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

2. 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.

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

5. 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

6. 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

7. 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

8. Patient Case Laboratory: Assessment/Plan: Na 122 WBC 6.8 AST 32
K Hgb ALT 33
Cl Hct LDH 160
CO2 21 Plts Alk. Phos 180
BUN 19 Cr 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.

9. 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)

10. Questions