Ch 11 -Pain Medicine: Cancer Pain Flashcards
Describe multiple myeloma pain
Result of a bone fracture or a tumor pressing against a nerve
How can multiple myeloma pain be controlled?
Radiation therapy and surgery can control myeloma pain by shrinking tumors that are compressing nerves
Describe Pancreatic cancer pain
Severe upper abdominal and back pain
Tx for Pancreatic pain unresponsive to other measures
Celiac plexus blocks,
External beam radiation
Intrathecal pain pumps
Describe Ovarian cancer pain
Earliest stages: mild to no symptoms. Abdominal or pelvic pain that may extend into the back and legs.
Advanced stages: pain MC
What is the MC diagnosed cancer in American men?
Prostate cancer
What is the 2nd leading cause of cancer death in men?
Prostate cancer
Describe prostate cancer pain
Advanced disease: sclerotic bone metastasis causing mild to very severe pain.
Enlargement of tumor: urethral, rectal, suprapubic, and penile pain
What is Post-mastectomy pain syndrome?
Intercostobrachial neuralgia (T1–T2) Pain is localized to the axilla, shoulder, arm, and/or chest wall
When is prevelance of post-masectomy pain syndrome higher?
Higher in lumpectomy rather than mastectomy
Especially post axillary dissection
Description of lymphedema pain
Heavy sensation or aching discomfort in the arm, swelling of the affected arm/upper chest, or numbness/tingling of the arm along with fatigue
Tx for lymphedema
Therapy program combining massage, skin care, exercise, and compression garments
Describe pain during acute radiation treatment period
painful skin irritation ranging from mild erythema to significant moist desquamation or sunburn pain
What are long term reactions to radiation therapy for breast cancer?
cervical or brachial plexopathies
What can Anthracyclines and alkylating chemo agents cause?
mucositis or painful mouth sores
What is acute paclitaxel syndrome?
Arthralgias and myalgias, which range from mild to debilitating
What can Taxanes chemo cause?
Painful peripheral neuropathy in up to 60% of patients
Which chemotherapy agents commonly cause peripheral neuropathy?
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)
What are the 3 main causes of pain in lung cancer?
Skeletal metastatic disease (34%) Pancoast tumor (31%) Chest wall disease (21%).
What is Costopleural syndrome?
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
What can relieve pain in Costopleural syndrome?
Percutaneous cervical cordotomy
What does Percutaneous cervical cordotomy do?
Procedure interrupts the spinothalamic tract at C1/2, causing contralateral loss of pain perception below the level of the lesion
What is Hypertrophic pulmonary osteoarthropathy?
Clubbing and periosteal proliferation of the tubular bones, causing a symmetrical painful arthropathy affecting the ankles, knees, wrists, and elbows
How can Hypertrophic pulmonary osteoarthropathy pain be tx?
Improved if tumor resected
NSAIDs/bisphosphonates in advanced lung cancer
WHO analgesic ladder for mild to moderate cancer pain
Non-opioid analgesics ± adjuvant
WHO analgesic ladder for moderate cancer pain
Short-acting opioids ± non-opioid analgesics ± adjuvant
WHO analgesic ladder for moderate to severe cancer pain
Short- and long-acting opioids ± non-opioid analgesics ± adjuvant
What is DREZ (Dorsal root entry zone) lesioning?
Surgical technique that selectively destroys neurons located in the posterolateral spinal cord
What is DREZ (Dorsal root entry zone) lesioning used for?
Refractory chronic pain syndromes associated with neurons that develop paroxysmal hyperactivity following deafferentation injury (e.g., brachial plexus avulsion)
What is a Cordotomy?
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
What is a Punctate midline myelotomy?
Neuroablative procedure that interrupts the midline of the dorsal column (which contains a pathway for nociceptive visceral signals)
What is a Punctate midline myelotomy used for?
Tx intractable abdominal and pelvic cancer pain
What is a Cordotomy used for?
Severe pain secondary to cancer (esp pleural and peritoneal mesothelioma) where treatment to level 3 of the WHO pain ladder was ineffective
What is a Cingulotomy?
Bilateral anterior cingulotomy targets the anterior cingulate cortex (part of the limbic system)
What is a Cingulotomy used for?
Was used to tx OCD & depression
Acute cancer pain when other methods have failed.
