Aditi Chaturvedi

Complementary and alternative medicine in cancer pain management: a systematic review.

Quality of life (QoL) encompasses the physical, psychosocial, social and spiritual dimensions of life lived by a person. Cancer pain is one of the physical component has tremendous impact on the QoL of the patient. Cancer pain is multifaceted and complex to understand and managing cancer pain involves a tool box full of pharmacological and non pharmacological interventions but still there are 50-70% of cancer patients who suffer from uncontrolled pain and they fear pain more than death. Aggressive surgeries, radiotherapy and chemotherapy focus more on prolonging the survival of the patient failing to realize that the QoL lived also matters equally. This paper reviews complementary and alternative therapy approaches for cancer pain and its impact in improving the QoL of cancer patients.

Comparison of the efficacy and tolerability of ivabradine and ranolazine in patients of chronic stable angina pectoris

Introduction: To compare the efficacy and tolerability of Ivabradine (IVA) and Ranolazine (RAN) in chronic angina patients. Materials and Methods: This was a follow-on, open-label trial conducted in a tertiary care hospital of Uttarakhand. Thirty patients each taking IVA 5 mg twice daily or RAN 500 mg twice daily were distributed to the respective groups. Patients were asked to fill a pretested questionnaire on frequency of anginal attacks and adverse reactions before and 2, 4 and 8 weeks after taking the respective medicines. Their blood pressure, heart rate and routine hematological and biochemical estimations were performed at baseline and after intervention. Results were statistically analyzed using different statistical tests, with P < 0.05 considered as significant. Results: There was no significant difference in the frequency of anginal attacks per week between the groups. The adverse drug reactions (ADRs) reported in the IVA group were dizziness (30%), headache (16.6%), backache (16.6%), vertigo (13.3%), blurred vision (13.3%), muscle cramps (10%), arthralgia (10%), cough and dyspnea (6.6%), hypersensitivity rash (6.6%), fever (3.3%) and nausea (3.3%). The ADRs in the RAN group were nausea (26.6%), dizziness (23.3%), vomiting (3.3%), constipation (3.3%) and vertigo (3.3%). The blood pressure, heart rate and routine hematological and biochemical evaluations did not show any significant difference in the pre–post values. IVA significantly decreased the resting heart rate after eight weeks of intervention. Conclusions: Both antianginal agents appeared equiactive. However, RAN had a better safety and tolerability profile than IVA. Serum sickness-like reaction was an adverse event noticed with IVA, which needs causality establishment.

The Unheard Pain of Cancer Patients

Cancer pain is multidimensional and complex mechanism rarely presenting as a pure neuropathic, visceral, or somatic pain syndrome. Rather, it may involve inflammatory, neuropathic, ischemic, breakthrough pain mechanisms at multiple sites. Despite recommendation and demonstration of patients′ need, these needs are not being met. Since two decades, a trend has been set to exclude pain specialist from mainstream cancer pain management, they are being called during the end stage making them the ′last resort′. Thus patients are missing out on benefits of multidisciplinary care combining palliative care and pain medicine. Morphine licensing is still a very painful procedure for the institutions trying to provide pain relief to the cancer patients and due to this troublesome procedure of morphine licensing many patients do not get adequate analgesia and die in pain. This review article highlights the importance of recognizing cancer-related pain and the need to optimize management. It emphasizes on pain management for the cancer population with evidence-based multimodal and mechanism-based treatments and finally to strengthen the relationship between palliative care, oncology, and pain medicine.

Super TB: Another Manmade Disaster

Resistant tuberculosis is aman made disaster due to negligence of patients, physicians, and policy makers. It has been fuelled by inadequate use of sputum smear microscopy, excessive dependence on chest radiography, illogical manufacture and irrational prescription of improper combinations of medicines, inadequate dose,duration and noncompliance to the prescribed treatment. The resultant gift is the dreaded Totally Drug Resistant Tuberculosis (TDR-TB). Culture and drug sensitivity testing (DST) should not blindly direct the management of TDR-TB, but has the importance in individualising the drug therapy in TDR-TB patients.The DST which is a crucial part of Directly Observed Treatment Short course (DOTS) plus has been introduced in a phased manner in India. However measuring resistance to second line anti-tubercular drugs (SLDs) with DST is complex and lacks standardization. The WHO has categorized the SLDs based on their efficacy. Most of the DST methods have a turnaround time of several months and empirical regimen should be switched to individual regimen depending on DST results. Newer assays like microscopic observation drug susceptibility assay,line-probe assay and bacteriophage assay can be used for rapid detection of drug resistance. Pharmacovigilanceis urgently needed for resistant tuberculosis as SLDs are less efficacious and more toxic. Presently, the treatment of TDR-TB is not consolidated. Precaution in the treatment, prevention of spread of the infected cases and use of newer vaccines are some of the strategies which have to be used to contain the new mighty variant of microbe mycobacterium tuberculosis.