Pain Management in Oncology Patients Val R. Adams, Pharm.D. Associate Professor University of Kentucky

Objectives At the end of this session and after performing the reading, the participant should be able to:   Explain the pathophysiology of each pain issue in a specific individual. Assess individual patient’s pain care needs as they apply to treatment and response to treatment Recommend an appropriate treatment plan for a patient in pain.

Prevalence Of Cancer Pain Portenoy; Cancer 63:2298, 1989

Pain Characteristics Significant interpatient variability “Pain is whatever the patient says it is” Total pain includes physical factors, anxiety, depression, and psychosocial pressures. Factors that decrease pain threshold: Insomnia, Fatigue, Stress, Fear, Depression, Anger Factors that increase pain threshold: Diversion, Pain relief, Sleep Origin – Visceral, Somatic, Neuropathic

Patient Case PM is a 68 yo WM who presents with  pain. HPI: intermittent pain x 2 weeks before diagnosed with stage IV NSCLCA (1/2013). It is now getting worse and the acetaminophen no longer relieves his pain. PMH: (COPD) x 4 years FH/SH: Widowed, retired / 37 pack-year-hx. Drug History: NKDA, Ipratropium Acetaminophen

Patient Case Physical Exam: BP 130/75 P 75 T 99.2 General: Slight Respiratory Problems HEENT: PERRLA, EOMI Neck: Supple, axillary lymphadenopathy Lung:  breath sounds, bilateral wheezes Heart: RRR Abdomen: + BS, NT/ND Genital: Deferred Extremities: Clubbing of fingers bilaterally Neuro: A & O x 3,  strength in left arm

Patient Case Laboratory: Assessment/Plan: Na 122 WBC 6.8 AST 32 K 3.9 Hgb 12.7 ALT 33 Cl 109 Hct 37.7 LDH 160 CO2 21 Plts 264 Alk. Phos 180 BUN 19 Cr 1.1 GGT 40 Bone scan: Positive (several ribs, lesion on skull) Assessment/Plan: Stage IV NSCLC: 18 days ago PM received cycle 2 of CDDP 75 mg/m2 and docetaxel 75 mg/m2.

Class Exercise Break into 4 groups and write a comprehensive order that is appropriate for this patient. If you need more information come ask me (please just one person per group)

Questions