Learning Objectives

  1. Perform a comprehensive assessment of pain in a cancer patient with a new pain complaint
  2. Choose and adjust appropriate medications, based on knowledge of pain pathways and analgesic mechanisms of action to optimize pain relief in a cancer patient
  3. Appreciate the contributions of all members of an interdisciplinary team to optimally manage the physical, psychological, social and spiritual aspects of pain in a cancer patient

Target  Audiences

  • Medical Students: Years 1-3
  • Nursing Students: Advanced undergraduates; 1st and 2nd year master’s degree candidates
  • Dental Students: Years 3-4
  • Physical Therapy Students (DPT): Year 2
  • Pharmacy Students: Year 3

Case Description

This case focuses on an adult with cancer and new pain. A complaint of new or worsening pain in a patient with cancer often signals advancing disease which along with the physical symptoms brings psychological, social and spiritual suffering. Pain from bony metastasis has complex pathophysiology with both nociceptive and neuropathic mechanisms. Teaching points will emphasize comprehensive pain assessment, treatment choices based on knowledge of pain pathways and analgesic mechanisms of action, and collaboration with an interdisciplinary team to optimize pain management in a cancer patient with progressive disease. Teaching also will cover the need to consider non-cancer causes of pain in the patient with cancer.

Potential Impact of Pain in a Patient with Metastatic Cancer Case Education

  1. Improve knowledge: Improve treatment prescribing appropriateness through understanding the pathophysiology of different types of pain in a cancer patient
  2. Change attitudes: Foster patient confidence that cancer-associated pain can be treated effectively; enhance appreciation by physicians and patients the unique contributions to improving quality of life of members of the interdisciplinary team
  3. Gain skills: Improve pain management and quality of life of patients with  metastatic cancer

Acknowledgements

University of Pittsburgh

Monica Malec, MD: Case Leader
Joseph Shega, MD: Case Content Expert
Julie Childers, MD1: Case Content Expert
Zsuzsa Horvath, PhD2,3: CoEPE Director
Debra K. Weiner, MD§,4,5,6,7: CoEPE Co-Director; Case Content Expert
Heiko Spallek, DMD, PhD, MSBA*: CoEPE Co-Director

Faculty appointments

1School of Medicine, Palliative Care Program; 2School of Dental Medicine, Office of Faculty Affairs; 3School of Dental Medicine, Department of Dental Public Health; 4School of Medicine, Department of Anesthesiology; 5School of Medicine, Division of Geriatric Medicine; 6School of Medicine, Department of Psychiatry; 7Clinical and Translational Science Institute

Non-University of Pittsburgh Related Appointments

University of Chicago School of Medicine, Section of Geriatrics and Palliative Medicine; Vitas Innovative Hospice Care, Southeast Region; §VA Pittsburgh Healthcare System, Geriatric Research Education and Clinical Center; *Faculty of Dentistry, The University of Sydney

Funding

  • National Institute on Drug Abuse for funding the Center of Excellence in Pain Education

Administration and planning

  • Center of Excellence in Pain Education Faculty Team
  • Denise Deverts, Translational Research Facilitator, University of Pittsburgh School of Dental Medicine, for her administrative support

Support

  • Thomas W. Braun, Dean, University of Pittsburgh School of Dental Medicine, for his support of the project 
  • Mark S. Redfern, Vice Provost for Research, University of Pittsburgh, for his support of the project
  • Deans of the Health Sciences School, University of Pittsburgh, for their support of the project
  • Support Staff, VA Pittsburgh Healthcare System, for administrative support and for providing recording locations for the project
  • Support Staff, University of Pittsburgh School of Dental Medicine, for administrative and technical support
  • University of Pittsburgh School of Health and Rehabilitation Sciences, Department of Physical Therapy, for providing recording locations for the project
  • University of Pittsburgh School of Medicine, Standardized Patient Program

Internal Review

  • Ajay Wasan, MD, Department Chair, Pain Medicine, University of Pittsburgh School of Medicine
  • Michael Elnicki, MD,  Professor, Department of Medicine, University of Pittsburgh School of Medicine
  • Carol Washburn, Teaching Commons Manager, University Center for Teaching and Learning

Production

  • Michael Dziabiak, Media Specialist, University of Pittsburgh School of Dental Medicine, for direction, camera, and sound and video editing
  • Adam Popchak, DPT, PhD, SCS, Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences for providing the supplemental materials 
  • Jordan Hammill, Instructional Technologist, University of Pittsburgh School of Dental Medicine, lighting, camera and sound recording
  • Alexander Kropinak, Instructional Technologist, University of Pittsburgh School of Dental Medicine, for lighting, camera and sound recording
  • Maro Avakian in the role of “Mary”
  • Sarah Carleton in the role of “Mary’s daughter”

Transcription

  • Mackenzie Rodgers, Student, University of Pittsburgh, for assistance with transcription

Disclaimer

This curriculum resource was supported with funding from the NIH Pain Consortium, which approves the educational value of the information provided. The authors listed on this resource are responsible for its content, and questions may be directed to their Center of Excellence in Pain Education. The NIH Pain Consortium provides these evidence-based curriculum resources on pain management as a service to academic medical, dental, nursing, pharmacy and other health professional schools.

This resource is for educational purposes and is not intended as medical practice guidelines. Evidence-based practices may have changed since the publication of the resource.

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