Advances in the therapy of cancer pain: from novel experimental models to evidence-based treatments (Views : 7622 times)
Cancer related pain may be due to the malignant disease itself, or subsequent to treatments, such as surgery, chemotherapy or radiation therapy. The pathophysiology of pain due to cancer may be complex and include a variety of nociceptive, inflammatory, and neuropathic mechanisms. Despite modern advances in pharmacotherapy, cancer pain remains overall under-treated in a world-wide scale, and a main reason is lack of understanding of its pertinent pathophysiology and basic pharmacology.
Recently, pertinent animal models have facilitated understanding of the pathobiology and have advanced the pharmacology of cancer pain, with significant translational applicability to clinical practice. Furthermore, quantitative and qualitative systematic reviews, integrating the best available evidence, indicate the validity of treatments that fit into an expanded view of the WHO-analgesic ladder. Appropriate current treatments include a valid therapeutic role of non-opioid and opioid analgesics, adjuvants -such as gabapentin, biphosphonates, palliative radiation therapy and radiopharmaceutical compounds, and interventional pain therapy (including neuraxial drug infusion and verterbroplasty for spine metastases) in selected patients.
Overall, experimental animal models simulating cancer pain have been useful in providing pertinent information on the pathophysiology of cancer pain, and provide a testing ground for established and novel therapies, which are validated by clinical evidence. This is clinically significant, considering the epidemiological dimensions and the problematic nature of cancer pain.
Key words: cancer, pain intractable, palliative care, neoplasm metastasis, analgesics non-narcotic, analgesics opioid.
Anesthetics and cardioprotection (Views : 5174 times)
The prevalence of the cardiovascular disease significantly affects the outcome of both cardiac and non-cardiac surgery, and perioperative cardiac morbidity is one of the leading causes of death following anesthesia and surgery. The considerable incidence of myocardial infarction, congestive heart failure, myocardial ischemia, or serious dysrhythmias during the intraoperative or postoperative periods, has led many studies to examine medical factors and interventions for decreasing cardiac risk in patients with cardiovascular disease. An extensive amount of work has focused on whether any one anesthetic agent or technique is particularly beneficial for patients with coronary artery disease. Experimental studies conducted in our laboratory have clearly shown that volatile anesthetics may exert profound cardioprotection against myocardial ischemia and reperfusion injury. This article examines the recent evidence about the importance of mitochondria, reactive oxygen species and the KATP channels in cardioprotective signaling by volatile anesthetics. Moreover, the article addresses current concepts and controversies regarding specific roles of the mitochondrial and the sarcolemmal KATP channels in anesthetic-induced preconditioning.
Key words: preconditioning, volatile anesthetics, heart, coronary disease, ischemia, myocardial infarction, mitochondria.
Cardiac protection by preoperative intervention in noncardiac surgery (Views : 7487 times)
Preoperative coronary intervention is one option to optimize the cardiac risk patient scheduled for noncardiac surgery. Such an intervention, however, is only justified for high risk procedures and if the indication for preoperative intervention is independent from surgery.
Currently, PTCA with stent implantation is the most commonly used practice. Dependent of the type of stent (bare-metal stent or drug-eluting stent) dual antiplatelet therapy is mandatory for 1 - 12 months.
The surgeon, the cardiologist and the anesthesiologist have to decide in an interdisciplinary approach the perioperative management to navigate the patient between stent thrombosis and surgical bleeding.
Key words: noncardiac surgery, cardiac risk, percutaneous coronary intervention, coronary stents
Gabapentin for acute and chronic post-surgical pain (Views : 6446 times)
Pain after surgery remains a significant clinical problem as it impairs recovery adversely and may lead to the transition to chronic pain. Opioid medications are far from ideal agents in suppressing postoperative pain. Gabapentin -an anticonvulsant with antihyperalgesic properties- originally efficacious against neuropathic pain seems to be very promising for the management of pain after surgery as well. Gabapentin, by decreasing noxious stimulus-induced excitatory neurotransmitter release at the spinal cord, may attenuate central sensitization, and eventually decrease postoperative late pain. Furthermore, different sites of action may be pertinent to a synergistic effect with opioids. Both actions (antihyperalgesic effect and synergy with opioid analgesia) may manifest as analgesia and/or opioid-sparing effect after surgery. This has been confirmed by a variety of clinical studies, in a variety of settings. Most of these studies have shown that either single preoperative or repeated doses of gabapentin, continued for up to a few days after surgery, decrease acute postoperative pain and/or need for postoperative opioids. This has been shown for procedures such as abdominal and vaginal hysterectomy, breast surgery for cancer (mastectomy or lumpectomy), lumbar discectomy and spinal fusion, laparoscopic cholecystectomy and other, such as ENT surgery. Finally, a few studies indicate that perioperative gabapentin may as well decrease chronic pain several weeks after surgery.
Key Words: pain postoperative, pain chronic, post-mastectomy pain, anticonvulsants, gabapentin
How to prepare for the European Diploma Examination of Anaesthesiology and Intensive Care (Views : 17143 times)
Key words: examinations, european diploma, education and training