• Older adults
• pain intensity
• pain management
• sublingual fentanyl citrate

• Humans
• Retrospective Studies
• Fentanyl/administration & dosage
• Fentanyl/adverse effects
• Fentanyl/therapeutic use
• Cancer Pain/drug therapy
• Aged
• Administration, Sublingual
• Male
• Female
• Breakthrough Pain/drug therapy
• Breakthrough Pain/etiology
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/adverse effects
• Analgesics, Opioid/therapeutic use
• Aged, 80 and over
• Age Factors
• Treatment Outcome
• Neoplasms/complications

• Care unit
• Lung cancer
• Narrative care
• Pain
• Quality of life

• bone metastasis pain
• functional connectivity
• gray matter volume
• voxel-based morphometry

• Humans
• Gray Matter/diagnostic imaging
• Lung Neoplasms/complications
• Cerebral Cortex
• Temporal Lobe
• Chronic Pain

• CSTB2022NSCQ-MSX0396 Chongqing Natural Science Foundation
• cstc2021jcyj-msxmX0319 Chongqing Natural Science Foundation
• cstc2021jcyj-msxmX0313 Chongqing Natural Science Foundation
• CSTB 2022NSCQ-MSX0823 Chongqing Natural Science Foundation
• Jcd2022+55 Chongqing Shapingba District Decision Consulting and Management Innovation project Guiding plan project
• Jcd202254 Chongqing Shapingba District Decision Consulting and Management Innovation project Guiding plan project
• 82071883 National Natural Science Foundation of China
• 82371937 National Natural Science Foundation of China
• cmba2022kyym-zkxmH0009 Research and Breeding Project of Chongqing Medical Biotechnology Association

• arthropathy
• chest pain
• chest wall pain
• chronic postsurgical pain
• facet joint pain
• knee pain
• persistent knee pain

• brief pain inventory
• cancer in latin america
• cancer pain
• cancer pain assessments
• latin american cancer patients
• pain assessment
• pain assessment tools
• pain intensity
• spiritual pain

• CPT-11
• chemotherapy
• drug metabolism
• gut microbiome
• irinotecan
• opioids

• Humans
• Mice
• Male
• Animals
• Irinotecan
• Analgesics, Opioid/pharmacology
• Dysbiosis
• Disease Models, Animal
• RNA, Ribosomal, 16S
• Antineoplastic Agents, Phytogenic/toxicity
• Mice, Inbred C57BL
• Camptothecin/toxicity
• Bacteria
• Neoplasms
• Glucuronidase/metabolism
• Glucuronidase/pharmacology
• Morphine Derivatives/pharmacology

• R01 DA012104 NIDA NIH HHS
• F31 DA053795 NIDA NIH HHS
• R01 DA043252 NIDA NIH HHS
• R01 DA044582 NIDA NIH HHS
• R01 DK117576 NIDDK NIH HHS
• R01 DA050542 NIDA NIH HHS
• R01 DA037843 NIDA NIH HHS
• R01 DA034582 NIDA NIH HHS
• R01 DA022935 NIDA NIH HHS
• R01 DA031202 NIDA NIH HHS
• T32 DA045734 NIDA NIH HHS
• R01 DA047089 NIDA NIH HHS

Rapid-onset opioids (ROOs) are effective treatments for breakthrough cancer pain (BTcP) given their rapid onset of action and relatively short duration of analgesia. The aim of this article is to describe specific considerations for the use of ROOs in daily practice, focusing on dose titration and treatment of specific populations.

We conducted a narrative review on the use of ROOs for BTcP. We selected papers according to the following search terms: “breakthrough cancer pain” and “rapid onset opioids”.

ROOs may be considered as the most suitable drugs to treat BTcP and can be used “on-demand”. Several fentanyl formulations are available and have been associated with control of BTcP and with improvement in quality of life. Various titration schemes have been used to optimize ROO dosing; however, a dose-proportional scheme could be considered safe and effective in most patients. Specific formulations may be more suitable for specific patient subgroups; for example, patients with oral mucositis may prefer intranasal to oral formulations. Moreover, elderly patients or those without caregivers should be clearly educated on the use of these formulations. A key element in achieving successful treatment of BTcP is awareness of the barriers to pain management, including poor overall assessment, patient reluctance to take opioids or report pain, and physician reluctance to prescribe opioids.

A personalized approach is fundamental when prescribing a medication for BTcP, and careful attention should be given to drug choice and route of administration, and to the need for alternative therapeutic options.

• Angelini Pharma

Pain is a fearful yet common symptom among lung cancer patients. This multicenter, cross‐sectional study was conducted to examine the current status of pain prevalence and management in lung cancer patients in northern China.

A total of 18 hospitals across northern China were selected. Patients with primary lung cancer who visited the outpatient clinic or were admitted in the wards on a preplanned day were invited to complete a questionnaire. Meanwhile, physicians who had experience of treating primary lung cancer patients were also surveyed.

A total of 533 patients and 197 physicians provided valid responses to the survey, of which 45.4% (242/533) of patients reported pain during the course of disease and 24.2% (129/533) of patients had experienced pain within the past 24 h. The mean average pain intensity by the brief pain inventory was 3.47 ± 1.55. The binary logistic regression analysis showed female gender and stage IV disease were significantly associated with the presence of pain. A total of 74.4% (96/129) of patients reporting pain within 24 h were taking analgesics. The most common reason for patients not using analgesics was that the pain was tolerable (48.2%), while the most common barriers to prescribing opioids as reported by physicians were fear of adverse reactions (43.7%) and fear of addiction (43.1%).

Despite recognition of the importance of pain control by most physicians and an improvement in cancer pain management, inadequate treatment of cancer pain still exists in lung cancer patients in northern China. High‐quality pain education for both patients and physicians is needed in the future.

• cancer pain
• lung cancer
• pain management
• prevalence
• survey

• Analgesics
• China/epidemiology
• Cross-Sectional Studies
• Female
• Humans
• Lung Neoplasms/complications
• Lung Neoplasms/epidemiology
• Lung Neoplasms/therapy
• Pain/drug therapy
• Prevalence

• Mundipharma (China) Pharmaceutical

• aged
• cancer
• epidemiology
• incidence
• older adults

• Aged, 80 and over
• Female
• Forecasting
• Global Health/trends
• Health Services for the Aged
• Humans
• Incidence
• Male
• Neoplasms/epidemiology

• 001 World Health Organization
• H2020 Marie Skłodowska‐Curie Actions

• cancer
• opioids
• pain
• survival

• Adult
• Aged
• Analgesics, Opioid/standards
• Analgesics, Opioid/therapeutic use
• Analysis of Variance
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Neoplasms/complications
• Neoplasms/drug therapy
• Neoplasms/mortality
• Pain/drug therapy
• Pain/etiology
• Pain Management/methods
• Pain Management/standards
• Pain Management/statistics & numerical data
• Proportional Hazards Models
• Retrospective Studies
• Survival Analysis

• adverse drug effects
• analgesics
• cancer
• pain management
• polymorphism

• ATP Binding Cassette Transporter, Subfamily B/genetics
• ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
• Analgesics/therapeutic use
• Cancer Pain/drug therapy
• Cancer Pain/genetics
• Cytochrome P-450 CYP2D6/genetics
• Gene Regulatory Networks
• Glucuronosyltransferase/genetics
• Humans
• Pain Management/methods
• Pharmacogenomic Variants
• Polymorphism, Single Nucleotide
• Quality of Life
• Receptors, Opioid, mu/genetics

Sublingual fentanyl tablets (SFTs) have been shown to be a safe and effective option in controlling breakthrough cancer pain (BTcP). However, further examination is required to investigate the use of SFTs among the elderly. The aim of this study was to examine the influence of age in BTcP management with SFTs in the elderly population.

We performed subgroup analyses of a recently completed trial in two subsets of individuals: patients aged 65–74 years (low age group) and patients ≥ 75 years (high age group). Pain intensity (PI), onset of pain relief, frequency and duration of BTcP episodes, and adverse events (AEs) were assessed at 3, 7, 15, and 30 days. Health status instruments used were the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and the Short Form 12, version 2 (SF-12v2) questionnaire.

Levels of PI at the end of the study improved significantly as compared with baseline in both the low and the high age groups (30.0% and 27.7% reduction, respectively). The onset of analgesia at the end of the study began in < 10 min in 85.0% of young–old subjects and in 62.5% of patients ≥ 75 years, but no significant differences were found. BTcP episodes lasted < 15 min in 75.0% of patients in the low age group and 58.3% in the high age group (p = 0.24). Most of patients in both groups experienced one to five BTcP daily episodes, at all assessment points. HADS-D decreased from 10.78 (± 4.33) to 8.21 (± 3.57) in the low age group, and from 10.96 (± 4.26) to 9.36 (± 3.35) in the high age group (p = 0.02). Significant differences in HADS-A scores from baseline to the end of the study were also observed in both subgroups (p < 0.05). Patients in the low age group had less favorable mental component summary (MCS) and physical component summary (PCS) scores than patients in the high age group. At the end of the study, 10.0% of young–old patients and 29.2% of patients aged ≥ 75 years reported AEs related to their treatment. The most commonly reported AEs included nausea, vomiting, constipation, somnolence, and skin disorders and they were generally mild to moderate in severity.

The results of this study showed that SFTs provided safe and clinically meaningful pain relief in both elderly subgroups. Clinical implications of these findings await validation in large, confirmatory studies to identify age subgroup divergences among elderly cancer patients treated with SFTs.

• Administration, Sublingual
• Aged
• Analgesics, Opioid/administration & dosage
• Breakthrough Pain/drug therapy
• Cancer Pain/drug therapy
• Female
• Fentanyl/administration & dosage
• Humans
• Male
• Neoplasms/complications
• Pain Management/methods
• Tablets/administration & dosage

• Kyowa Kirin Farmacéutica SLU, Spain

• Cancer pain
• Culture
• Global health
• Opioid availability
• Religion

• Cancer
• Epidemiology
• LAC
• Older adults

The aim of this study was to investigate the clinical correlation between sPD-1 (soluble programmed cell death-1) and PD-1 (programmed cell death-1) expression and cancer pain.

sPD-1 content in peripheral blood was determined by enzyme-linked immunosorbent assay (ELISA). T cell surface-positive rate was determined by flow cytometry, and the correlation of clinical characteristics of patients with cancer pain was analyzed.

The positive expression rate of PD-1 in sPD-1 and T cells of patients with cancer pain was higher than that in normal patients. There was a significant correlation between sPD-1 and PD-1 positivity on T cell surface with tumor type, differentiation degree, and VAS scores of patients with cancer pain (P<0.05). Peripheral blood sPD-1 level and PD-1 positivity in patients with liver cancer and melanoma cancer were higher than those in patients with renal cell carcinoma and breast cancer. In addition, peripheral blood sPD-1 level and PD-1 positivity in patients with poorly-differentiated cancer pain were higher than those in patients with intermediately- to well-differentiated cancer. The sPD-1 content was lower and PD-1 positivity rate was higher in cancer pain patients with low VAS scores.

The positive expression rate of sPD-1 and PD-1 in patients with cancer pain is higher than that in normal people. The activation rate of the PD-1/PD-L1 pathway was mediated by sPD-1 and PD-1 positive expression, age, tumor type, and differentiation. There are correlations between clinical characteristics such as degree and pain level as shown by VAS score.

Prevention of persistent pain following breast cancer surgery, via early identification of patients at high risk, is a clinical need. Supervised machine-learning was used to identify parameters that predict persistence of significant pain.

Over 500 demographic, clinical and psychological parameters were acquired up to 6 months after surgery from 1,000 women (aged 28–75 years) who were treated for breast cancer. Pain was assessed using an 11-point numerical rating scale before surgery and at months 1, 6, 12, 24, and 36. The ratings at months 12, 24, and 36 were used to allocate patents to either “persisting pain” or “non-persisting pain” groups. Unsupervised machine learning was applied to map the parameters to these diagnoses.

A symbolic rule-based classifier tool was created that comprised 21 single or aggregated parameters, including demographic features, psychological and pain-related parameters, forming a questionnaire with “yes/no” items (decision rules). If at least 10 of the 21 rules applied, persisting pain was predicted at a cross-validated accuracy of 86% and a negative predictive value of approximately 95%.

The present machine-learned analysis showed that, even with a large set of parameters acquired from a large cohort, early identification of these patients is only partly successful. This indicates that more parameters are needed for accurate prediction of persisting pain. However, with the current parameters it is possible, with a certainty of almost 95%, to exclude the possibility of persistent pain developing in a woman being treated for breast cancer.

The online version of this article (10.1007/s10549-018-4841-8) contains supplementary material, which is available to authorized users.

• Bioinformatics
• Chronification
• Data science
• Pain

• Cuidados paliativos
• Declive funcional
• Functional decline
• Oncology
• Oncológico
• Palliative care
• Symptoms
• Síntomas

• Aged
• Aged, 80 and over
• Clinical Deterioration
• Female
• Humans
• Male
• Neoplasms/therapy
• Palliative Care
• Prospective Studies
• Symptom Assessment

• Latin America
• analgesics
• cancer pain
• opioids
• pain control

• cancer pain
• cementoplasty
• lung neoplasms
• nerve block
• neurostimulation
• spinal anesthesia