Cancer Pain ManagementCancer Pain Management

Judith A. Paice, RN PhD FAANJudith A. Paice, RN PhD FAANDirector, Cancer Pain ProgramDirector, Cancer Pain Program

Northwestern University, Feinberg School of MedicineNorthwestern University, Feinberg School of MedicineDivision of Hematology-OncologyDivision of Hematology-Oncology

Chicago, ILChicago, IL

Prostate Cancer ForumNorthwestern University Prostate SPORE

PainPain

““Pain is an unpleasant sensory and Pain is an unpleasant sensory and emotional experience associated with emotional experience associated with actual or potential tissue damage, or actual or potential tissue damage, or described in terms of such damage.”described in terms of such damage.”

IASP Subcommittee on Taxonomy of Pain Terms. Pain 6:249-52, 1979

Cancer Pain: Multidimensional Cancer Pain: Multidimensional PhenomenonPhenomenon

Social

SpiritualEmotional

Functional

Physical

Consequences of Cancer PainConsequences of Cancer Pain

Functional impairmentFunctional impairment

Immobility Immobility

Social isolationSocial isolation

Emotional and spiritual distressEmotional and spiritual distress– SufferingSuffering

Suicidal ideationSuicidal ideation

Akechi, et al. Cancer 95:1085-1093, 2002

Consequences of Cancer PainConsequences of Cancer Pain

Inability to complete potentially curative Inability to complete potentially curative therapiestherapies

Caregiver distressCaregiver distress– Family and loved onesFamily and loved ones– Professional caregiversProfessional caregivers

Akechi, et al. Cancer 95:1085-1093, 2002

Miaskowski et al. Guideline for Management of Cancer Pain in Adults and Children, 2005

Etiology of Cancer PainEtiology of Cancer Pain

Tumor Infection

Hormonal

ChemotherapyRadiation

Diagnostic

Postoperative

Causes of Pain in People with Causes of Pain in People with Cancer: EtiologyCancer: Etiology

Pain due to cancerPain due to cancer– 85 – 93%85 – 93%

Pain due to cancer diagnosis and Pain due to cancer diagnosis and treatmenttreatment– 17 -21%17 -21%

Pain unrelated to cancer or its treatmentPain unrelated to cancer or its treatment– 2 – 9%2 – 9%

Zech, et al. Pain 63: 65-76, 1995

Caraceni & Portenoy. Pain 82:263-274, 1999

Common Pain Syndromes in Common Pain Syndromes in Cancer by PathophysiologyCancer by Pathophysiology

SomaticSomatic– Bone metastasesBone metastases– Skin lesionsSkin lesions

VisceralVisceral– Malignant bowel obstructionMalignant bowel obstruction

NeuropathicNeuropathic– Chemotherapy–induced peripheral Chemotherapy–induced peripheral

neuropathy neuropathy – PHNPHN

Goals of TreatmentGoals of Treatment

PreventionPrevention

Relief of painRelief of pain

Improved functionImproved function

SafetySafety

AssessmentAssessment

Inform your doctor and nurse about your Inform your doctor and nurse about your pain – they cannot always “see” your painpain – they cannot always “see” your pain

Questions they will ask:Questions they will ask:– LocationLocation– Intensity (0-10)Intensity (0-10)– Quality – what does it feel likeQuality – what does it feel like– What makes it better/worseWhat makes it better/worse– What have you tried already What have you tried already – Bring in pill bottlesBring in pill bottles

Therapeutic Advances in Pain

Non-opioids

Opioids

Adjuvants

Anticancer therapies

Therapeutic Advances in Pain

Non-opioids

Opioids

Adjuvants

Anticancer therapies

Therapeutic Advances in Pain

Non-opioids Opioids Adjuvants – Corticosteroids– Antiepilepsy drugs– Antidepressants– Local anesthetics– NMDA receptor antagonists– Cannabinoids

Anticancer TherapiesAnticancer 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

Never doubt that a small group of Never doubt that a small group of thoughtful, committed citizens can thoughtful, committed citizens can change the world. Indeed, it is the change the world. Indeed, it is the

only thing that ever has.only thing that ever has.

Margaret MeadMargaret Mead

Resources - PatientsResources - Patients

People Living With CancerPeople Living With Cancerwww.plwc.orgwww.plwc.org

The Neuropathy Association The Neuropathy Association www.neuropathy.orgwww.neuropathy.org

Lance Armstrong FoundationLance Armstrong Foundationwww.livestrong.orgwww.livestrong.org

Conversations: The International Ovarian Conversations: The International Ovarian Cancer Connection Cancer Connection

www.ovarian-news.org/neuropathy.htmlwww.ovarian-news.org/neuropathy.html

Cancer Pain ManagementCancer Pain Management

Judith A. Paice, RN PhD FAANJudith A. Paice, RN PhD FAANDirector, Cancer Pain ProgramDirector, Cancer Pain Program

Northwestern University, Feinberg School of MedicineNorthwestern University, Feinberg School of MedicineDivision of Hematology-OncologyDivision of Hematology-Oncology

Chicago, ILChicago, IL

Prostate Cancer ForumNorthwestern University Prostate SPORE