IMproved MAnagement (IM-MA study) in cancer-related pain: the value of a joint approach by an integrated team of radiotherapist and anesthetist

Abstract

A multidisciplinary Team for Pain Management improved the clinical management, optimizing pain control and increasing adequacy of pharmacological management. The TPM intervention seems particularly worth for patients presenting specific features including BTcP, neuropathic pain, severe pain due to bone metastases, and any potential candidate to radiotherapy. Larger series and QoL questionnaires are required to confirm these results.

Benefits of using the Brief Pain Inventory in patients with cancer pain: an intervention study conducted in Swedish hospitals

“…Our findings are consistent with others showing that pain intensity can decrease when medications are adjusted by an experienced pain management physician [28], when pain management guidelines are followed [29] or when pain consultations are conducted each week by the radiation oncologist and anaesthetist [30]. In summary, a combination of several [31].…”

“…In the intervention group, 25% were prescribed analgesics for neuropathic pain at follow-up. This is a higher percentage than the 10% and 8% reported elsewhere [33,36] but in line with Manfrida et al [30], who report an increase of neuropathic pain drugs of up to 27% after their intervention. In our study, the completed patient body chart and description of pain characteristics in the BPI likely contributed to the increased prescription of medications to treat neuropathic pain.…”

“…Furthermore, 80% of patients in the intervention group were prescribed opioids regularly at follow-up. The study by Manfrida et al [30] likewise showed an increase in opioid use; the authors report that 85% of patients received a prescription for opioids after an intervention. In other studies that achieved lower pain levels, increased use of opioids [29] and opioid rotation [28] were the most common interventions.…”

Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

“…Skeletal-related events (SRE) are complications of bone metastasis growth and consist of pathologic fractures, spinal cord compressions and the necessity of radiotherapy for pain/impending fracture or surgery to bone. SRE can compromise performance status, with a reduction of quality of life, poor survival outcomes and also limited access to systemic therapies [ 13 ].…”

Actualities on Diagnosis, Targeting and Treating Bone Metastases in Breast Cancer with Radiotherapy and New Drugs

“…Bone metastases are a common cause of cancer pain and its possible local mechanisms of aetiology are release of chemical mediators, increased pressure in the bone, microfractures, stretching of the periosteum, reactive muscle spasm, nerve root infiltration, compression of the nerve due to collapse of the bone [12]. Skeletal-related events (SRE) are complications of bone metastasis growing, such as pathological fracture, spinal cord compression, necessity of radiotherapy for pain/impending fracture or surgery to bone, that can compromise patients performance status with reduction of quality of life and limitation to access systemic therapies with a prejudice of survival outcomes [13]. On the other side, thanks to new emerging diagnostic imaging and new drugs [14], we are assisting even more to oligometastatic presentation (de novo or inducted) spread [8].…”