Download Pain Cases

Pain Cases
GPVTS Nov 08
Case 1 : Hospice patient •
•
•
•
•
•
RM
67/f
2004: Ovarian cancer
oophrectomy +salpingectomy
chemotherapy
2008: Pathological fracture to L5 treated
with Radiotherapy
Case 1 cont.
• Admitted to hospice 1 week later for
symptom control.
• main symptoms:
Pain – lower back, dull ache and intermittent
sharp pain.
Drowsiness – past 24hrs
• medications: MST 60mg bd, pregabalin
150mg bd, paracetamol 1g qid
Case 1
• O/E T=37.4, pulse= 88,
• CVS/RESP/NEURO: NAD
• Q1: what are the possible causes of RM’s
drowsiness
• Q2: what are the possible options to
manage pain?.
CASE 2: House call
•
•
•
•
•
DM
77/M
2008: Gastric Cancer
Not for chemotherapy/Radiotherapy
Poor prognosis
Case 2: cont
•
•
•
•
•
Main symptoms :
pain : Epigastric – severe dull ache
Vomiting : increasing over past few days.
Dysphagia : new onset
Medications: omeprazole 40mg od, MST
120mg bd and PRN oramorph.
metoclopramide 10mg tds
Case 2 cont
• O/E – unwell, grey, restlessness,
• abdo: pain on light palpation in
epigastrium.
• Q1: what analgesics / medications should
be started?
• Q2:what other considerations are there in
managing this patient?
Case 3: telephone call:
•
•
•
•
•
•
PF
80/f
2007: Rectal Cancer
Anterior resection + tumour debulking
chemotherapy + radiotherapy.
2008: Referred to palliative care.
Case 3 cont
• Meds: alfentanil 120mg and 12.5mg
levomepromazine by csci
• Q1. What prn medication should PF be on
and at what dose?
Case 4: Busy surgery
• TM
• 66/f
• Long history of osteoarthritis known:
previous gastric ulcer and renal
impairment
• awaiting knee replacement
• had previous joint injections for pain
Case 4 : cont
• main symptom: severe left knee pain.
• medications: co-codamol 30/500 qid, tramadol
100mg qid
• Q1 what medication could be started?
• Q2. what side effects should you warn the
patient about?