Neoplasms

Symptoms and General Pathology

All Conditions

Nervous System Diseases

Neoplasm Metastasis

Pain

Pain, Intractable

Neoplasms, Second Primary

Neoplastic Processes

Neurologic Manifestations

Analgesics

Central Nervous System Depressants

All Drugs and Chemicals

Dexmedetomidine

Morphine

Hypnotics and Sedatives

Analgesics, Non-Narcotic

Adrenergic Agents

Adrenergic alpha-Agonists

Adrenergic Agonists

Neurotransmitter Agents

Patients allocated to this group receive a combination of Morphine and Dexmedetomidine

Pain is a common symptom in patients nearing the end of life. Its prevalence varies between 30 and 75%. Nowadays, morphine is the most used molecule as first line treatment of moderate to severe pain. However, this molecule, considering its side effects, may contribute in part to the discomfort of these patients and may increase the pre-existing agitation or delirium. There is therefore a need to find new agents, other than morphine, for pain control at the end of life, without the limitations that the morphine molecule has. The author reviewed the literature on the role of dexmedetomidine in the treatment of refractory symptoms in palliative care, including pain. It is an agonist of the adrenergic alpha 2 receptor having a sedative, analgesic action and a morphine sparing effect demonstrated postoperatively.

This study aims primarily at demonstrating that dexmedetomidine has a beneficial role in the treatment of pain in patients with metastatic cancer.

Dexmedetomidine Addition to Morphine in Patients With Metastatic Cancer

Does the Addition of Dexmedetomidine to Morphine Improve the Treatment of Pain in Patients With Metastatic Cancer? A Pilot Study

The visual analogue score is used to asses for pain score, the scale varies between 0 and 10 where 0 is no pain and 10 is worst pain encountered

Hotel Dieu de France Hospital

Assistant professor

Ear, Nose, and Throat Diseases

Nausea

Vomiting

Cancer Pain

Vertigo

Dizziness

Oxycodone

Analgesics, Opioid

Narcotics

Patients with moderate to severe pain accept CR oxycodone treatment and if any follow situations appears, then change the dose frequency from every 12 hours to every 8 hours or 6 hours.

1. Patients are satisfied with the pain control, but unable to tolerate nausea、vomit or dizziness, and can't get satisfactory pain control if reducing the CR oxycodone dose.
2. Patients are unsatisfied with the pain control, but can't increase the CR oxycodone dose because of intolerable nausea、vomit or dizziness.

Keep the daily dose while increase the dose frequency of Controlled-Release Oxycodone so that reduce the single dose

Increasing the Controlled-Release Oxycodone dose frequency

Many patients with cancer experience moderate to severe pain that requires treatment with strong opioids, of which oxycodone and morphine are examples, they are widely applied in clinical treatment because of sustained-released formulation can reduce dosing frequency. Goal of pain management is get adequate analgesia and minimize the adverse event at the same time, but in fact there are about 10%-30% patients can't get adequate analgesia because of intolerable adverse event. The common adverse event of Controlled-Release Oxycodone(CR Oxycodone ) are nausea (29.9%)、constipation （25.4%）、dizziness（22.4%） and vomit（11.9%），about 32.8% patients treatment was discontinued because of these adverse event. The peak concentration of opioid is related to adverse event, while the valley concentration is correlated to the analgesic effect. Therefore, if we keep the daily dose while increase the dose frequency so that reduce the single dose, it's will help to avoid intolerable adverse event caused by excessive opioid peak concentration and keep the opioid analgesia at the same time. It's a reasonable way to solve the side effects of opioid.

In order to explore the effect of change the dosing frequency of CR Oxycodone to treat refractory pain, pre-experiment have done by several clinical centrals in Fujian province. Preliminary results show that for the patients who can't accept the current opioid dose because of intolerable side effect, changing the dosing frequency is a safe and effect way.

This is a multicenter、singe arm、prospective study.

Study population:

Moderate to severe cancer pain (4-6 on the standard Numerical Rating Scale \[NRS\], range 0-10) patients with unsatisfactory pain control because of intolerable nausea、vomit or dizziness during accept CR Oxycodone treatment.

Therapeutic schemes:

1. CR oxycodone dose titration scheme: adjusting the dose of CR oxycodone every 24 hours according to the NRS and adverse event;
2. Increasing the dose frequency scheme; Patients with moderate to severe pain accept CR oxycodone treatment and if any follow situations appears, then change the dose frequency from every 12 hours to every 8 hours or 6 hours.

Patients are satisfied with the pain control, but unable to tolerate nausea、vomit or dizziness, and can't get satisfactory pain control if reducing the CR oxycodone dose.

Patients are unsatisfied with the pain control, but can't increase the CR oxycodone dose because of intolerable nausea、vomit or dizziness.

Primary end point:

The effective rate of treatment: the rate of patients who get satisfactory pain control without intolerable adverse event in two consecutive day .

Secondary end point:

The time of reach effective treatment； The degree of pain reduction; The incident rate of adverse drug reaction The reduction rate of adverse drug reaction The change of plasm concentration after change the dose frequency; The relationship between peripheral blood gene and analgesia effect; The relationship between peripheral blood gene and adverse event;

Change the Dose Frequency of Controlled-Release Oxycodone to Refractory Pain

Phase II Study of Change the Dose Frequency of Controlled-Release Oxycodone to Refractory Pain

At study entry, assess the adverse drug reaction (ADR) and the pain degree by Likert scale everyday. The Likert scale of pain includes the absence of pain (a score of 0), mild pain (a score of 1), moderate pain (a score of 2), severe pain (a score of 3). The Likert scale of ADR includes the absence of ADR (a score of 0), mild ADR (a score of 1), moderate ADR (a score of 2), severe ADR (a score of 3).

The effective rate of treatment: the rate of patients who get satisfactory pain control (0 or 1 point on the 3-point Likert scale ) without intolerable adverse event (0 or 1 point on the 3-point Likert scale ) in two consecutive day .

Effective treatment means patients who get satisfactory pain control (0 or 1 point on the 3-point Likert scale ) without intolerable adverse event (0 or 1 point on the 3-point Likert scale ) in two consecutive day .

Apply the Likert scale to evaluate pain degree. The Likert scale of pain includes the absence of pain (a score of 0), mild pain (a score of 1), moderate pain (a score of 2), severe pain (a score of 3).

The blood samples are collected before and after changing the oxycodone dose frequency，For the patients whose frequency change from every 12 hours to every 8 hours ,the blood sampling time points are one hour before changing dose and one hour ,four hour after changing dose, For the patients whose frequency change from every 12 hours to every 6 hours ,the blood sampling time points are one hour before changing dose and one hour ,three hour after changing dose

The blood samples are collected before change the oxycodone dose frequency, and apply the Next-generation sequencing technology to check patient's peripheral blood geneblood gene

Fujian Cancer Hospital

Behaviors and Mental Disorders

Wounds and Injuries

Rare Diseases

Anxiety Disorders

Depressive Disorder

Depression

Chronic Pain

Peripheral Nervous System Diseases

Neuromuscular Diseases

Quality of Life

Chronic Graft Versus Host Disease

Patients treated with ozone as adjuvant palliative therapy. The procedure of ozone administration, dosage, frequency, and duration of ozone treatment will depend on the treated symptom and clinical evolution. Usually planned 40 sessions.

Systemic and/or local ozone administration. Dosage, frequency, and duration of ozone treatment will depend on the treated symptom and clinical evolution. Usually planned 40 sessions.

Ozone therapy

Bernardino Clavo, MD, PhyD

Francisco Rodríguez-Esparragón, BSci, PhyD

Francisco Rodríguez-Esparragón, BSc, PhyD

Miguel A Caramés-Álvarez, MD

Pedro G Serrano-Aguilar, MD, PhyD

The main objective of this study is to analyze the impact on the health-related quality of life of patients with refractory symptoms, who have been referred to the HUGCDN Chronic Pain Unit for adjuvant palliative treatment with ozone therapy between June-2022 and December-2025

Chronic Pain Unit in the absence or failure of standard treatment, or when the standard treatment is associated with high morbidity or high risk. Frequently, these patients present alterations in self-perceived health-related quality of life (HRQoL), anxiety, depression, and other symptoms. This study aims to evaluate in these patients the effect of adjuvant symptomatic/palliative ozone therapy on the HRQoL and the potential changes from baseline on several parameters after treatment.

MAIN OBJECTIVES: To evaluate in these patients: 1) the clinical effect on the HRQOL of adding ozone to the standard treatment.

SECONDARY OBJECTIVES: To evaluate in these patients changes from baseline on 2) anxiety and depression, 3) pain (if applicable), 4) grade of toxicity (if applicable), 5) requirements of invasive procedures for symptom management, 6) evolution of main symptoms, 7) evolution of oxidative stress and inflammation (if systemic ozone therapy).

METHODOLOGY: Prospective and observational study of patients referred to our Chronic Pain Unit for symptomatic/palliative treatment with ozone therapy between 2022 and 2025.

MAIN VARIABLE: 1) HRQoL through the EQ-5D-5L questionnaire

SECONDARY VARIABLE: 2) anxiety and depression through the hospital anxiety/depression (HAD) questionnaire, 3) Pain through the visual analog scale (VAS), 4) grade of toxicity in cancer patients through the CTCAE v5.0 scale, 5) the number of invasive procedures required for symptom management, 6) self -reported percentage of symptom improvement, 7) biochemical parameters of oxidative stress and inflammation.

Assessments at weeks: 0 (baseline), 16 (end of O3/O2 treatment, objective), 28 (12 weeks after the end of ozone), and 40 (24 weeks after the end of ozone, control) Length of treatment: as required; initially, planned 16 weeks. Follow-up: 24 weeks after finishing O3/O2 treatment. Planned length of the clinical trial: 49 months.

Patients Referred to the Chronic Pain Unit for Palliative Treatment With Ozone Therapy Between 2022 and 2025

Prospective and Observational Study of Patients Referred to the Chronic Pain Unit for Palliative Treatment With Ozone Therapy Between 2022 and 2025. (EPOOzo)

Self-reported evaluation of: a) 5 physical and emotional items scored in five levels, from 1 (best: I have no problem) to 5 (worst: I have extreme problem or I am unable to...) and b) additional self-assessment of health by a visual analogue scale (0 = worst health patient can imagine, 100 = best health patient can imagine)

HAD scale is a self-administered questionnaire which assesses 14 items pertaining to symptoms of anxiety (seven) and depression (seven) experienced by patients. Each item is scored from 0 (better, no alteration) to 3 (worse level of alteration). For each symptom, overall score is from 0 (better, no anxiety or depression) to 21 (worse, very severe anxiety or depression).

Self-reported evaluation of the severity of pain according to the VAS, scored from 0 ("No pain") to 10 ("Pain as bad as you can imagine")

Grade of toxicity secondary to cancer-treatment according to the CTCAE v5.0 (Common Terminology Criteria for Adverse Events from the National Cancer Institute) scale. Each toxicity is usually scored from 0 (asymptomatic or mild symptoms) to 5 (death).

Number of invasive procedures (surgery, blood transfusions, and therapeutic endoscopic procedures) required for symptom management.

Self -reported percentage of symptom improvement from Baseline

Serum levels of biochemical parameters of oxidative stress

Serum levels of pro-inflammatory cytokines

Number of invasive procedures ((surgery, blood transfusions, and therapeutic endoscopic procedures) required for symptom management.

Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)

Servicio Canario de Salud

Cabildo de Gran Canaria

Red de Investigación en Servicios de Salud en Enfermedades Crónicas

Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna

Bernardino Clavo, MD, PhD

MD, PhD, Head of Research Unit

Active tDCS will be delivered daily for 5 consecutive days with the patient either sitting or lying down.A tDCS session generally lasts 20 minutes.

Sham tDCS will be delivered daily for 5 consecutive days with the patient either sitting or lying down.A tDCS session generally lasts 20 minutes.

tDCS consists of delivering a low-intensity (1 to 2 milliamperes) direct electrical current by means of a pair of electrodes (anode and cathode) applied to the scalp. Electrodes generally have a diameter (round electrode) or a diagonal (rectangular electrodes) ranging from 2 to 3.5 cm.

To stimulate a given cortical zone, the anode is placed over of the selected zone, generally identified by means of an EEG headset (10/20 System Positioning). For the treatment of pain, the anode is placed over the primary motor cortex (M1) on the contralateral side to the pain or on the left side in patients with diffuse pain. The cathode is placed over a supposedly neutral cortical zone, usually the contralateral supraorbital cortex with respect to the anode. In this study, the stimulation intensity will be 1.5 mA using round sponge electrodes 3.5 cm in diameter.

Active Transcranial Direct Current Stimulation

The tDCS device has a "Sham" mode that allows for true placebo stimulation. A simulated session is thus designed as a real stimulation session without its effects. Sensations similar to tDCS are created by generating currents only at the start of the session.

Same modalities as for the Active tDCS procedure will therefore be put in place: a pair of electrodes (anode and cathode) are applied to the scalp.To stimulate a given cortical zone, the anode is placed over of the selected zone, generally identified by means of an EEG headset (10/20 System Positioning). For the treatment of pain, the anode is placed over the primary motor cortex (M1) on the contralateral side to the pain or on the left side in patients with diffuse pain. The cathode is placed over a supposedly neutral cortical zone, usually the contralateral supraorbital cortex with respect to the anode.

Sham Transcranial Direct Current Stimulation

Shahnaz KLOUCHE, MD

Marine ROYER

Jean-Paul NGUYEN, MD

Hélène GAILLARD-PERERA, MD

Pain is a common symptom in palliative care cancer patients and is often insufficiently relieved. The 2010 INCA report showed that France is not an exception to this worldwide observation (synopsis of the 2010 national survey). This report shows that pain is the symptom that these patients fear the most and that it dramatically impacts their quality of life. These patients may experience nociceptive pain related to stimulation of sensory nerve endings by the tumour. When tumour resection is impossible, a symptomatic analgesic treatment is generally proposed, mainly consisting of administration of opioid analgesics. At high doses, this treatment induces adverse effects, especially drowsiness and psychomotor retardation that impair the patient's quality of life.

They may also experience neuropathic pain, secondary to anatomical lesions or functional impairment of nerve structures (peripheral nerves or cerebral or spinal tracts) related to repeated surgical procedures and/or radiotherapy. This type of pain may respond to antiepileptic or antidepressant drugs. At high doses, these treatments also induce adverse effects fairly similar to those observed during treatment of nociceptive pain. As these two types of treatment often need to be coprescribed, these patients frequently present an almost permanent state of drowsiness at the end of life, preventing all normal activities of daily living.

In recent years, noninvasive brain stimulation (NIBS) techniques (transcranial magnetic stimulation (rTMS) or transcranial direct-current stimulation (tDCS)) have been successfully used to treat chronic pain. It was shown that these NIBS techniques can improve pain in cancer patients in the palliative care setting.

tDCS appears to be more suitable than rTMS for the treatment of palliative care patients, who are often difficult to mobilize, as tDCS can be delivered at the patient's bedside and possibly even at home, which is not the case with rTMS. tDCS also appears to be rapidly effective (after 5 sessions) in the context of cancer pain, and this effect lasts longer than that of rTMS.

The proposed treatment of refractory cancer pain by tDCS in palliative care patients is a new treatment modality that is well adapted to hospitalised patients. Each patient will receive 20 minutes of transcranial direct-current stimulation daily for 5 consecutive days.

One arm will receive active stimulation and the control arm will receive sham stimulation. Patients and investigators will be blinded to the type of tDCS.

By improving the patient's activities of daily living, this treatment will enable the patient to return home under good conditions for both the patient and the caregivers. This treatment can also be continued at home. This strategy is consistent with current guidelines in this field, in which the priorities are improvement of quality of life, return home and decreased workload for caregivers.

Bicentre, double blinded, randomized, parallel-arm, sham-controlled trial

Transcranial Direct-current Stimulation (tDCS) Efficacy in Refractory Cancer Pain.

Efficacy Assessment of Transcranial Direct Current STIMulation (tDCS) in Reducing Pain in PALliative Cancer Patients.

Pain intensity will be scored from 0 to 10 (0=No pain, 10 = worst pain) on the Numerical Rating Scale, 3 times daily. Mean variation of the pain NRS between the baseline assessment (Day -3 to Day -1) and the Day 8 assessment will be calculated and compared between arms.

Change in Pain Numerical Rating Scale score measured before and after each tDCS session.

Efficacy of treatment, defined by a ≥ 20% reduction of the mean Numerical Rating Scale score between Baseline and Day 8.

Pain Numerical Rating Scale scores will be measured 3 times daily. Mean Numerical Rating Scale score will be calculated and compared between arms.

Brief Pain Inventory questionnaire, short form (BPI). Mean variations of scores will be compared between arms.

Edmonton Symptom Assessment System (ESAS). Mean variations of scores will be compared between arms.

Hospital Anxiety and Depression Scale (HADS). Mean variations of scores will be compared between arms.

(State-Trait Anxiety Inventory (Form Y) (STAI-Y). Mean variations of scores will be compared between arms.

Medication Quantification Scale (MQS). Mean variations of scores will be compared between arms.

Elsan

Ketamine

Anesthetics

Anesthetics, Dissociative

Anesthetics, Intravenous

Anesthetics, General

Excitatory Amino Acid Antagonists

Drip continues of ketamine in intravenous injection included posology enters 0,5mg/kg /day and 2mg/kg/day during 4 days

Drip continues of NaCl 0,9% in intravenous injection during 4 days

NaCl

Sylvie ROSTAING-RIGATTIERI, MD

Long-term opioid therapy is commonly administered for the management of severe cancer pain. Increasing doses of opioids are titrated against effects until analgesia is achieved or intolerable adverse effects occur. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been reported to improve analgesia in patients with uncontrolled pain receiving high doses of opioids. This study aims at determining the effectiveness of ketamine as an adjuvant to opioids in relieving cancer pain.

Main objective:

To show that low analgesic doses of ketamine in intravenous infusion during 4 days associated with opioids better relieve refractory cancer pain than opioids without ketamine.

This study is a prospective study, multicenter (11 centres), consisting of 3 phases:

* a randomized controlled double blind phase of 5 days with 2 parallel groups of 38 patients each : ketamine (in association with high opioids), in intravenous injection during 4 days, versus placebo (in association with high opioids), in intravenous injection during 4 days ;
* an open-label phase of maximum 4 days, during which the ketamine Panpharma® is administered in intravenous infusion to the hospitalized patients who are still having uncontrolled pain persisting or recurrent ;
* an observational phase : starting at the discharge of the patient, of a maximal period of 6 months.The inclusion period is during 18 months, the total duration of the study is 2 years.

  76 patients are expected: 38 will be treated with opioids and ketamine; 38 will be treated with opioids and a placebo.

Success is defined by a decrease of the daily pain score of 50 % after 4 days. The expected rate of success in the placebo group is 10 % whereas the expected rate of success in the ketamine group is 30 %.

Primary outcome (pain score on a 11-point numerical scale) will be evaluated everyday as well as secondary outcomes (patient and clinician global impression of change, opioid consumption, adverse reactions, patient satisfaction on pain relief, sleep interference score).

Vital parameters (cardiac frequency, respiratory frequency and arterial blood pressure) will be checked everyday, many times a day : every hour for the four hours after the beginning of the treatment and then, every four hours ; every hour for the two hours following a dose shift).

Efficacy of Low Analgesic Doses of Ketamine Associated With Opioids in Refractory Cancer Pain Treatment

Study of the Efficiency of the Ketamine With Low Analgesic Doses, in Association With High Opioids, in the Treatment of the Rebels Pains, in Palliative Phase of the Cancerous Disease

The daily average score of painful intensity being the score of painful intensity of the previous 24 hours, determined by the patient on a digital scale(ladder) validated from 0 to 10

Number of Participants with Adverse Events as a Measure of Safety and Tolerability

Assistance Publique - Hôpitaux de Paris

Main objective :

To show that low analgesic doses of ketamine associated with opioids better relieve refractory cancer pain than opioids without ketamine.

Secondary objectives :

* Determine whether ketamine use allows to reduce opioid consumption
* Evaluate the adverse effects of opioids-ketamine association versus opioids-placebo.

  100 patients are expected : 50 will be treated with opioids and ketamine ; 50 will be treated with opioids and a placebo.

Treatment will be administered for 4 days. Patients will be followed-up for 5 days.

Success is defined by a decrease of the daily pain score of 50 % after 4 days. The expected rate of success in the placebo group is 10 % whereas the expected rate of success in the ketamine group is 35 %.

Primary outcome (pain score on a 11-point numerical scale) will be evaluated everyday as well as secondary outcomes (patient and clinician global impression of change, opioid consumption, adverse reactions, patient satisfaction on pain relief, sleep interference score).

Vital parameters (cardiac frequency, respiratory frequency and arterial blood pressure) will be checked everyday, many times a day : every hour for the four hours after the beginning of the treatment and then, every four hours ; every hour for the two hours following a dose shift).

Ketamine Associated With Opioids in Refractory Cancer Pain Treatment

Aurémie GUIMFACK

Subjects randomized to the Intrathecal Drug Delivery System group will be implanted with the Prometra System under sterile technique in accordance with the Instructions for Use. The pump will be filled at the time of implantation with the prescribed medication.

Subjects randomized to the Conventional Medical Management group will continue with the standard of care procedures.

The Flowonix Prometra® II Programmable Infusion System consists of an implanted infusion pump and catheter, and external components including a clinician programmer, refill and catheter access port kits, the PTC™(a subject operated controller).

Flowonix Prometra® II Programmable Infusion System

Injections, spinal cord stimulation, peripheral nerve stimulation, pain medication, etc.

Pain Medicine

Jason E Pope, MD

This study is being conducted to compare intrathecal morphine using the commercially available intrathecal drug delivery systems (IDDS), and conventional medical management (CMM) in subjects with non-cancer, refractory chronic pain.

This study will evaluate the following objectives:

Primary objective:

1. To compare the change in pain intensity from baseline based on the Numeric Rating Scale \[NRS\] between subjects randomized to the IDDS group and subjects randomized to the CMM group.The comparison will be conducted at 3, 6, 9 and 12 months following enrollment. The evaluation at 6 months will be considered the primary time point for evaluation.

Secondary objectives:

For each of the following secondary objectives, the comparisons between the IDDS group and CMM group will be made using the intra-subject change from baseline as the dependent variable.

1. Compare the subject reported PROMIS 29 between the IDDS group and CMM group. Individual subject scores recorded at baseline and months 3, 6, 9 and 12.
2. Compare the accrued cost of therapy for pain control including those related to adverse events, ED visits, cost of medications between the IDDS group and CMM group
3. Compare the number of other concurrent treatments performed on each subject between the IDDS group and CMM group. Individual subject counts recorded at months 3, 6, 9 and 12 will be compared.

Additional safety objective:

1. To characterize pain and device related adverse events for all subjects throughout the study through completion of 12 month follow-up or subject exit.

Subjects will be randomized in a 1:1 ratio to one of two groups

Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population

Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population (PROSPER)

The Numeric Pain Rating Scale (NPRS) is a 0-10 numeric pain rating scale (11 point scale), where a higher scores equates to more pain.

The primary endpoint for this post-marketing study is the comparison of the NPRS between the IDDS group and the CMM group collected in the Study Diary at various time points.

Compare the subject reported Patient-Reported Outcomes Measurement Information System (PROMIS) 29 between the IDDS group and CMM group. PROMIS 29 assesses pain intensity using a 0-10 numeric rating scale (11 point scale), where a higher score equates to more pain. Other health domains are scored using a Likert scale, where higher scores represent more of the specific domain being measured. The other health domains that are scored are: depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities.

Compare the accrued cost of therapy for pain control including those related to adverse events, ED visits, cost of medications between the IDDS group and CMM group.

Compare the number of other concurrent treatments performed on each subject between the IDDS group and CMM group.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Dexmedetomidine Addition to Morphine in Patients With Metastatic Cancer	NCT03936205	Refractory Pain Metastatic Canc...	Dexmedetomidine	18 Years - 75 Years	Hotel Dieu de France Hospital
Change the Dose Frequency of Controlled-Release Oxycodone to Refractory Pain	NCT03639415	Cancer Pains	Increasing the ...	18 Years -	Fujian Cancer Hospital
Patients Referred to the Chronic Pain Unit for Palliative Treatment With Ozone Therapy Between 2022 and 2025	NCT05417737	Radiation Toxic... Chemotherapeuti... Chemotherapy-in... Delayed Wound H... Chronic Pain Refractory Pain	Ozone therapy	18 Years -	Dr. Negrin University Hospital
Dexmedetomidine Addition to Morphine in Patients With Metastatic Cancer	NCT03936205	Refractory Pain Metastatic Canc...	Dexmedetomidine	18 Years - 75 Years	Hotel Dieu de France Hospital
Transcranial Direct-current Stimulation (tDCS) Efficacy in Refractory Cancer Pain.	NCT04683172	Cancer Pain Refractory Pain	Active Transcra... Sham Transcrani...	18 Years -	Elsan
Efficacy of Low Analgesic Doses of Ketamine Associated With Opioids in Refractory Cancer Pain Treatment	NCT01326325	Pain	Ketamine NaCl	18 Years -	Assistance Publique - Hôpitaux de Paris
Ketamine Associated With Opioids in Refractory Cancer Pain Treatment	NCT00484484	Pain	Ketamine	18 Years -	Assistance Publique - Hôpitaux de Paris
Efficacy of Low Analgesic Doses of Ketamine Associated With Opioids in Refractory Cancer Pain Treatment	NCT01326325	Pain	Ketamine NaCl	18 Years -	Assistance Publique - Hôpitaux de Paris
Efficacy of Low Analgesic Doses of Ketamine Associated With Opioids in Refractory Cancer Pain Treatment	NCT01326325	Pain	Ketamine NaCl	18 Years -	Assistance Publique - Hôpitaux de Paris
Transcranial Direct-current Stimulation (tDCS) Efficacy in Refractory Cancer Pain.	NCT04683172	Cancer Pain Refractory Pain	Active Transcra... Sham Transcrani...	18 Years -	Elsan
Post-market, Randomized, Controlled, Prospective Study Evaluating Intrathecal Pain Medication (IT) Versus Conventional Medical Management (CMM) in the Non-cancer, Refractory, Chronic Pain Population	NCT04096391	Chronic Nonmali... Pain, Intractab... Pain, Chronic	Flowonix Promet... Pain Medicine	22 Years -	Evolve Restorative Center

Spots Global Cancer Trial Database for refractory pain