Perioperative Immunosuppression and Risk of Cancer Progression: The Impact of Opioids on Pain Management

Zajączkowska, Renata; Leppert, Wojciech; Mika, Joanna; Kocot-Kępska, Magdalena; Woroń, Jarosław; Wrzosek, Anna; Wordliczek, Jerzy

doi:10.1155/2018/9293704

Cited by 23 publications

(18 citation statements)

References 57 publications

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“…The main mechanisms responsible for this effect are the stimulation of angiogenesis and immunosuppression, mainly mediated by agonism at MOR [66]. Studies have suggested that morphine has the greatest immunosuppressive potential, and fentanyl has intermediate potential, whereas buprenorphine and tramadol have shown the lowest or no immunosuppressive effect [67]. Experimental studies have shown that KOR agonists are efficacious in the treatment of CIBP in mice, without changing tumor size or proliferation in cancer cell lines.…”

Section: Treatment Of Cancer-induced Bone Painmentioning

confidence: 99%

Bone Pain in Cancer Patients: Mechanisms and Current Treatment

Zajączkowska

Kocot-Kępska

Leppert

et al. 2019

IJMS

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137

127

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The skeletal system is the third most common site for cancer metastases, surpassed only by the lungs and liver. Many tumors, especially those of the breast, prostate, lungs, and kidneys, have a strong predilection to metastasize to bone, which causes pain, hypercalcemia, pathological skeletal fractures, compression of the spinal cord or other nervous structures, decreased mobility, and increased mortality. Metastatic cancer-induced bone pain (CIBP) is a type of chronic pain with unique and complex pathophysiology characterized by nociceptive and neuropathic components. Its treatment should be multimodal (pharmacological and non-pharmacological), including causal anticancer and symptomatic analgesic treatment to improve quality of life (QoL). The aim of this paper is to discuss the mechanisms involved in the occurrence and persistence of cancer-associated bone pain and to review the treatment methods recommended by experts in clinical practice. The final part of the paper reviews experimental therapeutic methods that are currently being studied and that may improve the efficacy of bone pain treatment in cancer patients in the future.

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Section: Treatment Of Cancer-induced Bone Painmentioning

confidence: 99%

Bone Pain in Cancer Patients: Mechanisms and Current Treatment

Zajączkowska

Kocot-Kępska

Leppert

et al. 2019

IJMS

Self Cite

137

127

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“…The acute and chronic administration of exogenous opioids appear to affect the body's cell mediated and humoral immune response. Exogenous opioids have a significant effect on several components of the immune system including lymphocyte proliferation., phagocytic activity, natural killer cell activity, cytokine expression and antibody production [8,9].…”

Section: Introductionmentioning

confidence: 99%

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

Aboalsoud

Arida

Sabry³

et al. 2021

Egyptian Journal of Anaesthesia

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Background: Modified radical mastectomy (MRM) with axillary clearance of lymph nodes was routinely performed under general anaesthesia with intra-and postoperative opioid analgesia. Recently, there has been a move toward opioid-free anesthesia (OFA) to appreciate the goals of hypnosis with amnesia and sympathetic stability without the adverse effects of opioids.The aim of this study was to evaluate the effect of OFA versus opioid-based anaesthesia (OBA) in patients with breast cancer, who had undergone unilateral MRM. The primary aims:• Pain intensity using the visual analogue scale in the first 24 h post-operatively.• Screening for post mastectomy neuropathic pain. The secondary aims:• Effect of opioid and surgical stress on the immune system.• Patient outcome including haemodynamic stability, patient satisfaction and occurrence of post-operative complications. Methods: Forty adult female patients scheduled for elective unilateral MRM were randomly divided into two groups (20 patients in each group): OFA and OBA. Results: There was statistically significant decrease in pain score at rest and on movement in the OFA group. Postoperative nausea and vomiting was significantly decreased in the OFA group (P = 0.04). Patients in the OFA group were more satisfied than those in the OBA group using verbal rating scale for satisfaction (P < 0.001). There was significant low incidence of neuropathic pain in the OFA group; also, we found significant changes in interleukin 10, tumour necrosis factor alpha and caspase 3 between the two groups. Conclusion: OFA is safe and effective in mastectomy as it decreases the pain score and the incidence of post mastectomy neuropathic pain; moreover, it also shows better immune response postoperatively.

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“…[ 4 , 13 ] The use of RA has been reported to reduce the dose of opioids and thus minimize the risk of immune suppressive effect of opioids. [ 14 ] However, in the present study and even within RA patients, opioids were extensively administered to control pain in the perioperative period. However, the immunosuppressive effects of opioids have been reported in many previous and recent studies.…”

Section: Discussionmentioning

confidence: 93%

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

Alhayyan

McSorley²,

Kearns³

et al. 2021

Medicine

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There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear. The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer. Database of 507 patients who underwent elective open or laparoscopic colorectal cancer surgery between 2015 and 2019 at a single center was studied. The anesthetic technique used was categorized into either GA or GA + RA using a prospective proforma. The relationship between each anesthetic technique and perioperative clinicopathological characteristics was examined using binary logistic regression analysis. The majority of patients were male (54%), younger than 65 years (41%), either normal or overweight (64%), and were nonsmokers (47%). Also, the majority of patients underwent open surgery (60%) and received mainly general + regional anesthetic technique (80%). On univariate analysis, GA + RA was associated with a lower day 4 CRP (≤150/>150 mg/L) concentration. On day 4, postoperative CRP was associated with anesthetic technique [odds ratio (OR) 0.58; confidence interval (CI) 0.31–1.07; P = .086], age (OR 0.70; CI 0.50–0.98; P = .043), sex (OR 1.15; CI 0.95–2.52; P = .074), smoking (OR 1.57; CI 1.13–2.19; P = .006), preoperative mGPS (OR 1.55; CI 1.15–2.10; P = .004), and preoperative dexamethasone (OR 0.70; CI 0.47–1.03; P = .072). On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32–0.97; P = .039), age (OR 0.74; CI 0.55–0.99; P = .045), smoking (OR 1.58; CI 1.18–2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08–1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50–0.92; P = .014). There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.

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Perioperative Immunosuppression and Risk of Cancer Progression: The Impact of Opioids on Pain Management

Cited by 23 publications

References 57 publications

Bone Pain in Cancer Patients: Mechanisms and Current Treatment

Bone Pain in Cancer Patients: Mechanisms and Current Treatment

The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response

The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

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