Metastatic Bone Cancer: The Effect and Management of Persistent Discomfort within Malignancy

In almost every case of a terminal disease, pain is intolerable and seeing someone in such agony is heartbreaking. For example, Brittany Maynard, a 29 year old brain cancer patient who had to move to Oregon so she can avail of the Death with Dignity act. “Maynard knew that her form of brain cancer would be excruciating. She would endure swelling of the brain that would very likely cause seizures, painful headaches and the gradual loss of bodily function. Doctors know that for about 5 percent of the population, no amount of morphine can block the agonizing pain the terminally ill endure” (EDITORIAL: Dying with dignity). Palliative care can often be provided for the dying patients and alleviating pain to provide comfort for the dying has always been the priority. “Palliative care focuses on relieving the symptoms, particularly the pain, of incurable illness.” (Palliative Care) But, in relieving pain through the prescribed medications there are also side effects that are caused by the prescribed pain suppressors and two examples will be lethargy and it compromises breathing. In most cases the effectivity of the pain medication may no longer alleviate the pain. If a patient will be in such agony for the remaining days or weeks the quality of life is no longer present. The agony of pain prevents a patient from performing even just the bodily functions.

Pain is one of the most common and feared complications of cancer. It is exacerbated by stress, anxiety, fatigue, and malaise which accompany advanced cancer. Pain is generally absent in the early stages of cancer, but it is a significant factor as the illness progresses to advanced stages. Cancer-associated pain can arise from a variety of direct and indirect mechanisms including direct pressure, obstruction, and invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation (McCance 2010). Pain is generally accepted as whatever the patient says it is, wherever the patient says it is. Treatment of pain and its associated symptoms is a primary responsibility of the healthcare team. Treatment modalities for pain include the use of opioid analgesics, patient-controlled analgesia, psychological interventions, and preventing recurrence of pain. Reinforcing the reporting of pain by the patient is important, as is a respect for the social and cultural differences with respect to pain perception.

The author indicates that specialists in controlling certain types of pain, such as the pain of terminally ill cancer patients, believe that there are very few patients whose pain could not be adequately controlled. Although there are some ways to help a patient's pain, these methods unfortunately do not help. Many patients become sedated and cannot interact with other people or their environment (Hawkins 22). Clearly, all of these reasons are examples of self- deliverance and a liberty to choose. No patient should have to undergo a prolonged painful death.

Patients with chronic or life-threatening illnesses may turn to palliative care for its symptom relieving benefits as well as its ability to improve their quality of life. A key factor in quality palliative care is effective communication between medical professionals and the patient as well as the patient’s caretakers. Pain management, continuity of care among caretakers and medical providers, and concentration on the patient’s personal preference are all major aspects of palliative care. Good palliative care should begin with a discussion on advanced care directives, preferably initiated by a physician. (Fine, et al. 595,

This essay will aim to look at the main principles of cancer pain management on an acute medical ward in a hospital setting. My rational for choosing to look at this is to expend my knowledge of the chosen area. Within this pieces of work I will look to include physiological, psychological and sociological aspects of pain management.

According to Lossignol (2012, p.10) cancer treatment can also result in pain, thus, two major ways to alleviate the pain include considering the aetiology

Pain is a universal human experience and it is subjective. It is a major concern for those with cancer. One of the priorities of hospice is to provide comfort and a pain free death. It is however a concern that many people are still dying with uncontrolled pain. We are interested in hospice and pain management because hospice is known to be a place of comfort where individuals are provided with relief and allowed to die peacefully without pain. The majority of patients in the hospice settings are older adults with advanced cancer. Our goal is to create an intervention that will appropriately deal with the poor pain management experienced by many in hospice care. In order to help us with this task, four articles have been reviewed with regards to hospice and pain management.

Although symptoms usually progress slowly and increasingly becomes more severe, they could also occur spontaneously (National Comprehensive Cancer Network, 2017). However, of significant importance is the dose-limiting potential of CIPN. As the neurotoxic effects of chemotherapy accumulate the neuropathy intensifies and spreads from the fingers and toes to the arms and legs. This escalation of symptoms could lead to treatment delays, dose reductions, or if severe enough the patient’s ability to complete treatment (Stubblefield et al., 2009). This, in turn, could increase the morbidity and mortality of the oncology patient who is depending on a predetermined course of treatment for a successful outcome.

Surgery is the oldest type of treatment for cancer. In its earlier use, surgery was not as successful as it is today. This was due to the difficulties involved with the anesthesias, excessive blood loss,

As our technologies and advances in medicine improve, patients are living considerably longer with chronic and life-limiting illnesses. Living longer with an illness usually means that the patient suffers longer with the side effects from the disease and its treatment. Palliative care (PC) can be a very important and beneficial service for patients, their family as well as their healthcare provider in meeting the physical, psychosocial, and spiritual needs of the patient. Unfortunately, not all patients who suffer with a life-limiting illness experience the benefits of a palliative care service or if they do it is very near the end of life.

According to Cynthia R., of the Journal of Palliative Medicine, “Medical technology has been progressing in leaps and bounds since the second half of the 20th century” (1). This advancement is the result of ongoing studies of medical researchers, bringing about new curative treatments for a variety of diseases. Many of these are extending the lives and increasing comfort of those that are terminally ill. However, amongst the improvements in medical treatments available, they have become the default method of practice even for patients that will not ultimately overcome their condition. When given a diagnosis, patients are often thrust into a variety of treatments by health care providers. However, when that illness is no longer treatable to the extent that the patient will be cured, patients are often kept in the same realm of curative treatments despite their preferences. Hospice and palliative care is a specialized form of medical care that provides terminally ill patients (and their families) with pain management, family planning, and a focus on spiritual and emotional well being in the last days of a patients life, outside of a hospital environment. Hospice and palliative care does not mean that one is necessarily needing to be at an imminent stage before death. Rather, it is the ability of patients with terminal illnesses to receive pain management and care in order to live out the rest of their lives comfortably. Palliative care is said to have, “encouraged medicine to

Palliative care can overlap with life-sustaining approaches to a terminal illness and often palliative care is offered in conjunction with other medical treatments (Billings & Pantilat, 2001; Morrison & Meier, 2004). Palliative care is not curative, the intent is to provide relief from symptoms (both physical and emotional)(Kuziemsky, Jahnke, & Lau, 2006). Many treatments overlap between the palliative and curative models and these disciplines are synergistically linked (Table 1).

The end of life may be months, weeks, days, or hours depending on the situation at hand. This should be a time when many procedures and treatments should be knowledgeable by the caregiver in charge of a dying patient. “Traditionally, a hospital’s goals have been to cure illness and prolong life; in contrast, hospice care emphasizes palliative care, which involves reducing pain and suffering and helping individuals die with dignity” (Albrecht & others, 2013; Holloway & others, 2014; Kelly & others, 2014) (p. 410) Palliative care focuses on relieving pain and meeting practical needs. However, this new type of care enables quality of life. Care providers will work to identify and carry out goals: symptom relief, counseling, comfort, and everything that enhances your quality of life.

The most vital functions of the nervous system is to provide information about the occurrence or threat of injury. One of the ways this is done is in form of pain. However, sometimes, established pain can go beyond its protective role, thus becoming a disease in itself than just being a symptom. This condition is called chronic pain. The injury or the precipitating event can be physical (like in case of phantom limb pain or post-surgical pain), infection (as with post-herpetic neuralgia), systemic disease (like with diabetic neuropathy), drug (chemotherapy induced peripheral neuropathy) or can sometimes be unknown (trigeminal neuralgia, migraine, cluster headache, etc.) Even today, the pathological processes involved in genesis, establishment and continuation of such diseases are poorly understood. Eventually, such painful conditions usually remain refractory to available treatments.

I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of