Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Pain management in cancer patients

9.701 visualizaciones

Publicado el

CME presentation made on 10th Nov 2012. Discusses a Radiation Oncologist's perspectives of cancer pain management, shortcomings of WHO pain ladder, ASTRO guidelines for metastatic bone pain.

  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • Mom of 3 loses 62lbs with morning "hack" (before/after pics) ●●● http://t.cn/Airf776j
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... ,DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ,DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí
  • DOWNLOAD FULL. BOOKS INTO AVAILABLE FORMAT, ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Responder 
    ¿Estás seguro?    No
    Tu mensaje aparecerá aquí

Pain management in cancer patients

  1. 1. Pain is inevitable …… Suffering is optionalDr. T. SujitConsultant Radiation OncologistComprehensive Cancer Care Network
  2. 2. Pain – Just like Love….• “Pain is whatever the experiencing person says it is, existing whenever he/she says it does.” - Margo McCaffery, 1968• An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. - International Association for the Study of Pain (IASP)
  3. 3. Do all cancer patients suffer pain ?• Moderate to severe pain experienced by 40% to 50% of cancer patients.• Very severe pain experienced by 25% to 30% of cancer patients .• 80% of terminal stage cancer experience moderate to severe pain
  4. 4. Cancer related pain – overview.• Causes : – Infection – Tumor related – Nervous system, bone, visceral, mucosal – Treatment Related – surgery, radiation therapy, chemotherapy, interventional procedures• Types : – Nociceptive : pain signals from nerve endings – Neuropathic : damage to nerve fibres.
  5. 5. Diagnosis• Detailed history : – Location ; single or multiple – Onset and duration ; variation. – Characterisation of pain – Aggravating and relieving factors – Effect of medications – Effect of pain on patient’s life.
  6. 6. Imminent fracture of long bones• The score is a composite of the site (weight bearing status), pain, size, and lytic/blastic.Score more than 8 = requires surgical stabilisation
  7. 7. Vertebral metastases• Class I – III : Non-surgical management.• Class IV and V : Surgical management first.
  8. 8. WHO PAIN LADDER• Developed in 1986 to help primary care physicians.• Inexpensive drugs• Legitimised the use of Morphine• Oral administration of analgesics• Analgesics should be given at regular intervals.• Analgesics should be prescribed according to pain intensity as evaluated by a scale of intensity of pain.• Dosing of pain medication should be adapted to the individual.• Analgesics should be prescribed with a constant concern for detail.
  9. 9. Shortcomings of WHO ladder• Acute pain Vs Chronic pain• Cancer pain Vs Non-cancer pain• Newer drugs – Tramadol, Oxycodone, Buprenorphine other adjuvants like Gabapentin, anti-depressants etc.• Newer delivery methods – Transdermal patches – Infusion pumps
  10. 10. Adapted WHO pain ladder.
  11. 11. Radiation and pain relief• Effective for Nociceptive and Neuropathic pain• Effective for mild to moderate and severe pain• Pain relief starting from within 24 hrs.• Complete effects seen after 1 - 2 months.• Brings about alleviation of other associated symptoms – tumor swelling, anxiety and depression, appetite.
  12. 12. How does RT reduce pain ?• Cell kill – reduced tumor size and pressure effects• Endothelial damage of micro-vasculature – reduced blood flow. • Reduces edema • Reduces pain related neuro-transmitter concentrations• Bone – promotes re-mineralisation leading to structural stability.
  13. 13. When should a patient receive RT for pain ?• No fixed guideline until recently.• Prophylactic RT for pain – DEFINITELY NO ROLE• Early onset pain ? – Drugs Vs RT Vs Bisphosphonates ? – Drugs Vs RT + Bisphosphonates ?• Vertebral mets Vs Non-vertebral mets
  14. 14. • American Society for Radiation Oncology (ASTRO)• Third International Consensus Conference on Palliative Radiotherapy.
  15. 15. Single Vs Multi-Fraction
  16. 16. Single Vs Multi-Fraction• Nearly identical outcomes with regard to pain relief.• 20% of patients required re-treatment at a later date when treated with single fraction.• No guideline as to when to be re-treated or dose for re-treatment; suggests clinical trial setting.
  17. 17. SBRT for pain relief• Should not be used as the primary treatment for vertebral / spinal cord lesions.• Can be used in a clinical trial setting for re- irradiation of vertebral / spinal cord lesions.
  18. 18. Hemi-body Irradiation• For multiple lesions, when facilities for radionuclide therapy is un-avaialble.• More suited for lower hemibody than upper.• Ideally treated using 6MV photons or higher• Keep lung dose to < 6 Gy for upper HBI
  19. 19. Bisphosphonates and RT• “Bisphosphonates and RT can be given concurrently.”• Synergistic effect – Zoledronic acid pauses the cells in G2M phase.• Use of Bisphosphonates does not obviate the need for RT.
  20. 20. Radiopharmaceuticals• Use of Radiopharmaceuticals does not obviate the need for EBRT.• Ideal for osteoblastic, multi-focal and wide- spread disease.
  21. 21. Vertebral mets : RT Vs Sx No prospective data are available to suggest that the use of eitherkyphoplasty or vertebroplasty obviates the need for EBRT in themanagement of painful bone metastases
  22. 22. International Bone Metastases Consensus Working Party 2012

×