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Cancer Pain Gallery

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>> Cancer Pain

Introduction
The incidence of poorly managed pain in patients with cancer is very high,One quarter of all patients worldwide have pain at diagnosis of cancer,two thirds of patients receiving treatment for thier cancer report pain .the number of patients with unrelieved pain in cases with advancinf stagesof the disease .Bone involvement by the cancer increase the likelihood of pain.Nerve infiltration followed by the involvement of Hollow viscus,most patients have multiple sites of pain.the treatment of cancer can also be the cause of pain ,despite many advances in the treatment of acute vpain ,many patients still have significant post-operative pain.Chemotherapy and radiotherapy each can cause thier own pain Syndromes .Certain surgical procedures ,such as the approach used to treat Head and Neck cancers ,often sacrifice nerves to acheieve thier therapeutic goals.the loss of innervation to any part of the body is associated with a significant increase in the incidence of neuropathic pain.other types of Surgery ,such as mastectomies with lymph node dissection and thoracotomies ,also have a high incidence of associated nerve injury.

 

Treatmeant

Treatment goals for cancer pain should not just be pain relief.As with all other types of chronic pains ,the treatment goal for cancer pain should also be increased function.
1.Medications :
Opiates are the mainstay of treatment ,yet physicians still have concerns regarding thier use and the potential sanctions for chronic pain of any diagnosis,despite assurances by medical boards and the drug enforcement agewncy (DEA).patient also have concerns about the use of opiates ,despite thier efficacy,and will tend to under report theie painto avoid having to use opiates.the use of opiates for pain is often equated by thye patient and relatives with a poor prognosis and a loss of effective treatment options for pain later in the couse of the disease .patients are also concerned about the potential of sedation and regard this as an avoidable consequence of opiate use .All three of these concerns are myths.Further concerns associated with opiates use regarding issues of addiction ,dependence ,tolerance is not true if opioids administration and gradual increase was guided by the treating pain specialist and can be discussed with the patients prior to the start of treatment. 2.Nerve blocks and nerve radiofruency ablation.
Nerve blocks both reversible and neurodestructive blocks under local anesthesia or sedation can be very useful for patient with certain type of cancer pain such as patient with unresectable cancer of the pancrease with severe constant upper abdominal pain radiating to thye pack ,patient with post mastectomy or thoracotomy nouropathic chest pain or patient with pain poorly managed with opioids. 3.Spinal cord stimulator and intrathecal pumps .
Such advanced techniques can be used for different type of cancer pain and with different quality of pain . programmable intrathecal pump implants with multiple medications for different type of pain (opioids,clonidine,Bupivacaine and baclofen ) should be inseted as early as possible for patient with patient with cancer expected to have widespread metastatic cancer ,or patients unresposive to high doses of opioids with multiple adjuvent medications ,patient suffering from pain and expected to have good al long quality of life.after succesful trial ,a intrathecal infusion pump is implanted with excellent long- term response. programmable spinal cord stimulator can be implanted for refractory neuropathic pain such as refractory post thoracotomy ,post mastectomy and phantom limb pain ,post chemo or radiotheray neuropathic pain of the periphery.

 
 
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