This document discusses pain management in cancer patients. It describes different types of cancer pain such as nociceptive, neuropathic, somatic, visceral, and bony pain. It also discusses various pain rating scales. Treatment options covered include opioids, NSAIDs, steroids, bisphosphonates, radiation, surgery, and adjuvants like anticonvulsants and antidepressants. Non-pharmacological options like acupuncture and alternative therapies are also mentioned. The conclusion emphasizes the importance of comprehensive cancer pain assessment and management using a multidisciplinary approach.
18. Cancer Pain
Breakthrough
âIncidentalâ pain
Severe transitory increase in pain on
baseline of moderate intensity or less
Caused by movement, positioning,
cough, wound dressing, etc
Often associated with bony metastasis
20. Opioid receptors
Classically, opioids active on CNS receptors
mu (¾) kappa (κ) delta (δ) receptors
Now found on:
Peripheral Neurons
Immune Cells
Inflammed Tissue
Respiratory Tissue
GI Tract
38. Key Points
⢠Current, accurate information
⢠Use available resources
⢠Involve family & caregivers
⢠Know patient knowledge base
⢠Address patient priorities first
⢠Small doses of useful info (e.g., S/E)
⢠Individualize to patient (social,
education level)
39. Conclusion
ďą Cancer pain can be from the cancer
itself, or from cancer-related treatments
ďą Can be somatic, visceral, or
neuropathic
ďą Negative effects of cancer-related pain
can effect QOL, mortality
ďą Ask the patient about pain and
REASSESS!
40. ďą Choose non-opioid / adjuvants
carefully paying close attention to side
effect profile
ďą Use WHO ladder guidelines when
titrating pain medications
ďą Use long-acting opioids for chronic
cancer pain
ďą Recognize â4th
stepâ in WHO ladder and
utilize your multidisciplinary resources
patient with H&N cancer â large R sided mass â ex. Somatic pain
Colorectal CA with liver met â left lobe of liver â visceral pain
Vertebral met â localized somatic pain to vertebrae, visceral pain in abdomen â and neuropathic pain from nerve root involvement â ex â many cancer patients will have several sources and can have a combination of how theyâre experiencing pain
patients can have chemo-related neuropathies â cisplatin, taxol, the vinca alkaloid are well known players â
patients usually have a symmetrical polyneuropathy â localized in hands and feet
SURGICAL neuropathies â have distinct pain syndromes â phantom limb pain s/p amputation
Post-mastectomy syndrome â neuropathic pain in posterior arm, axilla and anterior chest wall â due to the interrupatiention of the intercostal brachial nerve (cutaneous sensory branch of T1-2) â little bit of a misnomer â you see this syndrome in women who have undergone a radical mastectomy, lumpectomy, even just an axillary node dissection ; 5% of women who undergo any of those procedures will have this syndrome (ex. Lady with dcis â b mastectomy- did fine (felt a lump in her axilla â lymph node dissection (fortunately benign) and since then has had debilitating neuropathic pain)
Same with post-thoracotomy â neuropathic pain along the distribution of an intercostal nerve following injury or surgery â ex. Lung ca patients s/p lobectomy
Lastly â what type of neuropathic pain does this picture demonstrate?? â CORD compression â which weâll talk about later
Constipation â easier to prevent than treat; all patients on opioids need a bowel regimen, dry mouth, nausea, sedation â usually go away in a few days; always clarify when a patient says they have an allergy to morphine
More uncommon adverse effects
can combat many side effects with medication, or with opioid rotation
The big fear â respiratory depression â patients will fall asleep/somnolent before their resp drive is affected
When we see it â patients continuing to get their opioids after theyâve become somnolent â RNs, family pushing pca, combining benzos and opiates; if vitals are stable and patient protecting airway â can just observe â if showing signs of resp depression â then give narcan
It increases the risk of developing pepatientic ulcers