Cancer pain therapy

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  • Cancer pain therapy
A 58 year old woman comes to a general practicioner with several days lasting vomiting, nausea and weakness. She's lost 12 kg in 4 months.She complains of occasional back pain in the lumbar region. The physio revealed icteric skin and soft painless abdomen. Imaging examination (USG, CT) and following biopsy revealed an inoperable tumor of the pancreatic head (T2/N1/M0). The stent was introduced into the biliary tract using ERCP and the patient was handovered to the oncologist. Later she arrives to a pain clinic. At home she's been using ibuprophen gel without help. The pain is barely tolerable.

We instruct her to keep a diary of pain and invite her for a follow-up in a week. Then we will prescribe adequate medication.

Wrong answer

The patient is in a severe pain, we can not keep her without adequate pain management.


Back

We prescribe paracetamol in combination with strong opioid.

Wrong answer

Severity of the pain has not been established yet.


Back

Since the pancreatic tumor pain is agonizing, we will prescribe a weak opioid (dihydrocodein 30 mg PO BD).

Wrong answer

Severity of the pain has not been established yet.


Back

Using the VAS scale we can objectify the pain and consequently we can prescribe adequate analgesics.

Correct answer

This is the only way to assess the severity of pain.


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Help

VAS - Visual Analog Scale, USG - ultrasonography, TNM – tumor – nodulus – metastasis, CT – computer tomography, PO - per os, ERCP - Endoscopic Retrograde Cholangiopancreatography, OD - once a day, BD - twice a day×
 
RR

17 bpm

HR

89 bpm

SpO2

97 %

BP

133/88 mmHg

ECG

not available

Examination:
amylase 2.5 - 3.2 mckat/L

Gly

results

ABG

results

CBC

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biochemistry

results