Ch 11 -Pain Medicine: Cancer Pain

Question 1

Describe multiple myeloma pain

Answer 1

Result of a bone fracture or a tumor pressing against a nerve

Question 2

How can multiple myeloma pain be controlled?

Answer 2

Radiation therapy and surgery can control myeloma pain by shrinking tumors that are compressing nerves

Question 3

Describe Pancreatic cancer pain

Answer 3

Severe upper abdominal and back pain

Question 4

Tx for Pancreatic pain unresponsive to other measures

Answer 4

Celiac plexus blocks,
External beam radiation
Intrathecal pain pumps

Question 5

Describe Ovarian cancer pain

Answer 5

Earliest stages: mild to no symptoms. Abdominal or pelvic pain that may extend into the back and legs.
Advanced stages: pain MC

Question 6

What is the MC diagnosed cancer in American men?

Answer 6

Prostate cancer

Question 7

What is the 2nd leading cause of cancer death in men?

Answer 7

Prostate cancer

Question 8

Describe prostate cancer pain

Answer 8

Advanced disease: sclerotic bone metastasis causing mild to very severe pain.
Enlargement of tumor: urethral, rectal, suprapubic, and penile pain

Question 9

What is Post-mastectomy pain syndrome?

Answer 9

Intercostobrachial neuralgia (T1–T2)
Pain is localized to the axilla, shoulder, arm, and/or chest wall

Question 10

When is prevelance of post-masectomy pain syndrome higher?

Answer 10

Higher in lumpectomy rather than mastectomy

Especially post axillary dissection

Question 11

Description of lymphedema pain

Answer 11

Heavy sensation or aching discomfort in the arm, swelling of the affected arm/upper chest, or numbness/tingling of the arm along with fatigue

Question 12

Tx for lymphedema

Answer 12

Therapy program combining massage, skin care, exercise, and compression garments

Question 13

Describe pain during acute radiation treatment period

Answer 13

painful skin irritation ranging from mild erythema to significant moist desquamation or sunburn pain

Question 14

What are long term reactions to radiation therapy for breast cancer?

Answer 14

cervical or brachial plexopathies

Question 15

What can Anthracyclines and alkylating chemo agents cause?

Answer 15

mucositis or painful mouth sores

Question 16

What is acute paclitaxel syndrome?

Answer 16

Arthralgias and myalgias, which range from mild to debilitating

Question 17

What can Taxanes chemo cause?

Answer 17

Painful peripheral neuropathy in up to 60% of patients

Question 18

Which chemotherapy agents commonly cause peripheral neuropathy?

Answer 18

Platinol (cisplatin)
Paraplatin (carboplatin)
Eloxatin (oxaliplatin)
Oncovin (vincristine)
Navelbine (vinorelbine)
Velban (vinblastine)
VePsid (etoposide, VP-16)
Taxol (paclitaxel)
Taxotere (docetaxel)
Thalomid (thalidomide)
Revlimid (lenalidomide)
Velcade (bortezomib)

Question 19

What are the 3 main causes of pain in lung cancer?

Answer 19

Skeletal metastatic disease (34%)
Pancoast tumor (31%)
Chest wall disease (21%).

Question 20

What is Costopleural syndrome?

Answer 20

Chest pain that is present in mesothelioma. Characteristically pleuritic, lateralized, dull, or diffuse; neuropathic components present secondary to entrapment of thoracic, autonomic, or brachial plexus nerves

Question 21

What can relieve pain in Costopleural syndrome?

Answer 21

Percutaneous cervical cordotomy

Question 22

What does Percutaneous cervical cordotomy do?

Answer 22

Procedure interrupts the spinothalamic tract at C1/2, causing contralateral loss of pain perception below the level of the lesion

Question 23

What is Hypertrophic pulmonary osteoarthropathy?

Answer 23

Clubbing and periosteal proliferation of the tubular bones, causing a symmetrical painful arthropathy affecting the ankles, knees, wrists, and elbows

Question 24

How can Hypertrophic pulmonary osteoarthropathy pain be tx?

Answer 24

Improved if tumor resected

NSAIDs/bisphosphonates in advanced lung cancer

Question 25

WHO analgesic ladder for mild to moderate cancer pain

Answer 25

Non-opioid analgesics ± adjuvant

Question 26

WHO analgesic ladder for moderate cancer pain

Answer 26

Short-acting opioids ± non-opioid analgesics ± adjuvant

Question 27

WHO analgesic ladder for moderate to severe cancer pain

Answer 27

Short- and long-acting opioids ± non-opioid analgesics ± adjuvant

Question 28

What is DREZ (Dorsal root entry zone) lesioning?

Answer 28

Surgical technique that selectively destroys neurons located in the posterolateral spinal cord

Question 29

What is DREZ (Dorsal root entry zone) lesioning used for?

Answer 29

Refractory chronic pain syndromes associated with neurons that develop paroxysmal hyperactivity following deafferentation injury (e.g., brachial plexus avulsion)

Question 30

What is a Cordotomy?

Answer 30

Surgical procedure that ablates the spinothalamic tract, providing selective loss of pain and temperature perception several segments below and contralateral to where the lesion is placed

Question 31

What is a Punctate midline myelotomy?

Answer 31

Neuroablative procedure that interrupts the midline of the dorsal column (which contains a pathway for nociceptive visceral signals)

Question 32

What is a Punctate midline myelotomy used for?

Answer 32

Tx intractable abdominal and pelvic cancer pain

Question 33

What is a Cordotomy used for?

Answer 33

Severe pain secondary to cancer (esp pleural and peritoneal mesothelioma) where treatment to level 3 of the WHO pain ladder was ineffective

Question 34

What is a Cingulotomy?

Answer 34

Bilateral anterior cingulotomy targets the anterior cingulate cortex (part of the limbic system)

Question 35

What is a Cingulotomy used for?

Answer 35

Was used to tx OCD & depression

Acute cancer pain when other methods have failed.