Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-18T08:34:33.678Z Has data issue: false hasContentIssue false
  • English
  • Français

A palliative care intervention for pain refractory to a percutaneous cordotomy

Published online by Cambridge University Press:  09 April 2014

Maxine de la Cruz ,
Akhila Reddy  and
Eduardo Bruera
Maxine de la Cruz*
Affiliation:
The University of Texas MD Anderson Cancer Center, Houston, Texas
Akhila Reddy
Affiliation:
The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint requests to: Maxine de la Cruz, The University of Texas MD Anderson Cancer Center, Department of Palliative Care and Rehabilitation Medicine, 1515 Holcombe Boulevard, Unit 1414, Houston, Texas 77030. E-mail: mdelacruz@mdanderson.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Intrathecal analgesia and radiofrequency techniques for tumor ablation are employed for palliation of symptoms. These interventions are efficacious in a select number of patients for controlling pain and improving quality of life. Careful selection of an appropriate candidate must be performed to prevent needless, invasive, and costly interventions, as interventional pain management alone will not treat total pain in cancer patients. We describe here a patient who experienced intractable pain and unsuccessfully underwent cordotomy but responded to the interdisciplinary (IDT) palliative care approach in an acute palliative care unit (APCU).

Case:

A middle-aged female with ovarian cancer metastatic to the left psoas muscle and the supraclavicular and retroperitoneal lymph nodes was admitted with severe left thigh and flank pain. She had been unsuccessfully treated with different opioid regimens, hypogastric nerve block, epidural steroid injection, and cordotomy. The palliative care team was consulted while awaiting placement of an intrathecal pump. The patient was subsequently transferred to the APCU for symptom management and transition to hospice. On admission, her morphine equivalent daily dose (MEDD) was 660 mg. Our IDT—composed of a physician, fellow, nurse practitioner, counselor, chaplain, social worker, and physical and occupational therapists—was able to identify several sources of distress that likely contributed to her expression of pain. Our IDT focused on frequent counseling, improving her function, provided medication education, discussed goals of care, and educated about hospice. She was discharged to hospice care with good pain control and an 85% reduction in her MEDD.

Conclusion:

An APCU approach involving an IDT alleviated the need for invasive interventions by diagnosing and treating the psychosocial, emotional, and spiritual distress contributing to the patient's total pain expression. Successful management must be reflective of rigorous assessment of the physical, psychological, spiritual, social, and practical aspects before consideration of more invasive treatments.

Keywords

PalliativeCordotomyPainRefractoryPercutaneous
Type
Case Report
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 395 - 398
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bruera, E., Kuehn, N., Miller, M.J., et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6–9.Google Scholar
Delgado-Guay, M., Parsons, H.A., Li, Z., et al. (2009). Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive Care in Cancer, 17(5), 573–579.Google Scholar
Ewing, J.A. (1984). Detecting alcoholism: The CAGE questionnaire. The Journal of the American Medical Association, 252(14), 1905–1907.Google Scholar
Fitzgibbon, D.R. (2009). Percutaneous CT-guided C1–2 cordotomy for intractable cancer pain. Current Pain and Headache Reports, 13(4), 253–255.CrossRefGoogle ScholarPubMed
Kanpolat, Y. (2004). The surgical treatment of chronic pain: Destructive therapies in the spinal cord. Neurosurgery Clinics of North America, 15(3), 307–317.Google Scholar
Kanpolat, Y., Savas, A., Ucar, T., et al. (2002). CT-guided percutaneous selective cordotomy for treatment of intractable pain in patients with malignant pleural mesothelioma. Acta Neurochirurgica (Wien), 144(6), 595–599; discussion 599.Google Scholar
Klepstad, P., Hilton, P., Moen, J., et al. (2002). Self-reports are not related to objective assessments of cognitive function and sedation in patients with cancer pain admitted to a palliative care unit. Palliative Medicine, 16(6), 513–519.Google Scholar
Mori, M., Elsayem, A., Reddy, S.K., et al. (2012). Unrelieved pain and suffering in patients with advanced cancer. American Journal of Hospice & Palliative Care, 29(3), 236–240.Google Scholar
Nersesyan, H. & Slavin, K.V. (2007). Current approach to cancer pain management: Availability and implications of different treatment options. Therapeutics and Clinical Risk Management, 3(3), 381–400.Google Scholar
Parsons, H.A., Delgado-Guay, M.O., El Osta, B., et al. (2008). Alcoholism screening in patients with advanced cancer: Impact on symptom burden and opioid use. Journal of Palliative Medicine, 11(7), 964–968.Google Scholar
Raslan, A.M., Cetas, J.S., McCartney, S., et al. (2011). Destructive procedures for control of cancer pain: The case for cordotomy. Journal of Neurosurgery, 114(1), 155–170.Google Scholar
Reddy, A., Hui, D. & Bruera, E. (2012). A successful palliative care intervention for cancer pain refractory to intrathecal analgesia. Journal of Pain and Symptom Management, 44(1), 124–130.Google Scholar
Saunders, C. (1987). The philosophy of terminal care. Annals of the Academy of Medicine (Singapore), 16(1), 151–154.Google Scholar
Strang, P., Strang, S., Hultborn, R., et al. (2004). Existential pain: An entity, a provocation, or a challenge? Journal of Pain and Symptom Management, 27(3), 241–250.Google Scholar
Yennurajalingam, S., Dev, R., Walker, P.W., et al. (2010). Challenges associated with spinal opioid therapy for pain in patients with advanced cancer: A report of three cases. Journal of Pain and Symptom Management, 39(5), 930–935.Google Scholar
Zuurmond, W.W., Perez, R.S. & Loer, S.A. (2010). Role of cervical cordotomy and other neurolytic procedures in thoracic cancer pain. Current Opinions in Supportive Palliative Care, 4(1), 6–10.CrossRefGoogle ScholarPubMed