Skip to main content

Acute Cancer Pain Syndromes in Palliative Care Emergencies

  • Reference work entry
  • First Online:
Textbook of Palliative Care

Abstract

Acute pain syndromes in palliative care are predominantly malignant in origin. These are often emergencies due to the severity of the pain, its meaning to the patient, the disruption of ongoing curative treatment, and the resultant erosion of quality of life. A prompt accurate pain assessment is a vital component of clinical management, followed by analgesic intervention and attention to the physical, psychological, social, and spiritual aspects of pain. Clinicians should develop excellent communication skills to support patients, their families, and also other healthcare professionals in the delivery of optimal care. Pain will not always be managed according to the expectations of others, and so how we deliver care and explain the limitations of treatment is important.

Acute cancer pain that is not managed well can become chronic in nature. The development of chronic pain can greatly reduce the functional ability and mood of patients over time. As with all symptoms, managing the acute presentation should lead to an investigation of causative factors, mechanism of pain, and potential therapeutic interventions. Acute pain syndromes can be approached via two causative mechanisms: treatment-related pain and pain directly related to the cancer process. A multimodal and multidisciplinary approach to treatment is often required to not only help the patient, but also to support the family during an uncertain and unsettling period of care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 819.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,099.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006;82(973):713–6.

    Article  CAS  Google Scholar 

  • Amini A, Yang J, Williamson R, McBurney ML, Erasmus J, Allen PK, Karhade M, Komaki R, Liao Z, Gomez D, Cox J. Dose constraints to prevent radiation-induced brachial plexopathy in patients treated for lung cancer. Int J Radiat Oncol Biol Phys. 2012;82(3):e391–8.

    Article  Google Scholar 

  • Ashby MA, Fleming BG, Brooksbank M, et al. Description of a mechanistic approach to pain management in advanced cancer: preliminary report. Pain. 1992;51:153–61.

    Article  CAS  Google Scholar 

  • Azevedo SLFK, Kimura M, Jacobsen-Teixeira M. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer. 2006;14(11):1086–93. Epub 2006 Jun 8

    Article  Google Scholar 

  • Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol. 2006;23(02):126–42.

    Article  Google Scholar 

  • Blinman P, Gainford C, Donoghoe M, Martyn J, Blomfield P, Grant P, Kichenadasse G, Vaughan M, Brand A, Shannon C, Gebski V. Feasibility, acceptability and preferences for intraperitoneal chemotherapy with paclitaxel and cisplatin after optimal debulking surgery for ovarian and related cancers: an ANZGOG study. J Gynecol Oncol. 2013;24(4):359–66.

    Article  CAS  Google Scholar 

  • Bruera E, Kim HN. Cancer pain. JAMA. 2003;290(18):2476–9.

    Article  CAS  Google Scholar 

  • Carr DB, Goudas LC. Acute pain. Lancet. 1999;353:2051–8.

    Article  CAS  Google Scholar 

  • Chandra RV, Leslie-Mazwi T, Hirsch JA. Vertebroplasty, Kyphoplasty, and Sacroplasty. Essentials of interventional techniques in managing chronic pain. Cham: Springer; 2018. p. 431–42.

    Book  Google Scholar 

  • Cipta AM, Pietras CJ, Weiss TE, Strouse TB. Cancer-related pain management in clinical oncology. J Community Support Oncol. 2015;13:347–55.

    Article  CAS  Google Scholar 

  • Cohen AD, Kemeny NE. An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist. 2003;8(6):553–66.

    Article  Google Scholar 

  • Della Corte F, Messina A, Mendola C, Cammarota G. Post thoracotomy pain syndrome: InTech; Open Access Publisher; [online] from http://cdn.intechopen.com/pdfs/26930/InTech-Post_thoracotomy_pain_syndrome.pdf. 2012.

    Google Scholar 

  • Fadul N, Elsayem A. Palliative Care in the Emergency Center. In: Manzullo EF, Gonzalez CE, Escalante CP, Yeung S-CJ, editors. Oncologic emergencies. New York: Springer; 2016. p. 273–85.

    Chapter  Google Scholar 

  • Fischer DJ, Villines D, Kim YO, et al. Anxiety, depression, and pain: differences by primary cancer. Support Care Cancer. 2010;18(7):801–10.

    Article  Google Scholar 

  • Forbes K. Pain in patients with cancer: the World Health Organization analgesic ladder and beyond. Clin Oncol. 2011;23:379–80.

    Article  CAS  Google Scholar 

  • Fujiwara S, Komasawa N, Hyoda A, Kuwamura A, Kido H, Minami T. Ultrasound-guided sciatic nerve block (pulsed radiofrequency) for intractable cancer pain caused by sacral bone metastasis. Masui. 2015;64:663–5.

    PubMed  Google Scholar 

  • Gutgsell T, Walsh D, Zhukovsky DS, et al. A prospective study of the pathophysiology and clinical characteristics of pain in a palliative medicine population. Am J Hosp Palliat Care. 2003;20(2):140–8.

    Article  Google Scholar 

  • Hart CYT, Ryu JH. Complications of percutaneous nephrostomy tube placement to treat nephrolithiasis. Hosp Physician. 2002;38(6):43–6.

    Google Scholar 

  • Hølen JC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, De Conno F, et al. Pain assessment tools: is the content appropriate for use in palliative care? J Pain Symptom Manag. 2006;32:567–80.

    Article  Google Scholar 

  • Jackson MA, Simpson KH. Pain after amputation. Continuing education in Anaesthesia. Critical Care & Pain. 2004;4(1):20–3.

    Google Scholar 

  • Jacob LA, Sreevatsa A, Chinnagiriyappa LK, Dasappa L, Suresh TM, Babu G. Methotrexate-induced chemical meningitis in patients with acute lymphoblastic leukemia/lymphoma. Annals of Indian Academy of Neurology. 2015;18(2):206.

    Article  Google Scholar 

  • Kent ML, Tighe PJ, Belfer I, Brennan TJ, Bruehl S, Brummett CM, et al. The ACTTION–APS–AAPM pain taxonomy (AAAPT) multidimensional approach to classifying acute pain conditions. Pain med. Oxford University Press. 2017;18:947–58.

    Google Scholar 

  • Kerr JZ, Berg S, Blaney SM. Intrathecal chemotherapy. Crit Rev Oncol Hematol. 2001;37(3):227–36.

    Article  CAS  Google Scholar 

  • Kroenke K, Theobald D, Wu J, et al. The association of depression and pain with health-related quality of life, disability, and healthcare use in cancer patients. J Pain Symptom Manag. 2010;40:327–41.

    Article  Google Scholar 

  • Levy N, Sturgess J, Mills P. “Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: why? Br J Anaesth. 2018;120(3):435–8. Available: https://www.sciencedirect.com/science/article/pii/S0007091217541823

    Article  CAS  Google Scholar 

  • Li BT, Wong MH, Pavlakis N. Treatment and prevention of bone metastases from breast Cancer: a comprehensive review of evidence for clinical practice. J Clin Med Res. 2014;3:1–24.

    Article  Google Scholar 

  • Lokich JJ, Moore C. Chemotherapy-associated palmar-plantar erythrodysesthesia syndrome. Ann Intern Med. 1984;101(6):798–800.

    Article  CAS  Google Scholar 

  • Loprinzi CL, Reeves BN, Dakhil SR, Sloan JA, Wolf SL, Burger KN, Kamal A, Le-Lindqwister NA, Soori GS, Jaslowski AJ, Novotny PJ. Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1. J Clin Oncol. 2011;29(11):1472–8.

    Article  CAS  Google Scholar 

  • Luckett T, Davidson PM, Green A, Boyle F, Stubbs J, Lovell M. Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care. J Pain Symptom Manag. 2013;46:229–53.

    Article  Google Scholar 

  • Maltoni M, Scarpi E, Modonesi C, Passardi A, Calpona S, Turriziani A, et al. A validation study of the WHO analgesic ladder: a two-step vs three-step strategy. Support Care Cancer. 2005;13:888–94.

    Article  Google Scholar 

  • Margolese RG, Hortobagyi GN, Buchholz TA. Management of Metastatic Breast Cancer. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer medicine. 6th ed. Hamilton: BC Decker; 2003.

    Google Scholar 

  • Matthews ML, Melika R, Murray Y. Nonopioid and adjuvant analgesics for acute pain management. Clinical approaches to hospital medicine. Cham: Springer; 2018. p. 225–41.

    Google Scholar 

  • McCarthy GM, Skillings JR. Jaw and other orofacial pain in patients receiving vincristine for the treatment of cancer. Oral surgery, oral medicine, oral pathology. 1992;74(3):299–304.

    Article  CAS  Google Scholar 

  • Mercadante S, Villari P, Ferrera P, Casuccio A, Fulfaro F. Rapid titration with intravenous morphine for severe cancer pain and immediate oral conversion. Cancer. 2002;95:203–8.

    Article  CAS  Google Scholar 

  • Metcalfe E, Etiz D. Early transient radiation-induced brachial plexopathy in locally advanced head and neck cancer. Contemp Oncol (Pozn). 2016;20(1):67–72.

    CAS  Google Scholar 

  • Neff SP, Stapelberg F, Warmington A. Excruciating perineal pain after intravenous dexamethasone. Anaesth Intensive Care. 2002;30(3):370–1.

    Article  CAS  Google Scholar 

  • Oefelein MG, Bayazit Y. Chronic pain syndrome after laparoscopic radical nephrectomy. J Urol. 2003;170:1939–40.

    Article  Google Scholar 

  • Pacenta HL, Kaddoum RN, Pereiras LA, Chidiac EJ, Burgoyne LL. Continuous tunnelled femoral nerve block for palliative care of a patient with metastatic osteosarcoma. Anaesth Intensive Care. 2010;38(3):563–5.

    Article  CAS  Google Scholar 

  • Pargeon KL, Hailey BJ. Barriers to effective cancer pain management: a review of the literature. J Pain Symptom Manag. 1999;18:358–68.

    Article  CAS  Google Scholar 

  • Pillitteri LC, Clark RE. Comparison of a patient-controlled analgesia system with continuous infusion for administration of diamorphine for mucositis. Bone Marrow Transplant. 1998;22(5):495–8.

    Article  CAS  Google Scholar 

  • Portenoy RK, Conn M. Cancer pain syndromes. In: Bruera ED, Portenoy RK, editors. Cancer pain: assessment and management. 2nd ed; 2009.

    Google Scholar 

  • Portenoy RK, Lesage P. Management of cancer pain. Lancet. 1999;353(9165):1695–700.

    Article  CAS  Google Scholar 

  • Porter LS, Keefe FJ. Psychosocial issues in cancer pain. Curr Pain Headache Rep. 2011;15:263–70.

    Article  Google Scholar 

  • Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, West A, Hettiarachchi G, Mukherjee D, Samuel J, Bentley A. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA. 2015;314(24):2641–53.

    Article  CAS  Google Scholar 

  • Rammohan A, Sathyanesan J, Ramaswami S, Lakshmanan A, Senthil-Kumar P, Srinivasan UP, et al. Embolization of liver tumors: past, present and future. World J Radiol. 2012;4:405–12.

    Article  Google Scholar 

  • Rubenstein EB, Peterson DE, Schubert M, Keefe D, McGuire D, Epstein J, Elting LS, Fox PC, Cooksley C, Sonis ST. Clinical practice guidelines for the prevention and treatment of cancer therapy–induced oral and gastrointestinal mucositis. Cancer. 2004;100(S9):2026–46.

    Article  Google Scholar 

  • Sohn TA, Lillemoe KD, Cameron JL, et al. Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg. 1999;188:658.

    Article  CAS  Google Scholar 

  • Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M, Bekele BN, Raber-Durlacher J, Donnelly JP, Rubenstein EB. Perspectives on cancer therapy-induced mucosal injury. Cancer. 2004;100(S9):1995–2025.

    Article  Google Scholar 

  • Tallman MS, Andersen JW, Schiffer CA, Appelbaum FR, Feusner JH, Ogden A, Shepherd L, Willman C, Bloomfield CD, Rowe JM, Wiernik PH. All-trans-retinoic acid in acute promyelocytic leukemia. N Engl J Med. 1997;337(15):1021–8.

    Article  CAS  Google Scholar 

  • Thompson IM. Flare associated with LHRH-agonist therapy. Reviews in urology. 2001;3(Suppl 3):S10.

    PubMed  PubMed Central  Google Scholar 

  • Vadalouca A, Moka E, Argyra E, Sikioti P, Siafaka I. Opioid rotation in patients with cancer: a review of the current literature. J Opioid Manag. 2008;4:213–50.

    Article  Google Scholar 

  • van den Beuken-van M, Hochstenbach L. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage: Elsevier; 2016. Available: http://www.sciencedirect.com/science/article/pii/S0885392416300483

  • Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56:514–7. e202–5

    PubMed  PubMed Central  Google Scholar 

  • Vial T, Descotes J. Clinical toxicity of cytokines used as haemopoietic growth factors. Drug Saf. 1995;13(6):371–406.

    Article  CAS  Google Scholar 

  • Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer. 2008;44(11):1507–15.

    Article  CAS  Google Scholar 

  • World Health Organization. Traitement de la douleur cancéreuse. Geneva: World Health Organization; 1987.

    Google Scholar 

  • Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215–25.

    Article  CAS  Google Scholar 

  • Zeimet AG, Reimer D, Radl AC, Reinthaller A, Schauer C, Petru E, Concin N, Braun S, Marth C. Pros and cons of intraperitoneal chemotherapy in the treatment of epithelial ovarian cancer. Anticancer Res. 2009;29(7):2803–8.

    CAS  PubMed  Google Scholar 

  • Zhu X-C, Zhang J-L, Ge C-T, Yu Y-Y, Wang P, Yuan T-F, et al. Advances in cancer pain from bone metastasis. Drug Des Devel Ther. 2015;9:4239–45.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sophia Lam .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Lam, S., William, L., Poon, P. (2019). Acute Cancer Pain Syndromes in Palliative Care Emergencies. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_79

Download citation

Publish with us

Policies and ethics