Medication Adherence in Chronic Pain Patients

Chronic pain is a common chronic medical condition. Its treatment is difficult and relies upon a multidisciplinary approach. Although pain medication remain one of the cornerstones of chronic pain therapy, the effects of pharmacological therapy are often less than expected. One of the reasons might be that a large proportion of chronic pain patients do not adhere to the prescribed therapy. In this thesis, prevalence and determinants of medication non- adherence in chronic pain patients are reviewed and investigated. Furthermore, the results of two randomized clinical trials investigating the effects of potential adherence improving interventions are presented. Finally, the design of a theory-based intervention with the help of psychological models of behaviour change is described. Medication adherence in chronic pain patients is complex behaviour in a complex medical condition. Health care providers play a crucial role to improve medication adherence by identifying patients at risk and apply adherence improving interventions

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

The design of a theory-based intervention to improve medication adherence in chronic pain patients

<p><b>Objective:</b> Non-adherence to pain medication is common in chronic pain patients and may result in unfavorable treatment outcomes. Interventions to improve adherence behavior often fail to significantly change medication use. In this report, we describe the application of a theoretical psychological model of behavior change in order to design an intervention to improve medication adherence in chronic pain patients.</p> <p><b>Methods:</b> This study applies the Behavior Change Wheel framework and the Behavior Change Techniques Taxonomy to design a theory-based intervention to improve pain medication use. Available literature was used to extract determinants of adherence in chronic pain patients.</p> <p><b>Results:</b> Selected target behaviors to improve medication adherence are: share agreement on follow up policy, monitor medication adherence, provide patient education routinely, discuss attitudes and concerns towards pain medication, develop medication taking habits and use medication reminders. The intervention consists of three components in which relevant behavior change techniques are applied: (1) changes in the electronic patient data management systems to enable medical staff to apply target behaviors; (2) bi-annual education of medical staff to commit the team to the proposed intervention and provide feedback; (3) routine and mandatory education of chronic pain patients following prescription of pain medication.</p> <p><b>Conclusions:</b> To improve medication adherence in chronic pain patients, most interventions should be focused on providers of pain therapy. Prescribing chronic pain medication should be seen as part of a larger treatment regimen including adequate follow-up, adherence monitoring and patient education during the course of treatment.</p

Adherence to Pharmacological Pain Therapy in Patients with NonMalignant Pain: The Role of Patients' Knowledge of Pain Medication

Background: Nonadherence to pharmacological therapy is a common and underexposed problem in patients with chronic nonmalignant pain. It may lead to treatment failure and increased healthcare costs. Methods: In this prospective observational study we analyzed the association between knowledge and adherence in the chronic nonmalignant pain population. We included 96 patients treated with a new pharmacological prescription. During the initial visit (T0), demographic variables, pain intensity, knowledge of the prescription (name, dose, and frequency), self-reported adherence to the prescription, and general knowledge of pharmacological pain therapy (according to the Pain Knowledge Questionnaire, Dutch Language Version (PKQ-DLV) were recorded. During two follow-up visits (T1, T2), apart from demographics, these parameters were measured again. Results: Adherence rates were 42%, 42%, and 46% at T0, T1 and T2, respectively. 53%, 59%, and 48% of patients had knowledge of their current prescription, and mean scores on the PKQ-DLV were 56, 55, and 52 percent of the maximum scores, respectively, at T0, T1 and T2. A multivariate binary logistic regression analysis resulted in a significant contribution of knowledge of the prescription and of age to the prediction of adherence. Conclusions: Knowledge of the analgesic prescription is associated with adherence and significantly contributes to the prediction of adherence to analgesic therapy. An interventional study is needed to determine whether increasing knowledge will improve medication adherence and therapy outcome in patients with chronic nonmalignant pain

Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group

The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.status: publishe