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Prostate Cancer Forum Northwestern University Prostate SPORE 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 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 Cancer Pain: Multidimensional Phenomenon Functional Social Physical Emotional Spiritual Consequences of Cancer Pain Functional impairment Immobility Social isolation Emotional and spiritual distress – Suffering Suicidal ideation Akechi, et al. Cancer 95:1085-1093, 2002 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 Etiology of Cancer Pain Diagnostic Hormonal Postoperative Tumor Infection Radiation Chemotherapy 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 Common Pain Syndromes in Cancer by Pathophysiology Somatic – Bone metastases – Skin lesions Visceral – Malignant bowel obstruction Neuropathic – Chemotherapy–induced peripheral neuropathy – PHN Goals of Treatment Prevention Relief of pain Improved function Safety 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 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 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 thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead 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 Prostate Cancer Forum Northwestern University Prostate SPORE 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