دانلود رایگان مقاله انگلیسی روش های بیهوشی مداخله ای برای درد در بیماران هماتولوژی / آنکولوژی - الزویر 2018

INTRODUCTION

When cancer pain cannot be adequately treated with traditional medication administration routes, there are numerous interventional procedures that can aid in the management of intractable pain. It has been estimated that cancer pain is well managed for 75% to 90% of patients with cancer by following the World Health Organization (WHO) stepladder for medication escalation.1,2 However, for the remaining 10% to 25% of patients who have failed conventional treatment, poor pain control is associated with decreased quality of life for patients and their families.3,4 Additionally, some patients experience intolerable systemic side effects from traditional pain management approaches that necessitate consideration of alternative approaches and routes of administration to achieve relief.5,6 For these patients, interventional anesthetic procedures are critical in improving daily functioning and quality of life, and reducing medication side effects

SUMMARY

Within the interdisciplinary cancer care team, the interventional pain physician is often the last resort to manage patients with cancer pain syndromes that have failed to respond to oral medication. By involving a pain care physician early in the process patients may receive superior quality pain relief before side effects from progressively increasing doses of opioids cause general malaise, fatigue, constipation, and cognitive decline. This may permit tolerating chemotherapy for longer periods and eventually increase survival times. A continual reassessment of a patient’s pain location, quality, nature, and evolution is imperative to proactively address the changing nature of cancer pain that a patient is likely to experience. An attempt should be made to stay “a step ahead” of a patient’s pain and predict what pain problems may occur next. Adopting an aggressive pain management strategy can help patients with devastating disease states live the best possible quality of life during the course of the disease. Although the complete eradication of cancer pain is a lofty goal that may not be possible with every patient, certainly it is an aspiration all team members can support. Finally, caregiver stress in pain management professionals who are unused to end-oflife situations demands co-training in palliative care to avoid compassion fatigue and physician burnout.