OBJECTIVE: In this study our aim was to investigate in clinical cancer patients whether purely nociceptive and mixed nociceptive-neuropathic cancer pain differ in opioid responsiveness. BACKGROUND: Pain is common in advanced cancer patients. Pain driven by neuropathic mechanisms is generally considered to be resistant to opioids. This hypothesis is based on animal studies and previous single-dose opioid studies in humans. DESIGN/METHODS: Clinical data were retrospectively collected from a patient cohort of 230 inpatient cancer pain patients using opioids. Outcome measures were opioid equianalgesic dose, numerical rating scales (NRS) of present pain intensity and Edmonton Symptom Assessment System (ESAS). RESULTS: The median equianalgesic opioid dose was 40 (range 0-240mg) in patients with nociceptive pain and 40 (range 0-280mg) in mixed pain patients (p=0.39; Wilcoxon rank-sum test). Present pain intensity at T=intake was 5.1±2.6 (mean±SD) in patients with nociceptive pain and 6.5±2.0 in patients with mixed pain, at T=3 days after intake 3.8±2.3 versus 3.7±1.6 and at T=discharge 3.0±1.9 versus 3.1±1.8 (p CONCLUSIONS: We found no significant differences in equianalgesic doses and present pain intensity between patients with purely nociceptive versus mixed cancer pain. A potentially higher prevalence of nausea and vomiting in nociceptive pain patients may represent a higher proportion of patients with gastrointestinal cancer in this group. We conclude that, at least in clinical cancer patients, there is no evidence for opioid resistance in pain driven by neuropathic mechanisms. Disclosure: Dr. Jongen has nothing to disclose. Dr. Moerdijk has nothing to disclose. Dr. Overbeck has nothing to disclose.

Opioid Responsiveness of Nociceptive Versus Mixed Pain in Clinical Cancer Patients (S35.005)

Classical phenylketonuria (PKU) presents a unique challenge for women of child-bearing age. In the context of pregnancy, poorly controlled hyperphenylalaninemia can result in a devastating constellation of outcomes for the baby referred to as the maternal PKU Syndrome. We present the case of a woman with classical PKU unable to maintain a restricted diet and refractory to pharmacological therapies. She elected to undergo a domino liver transplant, receiving an organ from a donor with classical branched chain ketoacid dehydrogenase deficiency (maple syrup urine disease). Plasma phenylalanine concentrations normalized within a few days after transplant and remained so on an unrestricted diet during the first year of follow-up. The patient reports subjective improvements in mood, energy level, and overall quality of life. In the appropriate clinical setting, liver transplant should be considered to provide metabolic stability for PKU patients, particularly women of childbearing age. 

https://doi.org/10.1016/j.ymgmr.2022.100866

Domino liver transplant from a donor with maple syrup urine disease into a recipient with phenylketonuria

Correlation between Cancer Pain and Psychological Health Problems in Breast Cancer Patients: A Preliminary Study

Society for Maternal-Fetal Medicine Consult Series #66: Pre-pregnancy Evaluation and Pregnancy Management of Patients with Solid Organ Transplants.

Purpose of review Pregnancy in solid organ transplantation (SOT) is a very complex part of transplant medicine wherein there is scarce information available in the literature. Solid organ transplant recipients often have comorbidities, such as hypertension and diabetes, which add additional risk to a pregnancy. Recent findings We present this review article on the various aspects of different types of immunosuppressant medications used in pregnancy with added inputs on contraception and fertility after transplant. We described the antepartum and postpartum considerations and discussed the adverse effects of the immunosuppressive medications. Maternal and fetal complications of each SOT have been also discussed in this article. Summary This article will serve as the primary review articles for the use of immunosuppressive medications during pregnancy with consideration during pregnancy after SOT.

Overview of pregnancy in solid-organ transplantation

Liver transplantation is a life-saving and successful therapeutic procedure which is more and more frequent worldwide, also among women of reproductive age. Consequently, there is an increasing number of reports of pregnancy following liver transplantation, but doubts still exist regarding preconception counseling and the optimal method of managing pregnancy. The aim of this study was to report and evaluate pregnancy outcomes in women who had undergone liver transplantation. We retrospectively analyzed female patients after orthotopic liver transplantation who reported pregnancy and were under medical care of a single transplant center. We identified 14 pregnancies in 10 women who had undergone liver transplantation (12 childbirths, one induced abortion due to fetal death in the first trimester, one pregnancy is still ongoing). Causes of transplantation include congenital or acquired disorders and the most common indication was autoimmune hepatitis (50%). The mean age at the point of transplantation was 28.5 (range 21–36), mean maternal age at pregnancy was 32 (range 26–43), and transplant-to-pregnancy interval was 4.07 years (range 1.5–7). The mean gestational week was 36.67 (range 31–40). Immunosuppression was maintained with combinations of prednisone (n = 11), tacrolimus (n = 13), and azathioprine (n = 8) prior to and during pregnancy. Two pregnancies were unintended, so women took mycophenolate mofetil in the first weeks of gestation. Another two women stopped taking azathioprine due to increasing anemia. Maternal complications included increase of aspartate transaminase and alanine transaminase (n = 2), anemia (n = 4) and hyperthyroidism (n = 2). Among the 12 childbirths, five (41.67%) were preterm. Only five women entered labor spontaneously, while seven (58,33%) had cesarean delivery. Pregnancy after liver transplantation can achieve relatively favorable outcomes. Liver transplantation does not influence women’s fertility and, during pregnancy, we report low rates of minor graft complications. A multidisciplinary team should be involved in contraceptive, fertility and consequently pregnancy counseling of female transplant recipients.

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Pregnancy after liver transplant: maternal and perinatal outcomes.

Introduction and objective: Pain is the most common and universal symptom among all patients with the oncological disease. Pain significantly reduces the quality of life, hinders decent functioning, and plays a significant role in the deterioration of the mental health of the patient and his close relatives. The study aimed to discuss the mainstreaming of effective pain treatment and to review various assessments and scales (including Brief Pain Inventory, Illness Perception Questionnaire and Numeric Rating Scale) concerning the psychological aspect of pain in selected neoplastic diseases.State of knowledge: We can distinguish various treatments for pain that can be divided into pharmacological and non-pharmacological methods. Latest studies revealed that pain treatment appears to be more and more meaningful. Various factors might influence pain perception and response to the applied treatment. Among all malignancies, special attention is paid to the pain issue in following cancers: colon cancer, gastric cancer, pancreatic cancer, ovarian cancer, breast cancer and lung cancer, that were described in this paper.Conclusions: Effective pain relief presents a positive effect, both on the physical and mental state of the patient. It also helps to maintain calm mental health among relatives. Nowadays, integration of the best methods for pain relief that are characterized as humanitarian, easily accessible and effective, seems to be one of the biggest challenges for both oncological and palliative health workers.

/pdf/cancer-pain-as-a-meaningful-aspect-of-the-oncological-3g8ldk1qu6.pdf

Izabela Marzec

Papers

Pregnancy after liver transplant: maternal and perinatal outcomes.

Cancer pain as a meaningful aspect of the oncological treatment