Articles of interest in other scholarly journals

Celiac plexus block for pancreatic cancer pain in adults

Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA.Cochrane Database Syst Rev 2011;3. CD007519.

In this Cochrane review, the authors conclude that although statistical evidence is minimal for the superiority of Celiac plexus block pain relief over analgesic therapy, it may be a preferred option as it causes fewer adverse effects than opioids.

An economic evaluation of short-acting opioids for treatment of breakthrough pain in patients with cancer

Vissers DC, Lenre M, Tolley K, Jakobsson J, Sendersky V, Jansen JP.Value in Health.2011;14,274-281.

Using a decision-analysis model to evaluate the cost-effectiveness of intranasal fentanyl spray compared with oral transmucosal fentanyl citrate and fentanyl buccal tablet for the treatment of breakthrough cancer pain. The authors conclude that given inherent limitations of modelling studies, the greater efficacy of intranasal fentanyl spray translates to cost and quality-adjusted life years advantages (QALYs) over oral transmucosal fentanyl citrate and fentanyl buccal tablet in the treatment for breakthrough cancer pain in Sweden.

Effectiveness of long-term opioid therapy for chronic non-cancer pain

Manchikanti L, Vallejo R, Manchikanti KN, Benyamin RM, Datta S, Christo PJ.Pain Physician.2011;14,E133-E156

In this comprehensive review of the literature, the authors state that there is a lack of qualitative and/or quantitative literature on long-term opioid therapy in chronic non-cancer pain. Only tramadol has shown effectiveness for pain relief and improvement of functional status. Opioid therapy should therefore be provided with great restraint and caution, based on the weak evidence available and the escalating misuse of prescription opioids, including abuse and diversion. The limitations are that this is a narrative review without application of methodological quality assessment criteria.

The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil

Bingel U, Wanigasekera V, Wiech K, Ni Mhuircheartaigh R, Lee MC, Ploner M, Tracey I.Sci. Transl. Med. 3, 70ra14 (2011).

In this study the effect of remifentanil on heat pain was assessed using fMRI in healthy volunteers. The same volunteers either had no expectation of analgesia, expectancy of a positive analgesic effect, or the expectation of hyperalgesia. Positive treatment expectancy doubled the analgesic benefit of remifentanil with associated activity in the endogenous pain modulatory system. Negative treatment expectancy abolished remifentanil analgesia with activity in the hippocampus. The authors contend that an individual’s expectation of a drug’s effect critically influences its therapeutic efficacy and that regulatory brain mechanisms differ as a function of expectancy. They conclude that to optimize treatment outcomes, patients’ beliefs and expectations should be integrated into drug treatment regimens.

Short Cuts by Jason Boland, University of Sheffield, School of Medicine and Biomedical Sciences