Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pain Medicine > Cancer pain > Flashcards

Cancer pain Flashcards

(58 cards)

Start Studying
1
Q

Name 4 sources if pain in a cancer patient

A
  1. Chemo/RT
  2. Diagnostic procedure
  3. Progression of disease
  4. Comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 6 poor prognostic factors in cancer pain management

A 
RAPIDN
rapid tolerance
Alcoholism
psychological (depression&anxiety)
Incidental pain
Delirium
Neuropathic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Spinal cord compression comes from what two mechanisms?

A
  1. hematogenic spread to bone marrow and vertebral body collapse and epidural mass formation
  2. direct tumour invasion from paravertebral source (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most spinal cord compression comes from what (in adults and children) and what area is most commonly affected?

A

In adults - metastatases from solid tumors (lung, breast, prostate, kidney)
In children - mets from neuroblastoma, Ewing’s sarcoma, osteogenic sarcoma, and rhabdomyosarcoma
70% in thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does spinal cord compression present?

A

95% initial symptom is progressive back pain with radiculopathy
radicular pain is unilateral in C-spine and L-spine; B/L in the T-spine
L’hermitte’s sign suggestive of epidural spread
After a period of progressive pain, patient will develop weakness, sensory loss, autonomic dysfunction and reflex abnormalities
weakness, hypereflexia and spasticity are some of the first signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Imaging in spinal cord compression?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment for spinal cord compression?

A
  1. Radiation therapy - external beam radiation, brachytherapy (definitive treatment for most)
  2. Surgery - decompression, stabilization
  3. Chemotherapy - alone, adjuvant
  4. High dose steroids IV x one dose then oral taper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Raised ICP presentation?

A

Headache, cranial nerve symptoms, nausea and vomiting, or the onset of seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name three types of herniation that exist with raised ICP

A

Central - slow deterioration in the level of consciousness, with associated headache and focal neurologic deficits.
Uncal - rapid loss of consciousness, lateral pupillary dilatation, and ipsilateral hemiparesis
Tonsillar - occipital headache, vomiting, and hiccups followed by decreasing level of consciousness and respiratory compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for raised ICP?

A
  1. dexamethasone

2. if herniation imminent - IV mannitol 1-1.5g/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tumour lysis syndrome (TLS) is seen in which cancers?

A

Burkitt’s lymphoma, acute lymphocytic leukemia, acute nonlymphocytic leukemia, and less frequently, solid tumors of small-cell type, breast cancer, and medulloblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the metabolic abnormalities found in TLS?

A

hyperuricemia
hyperkalemia
hyperphosphatemia
hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of TLS?

A

Regular monitoring of electrolytes, blood-urea-nitrogen (BUN), creatinine, uric acid, phosphorus, and calcium levels, often several times a day. Hydration should exceed 3,000 mL/m²/d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common metabolic emergency seen in cancer patients?

A

Hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypercalcemia is seen in which cancers commonly?

A 
breast
lung
kidney
esophagus
hematologic malignancies (notably multiple myeloma)
cancer of the head and neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical manifestations of Hypercalcemia?

A 
General:
Dehydration
Weight loss
Anorexia
Pruritus
Polydipsia

Neuromuscular:
Fatigue
Lethargy
Muscle weakness
Hyporeflexia
Confusion
Psychosis
Seizure
Obtundation
Coma

Gastrointestinal:
Nausea
Vomiting
Constipation
Obstipation
Ileus

Genitourinary:
Polyuria
Renal insufficiency

Cardiac:
Bradycardia
Prolonged PR interval
Shortened QT interval
Wide T wave
Atrial or ventricular arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatments for hypercalcemia?

A 
Gallium nitrate
Plicamycin
Calcitonin
Bisphosphonates (etidronate, pamidronate)
Hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lab findings in hypercalcemia?

A

high serum calcium level (can be greater than 14 mg/dL)
low serum chloride level
elevated or normal serum phosphate and bicarbonate levels
elevated alkaline phosphatase levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Post-mastectomy pain epidemiology?

A

4-30% incidence
most commonly mixed nociceptive and neuropathic
Onset 2 weeks to 6 weeks post-procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Post-mastectomy pain pathophysiology?

A
  1. damage to intercostobrachial nerve (lateral cutaneous branch of the second intercostal nerve) - lead to neuroma
  2. occurs more frequently in patients with post-op complications leading to fibrosis around the nerve
  3. axillary dissection and reconstructive surgery is most associated with PMPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Post-mastectomy pain clinical presentation?

A
  1. tight, constricting, burning sensation in anterior chest, axilla and medial and posterior aspects of the arm
  2. neuropathic elements
  3. Increased with arm movements
  4. allodynia occasionally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Post-mastectomy pain treatment?

A

Analgesics (NSAIDs, mild opioids, TCAs, AEDs, muscle relaxants),
CBT
Aggressive PT (to avoid adhesive capsulitis)
Interventional treatments - TPI, intercostal nerve blocks, paravertebral nerve blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name cancer-related syndromes following surgery that have a high risk of persistent pain?

A 
Post-thoracotomy pain
Post-mastectomy pain
Post-radical neck pain 
Stump pain
Phantom limb pain
post-surgery pelvic floor pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatments with evidence for phantom limb pain?

Study These Flashcards
A 
Gabapentin
Methadone
Clonazepam
Probably Canadian NeP guidelines
TENS
SCS
25
Give examples of chemotherapy related pain syndromes:
``` mucositis peripheral neuropathy bone pain headaches osteonecrosis visceral pain (pancreatitis) ```
26
Give examples of Radiation therapy related pain syndromes:
``` radionecrosis brachial plexopathy lumbosacral plexopathy myelopathy fibrosis chronic mucositis chronic esophagitis chronic pharynigitis chronic proctitis ```
27
Name some common pain management problems particular to cancer pain:
1. chemotherapies can cause painful syndromes 2. renal dysfunction from chemo may preclude use of NSAIDs 3. common drug-drug interactions 4. anti-coagulation issues for interventional pain management 5. significantly more psychological disorders 6. significant comorbid sleep disturbance 7. prognosis changes management dramatically
28
What are the indications for surgical management in the treatment of cancer pain?
``` Headache - obstructive hydrocephalus Bone pain - pathological fracture Dysphagia - esophageal obstruction Abdominal distention - ascites (drain) muscle pain - necrotic tumor (resection) ```
29
What are the indications for radiation treatment in the treatment of cancer pain?
Headache - primary cerebral tumor, brain mets Bone pain - pathological fracture, metastases Pelvic pain - local tumor infiltration Abdominal distention - ascites (drain) muscle pain - necrotic tumor (resection) chest pain - primary lung
30
What are the indications for chemotherapy in the treatment of cancer pain?
bone mets, brain mets, ascites, subacute obstruction, pancreatic pain, local tumor infiltration to chest or pelvis
31
For each indication, what is the most appropriate interventional pain procedure? 1. Pancreatic Ca pain 2. Pelvic Ca Pain 3. Perineum pain due to pelvic tumors 4. unilateral, neuropathic pain below C5 level 5. vetrebral compression fracture
1. celiac plexus block 2. superior hypogastric plexus block 3. Ganglion of Impar block 4. cordotomy 5. Vertebroplasty
32
Alcohol differs from phenol in many ways. List the differences in these categories: 1. Physical characteristic: 2. Concentration: 3. Baricity 4. Pain on injection 5. MOA 6. Duration
1. alcohol - water soluble, phenol - not 2. 50- 100%; 6-10% in gylcerol 3. hypobaric; hyperbaric 4. immediate burning; painless 5. extracts phospholipid, cholesterol and cerebroside and precipitates mucoprotein and lioprotein; induces protein precipitation, loss of cellular fatty elements (myelin), affinity for vascular tissue 6. longer; shorter and less profound
33
What are the indications to an intrathecal pump?
1. responsive to systemic opioids but intolerable side effects 2. resistant to high dose opioids
34
What are the contraindications to an intrathecal pump?
elevated ICP infections near or at spine or generalized infections suspected tumor mass at site hemorrhagic diathesis allergic reaction to epidural or intrathecal agents expected problem in nursing care or device refills
35
When should intrathecal pump be internal or external and what are some complications of an intrathecal pump?
external if goal is focal analgesia and short life expectancy internal if life expectancy >3months Complications: Meds related - nausea, urinary retention, pruritis Procedure related - dural puncture headache, infection, nerve damage, pain Device related - pump malfunction, infection
36
Name six neuropathic syndromes that are related to tumour burden?
``` plexopathy malignant painful radiculopathy painful cranial neuralgias (glossopharyngeal and trigeminal neuralgias) leptomeningeal metastases painful peripheral neuropathies paraneoplastic sensory neuropathy ```
37
Name seven visceral nociceptive syndromes present in cancer states.
``` chronic intestinal obstruction peritoneal carcinomatosis malignant perineal pain adrenal pain syndrome ureteric obstruction hepatic distension syndrome midline retroperitoneal syndrome ```
38
Tumor related bone pain syndromes
multifocal bone pain (metastatic invasion or focal invasion) vertebral syndrome (A-A destruction and odontoid #, spinal cord compression pain) pain syndromes related to the pelvis (pelvic and hip #) base of skull metastases (olfactory groove syndrome, orbital syndrome, sella turcica syndrome, sphenoid sinus syndrome, cavernous sinus syndrome, Gasserion Ganglion syndrome, clivus syndrome, occipital condyle syndrome, cerebellopontine angle syndrome, jugular foramen syndrome)
39
What are six paraneoplastic pain syndromes?
- muscle cramps - oncogenic osteomalacia - hypertrophic pulmonary osteoarthropathy - tumor-related gynecomastia - paraneoplastic pemphigus - paraneoplastic Raynaud's phenomenon
40
Name 4 chemotherapy-related causes of pain
1. CIPN 2. Raynauds 3. avascular necrosis of the hip 4. vertebral compression #
41
Name 6 radiation-related causes of pain
1. radiation induced brachial plexopathy 2. chronic radiation myelopathy 3. chronic radiation proctitis and enteritis 4. lymphoedema pain 5. burning perineum pain 6. osteoradionecrosis
42
What are the three most common sites of metastases?
lung liver bone
43
pathological fractures are most common in _____ and ___ and cause fractures in what three sites?
myeloma, breast Ca | long bones, ribs and vertebral bodies
44
What are the main chemotherapy agents that result in CIPN?
1. platinum analogues (cisplatin, carboplatin) 2. taxanes (paclitaxel, docitaxel) 3. vinca alkaloids (vincristine)
45
What are the common symptoms in CIPN?
``` stocking gloves sensory changes and pain motor weakness cranial nerve deficits autonomic deficits decreased or absent DTR (ankle primarily; first signs) ```
46
Medications used in CIPN?
Duloxetine (most evidence/studied)
47
Tests used for CIPN?
EMG/NCS | QST
48
Agents that have been used for prevention of CIPN?
``` alpha-lipoeic acid leukemia inhibitor factor lithium floinic acid amifostine IGF-1 nimodipine glutamate glutathione pyridoxine calcium-magnesium solution ```
49
EAPC guidelines for opioid use in cancer are:
1. use morphine as first choice for treatment of cancer pain 2. use oral route using both IR and LA formulations 3. for titration is starting with morphine IR q4h and BT q1h and then regular dose adjusted from there
50
Major neurological side effects of opioid treatment
1. sedation 2. myoclonus 3. hyperalgesia 4. hyperexcitability 5. delirium 6. muscle rigidity 7. headaches 8. hallucinations
51
Guidelines for medication choice in intrathecal pumps?
1st line - morphine 2nd line - alternative opioid (HM) or morphine + clonidine/bupivicaine 3rd line - fentanyl, sufentanil, fentanyl + BUP/clonidine 4th line - category one- meperidine, methadone, ROP or neostigmine; category two - baclofen; category three - tetracaine, midazolam, NMDAR antagonists
52
Major cardiopulmonary side effects of opioid treatment
``` resp depression non-cardiogenic pulmonary edema bradycardia hypotension cardiac dysrthymias ```
53
Major GI side effects of opioid treatment
``` nausea/vomiting constipation xerostomia GERD common bile duct obstruction ```
54
Major urological side effects of opioid treatment
AKI urinary retention peripheral edema
55
Major endocrine side effects of opioid treatment
hypogonadism/sexual dysfunction | osteoporosis
56
Major dermatological side effects of opioid treatment
pruritis | diaphoresis
57
Major immunological side effects of opioid treatment
immune suppression
58
How are SC tumours classified?
Extradural • Usually Metastatic – from lungs, breast, kidney, prostate • Often arise in VB • Can cause SC compression either via epidural growth o  extrinsic SC compression o  Cauda equina compression o  intradural invasion (less frequent) ``` Intradural • Extra-medullary (Tumor arise from w/in dura, but outside actual SC) o Usually benign o Meningiomas, Schwannomas (nerve sheath tumours) • Intra-medullary o Arise from SC itself o Primary intra-medullary tumours  Ependymomas  Astrocytomas o Mets  Increasing frequency ```

Pain Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions