Pain management in cancer patients (Proceedings)


Pain management in cancer patients (Proceedings)

Apr 01, 2009

Pain in Cancer

• Cancer is often a painful disease
• ⅓ of all human cancer patients report pain (60-90% with advanced cancer)
• 70-90% can achieve "good" pain control
• In human patients, pain is often more feared than death
• extension of these same concerns by owners to their pet's cancer

Optimal Treatment

• understand the disease and extent
• recognize the cause and importance of each pain
• consider diverse management options
• staged pain management approach
• titrate, adjust and balance care to maintain the most appropriate control

Acute Cancer Related Pain

• surgical oncology, radiation therapy, "break-through" pain

"Chronic" pain

• pain of metastasis, treatment related pain
• palliative care and terminal cancer pain
• Pain in dying, aspects of suffering and the psychology of cancer

Analgesia in Cancer Surgery

• Pre-emptive, balanced multi-modal and adequate analgesia
• 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

• History - comprehensive
• 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

• Evaluate extent of disease - extent of pain
• Treat the pain early and aggressively to fully gain control early
• Watch for development of tolerance (specifically to opioids) and side effects (can be managed)

"Acute" Cancer Pain

• associated with tumor involvement
o compression, erosion, nerve compromise
o paraneoplastic syndromes
• surgery or other procedures
• importance of operative pain management can not be overstated
o operative pain management is often the first opportunity we have

"Chronic" Cancer Pain

• more difficult to diagnose and to treat
• longer duration, less well defined onset
• may be associated with hypersensitivity
• may increase with tumor progression
• may subside during periods of tumor regression
• associated with a negative quality of life