Managing an acute pain crisis in a patient with advanced cancer: "This is as much of a crisis as a code" Journal Article
| Authors: | Moryl, N.; Coyle, N.; Foley, K. M. |
| Article Title: | Managing an acute pain crisis in a patient with advanced cancer: "This is as much of a crisis as a code" |
| Abstract: | The assessment and management of an acute pain crisis in the setting of advanced illness is challenging. Using the case of Mr X, a 33-year-old man with advanced metastatic mucinous adenocarcinoma of the appendix and "15 out of 10" pain, we explore the issues of acute pain and its management. We define a pain crisis as an event in which the patient reports pain that is severe, uncontrolled, and causing distress for the patient, family members, or both. Our management strategy focuses on making a pain diagnosis, differentiating reversible from intractable causes of pain, and making decisions about further workup; selecting the opioid and monitoring and treating opioid adverse effects; titrating and rotating opioid and coanalgesics; consulting experts to treat a pain crisis as quickly as possible to prevent unnecessary suffering;andco-opting the available institutional resources. The timely intervention of a palliative care team and its expertise can provide the staff, patients, andtheir families the benefit of an interdisciplinary approach and help the patients address goals of care; understand the benefits and risks of treatment decisions; and meet the psychological, social, and existential needs of the patient and the family commonly seen in this setting. ©2008 American Medical Association. All rights reserved. |
| Keywords: | adult; antibiotic agent; constipation; review; case report; advanced cancer; gastrointestinal hemorrhage; risk benefit analysis; side effect; adjuvant therapy; drug megadose; palliative care; medical decision making; low drug dose; metastasis; nephrotoxicity; pain; nausea; vomiting; lorazepam; midazolam; opiate; delirium; palliative therapy; sedation; adenocarcinoma, mucinous; dexamethasone; cancer pain; pathology; hyperglycemia; gastrointestinal toxicity; patient care; psychological aspect; patient care team; narcotic analgesic agent; clinical study; chemically induced disorder; nonsteroid antiinflammatory agent; anti-inflammatory agents, non-steroidal; diagnosis; single drug dose; benzodiazepine derivative; glucocorticoid; seizure; methadone; morphine; heart arrhythmia; myoclonus; respiration depression; analgesics, opioid; pain measurement; corticosteroid; psychosis; colloid carcinoma; hydromorphone; ketorolac; pain assessment; electrocardiogram; arrhythmias, cardiac; acute disease; clinical observation; mucinous carcinoma; fentanyl; ketamine; levorphanol; oxycodone; glucocorticoids; appendix tumor; appendiceal neoplasms; oxymorphone; anesthetic agent; emergency; anxiolytic agent; anti-anxiety agents; tachyphylaxis; central depressant agent; social care; emergencies; dantrolene; appendix carcinoma; celiac plexus; adjuvants, anesthesia; anesthetics, dissociative; benzodiazepines |
| Journal Title: | JAMA - Journal of the American Medical Association |
| Volume: | 299 |
| Issue: | 12 |
| ISSN: | 0098-7484 |
| Publisher: | American Medical Association |
| Date Published: | 2008-03-26 |
| Start Page: | 1457 |
| End Page: | 1467 |
| Language: | English |
| DOI: | 10.1001/jama.299.12.1457 |
| PUBMED: | 18364488 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 9" - "Export Date: 17 November 2011" - "CODEN: JAMAA" - "Source: Scopus" |
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