13.1 Cancer Pain Syndromes

Question 1

Acute pain in the cancer patient is most commonly due to one of two things

Answer 1

1. Diagnostic interventions
2. Therapeutic interventions

Question 2

What is best characterized acute pain syndrome from a diagnostic procedure? List two ways this can be avoided

Answer 2

Lumbar puncture headache - delayed development of a positional HA, markedly exacerbated by upright posture

longitudinal bevel insertion of a regular bevelled needle
use a non-traumatic conical tipped needle with lateral opening

Question 3

What type of underlying mass makes a transthoracic bx more painful

Answer 3

neurogenic tumor

Question 4

List four therapeutic interventions that can cause acute pain in the cancer patient

Answer 4

surgery
RF tumor ablation
cryosurgery
tumor embolization techniques
pleurodesis

Question 5

List two factors that influence pain associated with subcut injectios

Answer 5

volume
chemical characteristics of injectant

Question 6

List four symptoms of spinal opioid hyperalgesia syndrome. How is it managed?

Answer 6

pain (typically perineal, buttock, leg)
hyperalgesia
priaprism
piloerection
segmental myoclonus

stop infusion

Question 7

List four pain syndromes associated with IV infusion of chemo

Answer 7

hepatic artery infusion pain (for pts with hepatic mets)
intraperitonal chemo pain
Intravesical chemo (BCG, doxorubicin)
Intravesical immunotx

Question 8

List four drugs known to have a high association with mucositis

Answer 8

cytarabine
doxorubicin
MTX
etoposide
5-FU

Question 9

A patient stops taking a medication and develops myalgias/arthralgias and tenderness of muscles of joints. There is no past medical aside from malignancy. The medication stopped was started to prevent pain from XRT. What type of medication was it?

Answer 9

Steroid

Question 10

List three chemotherapies associated with painful neuropathy

Answer 10

cis-platinum
oxaliplatin
paclitaxel
vinca alkaloids (vincristine)

Question 11

List three chemotherapies whose administration is associated with headache

Answer 11

intrathecal MTX
L-asparginase
transretinoic acid therapy

Question 12

Match the pain syndrome with the causative chemotherapy

Arthalgia/Myalgia
Anginal chest pain
palmar plantar erythrodysesthesia syndrome
diffuse bone pain

paclitaxel
transretinoic acid
5-FU
capcitabine

Answer 12

Arthalgia/Myalgia = paclitaxel
Anginal chest pain = 5-FU
palmar plantar erthroaesthesia syndrome = capcitabine (also 5-fu)
diffuse bone pain - transretinoic acid

Question 13

List 3 agents associated with hand foot syndrome

Answer 13

5-FU
liposonal doxorubicin
capecitabine
paclitaxel
sunitinib
everolimus
sorafenib

Question 14

Why does LH therapy cause pain in patients with prostate ca

Answer 14

Produces an LH surge before suppression (thus bone pain, urinary retention etc) may worsen before improving

Question 15

What is the common pain associated with GCSF

Answer 15

myalgia

Question 16

List four acute pain syndrome associated with XRT

Answer 16

Incident pain due to transport
acute XRT toxicity (inflammation of skin)
mucositis
proctitis
enteritis (any itis - depending on field treated)
Pain flare
early onset brachialplexopathy

Question 17

List two cancers associated with PHN

Answer 17

hematological
lymphoproliferative

Question 18

List three cancers associated with VTE

Answer 18

bone
ovary
brain
pancreas