7.3 () Acute Cancer Pain Syndromes Flashcards
Name FOUR characteristics of a lumbar puncture headache.
◆ develops hrs to several days after procedure
◆ dull occipital discomfort
◆ may radiate to the frontal region or to the shoulders
◆ nausea and dizziness
◆ duration is ~1–7 days
FS
L occipital
O hours to days after LP
P standing up
Q dull, throbbing, with nausea
R to frontal area and shoulders
S mild to intense
T last for around a week
Describe the pathophysiology of a lumbar puncture headache.
ongoing leakage through the defect in the dural sheath
—> reduction in CSF volume (in subarachnoid space)
—> compensatory expansion of the pain-sensitive intracerebral veins
◆ incidence of headache is related to the calibre of the LP needle
- ie. Larger calibre inc likelihood of headache
Name THREE management options for a lumbar puncture headache.
◆ rest, hydration, and analgesics
◆ persistent headache may necessitate an epidural blood patch
- small evidence for prophylactic admin
◆ severe headache reported to respond to tx w/ IV or PO caffeine
Name FIVE malignancy/metastatic sites that radiofrequency ablation is utilized.
◆ liver metastases
◆ adrenal metastases
◆ renal tumors
◆ lung tumors
◆ bone tumors
◆ breast tumors
Name THREE complications of intrathecal/epidural opioid injections-related spinal opioid hyperalgesia syndrome
◆ Pain typically perineal, buttock, or leg
◆ hyperalgesia
◆ segmental myoclonus
◆ piloerection
◆ priapism
Name 2 pain syndromes associated with IV infusions of chemotherapeutic agents.
◆ venous spasm
◆ chemical phlebitis
◆ vesicant extravasation
◆ anthracycline-associated flare
Name THREE chemotherapeutic agents that are associated with painful peripheral neuropathy.
◆ vinca alkaloids
◆ cis-platinum
◆ oxaliplatin
◆ paclitaxel
COP
Name the TWO clinical forms of peripheral neuropathy syndromes associated with oxaliplatin.
◆ a neuromyotonia-like, acute, transient syndrome characterized by cold-induced distal pain or perioral paraesthesias and pharyngolaryngeal dysaesthesias
◆ a chronic sensory neuropathy w/ a stocking-and-glove distribution
Name TWO chemotherapeutic agents that are associated with headaches. *
◆ Intrathecal methotrexate
- tx of leukaemia or leptomeningeal metastases produces an acute meningitic syndrome in 5–50% of patients
◆ Sys admin of L-asparaginase
- tx acute lymphoblastic leukaemia produces thrombosis of cerebral veins or dural sinuses in 1–2% of patients
◆ Trans-retinoic acid therapy, used in the tx of acute promyelocytic leukaemia
Name THREE chemotherapeutic agents associated Palmar–plantar erythrodysaesthesia syndrome (aka acral erythema, hand–foot syndrome, toxic erythema of the palms and soles, and Burgdof’s syndrome). *
◆ continuously infused 5-fluoruracil
◆ capecitabine
◆ liposomal doxorubicin
◆ paclitaxel
◆ sorafenib and sunitinib (tyrosine kinase inhibitors)
◆ high-dose methotrexate
◆ everolimus (mTOR inhibitor)
Note: do you feel like an oncologist yet?
Name TWO chemotherapeutic agents associated w/ chemotherapy-induced acute digital ischemia. *
◆ Bleomycin
◆ Vinblastine
◆ cisplatin treatment for testicular cancer
◆ Rarely, irreversible digital ischaemia leading to gangrene has been reported after bleomycin , capecitabine and vincristine.
Name 3 risk factors for thrombosis in cancer patients.
◆ Cancer: pancreatic, brain, ovary
◆ Mets: distant, bone
◆ Cancer treatment: chemo, hormonal therapy
What is and name THREE clinical characteristics of phlegmasia cerulea dolens.
◆ Rare lower extremity DVT syndrome with tissue ischaemia/frank gangrene (even without arterial or capillary occlusion)
- most commonly seen in patients with underlying neoplasm
- seen proximal to inferior vena cava filters
◆ clinically characterized by:
- severe pain
- extensive oedema
- cyanosis of the legs
- gangrene can occur unless the venous obstruction is relieved
Name THREE major clinical features of upper extremity venous thrombosis.
◆ oedema
◆ dilated collateral circulation
◆ Pain
- approximately 2/3 of patients have arm pain
