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Cancer Pain Management

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

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Cancer Pain Management

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

  2. 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 6:249-52, 1979

  3. Functional Social Physical Emotional Spiritual Cancer Pain: Multidimensional Phenomenon

  4. Consequences of Cancer Pain • Functional impairment • Immobility • Social isolation • Emotional and spiritual distress • Suffering • Suicidal ideation Akechi, et al. Cancer 95:1085-1093, 2002

  5. Consequences of Cancer Pain • Inability to complete potentially curative therapies • Caregiver distress • Family and loved ones • Professional caregivers Akechi, et al. Cancer 95:1085-1093, 2002 Miaskowski et al. Guideline for Management of Cancer Pain in Adults and Children, 2005

  6. Diagnostic Hormonal Postoperative Tumor Infection Radiation Chemotherapy Etiology of Cancer Pain

  7. 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 82:263-274, 1999

  8. Common Pain Syndromes in Cancer by Pathophysiology • Somatic • Bone metastases • Skin lesions • Visceral • Malignant bowel obstruction • Neuropathic • Chemotherapy–induced peripheral neuropathy • PHN

  9. Goals of Treatment • Prevention • Relief of pain • Improved function • Safety

  10. 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

  11. Therapeutic Advances in Pain • Non-opioids • Opioids • Adjuvants • Anticancer therapies

  12. Therapeutic Advances in Pain • Non-opioids • Opioids • Adjuvants • Anticancer therapies

  13. Therapeutic Advances in Pain • Non-opioids • Opioids • Adjuvants • Corticosteroids • Antiepilepsy drugs • Antidepressants • Local anesthetics • NMDA receptor antagonists • Cannabinoids

  14. Anticancer 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

  15. 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

  16. 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

  17. Prostate Cancer Forum Northwestern University Prostate SPORE Cancer Pain Management 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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