Pain and its relief

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Reiief of pain, Pharmacologic management, Surgical management, Implanted electrodes. The physician who attends patients with malignant disease must draw a practical distinction between the management of pain as a symptom requiring analysis and treatment of underlying causes and pain as suffering requiring considerate treatment of the symptom per se. Unremitting pain associated with cancer is a late manifestation. A sympathetic physician whose analytical powers are burdened by feelings of hopelessness and helplessness in the face of a patient’s advancing malignancy may pursue symptomatic pain relief through prescription of narcotic agents without maintainance of adjuvant clinical reflection. The outcome can be most devestating to the patient. Symptomatic treatment of constant midline back pain in a patient known to have metastatic cancer without detailed investigation of the clinical syndrome may obscure the reality of malignancy-related early spinal cord compression. The development of new complaints such as difficulty in urination and obstipation which readily might raise the possibility of spinal cord compression under other diagnostic circumstances may be attributed to the side effects of the prescribed narcotic drugs. Insight into the underlying pathophysiological process may come too late to prevent paraplegia. Other similar examples will undoubtedly come to mind readily. The first precept in the management of pain associated with malignancy must be the maintainance of analytical clinical initiatives. INTRACTABLE PAIN: PHARMACOLOGIC MANAGEMENT Pain associated with carcinomatous invasion of brachial or lumbar plexus, intercostal nerves, parietal pleura, peritoneum and periosteum which persists despite specific treatment directed at altering the course of the malignant process requires symptomatic treatment which alters the patient’s perception of or reaction to pain. Pain at this stage of the disease is usually constant with exacerbations. Often. we physicians institute the use of analgesic drugs to treat the exacerbations but not the pervasive background of pain. Hence, analgesic medication is ordered to be taken p.r.n. Following this dosage plan, resultant analgesia is partial at best. The practical aim of symptomatic treatment is the provision of total pain relief with preservation of physical, intellectual and emotional strengths. Therefore, the prescription of analgesic drugs ought to be directed toward this end. Scheduled, rather than episodic use of analgesic agents will be effective in this regard. Saunders” has pointed out that “pain itself is the strongest antagonist to successful analgesia and if it is ever allowed to become severe the patient will then increase it with his own tension and fear”. The secret in the use of medication for the management of intractable pain lies as much in proper dosage scheduling as in drug selection.