chronic pain related to cancer nursing diagnosis

[107] Embedding opioid into a matrix that cannot be obtained by crushing or chemical extraction is another pharmacological deterrent.[108]. Ascertain the amount of recent weight loss. The selection of a target opioid depends on the reason for rotation. Passik SD, Kirsh KL: The need to identify predictors of aberrant drug-related behavior and addiction in patients being treated with opioids for pain. Rokke PD, Fleming-Ficek S, Siemens NM, et al. Women and younger patients reported greater improvements in QOL. Age-related physiologic changes alter pharmacodynamics and pharmacokinetic drug properties (see Table 7). There is no definite length but, in general, acute pain resolves within 3 to 6 months. J Clin Oncol 34 (5): 436-42, 2016. Encourage adequate fluid intake (2000 mL per 24 hr), increased fiber in the diet; regular exercise.May reduce the potential for constipation by improving stool consistency and stimulating peristalsis; can prevent dehydration associated with diarrhea. For patients with risk factors for QT prolongation, it is important to conduct a baseline electrocardiogram (ECG) before treatment with methadone. The liver produces enzymes involved in two forms of metabolism:[31], Methadone and fentanyl are unaffected by liver disease and are drugs of choice in patients with hepatic failure.[73,74]. : Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. Review the patients and SOs previous experience with cancer. Oncol Nurs Forum 17 (3): 387-9, 1990 May-Jun. : The Edmonton staging system for cancer pain: preliminary report. A focused physical examination includes clinical observation of pain behaviors, pain location, and functional limitations. Richardson MA, Sanders T, Palmer JL, et al. J Clin Oncol 29 (9): 1221-7, 2011. : The effects of opioids and opioid analogs on animal and human endocrine systems. [22,23] Single-fraction radiation has several potential advantages: A study published in 2019 evaluated a higher-dosage (Gy) single-fraction stereotactic body radiation therapy (SBRT) versus multifraction radiation therapy (MFRT), in which patients with primarily nonspine bone metastases received either single-fraction SBRT (12 Gy for 4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in ten fractions. Minimally verbally communicative. Recommend wearing soft, loose cotton clothing; have female patients avoid wearing bras if it creates pressure.Protects skin from ultraviolet rays and reduces the risk of recall reactions. In addition, starting doses of gabapentin may be given at bedtime to assist with tolerating any sedation. It is an NMDA receptor antagonist that, at low doses, produces analgesia, modulates central sensitization, and circumvents opioid tolerance. : The opioid rotation ratio of strong opioids to transdermal fentanyl in cancer patients. Clemens KE, Klaschik E: Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. : Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. : Patient barriers to optimal cancer pain control. Gagliese L, Melzack R: Age differences in nociception and pain behaviours in the rat. Mental health issues such as depression or anxiety. Galloway SK, Baker M, Giglio P, et al. Encourage the patient to share thoughts and feelings.Provides an opportunity to examine realistic fears and misconceptions about the diagnosis. More common among diabetics. Nutritional and fluid volume status can be significantly affected in patients with cancer. Ilfeld BM, Madison SJ, Suresh PJ, et al. Constipation in patients with cancer can occur due to various factors such as reduced physical activity, side effects of medications (such as opioids), dehydration, or tumor obstruction. Cherny N, Ripamonti C, Pereira J, et al. Chronic pain is pain that is ongoing and usually lasts longer than six months. J Clin Oncol 22 (14): 2909-17, 2004. : Intravenous lidocaine for postmastectomy pain treatment: randomized, blind, placebo controlled clinical trial. Opioids:codeine, morphine (MS Contin), oxycodone (oxycontin) hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), fentanyl (Duragesic); oxymorphone (Numorphan)A wide range of analgesics and associated agents may be employed around the clock to manage pain. Pain is usually the symptoms are slow. [89] In 2013 alone, 2 million Americans were estimated to have either abused or been dependent on opioids, with 22,767 deaths related to prescription drug overdose. [27,28] Risk factors for mucositis include preexisting oral pathology, poor dental hygiene, and younger age.[26]. Although many antiemetic regimens have been proposed for OINV, there is no current standard. It is intended as a resource to inform and assist clinicians in the care of their patients. : Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. WebMD Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2021. Instruct regarding dietary changes: avoid hot or spicy foods and acidic juices; suggest the use of a straw; ingest soft or blenderized foods, Popsicles, and ice cream as tolerated.Severe stomatitis may interfere with nutritional and fluid intake leading to negative nitrogen balance or dehydration. NSAID = nonsteroidal anti-inflammatory drug. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance. Massaccesi M, Deodato F, Caravatta L, et al. : Effect of Radiotherapy on Painful Bone Metastases: A Secondary Analysis of the NCIC Clinical Trials Group Symptom Control Trial SC.23. Limit on number of pills per prescription. Chronic or persistent pain can come on quickly or slowly, and can range from mild to severe. [40-42] ASCO guidelines [39] recommend against the use of many commonly prescribed agents for the treatment of existing CIPN and do not recommend any agent for CIPN prevention. : Opioid complications and side effects. [13] In addition, one-third of patients with mild pain progressed to moderate to severe pain by the time of their first follow-up visit. Nursing interventions for preventing stomatitis include providing meticulous oral hygiene, such as gentle brushing with a soft toothbrush and regular rinsing with a non-alcoholic mouthwash, and encouraging patients to maintain adequate oral hydration. Encourage the use of relaxation techniques, visualization, guided imagery, and moderate exercise before meals.May prevent the onset or reduce the severity of nausea, decrease anorexia, and enable the patient to increase oral intake. : Pain during bone marrow aspiration: prevalence and prevention. Clin Oncol (R Coll Radiol) 24 (2): 112-24, 2012. van der Linden YM, Lok JJ, Steenland E, et al. : Naloxegol for opioid-induced constipation in patients with noncancer pain. Promote good handwashing procedures by staff and visitors. Screening tools help in risk assessment. Support and counseling are often necessary to enable individuals to recognize and deal with fear and to realize that control and coping strategies are available. Neuroreport 14 (1): 1-7, 2003. [23] Furthermore, several patient characteristics are associated with higher pain expression, higher opioid doses, and longer time to achieve pain control. [62] The chemoreceptor trigger zone is stimulated by dopamine, serotonin, and histamine. Lacouture ME, Anadkat MJ, Bensadoun RJ, et al. : Depression and Anxiety Symptoms Relate to Distinct Components of Pain Experience among Patients with Breast Cancer. For more information, check out our privacy policy. Support Care Cancer 26 (4): 1323-1334, 2018. Slatkin N, Rhiner M: Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report. Provide information about the normality of these problems and that many people find it helpful to seek assistance with the adaptation process.Acknowledges the legitimacy of the problem. : Aromatase inhibitor-induced arthralgia: clinical experience and treatment recommendations. Mercadante S, Giarratano A: The long and winding road of non steroidal antinflammatory drugs and paracetamol in cancer pain management: a critical review. A retrospective study was conducted in patients with advanced cancer who received palliative care consultations at the University of Texas MD Anderson Cancer Center; the researchers sought to determine the frequency of and risk factors for OIN in 390 patients who had been taking opioids for 24 hours or longer. [93] See Table 6 for more information. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Pain management varies widely in complexity. [35] The B-30 trial randomly assigned women with node-positive, early-stage breast cancer to one of three regimens: four cycles of doxorubicin plus cyclophosphamide every three weeks, followed by four cycles of docetaxel 100 mg/m2 (ACT); four cycles of doxorubicin plus docetaxel 60 to 75 mg/m2 (AT); or four cycles of doxorubicin plus cyclophosphamide plus docetaxel 60 to 75 mg/m2 (ACT). Mechanisms of analgesic action include decreased inflammation, decreased peritumoral edema, and modulation of neural activity and plasticity.[114]. Taxanes (e.g., paclitaxel, docetaxel, and cabazitaxel). Oldenmenger WH, de Raaf PJ, de Klerk C, et al. : Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? Pain 64 (2): 293-302, 1996. [76], There are conflicting reports about the safety of hydromorphone in patients with renal failure. J Clin Oncol 16 (10): 3222-9, 1998. Less breakthrough pain associated with transportation to the radiation facility and with getting on and off the radiation table. Br J Anaesth 101 (1): 95-100, 2008. Clin J Pain 29 (11): 944-7, 2013. Yu LM, Chen DX, Zhou QX, et al. Is it somatic, visceral, neuropathic, or mixed? Administer antibiotics as indicated.May be used to treat the identified infections or given prophylactically in immuno- compromised patients. Acta Oncol 42 (5-6): 620-33, 2003. Be aware of debilitating depression. Given the similarities between OIH and neuropathic pain, the addition of an adjunctive medication such as pregabalin has been recommended.[40]. : A randomized, double-blind, double-dummy, crossover trial comparing the safety and efficacy of oral sustained-release hydromorphone with immediate-release hydromorphone in patients with cancer pain. Pain with features suggestive of neuropathic pain is common among patients with cancer and can have substantial negative consequences. Palliat Support Care 7 (1): 75-86, 2009. WebChronic pain is pain that lasts for over three months. [2,3], For patients with regional pain, a peripheral nerve block infusing a local anesthetic can achieve local pain control. Inhibits reuptake of norepinephrine and serotonin. However, none are bioequivalent to others, making dose interchange complicated and requiring dose titration of each product individually, without regard to previous doses of another fentanyl product. Chronic pain related to tumor infiltration into nerves; post-chemotherapy pain syndromes (such as peripheral neuropathy or The addition of a stool softener offers no further benefit. Patients who have persistent problems may benefit from opioid rotation. Comorbidities (e.g., renal or hepatic failure). Med Clin North Am 66 (5): 1079-89, 1982. Individuals may ask direct questions about death, and honest answers promote trust and provide reassurance that correct information will be given. [35], Adverse effects from opioids are common and may interfere with achieving adequate pain control (see Table 5). J Natl Cancer Inst 85 (17): 1432-3, 1993. : The abuse potential of Remoxy(), an extended-release formulation of oxycodone, compared with immediate- and extended-release oxycodone. The infusion of intravenous chemotherapy causes four pain syndromes:[22-24], Some chemotherapy agents such as vinorelbine may cause pain at the tumor site. [29] Overall, 40% of patients experienced pain reduction and improvement in QOL at day 10, with continued improvement in QOL at day 42. Bhatnagar S, Khanna S, Roshni S, et al. Hepatic disease increases the bioavailability of oxymorphone as liver function worsens. J Rehabil Res Dev 44 (2): 315-30, 2007. Establishing treatment adherence and responsiveness. Dexamethasone is preferred because it has reduced mineralocorticoid effects, resulting in reduced fluid retention; however, it does exhibit cytochrome P450mediated drug interactions. In addition, state guidelines for chronic opioid use, state prescription monitoring, and the use of pharmacists may reduce the potential for worsening addictive behavior. J Clin Oncol 30 (16): 1974-9, 2012. Healthcare system problems include factors such as inadequate assessment of pain, concern about controlled substances or patient addiction, inadequate reimbursement, or cost of treatment modalities. Hooten WM, Townsend CO, Bruce BK, et al. The patient will continue normal life activities, looking toward/planning for the future, one day at a time. Health & Parenting Guide - Your Guide to Raising a Happy Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Have the patient rate fatigue, using a numeric scale, if possible, and the time of day when it is most severe.Helps in developing a plan for managing fatigue. Discuss with the patient and SO the nature of sexuality and reactions when it is altered or threatened. Hawley PH, Byeon JJ: A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer. Dry desquamation (dryness and pruritus), moist desquamation (blistering), ulceration, hair loss, and loss of dermis and sweat glands may also be noted. The patient will display intact mucous membranes, which are pink, moist, and free of inflammation/ulcerations. In addition, patients expressed concerns that the pain represented disease progression (71%), that they were distracting the doctor (49%), or that they would not be seen as a good patient (46%). [28] Patients randomly assigned to receive intraoperative cryoanalgesia versus placebo were found to have less pain at time points up to 60 days postoperatively and reduced analgesic use in the first 3 days. However, this may be psychologically distressing to oncology patients who require opioid treatment. Nursing Anticancer Res 33 (5): 1793-7, 2013. The lack of an effective sham control is a significant limitation, as is the potential that the attention paid to the patient may have a salutary effect. In people who are unable to take oral medications, a subcutaneous method of delivery is as effective as the intravenous route for morphine and hydromorphone. [8] The prevalence of chronic nonmalignant painsuch as chronic low back pain, osteoarthritis pain, fibromyalgia, and chronic daily headacheshas not been well characterized in cancer patients. Basurto Ona X, Osorio D, Bonfill Cosp X: Drug therapy for treating post-dural puncture headache. One group of investigators performed a 24-week, open-label pilot study of a testosterone patch in 23 men with opioid-induced androgen deficiency and reported an improvement in androgen deficiency symptoms, sexual function, mood, depression, and hematocrit levels. Reddy A, Yennurajalingam S, de la Cruz M, et al. Doses of both agents need to be adjusted for patients with renal dysfunction.[10,109]. Turk DC, Okifuji A: Psychological factors in chronic pain: evolution and revolution. Numerical rating scale (010: 0 = no pain, 10 = worst pain imaginable). Schreiber KL, Kehlet H, Belfer I, et al. Not all internal organs have nociceptors. Many of these adjunct agents are listed in the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, to be avoided or used with caution in geriatric patients because of their increased risk of adverse effects [57] (see Table 8). Encourage the patient to assess the oral cavity daily, noting changes in mucous membrane integrity (dry, reddened). [27] A small randomized trial of transcutaneous electrical nerve stimulation demonstrated decreased pain and reduced use of morphine and nonopioid analgesia in the immediate postoperative period. Clin Lab Haematol 28 (5): 321-4, 2006. Etiology. J Clin Oncol 29 (19): 2683-8, 2011. Jim HS, Andersen BL: Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Chronic pain persists three months or more. Saito T, Toya R, Tomitaka E, et al. Chou R, Cruciani RA, Fiellin DA, et al. Neurosignals 14 (4): 194-205, 2005. : The effects of smoking status on opioid tapering among patients with chronic pain. Ann Surg 267 (3): 468-472, 2018. Malvern, Pa: Endo Pharmaceuticals Inc., 2019. : The Paclitaxel acute pain syndrome: sensitization of nociceptors as the putative mechanism. Although there was no statistically significant difference between treatment groups, the authors concluded that loratadine administration has a favorable risk-to-benefit profile and should be considered. Chronic pain, with its multiple factors for perpetuation, often benefits from a multidisciplinary approach to treatment. [12], The management of acute pain begins with an immediate-release opioid formulation. Referral to a pain specialist or a palliative care team may be indicated. : Risks of Developing Persistent Opioid Use After Major Surgery. Specifically, a high baseline pain intensity, neuropathic pain, and incident pain are often more difficult to manage. : Effect of alternate-week versus continuous dexamethasone scheduling on the risk of osteonecrosis in paediatric patients with acute lymphoblastic leukaemia: results from the CCG-1961 randomised cohort trial. 1.6%). Open-label RCT showed benefit over transmucosal fentanyl and oral morphine. A 2012 Cochrane review of ketamine used as an adjuvant to opioids in the treatment of cancer pain concluded there is insufficient evidence to evaluate its efficacy in this setting.[130]. Hjortholm N, Jaddini E, Haaburda K, et al. These medications may cause the following symptoms:[10,109], Gradual upward titration of gabapentin to a maximum of 3,600 mg per day and pregabalin to 300 mg per day can help with dose-dependent sedation and dizziness. The patient will identify and express feelings appropriately. Chronic pain [8] The pain may be evoked by stimuli or spontaneous. Board members will not respond to individual inquiries. J Palliat Med 11 (7): 964-8, 2008. Chey WD, Webster L, Sostek M, et al. : Opioid abuse in cancer pain: report of two cases and presentation of an algorithm of multidisciplinary care. This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is Updated . Can potentiate or otherwise interfere with radiation delivery. Administer medications as indicated.See Pharmacologic Management. J Oncol Pharm Pract 12 (3): 131-41, 2006. [30] Short-acting opioids, not methadone, should also be available for breakthrough pain. Palliative care providers work in interdisciplinary teams that include: For patients with refractory pain, prominent nonpain symptoms, or intense psychosocial distress, a referral to palliative care may be appropriate, where available. Cavaletti G, Alberti P, Frigeni B, et al. Neuropathic pain is pain caused by damage to the peripheral nervous system or the CNS (spinal cord or brain). Dean M: Opioids in renal failure and dialysis patients. Smith EM, Pang H, Cirrincione C, et al. : Chemotherapy-induced neuropathy. It can lead to discomfort, abdominal pain, and decreased appetite. J Clin Oncol 32 (29): 3221-8, 2014. : Methadone safety: a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society. Hasselstrm J, Eriksson S, Persson A, et al. : A dose-controlled study of 153Sm-ethylenediaminetetramethylenephosphonate (EDTMP) in the treatment of patients with painful bone metastases. Mannix KA: Palliation of nausea and vomiting. : Percutaneous cervical cordotomy: a review of 181 operations on 146 patients with a study on the location of "pain fibers" in the C-2 spinal cord segment of 29 cases. Israel FJ, Parker G, Charles M, et al. Palliative care specialists may also help manage patients with multiple comorbidities, those requiring higher doses of opioids, and those with a history of substance use disorder or complex psychosocial dynamics that can complicate the management of pain and adherence to recommended medications. J Clin Oncol 21 (16): 3150-7, 2003. Radium Ra 223-dichloride (223Ra-dichloride) (an alpha-emitter) is approved for use in patients with castration-resistant prostate cancer. Provide supplemental oxygen as indicated.The presence of anemia and hypoxemia reduces oxygen available for cellular uptake and contributes to fatigue. Before use, wet mouth if dry. Treatment may include surgery (curative, preventive, palliative), as well as chemotherapy, radiation (internal, external), or organ-specific treatments such as whole-body hyperthermia or biotherapy. Ann Pharmacother 51 (9): 797-803, 2017. During ongoing pain management, the immediate-release opioids inform the titration of long-acting medications. : Zoledronic acid versus placebo in the treatment of skeletal metastases in patients with lung cancer and other solid tumors: a phase III, double-blind, randomized trial--the Zoledronic Acid Lung Cancer and Other Solid Tumors Study Group. [25] In a secondary analysis of the National Cancer Institute of Canada (NCIC) Clinical Trials Group Symptom Control Trial SC.20, which examined outcomes of 847 patients who underwent palliative re-irradiation of painful bone metastases, the team found no differences in pain relief or side effects across age or gender demographics. Cognitive impairment may impede a persons ability to describe pain, recall pain events, or understand the tools used to assess pain. : Personalized Pain Goal as an Outcome Measure in Routine Cancer Pain Assessment. For more information, see the, Proper characterization of the pain to identify underlying pathophysiology, which could significantly influence treatment options. Paclitaxel generates a syndrome of diffuse arthralgias and myalgias in 10% to 20% of patients. [31] Hepatic impairment affects both CYP enzymes and glucuronidation processes. Catastrophizing is strongly associated with low self-efficacy and greater reliance on chemical coping strategies. Discuss the limitations of smoking and alcohol intake.May cause further irritation and dryness of mucous membranes. Identifying the optimal pharmacological and nonpharmacological treatment options, including referrals to specialists, if needed. J Pain Symptom Manage 26 (3): 860-6, 2003. Cancer Invest 22 (6): 944-8, 2004. Pain Med 6 (6): 432-42, 2005 Nov-Dec. Butler SF, Fernandez K, Benoit C, et al. Eur J Cardiothorac Surg 41 (4): 861-8; discussion 868, 2012. : Methadone disposition in patients with chronic liver disease. Skin is very sensitive during and after treatment, and all irritation should be avoided to prevent dermal injury. Ann Hematol 92 (2): 145-9, 2013. Bosilkovska M, Walder B, Besson M, et al. Hjsted J, Sjgren P: Addiction to opioids in chronic pain patients: a literature review. Oncologist 25 (2): 99-104, 2020. Notably, in a systemic review of neuropathic pain that included mostly patients with a nonmalignant source of neuropathic pain, the effect of gabapentin and pregabalin appeared less robust. In addition, few clinical trials have been performed in patients older than 65 years to confirm drug safety and efficacy. However, a meta-analysis of multi-institutional, randomized, controlled trials for cancer-related pain concluded that methodological flaws hampered interpretation of the few available studies. Curr Pain Headache Rep 16 (4): 307-13, 2012. Nurse's role in controlling cancer pain - PubMed [31] The percentage of patients experiencing any grade bone pain was 40.3% in the naproxen group, 42.5% in the loratadine group, and 46.6% in the no-prophylaxis group. Venlafaxine and duloxetine are serotonin and norepinephrine reuptake inhibitors (SNRIs) originally approved for depression; however, both are used off-label for the treatment of chemotherapy-induced peripheral neuropathy (CIPN). Because of methadones long half-life, naloxone infusion may be required for respiratory depression caused by methadone.
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