APS Press Room

News Highlights from The Journal of Pain • June 2007
The Peer Review Journal of the American Pain Society

 
For immediate release Contact: Chuck Weber
(847) 705-1802

Help for Children with Severe Cancer Pain

Low-dose infusions of ketamine, a drug used as adjuvant therapy for chronic and acute pain in adults, could help provide significant pain relief for children with advanced cancer whose pain is uncontrolled by other pain medications, according to research reported in The Journal of Pain.

Refractory pain is a common reason for hospitalization of children with cancer and often warrants prolonged stays. According to published studies, in a significant number of children with terminal cancer pain therapy appears to be inadequate.

This is the first study examining the role of ketamine as an adjuvant treatment for children with advanced cancer and pain that doesn’t respond to large doses of opioids, or in which there were serious side effects related to opioid use. In some patients, high opioid doses can be associated with hyperalgesia, allodynia, myotonia and seizures. Eleven children with advanced cancer were evaluated at George Washington University Medical Center, of which five were admitted for optimization of pain therapy.

After administering ketamine, the researchers found that 8 of 11 patients (73%) had reduced need for opioids to manage their pain and improved ability to interact with relatives and friends. The authors noted that tolerance to opioids and possible opioid-induced hyperalgesia typically result in inadequate pain relief in young cancer patients. Ketamine possibly reversed opioid tolerance. Also, by increasing opioid efficacy and reducing side effects, the children became more interactive. The findings offer the potential that ketamine, by preventing or reducing opioid-induced tolerance or hyperalgesia, might be an effective adjuvant in the treatment of cancer pain in children.

Source: Ketamine as an Adjuvant for Treatment of Cancer Pain in Children and Adolescents: Julia C. Finkel, Sophie R. Pestieau and Zenaide, George Washington University School of Medicine

External Magnetic Stimulation Reviewed for Pain Management

Repetitive Transcranial magnetic stimulation (rTMS) has been shown to be useful in treating some neurologic-based disorders, such as depression and seizures. More recently, there has been increasing attention devoted to evaluating the efficacy of rTMS for treating patients with chronic neuropathic pain.

In rTMS treatment, electric current passes through a coil applied to the head through which the electric pulse passes to the cortex of the brain. It is believed that rTMS influences cortical and subcortical neurons to reduce pain transmission. The authors conducted a literature review of 16 studies assessing the influence of TMS in pain management. They reported:

  • Overall it can be stated that rTMS can relieve pain but the effect is brief.
  • Pain relief may be related to the number of pulses administered in each rTMS session.
  • The cause of neuropathy and the location within the body may influence the efficacy of rTMS.
  • None of the subjects experienced adverse events.
  • The fact that rTMS-induced pain relief is transient raises questions about its practical clinical utility.

The authors concluded that studies involving functional imaging will be necessary to clarify the neurophysiologic mechanisms that underlie rTMS analgesia.

Source: Repetitive Transcranial Magnetic Stimulation (rTMS) in Experimentally Induced and Chronic Neuropathic Pain: A Review: Raphael J. Leo and Tariq Latif, School of Medicine and Biomedical Sciences, State University of New York at Buffalo