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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:

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Pain Cases

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  1. Pain Cases GPVTS Nov 08

  2. Case 1 : Hospice patient - • RM • 67/f • 2004: Ovarian cancer • oophrectomy +salpingectomy • chemotherapy • 2008: Pathological fracture to L5 treated with Radiotherapy

  3. 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

  4. 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?.

  5. CASE 2: House call • DM • 77/M • 2008: Gastric Cancer • Not for chemotherapy/Radiotherapy • Poor prognosis

  6. 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

  7. 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?

  8. Case 3: telephone call: • PF • 80/f • 2007: Rectal Cancer • Anterior resection + tumour debulking • chemotherapy + radiotherapy. • 2008: Referred to palliative care.

  9. Case 3 cont • Meds: alfentanil 120mg and 12.5mg levomepromazine by csci • Q1. What prn medication should PF be on and at what dose?

  10. 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

  11. 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?

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