% CI: 2.50-30.09, p = 0.001). Disruptions in rest-activity rhythm were negatively correlated with the survival of hospitalized cancer patients experiencing pain. Effects were particularly pronounced in cancer patients with poor performance status.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 96%

Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

Chang

2014

Chronobiology International

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“…Diurnal rhythms in pain hypersensitivity have been demonstrated clinically 1 2 3 4 5 6 . However, the temporal pattern of the exacerbation of pain is distinct in a manner that is dependent on the cause of the pain.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of pathological conditions exhibit profound day–night changes in the symptom intensity with a large portion exacerbating and occurrence of grave events. Diurnal alterations in pain hypersensitivity have been confirmed in patients with cancer 1 2 , rheumatoid arthritis 3 , diabetic neuropathy 4 , fibromyalgia 5 and multiple sclerosis 6 ; however, the underlying mechanism remains unknown.…”

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confidence: 99%

Glucocorticoid regulation of ATP release from spinal astrocytes underlies diurnal exacerbation of neuropathic mechanical allodynia

et al. 2016

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Diurnal variations in pain hypersensitivity are common in chronic pain disorders, but the underlying mechanisms are enigmatic. Here, we report that mechanical pain hypersensitivity in sciatic nerve-injured mice shows pronounced diurnal alterations, which critically depend on diurnal variations in glucocorticoids from the adrenal glands. Diurnal enhancement of pain hypersensitivity is mediated by glucocorticoid-induced enhancement of the extracellular release of ATP in the spinal cord, which stimulates purinergic receptors on microglia in the dorsal horn. We identify serum-and glucocorticoid-inducible kinase-1 (SGK-1) as the key molecule responsible for the glucocorticoid-enhanced release of ATP from astrocytes. SGK-1 protein levels in spinal astrocytes are increased in response to glucocorticoid stimuli and enhanced ATP release by opening the pannexin-1 hemichannels. Our findings reveal an unappreciated circadian machinery affecting pain hypersensitivity caused by peripheral nerve injury, thus opening up novel approaches to the management of chronic pain.

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“…Other studies have found the mean incidence to be four episodes per day, with a mean duration of 30 minutes each (range 1-240 minutes) 49 , and the median time from onset to peak intensity to be 3 minutes (range 1 second to 30 minutes) 81 . Although BTCP follows a circadian pattern 83 , there is considerable variability in duration and intensity from one patient to another, and from one episode to another in an individual patient.…”

Section: Breakthrough Cancer Painmentioning

confidence: 99%

Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements

Müller-Schwefe¹,

Ahlbeck

Aldington

et al. 2014

Current Medical Research and Opinion

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Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms -rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapyinduced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level.

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Circadian variation of breakthrough pain in cancer patients

Abstract: BTP onset follows a circadian rhythm, with an acrophase occurring in the late morning.

Cited by 23 publications

References 23 publications

Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

Glucocorticoid regulation of ATP release from spinal astrocytes underlies diurnal exacerbation of neuropathic mechanical allodynia

Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements

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