cancer pain management judith a. paice, rn phd faan director, cancer pain program northwestern...
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Cancer Pain ManagementCancer Pain Management
Judith A. Paice, RN PhD FAANJudith A. Paice, RN PhD FAANDirector, Cancer Pain ProgramDirector, Cancer Pain Program
Northwestern University, Feinberg School of MedicineNorthwestern University, Feinberg School of MedicineDivision of Hematology-OncologyDivision of Hematology-Oncology
Chicago, ILChicago, IL
Prostate Cancer ForumNorthwestern University Prostate SPORE
PainPain
““Pain is an unpleasant sensory and Pain is an unpleasant sensory and emotional experience associated with emotional experience associated with actual or potential tissue damage, or actual or potential tissue damage, or described in terms of such damage.”described in terms of such damage.”
IASP Subcommittee on Taxonomy of Pain Terms. Pain 6:249-52, 1979
Cancer Pain: Multidimensional Cancer Pain: Multidimensional PhenomenonPhenomenon
Social
SpiritualEmotional
Functional
Physical
Consequences of Cancer PainConsequences of Cancer Pain
Functional impairmentFunctional impairment
Immobility Immobility
Social isolationSocial isolation
Emotional and spiritual distressEmotional and spiritual distress– SufferingSuffering
Suicidal ideationSuicidal ideation
Akechi, et al. Cancer 95:1085-1093, 2002
Consequences of Cancer PainConsequences of Cancer Pain
Inability to complete potentially curative Inability to complete potentially curative therapiestherapies
Caregiver distressCaregiver distress– Family and loved onesFamily and loved ones– Professional caregiversProfessional caregivers
Akechi, et al. Cancer 95:1085-1093, 2002
Miaskowski et al. Guideline for Management of Cancer Pain in Adults and Children, 2005
Etiology of Cancer PainEtiology of Cancer Pain
Tumor Infection
Hormonal
ChemotherapyRadiation
Diagnostic
Postoperative
Causes of Pain in People with Causes of Pain in People with Cancer: EtiologyCancer: Etiology
Pain due to cancerPain due to cancer– 85 – 93%85 – 93%
Pain due to cancer diagnosis and Pain due to cancer diagnosis and treatmenttreatment– 17 -21%17 -21%
Pain unrelated to cancer or its treatmentPain unrelated to cancer or its treatment– 2 – 9%2 – 9%
Zech, et al. Pain 63: 65-76, 1995
Caraceni & Portenoy. Pain 82:263-274, 1999
Common Pain Syndromes in Common Pain Syndromes in Cancer by PathophysiologyCancer by Pathophysiology
SomaticSomatic– Bone metastasesBone metastases– Skin lesionsSkin lesions
VisceralVisceral– Malignant bowel obstructionMalignant bowel obstruction
NeuropathicNeuropathic– Chemotherapy–induced peripheral Chemotherapy–induced peripheral
neuropathy neuropathy – PHNPHN
Goals of TreatmentGoals of Treatment
PreventionPrevention
Relief of painRelief of pain
Improved functionImproved function
SafetySafety
AssessmentAssessment
Inform your doctor and nurse about your Inform your doctor and nurse about your pain – they cannot always “see” your painpain – they cannot always “see” your pain
Questions they will ask:Questions they will ask:– LocationLocation– Intensity (0-10)Intensity (0-10)– Quality – what does it feel likeQuality – what does it feel like– What makes it better/worseWhat makes it better/worse– What have you tried already What have you tried already – Bring in pill bottlesBring in pill bottles
Therapeutic Advances in Pain
Non-opioids
Opioids
Adjuvants
Anticancer therapies
Therapeutic Advances in Pain
Non-opioids
Opioids
Adjuvants
Anticancer therapies
Therapeutic Advances in Pain
Non-opioids Opioids Adjuvants – Corticosteroids– Antiepilepsy drugs– Antidepressants– Local anesthetics– NMDA receptor antagonists– Cannabinoids
Anticancer TherapiesAnticancer Therapies
Radiation therapy
Chemotherapy
Bisphosphonates
Surgery
Berenson et al. Cancer 2001; 91:1191-1200
Doyle et al. JCO 2001;19:1266-1274
Jeremic. JPSM 2001;22:1048-1058
Never doubt that a small group of Never doubt that a small group of thoughtful, committed citizens can thoughtful, committed citizens can change the world. Indeed, it is the change the world. Indeed, it is the
only thing that ever has.only thing that ever has.
Margaret MeadMargaret Mead
Resources - PatientsResources - Patients
People Living With CancerPeople Living With Cancerwww.plwc.orgwww.plwc.org
The Neuropathy Association The Neuropathy Association www.neuropathy.orgwww.neuropathy.org
Lance Armstrong FoundationLance Armstrong Foundationwww.livestrong.orgwww.livestrong.org
Conversations: The International Ovarian Conversations: The International Ovarian Cancer Connection Cancer Connection
www.ovarian-news.org/neuropathy.htmlwww.ovarian-news.org/neuropathy.html
Cancer Pain ManagementCancer Pain Management
Judith A. Paice, RN PhD FAANJudith A. Paice, RN PhD FAANDirector, Cancer Pain ProgramDirector, Cancer Pain Program
Northwestern University, Feinberg School of MedicineNorthwestern University, Feinberg School of MedicineDivision of Hematology-OncologyDivision of Hematology-Oncology
Chicago, ILChicago, IL
Prostate Cancer ForumNorthwestern University Prostate SPORE