Pain management in cancer cervix

被引:5
作者
Palat, Gayatri [1 ]
Biji, M. S. [1 ]
Rajagopal, M. R. [1 ]
机构
[1] Amrita Inst Med Sci, Dept Pain & Palliat Med, Kochi 682026, Kerala, India
关键词
cancer cervix uteri; pain; palliative care; India; developing countries;
D O I
10.4103/0973-1075.19182
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Cancer of the cervix uteri is a common cause of pain among women. On the physical realm, the cancer may cause somatic [soft tissue and bone], visceral and neuropathic pain [lumbosacral plexopathy]. Radiotherapy and chemotherapy may cause neuropathy too. Psychological, social and cultural factors modify the pain. Evaluation of the individual type of pain and a patient-centred approach are fundamental requirements for rational management. Disease modifying treatment like radiotherapy and chemotherapy must be considered when applicable. Pain control is usually achieved by the use of WHO three-step ladder, remembering that possible association of renal dysfunction would necessitate caution in the use of NSAIDs and opioids. Side effects must be anticipated, prevented when possible, and aggressively treated; nausea and vomiting may already be present, and constipation can worsen pain when there is a pelvic mass. Pain emergencies can be treated by quick titration with intravenous morphine bolus doses. Neuropathic pain may warrant the use of usual adjuvants, with particular reference to cortico-steroids and the NMDA antagonist, ketamine. In intractable pain, many neurolytic procedures are tried, but a solid evidence base to justify their use is lacking. Continuous epidural analgesia with local anaesthetic and opioid may be needed when drug therapy fails, and desperate situations may warrant interventions such as neurolysis. Such physical measures for pain relief must be combined with psychosocial support and adequate explanations to the patient and the family.
引用
收藏
页码:64 / 73
页数:10
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