tailieunhanh - Chapter 077. Approach to the Patient with Cancer (Part 8)

Pain Pain occurs with variable frequency in the cancer patient: 25–50% of patients present with pain at diagnosis, 33% have pain associated with treatment, and 75% have pain with progressive disease. The pain may have several causes. In ~70% of cases, pain is caused by the tumor itself—by invasion of bone, nerves, blood vessels, or mucous membranes or obstruction of a hollow viscus or duct. In ~20% of cases, pain is related to a surgical or invasive medical procedure, to radiation injury (mucositis, enteritis, or plexus or spinal cord injury), or to chemotherapy injury (mucositis, peripheral neuropathy, phlebitis, steroid-induced aseptic. | Chapter 077. Approach to the Patient with Cancer Part 8 Pain Pain occurs with variable frequency in the cancer patient 25-50 of patients present with pain at diagnosis 33 have pain associated with treatment and 75 have pain with progressive disease. The pain may have several causes. In 70 of cases pain is caused by the tumor itself by invasion of bone nerves blood vessels or mucous membranes or obstruction of a hollow viscus or duct. In 20 of cases pain is related to a surgical or invasive medical procedure to radiation injury mucositis enteritis or plexus or spinal cord injury or to chemotherapy injury mucositis peripheral neuropathy phlebitis steroid-induced aseptic necrosis of the femoral head . In 10 of cases pain is unrelated to cancer or its treatment. Assessment of pain requires the methodical investigation of the history of the pain its location character temporal features provocative and palliative factors and intensity Chap. 12 a review of the oncologic history and past medical history as well as personal and social history and a thorough physical examination. The patient should be given a 10-division visual analogue scale on which to indicate the severity of the pain. The clinical condition is often dynamic making it necessary to reassess the patient frequently. Pain therapy should not be withheld while the cause of pain is being sought. A variety of tools are available with which to address cancer pain. About 85 of patients will have pain relief from pharmacologic intervention. However other modalities including antitumor therapy such as surgical relief of obstruction radiation therapy and strontium-89 or samarium-153 treatment for bone pain neurostimulatory techniques regional analgesia or neuroablative procedures are effective in an additional 12 or so. Thus very few patients will have inadequate pain relief if appropriate measures are taken. A specific approach to pain relief is detailed in Chap. 11. Nausea Emesis in the cancer patient is usually .