TY  - CHAP
M1  - Book, Section
TI  - Chapter 93. Cancer Pain and Palliative Care
A1  - Gebhardt, Rodolfo
A1  - Phan, Phillip C.
A1  - Burton, Allen W.
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Cancer  pain  remains  a  significant  problem.  Studies  show  approximately  30%  of  ambulatory  cancer  patients  suffer  moderate  to  severe  pain.  With  progressive  disease,  the  incidence  is  far  higher.  Incident  pain  or  episodic  severe  pain  often  is  problematic  for  cancer  patients.Elucidation  of  the  painful  syndrome  helps  guide  effective  treatment.  In  most  cases,  cancer  pain  stems  from  the  tumor  itself.  Tumors  cause  pain  due  to  invasion  of  bone,  soft  tissues,  muscle,  and  nervous  structures.  A  less  frequent  cause  of  cancer  pain  is  treatment-related  pain,  including  postchemotherapy  neuropathic  pain,  postsurgical  pain  syndromes,  and  postradiation  pain  syndromes.Neuropathic  pain  is  usually  more  difficult  to  treat.  Neuropathic  pain  is  seen  with  chemotherapy-induced  painful  peripheral  neuropathies,  postherpetic  neuralgias,  phantom  limb  pain,  and  others.  Nociceptive  pain  syndromes  typically  are  opioid  responsive,  whereas  in  neuropathic  pain  states,  adjuvant  analgesics  may  be  needed  to  obtain  adequate  analgesia.Treat  opioid-related  side  effects  aggressively.  In  some  patients,  opioid  doses  are  limited  by  intolerable  side  effects,  including  sedation,  confusion,  constipation,  nausea,  and  pruritus.  These  side  effects  are  best  managed  by  changing  opioids,  adding  agents  to  treat  the  side  effect,  or  using  neuraxial,  neural  blockade,  or  other  interventional  pain  techniques  to  lower  systemic  opioid  doses.Stick  with  the  basic  tenets  of  cancer  pain  management.  These  include  the  use  of  oral  opioids  whenever  possible,  often  with  combinations  of  long-acting  opioids  for  constant  pain  with  short-acting  opioids  for  incident  pain.  It  also  includes  the  use  of  adjuvant  coanalgesics,  including  nonsteroidal  anti-inflammatory  drugs,  anticonvulsants,  antidepressants,  and  topicals  to  minimize  opioid  doses  and  concomitant  opioid-related  side  effects.Treat  constipation  and  nausea  prophylactically.Advance  to  interventional  therapies  when  the  risk-to-benefit  ratio  is  favorable.  Interventional  options  for  pain  control  include  nerve  blocks,  parenteral  infusions,  neuraxial  infusions,  palliative  radiotherapy,  palliative  chemotherapy,  and  surgery  in  combination  for  optimal  patient  quality  of  life.  The  optimal  blend  of  these  techniques  currently  is  empirical  and  based  largely  on  availability  of  services.Cancer  pain  management  is  rewarding.  In  most  cases,  adequate  pain  and  symptom  control  can  be  obtained  through  regular  assessment  and  application  of  the  relatively  straightforward  principles  outlined.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56659071
ER  -