The Need of a Comprehensive Approach in a Condition of Poorly Opioid-Responsive Cancer Pain

Review Clinical Neurology

Refractory Cancer Pain and Intrathecal Therapy: Critical Review of a Systematic Review

Sebastiano Mercadante

Summary: This critical review assesses invasive procedures included in recent systematic reviews, questioning if refractory pain condition definitions were followed and if data were positively interpreted. 21 studies were reviewed, including 3 randomized controlled, 10 prospective, and 8 retrospective studies. Analysis showed poor pre-implantation assessment practices, optimistic outcome interpretation, inadequate consideration of complications, and inclusion of patients with short survival. The indication of intrathecal therapy for patients unresponsive to multiple therapies has been disregarded, potentially limiting its use in a selective population.

PAIN AND THERAPY (2023)

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Article Health Care Sciences & Services

When the game is hard, more complex weapons are needed

Sebastiano Mercadante et al.

Summary: This paper illustrates the management of a challenging pain condition using multiple analgesic regimens, requiring specialized interventions to effectively alleviate the evolving clinical situation.

BMJ SUPPORTIVE & PALLIATIVE CARE (2022)

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Article Anesthesiology

Dexmedetomidine Continuous Infusion for Refractory Cancer Pain at End of Life: A Case Report

Jennifer M. Byrne et al.

Summary: This case report demonstrates the clinical utility of dexmedetomidine in managing refractory cancer-related pain at the end-of-life. The medication effectively relieved pain and agitation in the patient, allowing for a peaceful death.

JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY (2022)

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Article Health Care Sciences & Services

Rapid Titration With Intravenous Oxycodone for Severe Cancer Pain and Oral Conversion Ratio

Sebastiano Mercadante et al.

Summary: This study aimed to assess the effectiveness of dose titration with intravenous oxycodone for rapid pain relief in severe cancer pain and provide a conversion ratio with the oral route. The results showed that rapid intravenous oxycodone dose titration resulted in rapid pain relief, and the intravenous-oral conversion ratio of 1:2 was reliable.

JOURNAL OF PAIN AND SYMPTOM MANAGEMENT (2022)

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Article Anesthesiology