1. 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 Prostate Cancer Forum Northwestern University Prostate SPORE

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. Cancer Pain: Multidimensional Phenomenon Social Spiritual Emotional Functional Physical

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

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. 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 Prostate Cancer Forum Northwestern University Prostate SPORE