Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T13:54:02.620Z Has data issue: false hasContentIssue false
  • English
  • Français

The need for a multidisciplinary approach to pain management in advanced cancer: A clinical case

Published online by Cambridge University Press:  17 April 2014

Neha Didwaniya ,
Kimberson Tanco ,
Maxine de la Cruz  and
Eduardo Bruera
Neha Didwaniya
Affiliation:
Department of Internal Medicine, North Bend Medical Center, Coos Bay, Oregon
Kimberson Tanco*
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, University of Texas M D Anderson Cancer Center, Houston, Texas
Maxine de la Cruz
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, University of Texas M D Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, University of Texas M D Anderson Cancer Center, Houston, Texas
*
Address correspondence to: Kimberson Tanco, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. E-mail: kctanco@mdanderson.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Advanced cancer patients are often affected by multiple complex symptoms brought about by persistent nociceptive stimuli and intense psychosocial distress. One such complex symptom, cancer pain, has continued to pose a challenge in medical management even though the concept of total pain was described several years ago by Cicely Saunders. Oftentimes, the application of a multidisciplinary approach is delayed after numerous opioid dose escalations and invasive procedures have been performed. The case presented here highlights the importance of timely multidisciplinary intervention and the use of an acute palliative care unit, which resulted in adequate pain control after multiple medical and invasive procedures that caused toxicities.

Keywords

Cancer painMultidisciplinary approachOpioid managementPalliative care unitTotal pain
Type
Case Report
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 389 - 394
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ahles, T.A., Blanchard, E.B. & Ruckdeschel, J.C. (1983). The multidimensional nature of cancer-related pain. Pain, 17(3), 277–288.Google ScholarPubMed
Archie, P., Bruera, E. & Cohen, L. (2013). Music-based interventions in palliative cancer care: A review of quantitative studies and neurobiological literature. Supportive Care in Cancer, 21(9), 1–16.CrossRefGoogle Scholar
Basile, A., Masala, S., Banna, G., et al. (2012). Intrasomatic injection of corticosteroid followed by vertebroplasty increases early pain relief rather than vertebroplasty alone in vertebral bone neoplasms: Preliminary experience. Skeletal Radiology, 41(4), 459–464.CrossRefGoogle ScholarPubMed
Berenson, J., Pflugmacher, R., Jarzem, P., et al. (2011). Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: A multicentre, randomised controlled trial. Lancet, 12(3), 225–235.CrossRefGoogle Scholar
Bruera, E. & Watanabe, S. (1994). New developments in the assessment of pain in cancer patients. Supportive Care in Cancer, 2(5), 312–318.CrossRefGoogle ScholarPubMed
Casarett, D., Johnson, M., Smith, D., et al. (2011). The optimal delivery of palliative care: A national comparison of the outcomes of consultation teams vs. inpatient units. Archives of Internal Medicine, 171(7), 649–655.CrossRefGoogle ScholarPubMed
Cherny, N.I., Coyle, N. & Foley, K.M. (1994). Suffering in the advanced cancer patient: A definition and taxonomy. Journal of Palliative Care, 10(2), 57–70.CrossRefGoogle Scholar
Delgado-Guay, M., Parsons, H.A., Li, Z., et al. (2009). Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive Care in Cancer, 17(5), 573–579.CrossRefGoogle ScholarPubMed
Elsayem, A., Calderon, B.B., Camarines, E.M., et al. (2011). A month in an acute palliative care unit: Clinical interventions and financial outcomes. American Journal of Hospice & Palliative Care, 28(8), 550–555.CrossRefGoogle Scholar
Ewing, J.A. (1984). Detecting alcoholism. The Journal of the American Medical Association, 252(14), 1905–1907.CrossRefGoogle ScholarPubMed
Hanks, G.W., Conno, F., Cherny, N., et al. (2001). Morphine and alternative opioids in cancer pain: The EAPC recommendations. British Journal of Cancer, 84(5), 587–593.CrossRefGoogle ScholarPubMed
Hui, D., Elsayem, A., De La Cruz, M., et al. (2010). Availability and integration of palliative care at U.S. cancer centers. The Journal of the American Medical Association, 303(11), 1054–1061.CrossRefGoogle ScholarPubMed
Kerr, C.W., Drake, J., Milch, R.A., et al. (2012). Effects of methylphenidate on fatigue and depression: A randomized, double-blind, placebo-controlled trial. Journal of Pain and Symptom Management, 43(1), 68–77.CrossRefGoogle ScholarPubMed
McCall, M.C., Ward, A., Roberts, N.W., et al. (2013). Overview of systematic reviews: Yoga as a therapeutic intervention for adults with acute and chronic health conditions. Evidence-Based Complementary and Alternative Medicine. Available from http://www.hindawi.com/journals/ecam/2013/945895/. Epub ahead of print.Google Scholar
McKiernan, F., Faciszewski, T. & Jensen, R. (2004). Quality of life following vertebroplasty. Journal of Bone and Joint Surgery. American Volume, 86(12), 2600–2606.Google ScholarPubMed
Mercadante, S. (1999). Opioid rotation for cancer pain. Cancer, 86(9), 1856–1866.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Mori, M., Elsayem, A., Reddy, S.K., et al. (2012). Unrelieved pain and suffering in patients with advanced cancer. American Journal of Hospice & Palliative Care, 29(3), 236–240.CrossRefGoogle ScholarPubMed
Portenoy, R.K. & Lesage, P. (1999). Management of cancer pain. Lancet, 353(9165), 1695–1700.CrossRefGoogle ScholarPubMed
Portenoy, R.K., Thaler, H.T., Kornblith, A.B., et al. (1994). Symptom prevalence, characteristics and distress in a cancer population. Quality of Life Research, 3(3), 183–189.CrossRefGoogle Scholar
Prommer, E. (2012). Methylphenidate: Established and expanding roles in symptom management. American Journal of Hospice & Palliative Care, 29(6), 483–490.CrossRefGoogle ScholarPubMed
Reddy, A., Hui, D. & Bruera, E. (2012). A successful palliative care intervention for cancer pain refractory to intrathecal analgesia. Journal of Pain and Symptom Management, 44(1), 124–130.Google ScholarPubMed
Richmond, C. (2005). Dame Cicely Saunders. BMJ, 331(7510), 238.Google Scholar
Ripamonti, C. & Bruera, E. (1997). CNS adverse effects of opioids in cancer patients: Guidelines for treatment. CNS Drugs, 8(3), 21–37.CrossRefGoogle Scholar
Stallmeyer, M., Zoarski, G.H. & Obuchowski, A.M. (2003). Optimizing patient selection in percutaneous vertebroplasty. Journal of Vascular and Interventional Radiology, 14(6), 683–696.CrossRefGoogle ScholarPubMed
Stone, C., Lawlor, P.G., Nolan, B., et al. (2011). A prospective study of the incidence of falls in patients with advanced cancer. Journal of Pain and Symptom Management, 42(4), 535–540.CrossRefGoogle ScholarPubMed
Yennurajalingam, S., Kwon, J.H., Urbauer, D.L., et al. (2013). Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center. Palliative & Supportive Care, 7, 1–8.Google Scholar