Cancer Pain

Question 1

punctate midline myelotomy

Answer 1

ablation of the midline of the dorsal column to treat intractable abdominal and pelvic cancer pain

Question 2

where is celiac plexus located?

Answer 2

between T12 and L1

Question 3

clubbing and periosteal proliferation of tubular bones causing pain at large joints, including ankles, knees, wrists, elbows

Answer 3

hypertrophic pulmonary osteoarthropathy

Question 4

what medications can you use to treat hypertrophic pulmonary osteoarthropathy

Answer 4

bisphosphonates and NSAIDs

Question 5

cordotomy

Answer 5

ablation of spinothalamic tract causing contralateral loss of pain and temperature below the level of the lesion

Question 6

dorsal root entry zone lesioning

Answer 6

selectively destroying neurons in the posterolateral spinal cord

Question 7

patient with Hx of multiple myeloma and bone pain - main DDx?

Answer 7

bone fracture or tumor compressing nerve

Question 8

definitive treatment of costoplueral pain due to chest wall pain from cancer

Answer 8

percutaneous cervical cordotomy - interrupts spinothalamic tract at C1/2 which causes loss of contralateral pain and temperature below level of lesion

Question 9

what causes intercostobrachial neuralgia

Answer 9

post-mastectomy pain syndrome. Affects intercostal nerves from T1-T2

Question 10

WHO analgesic ladder for mild to moderate, moderate and severe pain

Answer 10

mild to moderate: non-opioids +/- adjuvants
Moderate: short-acting opioids +/- non-opioids +/- adjuvants
Severe: long-acting opioids +/- all of the above

Question 11

celiac plexus is formed by…

Answer 11

greater and lesser splanchnic nerves and vagus nerve