Workshop Manual - Faculty of pain medicine - Australian and New ...

EXAMPLE 6:
55-year-old woman with metastatic breast cancer. Large
tumour of left breast with spread to spine causing severe
pain.
1. RECOGNIZE
• Patient may have pain in both her breast and back.
• New severe back pain may not be recognized.
• Ask the patient about her pain symptoms!
2. ASSESS
• Assessment may be difficult because of two types of pain
• Both breast pain and back pain may be severe.
• Chronic cancer pain getting worse over time, acute
musculoskeletal pain caused by spinal metastases
(e.g. collapse of vertebra with nerve compression)
• The pain may have both nociceptive and neuropathic
features. Neuropathic symptoms may be present especially
if nerve compression – burning, pins and needles
• Multiple factors may be contributing to the pain
— Physical
— Psychological and social
3. TREAT
• Non-drug treatments
— Treatment of breast tumour
• Nursing care, possibly surgery, treatment of
infection
— Psychological or social support
— Other treatments
PAIN MANAGEMENT EXAMPLES
• Drug treatments
— Regular simple analgesics + opioid.
— If possible, control acute severe pain with IV morphine
— Convert to regular oral morphine when pain controlled
— Consider amitriptyline if features of neuropathic pain
(especially if poor sleep)
40 ESSENTIAL PAIN MANAGEMENT