Renata Zajączkowska - Academia.edu (original) (raw)

Papers by Renata Zajączkowska

Palliative Medicine in Practice, 2017

Ból neuropatyczny stanowi istotny problem ze względu na częstość występowania i trudności w zapew... more Ból neuropatyczny stanowi istotny problem ze względu na częstość występowania i trudności w zapewnieniu skutecznego leczenia. Wśród chorych na nowotwory komponent neuropatyczny bólu jest częsty, między innymi z powodu zmian w układzie nerwowym u pacjentów z bólem kostnym i częstego stosowania neurotoksycznych metod leczenia nowotworów: radioterapii, chemioterapii i terapii molekularnych. Rozpoznanie bólu neuropatycznego oparte jest na dokładnym wywiadzie, objawach klinicznych, badaniu fizykalnym, badaniach obrazowych, ilościowych badaniach zaburzeń czucia i zastosowaniu walidowanych kwestionariuszy. Leczenie bólu neuropatycznego oparte jest głównie na farmakoterapii, przy czym u chorych na nowotwory opioidy stanowią najczęściej leki pierwszego wyboru. Natomiast u pacjentów z bólem pochodzenia innego niż nowotworowy do leków pierwszej linii zaliczane są adjuwanty analgetyczne, zwłaszcza leki przeciwdepresyjne i przeciwpadaczkowe. W zlokalizowanym bólu neuropatycznym istotną rolę odgrywają leki miejscowo znieczulające i wpływające na receptory waniloidowe. Rola opioidów w tej grupie pacjentów jest ograniczona do drugiej bądź trzeciej linii leczenia, przy nieskuteczności innych grup leków. Ograniczoną rolę odgrywają inne leki: kortykosteroidy, antagoniści receptorów NMDA czy toksyna botulinowa. Istotne znaczenie u części chorych mają umiejętnie stosowane techniki interwencyjne leczenia bólu, a u chorych na nowotwory leczenie przyczynowe (miejscowe, głównie radioterapia i systemowe, głównie leczenie chemiczne, hormonalne i molekularne). Terapia bólu neuropatycznego powinna stanowić ważny element szerszego, całościowego planu leczenia, który uwzględnia dokładną ocenę bólu i innych objawów, oszacowanie potrzeb chorych i opiekunów, a celem kompleksowego postępowania jest skuteczne leczenie objawów, wsparcie psychosocjalne i duchowe, co istotnie poprawia jakość życia chorych i ich opiekunów.

The Cochrane library, May 19, 2022

Palliative Medicine in Practice, 2016

Leczenie bólu neuropatycznego u chorych na nowotwory Treatment of neuropathic pain in cancer pati... more Leczenie bólu neuropatycznego u chorych na nowotwory Treatment of neuropathic pain in cancer patients Streszczenie Częstość występowania bólu neuropatycznego u chorych na nowotwór jest wysoka i sięga nawet 40% pacjentów z chorobą nowotworową cierpiących z powodu bólu. Wydaje się, że odsetek ten może być wyższy z powodu współistnienia zmian w układzie nerwowym u chorych z bólem kostnym, a także z powodu coraz częstszego stosowania neurotoksycznych metod leczenia nowotworów: radioterapii, chemioterapii czy też nowych terapii onkologicznych ukierunkowanych molekularnie. Rozpoznanie bólu neuropatycznego stawiane jest na podstawie dokładnego wywiadu i analizy objawów klinicznych, badania fizykalnego, badania obrazowego oraz zastosowania walidowanych narzędzi służących do oceny bólu neuropatycznego. Leczenie bólu neuropatycznego u chorych na nowotwory oparte jest głównie na farmakoterapii, przy czym opioidy są często lekami pierwszego wyboru. Leki adjuwantowe, zwłaszcza leki przeciwdepresyjne i przeciwpadaczkowe, są również skuteczne, zwłaszcza w połączeniu z opioidami, jednak oprócz poprawy analgezji zwiększają ryzyko wystąpienia działań niepożądanych. Istotną rolę u części chorych odgrywa umiejętnie stosowane leczenie przeciwnowotworowe, zwłaszcza paliatywna radioterapia i leczenie systemowe, a także-u wybranych pacjentów-techniki interwencyjne leczenia bólu. Terapia bólu neuropatycznego powinna stanowić ważny element szerszego, całościowego planu leczenia u chorych na nowotwory, który uwzględnia dokładną ocenę bólu i innych objawów oraz oszacowanie potrzeb chorych i ich opiekunów, a celem kompleksowego postępowania terapeutycznego jest skuteczne leczenie objawów oraz wsparcie psychospołeczne i duchowe, które mogą istotnie poprawić jakość życia chorych i ich opiekunów.

PubMed, Dec 1, 2016

Pain is one of the most common symptoms in cancer patients, especially in advanced disease. Howev... more Pain is one of the most common symptoms in cancer patients, especially in advanced disease. However, pain also accompanies a significant percentage of patients during diagnostic and therapeutic procedures. In some patients pain may be the first symptom of the disease. The causes of pain in cancer patients are often multifactorial including direct and indirect cancer effects, anticancer therapy and co-morbidities. Moreover, pain in cancer patients often has mixed pathophysiology including both nociceptive and neuropathic components, especially in patients with bone metastases. In this article, basic knowledge regarding epidemiology, pathophysiology and clinical features of pain in cancer patients with a primary tumour localised in lung, gastrointestinal tract (stomach, colon and pancreas), breast in women and prostate in men are presented. Pain is a common symptom in cancer patients and its appropriate assessment and treatment may significantly improve in patients' and families' quality of life.

The Cochrane library, Dec 12, 2019

BackgroundPerioperative fluid management is a crucial element of perioperative care and has been ... more BackgroundPerioperative fluid management is a crucial element of perioperative care and has been studied extensively recently; however, 'the right amount' remains uncertain. One concept in perioperative fluid handling is goal‐directed fluid therapy (GDFT), wherein fluid administration targets various continuously measured haemodynamic variables with the aim of optimizing oxygen delivery. Another recently raised concept is that perioperative restrictive fluid therapy (RFT) may be beneficial and at least as effective as GDFT, with lower cost and less resource utilization.ObjectivesTo investigate whether RFT may be more beneficial than GDFT for adults undergoing major non‐cardiac surgery.Search methodsWe searched the following electronic databases on 11 October 2019: Cochrane Central Register of Controlled Trials, in the Cochrane Libary; MEDLINE; and Embase. Additionally, we performed a targeted search in Google Scholar and searched trial registries (World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov) for ongoing and unpublished trials. We scanned the reference lists and citations of included trials and any relevant systematic reviews identified.Selection criteriaWe included randomized controlled trials (RCTs) comparing perioperative RFT versus GDFT for adults (aged ≥ 18 years) undergoing major non‐cardiac surgery.Data collection and analysisTwo review authors independently screened references for eligibility, extracted data, and assessed risk of bias. We resolved discrepancies by discussion and consulted a third review author if necessary. When necessary, we contacted trial authors to request additional information. We presented pooled estimates for dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), and for continuous outcomes as mean differences (MDs) with standard deviations (SDs). We used Review Manager 5 software to perform the meta‐analyses. We used a fixed‐effect model if we considered heterogeneity as not important; otherwise, we used a random‐effects model. We used Poisson regression models to compare the average number of complications per person.Main resultsFrom 6396 citations, we included six studies with a total of 562 participants. Five studies were performed in participants undergoing abdominal surgery (including one study in participants undergoing cytoreductive abdominal surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)), and one study was performed in participants undergoing orthopaedic surgery. In all studies, surgeries were elective. In five studies, crystalloids were used for basal infusion and colloids for boluses, and in one study, colloid was used for both basal infusion and boluses. Five studies reported the ASA (American Society of Anesthesiologists) status of participants. Most participants were ASA II (60.4%), 22.7% were ASA I, and only 16.9% were ASA III. No study participants were ASA IV. For the GDFT group, oesophageal doppler monitoring was used in three studies, uncalibrated invasive arterial pressure analysis systems in two studies, and a non‐invasive arterial pressure monitoring system in one study. In all studies, GDFT optimization was conducted only intraoperatively. Only one study was at low risk of bias in all domains. The other five studies were at unclear or high risk of bias in one to three domains.RFT may have no effect on the rate of major complications compared to GDFT, but the evidence is very uncertain (RR 1.61, 95% CI 0.78 to 3.34; 484 participants; 5 studies; very low‐certainty evidence). RFT may increase the risk of all‐cause mortality compared to GDFT, but the evidence on this is also very uncertain (RD 0.03, 95% CI 0.00 to 0.06; 544 participants; 6 studies; very low‐certainty evidence). In a post‐hoc analysis using a Peto odds ratio (OR) or a Poisson regression model, the odds of all‐cause mortality were 4.81 times greater with the use of RFT compared to GDFT, but the evidence again is very uncertain (Peto OR 4.81, 95% CI 1.38 to 16.84; 544 participants; 6 studies; very low‐certainty evidence). Nevertheless, sensitivity analysis shows that exclusion of a study in which the final volume of fluid received intraoperatively was higher in the RFT group than in the GDFT group revealed no differences in mortality. Based on analysis of secondary outcomes, such as length of hospital stay (464 participants; 5 studies; very low‐certainty evidence), surgery‐related complications (364 participants; 4 studies; very low‐certainty evidence), non‐surgery‐related complications (74 participants; 1 study; very low‐certainty evidence), renal failure (410 participants; 4 studies; very low‐certainty evidence), and quality of surgical recovery (74 participants; 1 study; very low‐certainty evidence), GDFT may have no effect on the risk of these outcomes compared to RFT, but the evidence is very uncertain. Included studies provided no data on administration of vasopressors or inotropes to correct haemodynamic instability nor on cost of treatment.Authors' conclusionsBased on very low‐certainty evidence, we are uncertain whether RFT is inferior to GDFT in selected populations of adults undergoing major non‐cardiac surgery. The evidence is based mainly on data from studies on abdominal surgery in a low‐risk population. The evidence does not address higher‐risk populations or other surgery types. Larger, higher‐quality RCTs including a wider spectrum of surgery types and a wider spectrum of patient groups, including high‐risk populations, are needed to determine effects of the intervention.

Expert Opinion on Pharmacotherapy, Jan 9, 2019

Introduction: Common opioid adverse effects (AE) of the gastrointestinal tract include opioid-ind... more Introduction: Common opioid adverse effects (AE) of the gastrointestinal tract include opioid-induced constipation (OIC) and opioid-induced bowel dysfunction (OIBD) with traditional laxatives being of limited efficacy, having AEs and not addressing the pathophysiology of OIC or OIBD. Targeted treatment comprises of PAMORA (peripherally acting mu-opioid receptor antagonists) and a combination of an opioid receptor agonist with its antagonist, namely prolonged-release oxycodone with prolongedrelease naloxone (OXN) tablets at a fixed ratio of 2:1. Oxycodone provides analgesia, whereas naloxone prevents binding or displaces it from opioid receptors located in the gut wall. Areas covered: The authors review the role of OXN in the management of patients with pain and OIC. A literature search was performed using the search terms 'oxycodone/naloxone' and 'opioid-induced constipation' using the PubMed database up to October 2018. Expert opinion: OXN delivers analgesia comparable (or superior versus placebo and in observational studies) to oxycodone alone and other opioids with a limited or decreased disturbing effect on bowel function. OXN in daily doses of up to 160 mg/80 mg provides effective analgesia with little negative impact on bowel function. OXN may be successfully used in patients with chronic pain, to prevent or treat symptoms of OIC and OIBD.

Pharmaceuticals

Neuropathic pain is a chronic condition that significantly reduces the quality of life of many pa... more Neuropathic pain is a chronic condition that significantly reduces the quality of life of many patients as a result of ineffective pain relief therapy. For that reason, looking for new analgesics remains an important issue. Mirogabalin is a new gabapentinoid that is a specific ligand for the α2σ-1 and α2σ-2 subunits of voltage-gated calcium channels. In the present study, we compared the analgesic effect of pregabalin and mirogabalin in a neuropathic pain chronic constriction injury (CCI) of the sciatic nerve in a mouse model. The main purpose of our study was to determine the effectiveness of mirogabalin administered both once and repeatedly and to explain how the drug influences highly activated cells at the spinal cord level in neuropathy. We also sought to understand whether mirogabalin modulates the selected intracellular pathways (p38MAPK, ERK, JNK) and chemokines (CCL2, CCL5) important for nociceptive transmission, which is crucial information from a clinical perspective. Fir...

Frontiers in Medicine

BackgroundAppropriate fluid management is essential in the treatment of critically ill trauma pat... more BackgroundAppropriate fluid management is essential in the treatment of critically ill trauma patients. Both insufficient and excessive fluid volume can be associated with worse outcomes. Intensive fluid resuscitation is a crucial element of early resuscitation in trauma; however, excessive fluid infusion may lead to fluid accumulation and consequent complications such as pulmonary edema, cardiac failure, impaired bowel function, and delayed wound healing. The aim of this study was to examine the volumes of fluids infused in critically ill trauma patients during the first hours and days of treatment and their relationship to survival and outcomes.MethodsWe retrospectively screened records of all consecutive patients admitted to the intensive care unit (ICU) from the beginning of 2019 to the end of 2020. All adults who were admitted to ICU after trauma and were hospitalized for a minimum of 2 days were included in the study. We used multivariate regression analysis models to assess a...

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Warszawa : Wydawnictwo Lekarskie PZWL eBooks, 2017

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BÓL, 2021

Neuropathic pain is still a challenging problem. It is experienced by millions of people worldwid... more Neuropathic pain is still a challenging problem. It is experienced by millions of people worldwide, with an approximate prevalence of 7‒10% in the general population. Despite the availability of a variety of treatment methods, a significant proportion of patients suffer from poorly controlled neuropathic pain. Capsaicin is a highly selective TRPV1 (Transient Receptor Potential Vanilloid Type 1) agonist. When applied topically, it leads to the defunctionalisation of hyperactive nociceptive receptors, temporary destruction of peripheral nerve endings, and a significant reduction or cessation of pain. Therefore 8% capsaicin patches are used to treat several peripheral, localized neuropathic pain syndromes. The study aimed to present a case series of patients suffering from peripheral, localized neuropathic pain in case the use of repeated applications of 8% capsaicin patches significantly reduced the intensity of pain. In 5 out of 6 patients we observed a gradual extension of the pain ...

Molecules, 2018

The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An ... more The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients' age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non-steroidal anti-inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti-inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.

Cochrane Database of Systematic Reviews, 2017

Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-card... more Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery.

Brain Sciences

Neuropathic pain remains a clinical challenge due to its complex and not yet fully understood pat... more Neuropathic pain remains a clinical challenge due to its complex and not yet fully understood pathomechanism, which result in limited analgesic effectiveness of the management offered, particularly for patients with acute, refractory neuropathic pain states. In addition to the introduction of several modern therapeutic approaches, such as neuromodulation or novel anti-neuropathic drugs, significant efforts have been made in the repurposing of well-known substances such as phenytoin. Although its main mechanism of action occurs at sodium channels in excitable and non-excitable cells and is well documented, how the drug affects the disturbed neuropathic interactions at the spinal cord level and how it influences morphine-induced analgesia have not been clarified, both being crucial from a clinical perspective. We demonstrated that single and repeated systemic administrations of phenytoin decreased tactile and thermal hypersensitivity in an animal model of neuropathic pain. Importantly...

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Bone is after lung and liver the third most common site of metastatic disease in cancer patients.... more Bone is after lung and liver the third most common site of metastatic disease in cancer patients. Many cancer types including breast, prostate, lung, and kidney have a strong predilection to metastasize to bones, which induce pain, pathologic skeletal fractures, spinal instability and compression of the spinal cord or others structures of nervous system, hypercalcemia, decreased mobility and increased mortality. Bone cancer pain is a kind of chronic pain with unique and complicated pathophysiology with both a nociceptive and neuropathic component. The nociceptive component of cancer bone pain is driven by the release of pronociceptive substances produced by tumor and their stromal cells, acidosis caused by bone-destroying osteoclasts, and mechanical destabilization and fracture of the bone. The neuropathic component of cancer bone pain is induced by tumor cell growth which injures and destroys structures of nervous system and distal ends of nerve fibers that normally innervate the b...