Cancer Pain Management

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Cancer Pain Management
Prostate Cancer Forum Northwestern University
Prostate SPORE

• Judith A. Paice, RN PhD FAAN
• Director, Cancer Pain Program
• Northwestern University, Feinberg School of
  Medicine
• Division of Hematology-Oncology
• Chicago, IL

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Pain

• Pain is an unpleasant sensory and emotional
  experience associated with actual or potential
  tissue damage, or described in terms of such
  damage.

IASP Subcommittee on Taxonomy of Pain Terms. Pain
6249-52, 1979
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Cancer Pain Multidimensional Phenomenon
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Consequences of Cancer Pain

• Functional impairment
• Immobility
• Social isolation
• Emotional and spiritual distress
• Suffering
• Suicidal ideation

Akechi, et al. Cancer 951085-1093, 2002
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Consequences of Cancer Pain

• Inability to complete potentially curative
  therapies
• Caregiver distress
• Family and loved ones
• Professional caregivers

Akechi, et al. Cancer 951085-1093,
2002 Miaskowski et al. Guideline for Management
of Cancer Pain in Adults and Children, 2005
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Etiology of Cancer Pain
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Causes of Pain in People with Cancer Etiology

• Pain due to cancer
• 85 93
• Pain due to cancer diagnosis and treatment
• 17 -21
• Pain unrelated to cancer or its treatment
• 2 9

Zech, et al. Pain 63 65-76, 1995 Caraceni
Portenoy. Pain 82263-274, 1999
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Common Pain Syndromes in Cancer by Pathophysiology

• Somatic
• Bone metastases
• Skin lesions
• Visceral
• Malignant bowel obstruction
• Neuropathic
• Chemotherapyinduced peripheral neuropathy
• PHN

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Goals of Treatment

• Prevention
• Relief of pain
• Improved function
• Safety

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Assessment

• Inform your doctor and nurse about your pain
  they cannot always see your pain
• Questions they will ask
• Location
• Intensity (0-10)
• Quality what does it feel like
• What makes it better/worse
• What have you tried already
• Bring in pill bottles

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Therapeutic Advances in Pain

• Non-opioids
• Opioids
• Adjuvants
• Anticancer therapies

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Therapeutic Advances in Pain

• Non-opioids
• Opioids
• Adjuvants
• Anticancer therapies

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Therapeutic Advances in Pain

• Non-opioids
• Opioids
• Adjuvants
• Corticosteroids
• Antiepilepsy drugs
• Antidepressants
• Local anesthetics
• NMDA receptor antagonists
• Cannabinoids

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Anticancer Therapies

• Radiation therapy
• Chemotherapy
• Bisphosphonates
• Surgery

Berenson et al. Cancer 2001 911191-1200 Doyle
et al. JCO 2001191266-1274 Jeremic. JPSM
2001221048-1058
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Never doubt that a small group of thoughtful,
committed citizens can change the world. Indeed,
it is the only thing that ever has.Margaret Mead
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Resources - Patients

• People Living With Cancer
• www.plwc.org
• The Neuropathy Association
• www.neuropathy.org
• Lance Armstrong Foundation
• www.livestrong.org
• Conversations The International Ovarian Cancer
  Connection
• www.ovarian-news.org/neuropathy.html

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Cancer Pain Management
Prostate Cancer Forum Northwestern University
Prostate SPORE

• Judith A. Paice, RN PhD FAAN
• Director, Cancer Pain Program
• Northwestern University, Feinberg School of
  Medicine
• Division of Hematology-Oncology
• Chicago, IL