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EFFICIENCY TREATMENT OF
CHRONIC PAIN SYNDROME IN
CANCER PATIENTS IV
CLINICAL GROUP
Rapporteur Sherbak Anna
Belarusian State Medical University, Minsk, Belarus
Supervisor of PhD Papok V.E.
Aim of work
 examine the incidence of chronic pain (CPS)
depending from the primary tumor site
 causes of CPS
 estimate the effectiveness of treatment in
cancer patients CPS IV clinical group
The urgency of the problem
 According toWHO statistics, 6 million cases of
cancer, 5.5 million suffer from pain.
 In Belarus, 40,000 patients with newly diagnosed
malignant process (about 9000 patients in
Minsk).
 Of these, 13.5% is in stage III-IV disease and 25%
of patients die within the first year after
diagnosis.
 Thus each year nearly 20,000 cancer patients
suffer from pain
Materials and methods(1)
 The studies were performed in 60 cancer
patients with chronic pain (32 women and 28
men) aged 46 - 89 years. All patients were in the
hospital 'Hospital palliative care "Hospice".
26, 43%
19, 32%
15, 25%
The age structure of patients
61-75 years
(advanced age)
46-60 years
(adulthood)
76-89 years
(senium)
Materials and methods(2)
 Hospital record
 McGill Pain Questionnaire
 10-point visual analogue scale (VAS)
 Verbal pain scale (VPS).
 Physical activity scale (PAS)
 Side effects of drugs
The distribution of patients
depending on the location of the
primary tumor
23, 38%
10, 17%
8, 13%
4, 7%
4, 7%
3, 5%
2, 3% 6, 10%
Digestive organs
Breathing system
Mammary gland
Prostate
Pancreas
Organs ot the
urinary system
CUP
Other localization
The distribution of patients
depending on the type of pain
37, 63%
14, 24%
5, 8% 3, 5%
Visceral pain
Somatic pain
Mixed pain
Neuropathic pain
The distribution of patients
depending on the causes of pain
Cause of pain The number of
patients
The proportion of
patients (%)
The pain caused by
a neoplastic
process
49 82
The pain caused by
complications of
tumor
8 13
The pain is caused
by anti-tumor
therapy
3 5
Patients with CPS associated
with neoplastic process
 The pain is associated with a primary tumor - 15 patients
(30.6%)
 The pain associated with metastatic disease - 34 patients
(56.6%)
11, 32%
9, 26%
8, 24%
3, 9%
3, 9%
Bones
Hepar
Lungs
Brain
Other localization
Characteristics of patient
groups
A group of
patients
Number of
patients
The pain
intensity on
theVAS
The nature
of pain
(VPS)
Drugs
Group I 33 3 - 5 Moderate
pain
Ketorolac
Group II 17 5 - 8 Severe pain Tramadol
Group III 10 8 - 10 Horrible pain Promedol
The condition of patients
before and after treatment
A group of
patients
VAS
before
treatment
VAS after
treatment*
PAS before
treatment
PAS after
treatment
Side
effects
(%)
Group I
(VAS=3 – 5)
4,1 ± 0,82 2,3 ± 0,64 2,6 ± 0,49 2,1 ± 0,17 4 (12%)
Group II
(VAS=5-8)
6,2 ± 0,41 2,8 ±0,79 3,4 ± 0,61 2,3 ± 0,96 6 (35 %)
Group III
(VAS=8-10)
8,3 ± 0,46 3,2 ± 1,14 3,6 ± 0,49 2,1 ± 0,61 2 ( 20 %)
The changes are significant at p <0,0001
The effectiveness of
treatment in each group CBS
31;94%
13;76%
9;90%
2;6%
4;23%
1;10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group I Group II Group III
Effective therapy no effective therapy
The incidence of side
effects
29;88%
11;65%
8;80%
4;12%
6;35%
2;20%
0
5
10
15
20
25
30
35
Group I Group II Group III
No side effects Side effects of
The effectiveness of
tramadol
 The group II of the most high indicators of the
inefficiency (4;23%) and the emergence of
side-effects (6;35%)
 MeanVAS before treatment in this group of
patients whose treatment was ineffective
was 6,75 ± 0,43
The results and conclusions (1)
 CPS in patients with cancer is more common in
the localization of the primary tumor in the
organs of the gastrointestinal tract, the
respiratory tract and mammary gland
 The emergence of CPS in patients with cancer is
more often associated neoplastic process
itself, especially with the presence of metastases
 The most severe pain syndrome seen in patients
with brain metastases and metastatic having
lytic activity in the bone
The results and conclusions (2)
 The use of ketorolac in patients with
moderate pain and promedol in patients with
intolerable pain is an effective
 The results of use of tramadol in patients with
strong pain differ, so patients with CPS 5-7
points on theVAS application is effective, and
in patients with a ≥ 7 points CPS is inefficient
and requires the use of drugs.
Thank you for your attention!

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EFFICIENCY TREATMENT OF CHRONIC PAIN SYNDROME IN CANCER PATIENTS IV CLINICAL GROUP

  • 1. EFFICIENCY TREATMENT OF CHRONIC PAIN SYNDROME IN CANCER PATIENTS IV CLINICAL GROUP Rapporteur Sherbak Anna Belarusian State Medical University, Minsk, Belarus Supervisor of PhD Papok V.E.
  • 2. Aim of work  examine the incidence of chronic pain (CPS) depending from the primary tumor site  causes of CPS  estimate the effectiveness of treatment in cancer patients CPS IV clinical group
  • 3. The urgency of the problem  According toWHO statistics, 6 million cases of cancer, 5.5 million suffer from pain.  In Belarus, 40,000 patients with newly diagnosed malignant process (about 9000 patients in Minsk).  Of these, 13.5% is in stage III-IV disease and 25% of patients die within the first year after diagnosis.  Thus each year nearly 20,000 cancer patients suffer from pain
  • 4. Materials and methods(1)  The studies were performed in 60 cancer patients with chronic pain (32 women and 28 men) aged 46 - 89 years. All patients were in the hospital 'Hospital palliative care "Hospice". 26, 43% 19, 32% 15, 25% The age structure of patients 61-75 years (advanced age) 46-60 years (adulthood) 76-89 years (senium)
  • 5. Materials and methods(2)  Hospital record  McGill Pain Questionnaire  10-point visual analogue scale (VAS)  Verbal pain scale (VPS).  Physical activity scale (PAS)  Side effects of drugs
  • 6. The distribution of patients depending on the location of the primary tumor 23, 38% 10, 17% 8, 13% 4, 7% 4, 7% 3, 5% 2, 3% 6, 10% Digestive organs Breathing system Mammary gland Prostate Pancreas Organs ot the urinary system CUP Other localization
  • 7. The distribution of patients depending on the type of pain 37, 63% 14, 24% 5, 8% 3, 5% Visceral pain Somatic pain Mixed pain Neuropathic pain
  • 8. The distribution of patients depending on the causes of pain Cause of pain The number of patients The proportion of patients (%) The pain caused by a neoplastic process 49 82 The pain caused by complications of tumor 8 13 The pain is caused by anti-tumor therapy 3 5
  • 9. Patients with CPS associated with neoplastic process  The pain is associated with a primary tumor - 15 patients (30.6%)  The pain associated with metastatic disease - 34 patients (56.6%) 11, 32% 9, 26% 8, 24% 3, 9% 3, 9% Bones Hepar Lungs Brain Other localization
  • 10. Characteristics of patient groups A group of patients Number of patients The pain intensity on theVAS The nature of pain (VPS) Drugs Group I 33 3 - 5 Moderate pain Ketorolac Group II 17 5 - 8 Severe pain Tramadol Group III 10 8 - 10 Horrible pain Promedol
  • 11. The condition of patients before and after treatment A group of patients VAS before treatment VAS after treatment* PAS before treatment PAS after treatment Side effects (%) Group I (VAS=3 – 5) 4,1 ± 0,82 2,3 ± 0,64 2,6 ± 0,49 2,1 ± 0,17 4 (12%) Group II (VAS=5-8) 6,2 ± 0,41 2,8 ±0,79 3,4 ± 0,61 2,3 ± 0,96 6 (35 %) Group III (VAS=8-10) 8,3 ± 0,46 3,2 ± 1,14 3,6 ± 0,49 2,1 ± 0,61 2 ( 20 %) The changes are significant at p <0,0001
  • 12. The effectiveness of treatment in each group CBS 31;94% 13;76% 9;90% 2;6% 4;23% 1;10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Group I Group II Group III Effective therapy no effective therapy
  • 13. The incidence of side effects 29;88% 11;65% 8;80% 4;12% 6;35% 2;20% 0 5 10 15 20 25 30 35 Group I Group II Group III No side effects Side effects of
  • 14. The effectiveness of tramadol  The group II of the most high indicators of the inefficiency (4;23%) and the emergence of side-effects (6;35%)  MeanVAS before treatment in this group of patients whose treatment was ineffective was 6,75 ± 0,43
  • 15. The results and conclusions (1)  CPS in patients with cancer is more common in the localization of the primary tumor in the organs of the gastrointestinal tract, the respiratory tract and mammary gland  The emergence of CPS in patients with cancer is more often associated neoplastic process itself, especially with the presence of metastases  The most severe pain syndrome seen in patients with brain metastases and metastatic having lytic activity in the bone
  • 16. The results and conclusions (2)  The use of ketorolac in patients with moderate pain and promedol in patients with intolerable pain is an effective  The results of use of tramadol in patients with strong pain differ, so patients with CPS 5-7 points on theVAS application is effective, and in patients with a ≥ 7 points CPS is inefficient and requires the use of drugs.
  • 17. Thank you for your attention!