Gender based differences, pharmacogenetics and adverse events in chronic pain management

Planelles, Beatriz; Margarit, César; Inda, María-del-Mar; Ballester, Pura; Muriel, Javier; Barrachina, Jordi; Ajo, Raquel; Esteban, Maria J.; Peiró, Ana M.

doi:10.1038/s41397-019-0118-9

Cited by 29 publications

(23 citation statements)

References 41 publications

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“…Similarly, the implications of emerging data regarding gender and sex differences in response to opioid therapy for pain have not been considered within a palliative care context. 44 Given the centrality of effective pain management to palliative care, we believe interrogating gender as a determinant of both pain experience and pain management must be prioritised in future research. We therefore provide a brief overview of the gendered nature of pain below.…”

Section: Women’s Symptom Experience At End Of Lifementioning

confidence: 99%

Gender and palliative care: a call to arms

2020

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There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice.

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Section: Women’s Symptom Experience At End Of Lifementioning

confidence: 99%

Gender and palliative care: a call to arms

2020

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“…Gender In palliative care and in the field of cancer pain management, gender issues are currently becoming increasingly recognized and future research in this area is advocated [34][35][36]. Interestingly, in our trial, women were more likely to report improvement from TENS.…”

Section: Gender Aspects and Incident Painmentioning

confidence: 75%

Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial

Siemens

Boehlke

Bennett

et al. 2020

Support Care Cancer

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Purpose Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. Methods A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensitymodulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." Results Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: − 0.2, 95% confidence interval − 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. Conclusion TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.

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“…A total of 137 patients with OUD (cases) were included from an opioid tapering procedure routinely developed at PU [ 15 ] under the following inclusion criteria: adults (>18 years old) with CNCP under long-term prescribed opioids (≥6 months) and a clinical diagnosis of OUD Controls data ( n = 669) were obtained from two concomitant observational studies [ 16 , 17 ] with same inclusion criteria except OUD diagnosis. All variables were collected from their original database and, if needed, they were completed using Electronic Health Records (EHRs), which allows for reviewing medical diagnoses, outcomes, and medication use.…”

Section: Methodsmentioning

confidence: 99%

Sex-Differences in Pain and Opioid Use Disorder Management: A Cross-Sectional Real-World Study

Escorial

Muriel²,

Ferrí

et al. 2022

Biomedicines

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(1) Background: It is essential to focus attention on sex-specific factors which are clinically relevant in pain management, especially with regards to opioid use disorder (OUD) risk. The aim of this study was to explore potential sex-differences in chronic non-cancer pain (CNCP) outpatients. (2) Methods: An observational cross-sectional study was conducted under CNCP outpatients with long-term prescribed opioids (n = 806), wherein 137 patients had an OUD diagnosis (cases, 64% females) and 669 did not (controls, 66% females). Socio-demographic, clinical, and pharmacological outcomes were analyzed. (3) Results: Female controls presented an older age and less intensive pain therapy but higher psychotropic prescriptions and emergency department visits compared to male controls. Meanwhile, cases demonstrated a younger age, higher work disability, double morphine equivalent daily dose, and benzodiazepine use compared with controls. Here, female cases showed an 8% greater substance use disorder (OR 2.04 [1.11–3.76]) and 24% lower tramadol use, while male cases presented a 22% higher fentanyl use (OR 2.97 [1.52–5.81]) and reported the highest number of adverse drug reactions (24%, OR 2.40 [1.12–5.16]) compared with controls. (4) Conclusions: An OUD individual risk profile was evidenced with sex-differences to take into consideration to design equal prevention programs.

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Gender based differences, pharmacogenetics and adverse events in chronic pain management

Cited by 29 publications

References 41 publications

Gender and palliative care: a call to arms

Gender and palliative care: a call to arms

Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial

Sex-Differences in Pain and Opioid Use Disorder Management: A Cross-Sectional Real-World Study

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