Cancer patients and their caregivers in the face of opioid analgesic treatment — opportunities and threats to the treatment process

Failure to alleviate cancer pain may deteriorate mental functioning, increase depression symptoms, result in the clinical diagnosis of demoralization syndrome nonadherence of treatment, functioning discipline, which together, may precipitate desire for euthanasia. Increased incidence of pain in patients with advanced or terminal disease has been reported to range from 39% to 66.4% depending on the stage of the cancer being experienced. Further, the progressive aging of societies and increased life expectancy in cancer patients has changed the dynamics of modern treatment processes. Despite their efficacy, the use of opioids as an analgesic treatment during terminal disease has been affected by the quality, availability, and negative reputation of these scheduled drugs. This review aims to describe the specific factors and limitations of opioid pain management from the perspective of patients and their caregivers. Further, we aim to identify and discuss the key factors which determine the success or failure of opioid use for the treatment of pain with links to internationally recognized recommendations and current research

Between “opioidophobia” and the opioid crisis: a cross-sectional comparison of opinions on opioid analgesic treatment between palliative care patients with cancer and physicians in Poland

Introduction. Inadequate pain control may contribute to a desire to die. Early use of opioid analgesics could improve pain treatment. On the other hand, opioids are associated with risk of addiction. We aimed to compare the opinions on opioid analgesic use between palliative care patients and physicians.  Material and methods. Data on the opinions of hospice and palliative care patients (n = 104) and physicians of different specialties (n = 216) were collected using a survey with closed-ended questions scored on a 5-point Likert scale.  Results. The majority (87.5%) of cancer patients experienced pain during their illness (mean intensity: 7.01±2.44).More than half (53.3%) of physicians had concerns that patients overuse opioid drugs. Negative connotations associated with the word “morphine” were expressed in both study groups. Survey responses of both patients and physicians were consistent with the phenomenon of “opioidophobia”.  Conclusions. We found a high degree of consensus between cancer patients’ and physicians’ opinions on opioid analgesic use. However we also found some discrepancies in opinions and they were mostly related to medical knowledge, which may indicate poor patient education about opioid use and poor communication between patients and physicians. It is concerning to note these significant discrepancies concerning opioid use since patients considered opioids useful in ensuring pain relief and improving their quality of life. The majority (almost 90%) of patients surveyed struggled with pain over the course of their illness and treatment.

Polish Physicians’ Perspectives on Medical Cannabis Policy and Educational Needs: Results of An Online Survey

(1) Background: In November 2017, medical cannabis was legalized in Poland. Until now, there have been no studies conducted to examine the perspectives of Polish physicians about their preferences regarding medical cannabis legal status and educational needs. (2) Methods: The survey was a self-developed online questionnaire with 57 participants. Participation was voluntary. The link was shared through a personal network of medical doctors, regional medical chambers, and with doctors attending palliative care courses organized by our research group. Results: Between June and October 2020, 173 HCPs from Poland completed the survey. More than half of the study participants never received any education on medical cannabis (60.1%); 71.1% declared their knowledge was insufficient to counsel patients about medical cannabis use. The majority claimed that they would like to be able to answer patient questions (92.4%); 93.1% declared a need to create clear guidelines for using cannabinoids in clinical practice. Furthermore, 71.7% believed that medicines containing cannabinoids and 52.0% that herbal cannabis should be reimbursed (3). Conclusion: Most medical doctors do not feel prepared for patient counseling. They could benefit from targeted educational interventions. We have also identified physicians’ preferences that might inspire the stakeholders involved who are critical for shaping policies regarding cannabis-based therapeutics

Ultrasound in the Differential Diagnosis of Medial Epicondylalgia and Medial Elbow Pain—Imaging Findings and Narrative Literature Review

Medial epicondylalgia (ME), commonly known as “the golfer’s elbow”, typically develops in individuals who perform repetitive forearm movements and weight-bearing activities. It accounts for up to 20% of all epicondylitis cases and is most prevalent in particular sports and occupations. Though the diagnosis can be made based on sole clinical examination, additional imaging might be essential for confirmation of medial epicondylitis and excluding other pathologies of the medial epicondyle region. US imaging, with a sensitivity and specificity of 95% and 92%, respectively, remains a practical and accessible alternative to MRI. However, its diagnostic efficacy highly depends on the operator’s experience and requires proper technique. This article describes the ultrasound examination and technique for adequate visualization of elbow joint structures. It also discusses the differential diagnosis of other common and less-known pathologies of the medial compartment of the elbow, including snapping triceps, medial collateral ligament injury, and cubital tunnel neuropathy

Pacjenci onkologiczni oraz ich opiekunowie wobec opioidowego leczenia przeciwbólowego — szanse i zagrożenia dla procesu leczenia

Failure of pain treatment may cause worsening of mental functioning, increase in depression symptoms and clinical diagnosis of demoralization syndrome (ICD-10, category R45.4 Demoralization and apathy), inhibiting obeying the treatment and functioning discipline, which may lead to the risk of desiring euthanasia. According to a research review carried out in 2016, the incidence of pain in the group of patients with advanced or terminal disease amounted to 66.4% (in comparison to 64% in 2007), 55% (in comparison to 59% in 2007) during anti-cancer treatment and 39.3% (in comparison to 33% in 2007) in the group of patients after completing the treatment. The aging of societies and increasing life expectancy in cancer patients change the dynamics and length of treatment processes. The paper described specific limitations in opioid pain treatment on the side of patients and their caregivers: concern not to distract the doctor’s focus on the cancer treatment, concern for obtaining an opinion from a difficult, complaining patient, a conviction that pain is significant information about the course of the disease, vital for the treatment of fatalistic attitude towards the pain alleviation. The lack of current knowledge, false convictions, negative attitude concerning opioid pain treatment are indicated in many studies as common for patients, caregivers and doctors. Convictions most frequent in these groups include the concern for addiction, developing tolerance and side effects. The paper indicated the distinguished factors deciding about the effect of treatment, such as the ability to build, correct and maintain the cooperation between a doctor and a patient in the treatment process, which may last many years or decades. It refers to guidelines and recommendations, which are a detailed source of knowledge concerning opioid pain treatment.Niepowodzenie w leczeniu bólu może być przyczyną pogorszenia funkcjonowania psychicznego, nasilenia objawów depresji czy klinicznego syndromu demoralizacji (w ICD-10, kategoria R45.3 Demoralizacja i apatia) uniemożliwiających utrzymanie się w rygorze leczenia i funkcjonowania, które może prowadzić do ryzyka pragnienia eutanazji. Według przeglądu badań z 2016 roku częstość występowania bólu w grupie pacjentów w zaawansowanej lub terminalnej chorobie wyniosła 66,4% (wobec 64% w 2007 roku), podczas leczenia przeciwnowotworowego 55% (wobec 59% w 2007 roku), a w grupie chorych po przebytym leczeniu 39,3% (wobec 33% w 2007 roku). Proces starzenia się społeczeństw oraz wydłużający się okres przeżycia w chorobach nowotworowych zmieniają dynamikę i długość procesów leczenia. W pracy omówiono specyficzne bariery skutecznego opioidowego leczenia przeciwbólowego u pacjentów i ich opiekunów: obawy przed rozpraszaniem skupienia lekarza na leczeniu choroby nowotworowej, przed otrzymaniem opinii trudnego czy skarżącego się pacjenta, przekonanie, że ból jest ważną informacją o przebiegu choroby niezbędną do jej leczenia, czy fatalistyczne nastawienie do możliwości uśmierzenia bólu. Brak aktualnej wiedzy, fałszywe przekonania, negatywne nastawienie dotyczące opioidowego leczenia przeciwbólowego są w wielu badaniach wskazywane jako wspólne dla pacjentów, opiekunów i lekarzy. Najczęstsze w tych grupach przekonania to obawa przed uzależnieniem, rozwijanie tolerancji i skutki uboczne. Praca wskazuje wyróżniane czynniki decydujące o powodzeniu leczenia, takie jak umiejętność budowania, korygowania i utrzymania relacji współpracy lekarza z pacjentem w kilku lub kilkudziesięcioletnim procesie leczenia. Zawiera odniesienia do wytycznych i zaleceń będących szczegółowym źródłem wiedzy dotyczącej opioidowego leczenia bólu

Avascular Necrosis of Femoral Head—Overview and Current State of the Art

Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients’ complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease

The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

Background: Avascular necrosis (AVN) of the femoral head often requires surgical treatment and is often associated with femoral neck fractures. We conducted a systematic review and meta-analysis of recent research on the risk of AVN following the stabilization of fractured femoral neck with implants in PubMed. We assessed the effect of age on AVN incidence among patients aged > 50 and younger, depending on fracture type, Garden stage, Pouwels degree, Delbet stage, and age category. We followed PRISMA guidelines. Relevant studies were defined as research articles describing real-world studies reporting on the risk of AVN following primary surgical fracture stabilization with implants, published between 1 January 2011 and 22 April 2021. Fifty-two papers met the inclusion criteria, with a total of N = 5930 with surgically managed fractures. The pooled mean AVN incidence was significantly higher among patients with displaced fractures (20.7%; 95% CI: 12.8–28.5%) vs. those with undisplaced fractures (4.7%; 95% CI: 3.4–6.0%). No significant correlation was observed between AVN incidence weighted by sample size and time interval from injury to surgery (p = 0.843, R2 = 0.01). In conclusion, the risk of AVN following femoral neck fractures was generally high, especially in patients with displaced fractures. The time from injury to surgery did not correlate with AVN incidence

Bone Infarcts and Tumorigenesis—Is There a Connection? A Mini-Mapping Review

(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012–2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy