Question

Mrs. R is a 70-year-old female with metastatic breast cancer. She was initially treated with right-sided mastectomy and lymph node resection followed by radiation. She has been on Anastrozole for 5 years. Recently, she reported right shoulder pain and was found to have a pathological humerus fracture. She is waiting for surgical fixation of the humerus. Scans revealed metastatic lesions in the thoracic spine and a right rib. “That explains the pain I’ve been having for a long time,” Mrs. R tells you.

1. Mrs. R will be treated for both chronic and acute pain. Which is which? Describe how chronic and acute pain differ with regard to cause and clinical manifestations.

2. What kinds of medications and approaches might you expect to be used for her acute pain?

3. What kinds of medications and non-medication strategies might you expect to be used for her chronic pain?

Answer 1

PAIN AND ITS MANAGEMENT

Pain is an unpleasant physical sensation caused due to either illness or injury.

There are two major types of pain based on the duration of pain are acute and chronic.

Describe how chronic and acute pain differs about cause and clinical manifestations.

Acute pain:

• An acute pain is the predicted normal physiological response to a stimulus (adverse effect of chemical, thermal or mechanical) this may be associated with trauma, illness or surgery.
• This type of pain associated with sudden onset of pain and that is severe.
• Acute pain is associated with hyperactivity of sympathetic nervous system and anxiety.
• Acute pain clinical manifestation includes diaphoresis, tachycardia, increased respiratory rate, and dilated pupils.
• Acute pain is usually prolonged; continue until the healing process begins.

Chronic pain

• Chronic pains are long term pain.
• Chronic pain does not reduce and continues though the healing is complete.
• Chronic pain clinical manifestation includes loss of appetite, fatigue, and depressed mood. Chronic pain does not have any effect on the patient vital signs.
• Common types of chronic pains are cancer pain, headaches, arthritis, back pain, neuropathic pain (caused due to nerve damage and psychogenic pain).
• Chronic pain detrimentally affects the patient quality of life. Hence it is very essential to control and treat the chronic pain.

Medications and approaches used for her acute pain

• Mild acute pain can be controlled by simple analgesics.
• Acute pain can be effective relieved by oral non-opioids and non-steroidal anti-inflammatory’s (NSAIDs).
• In Severe acute pain as first line of treatment an opioids is recommended.

Medications and non-medication strategies used for her chronic pain

Drug treatments for chronic pain are

• Non-narcotic pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids, or combinations of opioids and non-narcotic analgesics
• Sedatives/anti-anxiety agents
• Corticosteroids
• Antirheumatics/immunological agents
• Muscle relaxants

Non-pharmacological measures for chronic pain

• Heat and/or cold application
• Acupuncture
• Massage therapy
• General mental health and behavioral counselling
• Cognitive behavioral therapy (CBT)
• Relaxation techniques
• Meditation
• Biofeedback
• Guided imagery
• Aromatherapy
• Hypnosis