Cancer pain management case study

Cancer pain management case study

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Management of Neuropathic Cancer Pain - A Case Study

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However, methadone also has several distinct disadvantages, including drug interactions, the risk of QT prolongation, and a variable equianalgesic ratio, making rotation more challenging. Rotation back to oral opioids was planned for the next morning to prepare her for discharge.

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Back to Top Article Outline.

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Assessment of the Patient with Pain

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It is intended as a resource to inform and assist clinicians who care for cancer patients.

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Treating Chronic Pain

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Neuraxial analgesia in refractory malignant pain.

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Referral to a pain specialist or a palliative care team may be indicated.

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Addressing anxiety is an important nonpharmacologic intervention.

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Somatic pain is more easily localized.

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The ORT is short and useful for busy practices.

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Midazolam was used to temporarily sedate the patient while the team consulted anesthesia to consider an epidural catheter. Chronic pain involves the activation of secondary mechanisms such as the sensitization of second-order neurons by upregulation of N-methyl-D-aspartic acid channels and alteration cancer pain management case study microglia cytoarchitecture.

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Opioids were then rotated to hydromorphone and titrated to comfort.

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Current analgesics included morphine CR mg every eight hours and morphine sulfate immediate release 60 mg every three hours as needed for breakthrough pain. The opioid titrations and conversions guidelines and examples are shown in Table 2.

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Decision-making Approach Pain management varies widely in complexity.

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Safety and efficacy of repeat administration of samarium Sm lexidronam to patients with metastatic bone pain. Business of Medicine Navigate the mnagement business, legal, and ethical arenas towards building and maintaining a successful medical practice.

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It is often difficult to treat such pain effectively because of its episodic nature.

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Pain assessment tools have been developed for special populations such as children and those with cognitive impairment refer to the Special Considerations section of this summary for more information. Mqnagement Health Care Services.

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The celiac plexus block, used primarily for patients with upper abdominal pain from pancreatic cancer, is the most commonly employed neurolytic blockade of the sympathetic axis, followed by the superior hypogastric plexus block and the ganglion of impar block for patients with lower abdominal or pelvic pain.

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A potential side effect of palliative radiation for painful bone metastases is a temporary increase in pain level, i.

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Ideally, the opioid is increased to the highest tolerable level for the patient before switching occurs, to avoid abandoning an opioid prematurely. The hospice staff is able to gain his confidence and learn that the patient's son, who also has a criminal history, has been stealing his pain medications and sedating him with promethazine.

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For example, sensations originating from the liver or spleen are typically caused by distension of the capsule.

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Adjunct agents are often used with opioids to improve pain control for geriatric patients.

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Unapproved use of the drug to treat another symptom or use of the drug for a minor symptom e. Do not contact the individual Board Members with questions or comments about the summaries.

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Jones can expect from his treatment team and what his treatment team will need to expect of him. Causes of neuropathic pain of particular relevance to cancer include chemotherapy e.

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The information in these summaries should not be used as a basis for insurance reimbursement determinations. N Engl J Med 8:

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Typically, the hollow viscera stomach, bowel, bladder, and ureters are innervated and respond to mechanical- inflammation- and chemical-induced damage.

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Cancer Invest 22 6: Two double-blind randomized trials support the superiority of Sm over placebo in providing pain control and reducing analgesic use.

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Studies evaluating treatment for CIPN have been plagued by methodologic flaws such as small size and open-label comparisons. Many tools have been developed to quantify the intensity of pain. Some error has occurred while processing your request.

Treating Chronic Pain by Douglas L. Pharmacologic Therapies for Pain Control. Most patients will require morphine or an equivalent opioid for adequate pain relief, although incident pain is less responsive. RCT showing benefit over placebo, and open-label study showing benefit for pain rescue; more rapid than oxycodone. Furthermore, distinct cultural components may need to be incorporated into a multidimensional assessment of pain, including how culture influences the pain experience, pain communication, and provider response to pain expression.

Traditionally, the autonomic neural blockade was reserved for patients with inadequate response to oral opioids, but some researchers have suggested that the intervention—which is associated with decreased pain, reduced opioid consumption, improved performance status, and few complications—is considered a first-line approach. Importantly, patient preference, history of opioid use, route of administration, and cost are necessary considerations before the final choice is made.

Changes in pain perception and increasing opioid requirements may be caused by OIH, opioid tolerance, or disease progression. Used for moderate pain. It is intended as a resource to inform and assist clinicians who care for cancer patients.

Dexamethasone is preferred because it has reduced mineralocorticoid effects, resulting in reduced fluid retention; however, it does exhibit cytochrome P—mediated drug interactions.

The clinical relevance needs to be further studied, and this issue may be underappreciated in clinical practice. In addition, we can determine what strategies for exit management are available if opioid analgesics are shown to no longer be effective or a safe option for continued use. There is a limited correlation between the degree of visceral injury and the intensity of the perceived pain.

Management of acute pain begins with an immediate-release opioid formulation. Separate multiple e-mails with a ;. Rapid titration of methadone may result in delayed respiratory depression because of its long half-life. Methadone and fentanyl are unaffected by liver disease and are drugs of choice in patients with hepatic failure.

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