Pain in Cancer
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Cancer is often a painful disease
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⅓ of all human cancer patients report pain (60-90% with advanced cancer)
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70-90% can achieve "good" pain control
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In human patients, pain is often more feared than death
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extension of these same concerns by owners to their pet's cancer
Optimal Treatment
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understand the disease and extent
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recognize the cause and importance of each pain
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consider diverse management options
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staged pain management approach
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titrate, adjust and balance care to maintain the most appropriate control
Acute Cancer Related Pain
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surgical oncology, radiation therapy, "break-through" pain
"Chronic" pain
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pain of metastasis, treatment related pain
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palliative care and terminal cancer pain
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Pain in dying, aspects of suffering and the psychology of cancer
Analgesia in Cancer Surgery
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Pre-emptive, balanced multi-modal and adequate analgesia
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Value of local anesthetics in surgical oncology
o Injection of nerve sheath prior to transection (amputation)
• Brachial Plexus nerve block - effective distal to elbow
Clinical Assessment
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History - comprehensive
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Examine sites of pain and dysfunction thoroughly (may need analgesics!)
• Use appropriate diagnostic tools: (Radiography, Ultrasound, CT, MRI, Nuclear Scintigraphy) Advanced techniques can be very
helpful.
Clinical Assessment
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Evaluate extent of disease - extent of pain
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Treat the pain early and aggressively to fully gain control early
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Watch for development of tolerance (specifically to opioids) and side effects (can be managed)
"Acute" Cancer Pain
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associated with tumor involvement
o compression, erosion, nerve compromise
o paraneoplastic syndromes
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surgery or other procedures
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importance of operative pain management can not be overstated
o operative pain management is often the first opportunity we have
"Chronic" Cancer Pain
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more difficult to diagnose and to treat
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longer duration, less well defined onset
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may be associated with hypersensitivity
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may increase with tumor progression
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may subside during periods of tumor regression
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associated with a negative quality of life
