Procedimentos intervencionistas para o manejo da dor no câncer

Abstract

Objective: To describe types of interventional medical procedures, its rationale use and benefits for a population with cancer assisted at a private hospital in São Paulo. Methods: Quantitative and descriptive cross-sectional study using data from patients submitted to interventional procedures between 2007 and 2008. We used descriptive and inferential statistics (frequency, mean, and t-test) to analyze data. Results: A total of 137 patients were submitted to interventional procedures for pain and, out of this total, 14 mentioned cancer-related pain. The mean pain intensity was 7.1 before the procedure and 1.3 after it. Reduction in pain intensity was statistically significant in this population (t=9.09; p=0.001). In almost 70% of patients (n=10) a reduction of 50% of the consumption of opioid a month after the procedure was realized. Conclusion: These results are in accordance with the literature and support the efficacy of interventional procedures for several types of cancer pain.Keywords: Pain/drug therapy; Analgesics/therapeutic use; Neoplasms RESUMO Objetivo: Descrever tipos de procedimentos (seu uso racional e alguns de seus benefícios) realizados em pacientes com câncer tratados em um hospital privado de São Paulo. Métodos: Estudo quantitativo de corte transversal, que usou informações oriundas dos prontuários de pacientes submetidos a procedimentos intervencionistas para dor durante os anos de 2007 e 2008. Os dados foram analisados por meio de estatística descritiva e inferencial (frequência e média, e teste t). Resultados: Durante esse período, 137 pacientes foram submetidos a procedimentos intervencionistas para a dor e, desse total, 14 possuíam dores de natureza oncológica. A intensidade média da dor nos pacientes tratados foi de 7,1 antes do procedimento e, após, 1,3. A redução da dor foi estatisticamente significativa nessa população (t=9,09; p=0,001). Em cerca de 70% dos pacientes (n=10), houve redução de 50% no uso de opioide 1 mês após a realização do procedimento. Conclusão: Estes resultados estão de acordo com a literatura e confirmam a eficácia dos procedimentos intervencionistas para diversos tipos de dor oncológica.

Difficult situation in cancer pain: breakthrough pain

“…This may reflect a broader use of morphine to treat cancer pain in our country, as well as low availability of other potent opioids for Single Health System patients. From 20 patients reporting breakthrough pain, most (60%) had in average two to four episodes per day during the first interview; this number was higher for subsequent interviews (80%), similar to the average of one to four episodes per day found in other studies 1,13,20,21 . The increase observed during second and third interviews was expected, since characteristics of breakthrough pain were explained to patients, thus allowing for better understanding and easy identification, resulting in further requests for assistance (70%).…”

“…Pain may be present at any moment during disease and may be triggered by different mechanisms, such as direct tumor participation, anti-cancer therapies and other non-cancer related causes 1 . In addition, many cancer patients look for health professionals due to pain, which may be the first sign of malignancy [2][3][4] .…”

Applicability of the Nursing Outcomes Classification (NOC) to the evaluation of cancer patients with acute or chronic pain in palliative care

“…Cancer-related pain is present in 70 to 90% of those patients, and it is among the most common causes of disability in cancer patients (Minson et al, 2012). The cancerrelated pain evaluation is a challenging task for nurses.…”

Chronic cancer pain management by the nursing team

“…Among these drugs, anti-inflammatory, opioids, antidepressants, and anticonvulsants, among others, were the most commonly mentioned 15 . Pharmacological treatment, according to the three steps ladder proposed by the World Health Organization (WHO) is the basis to control cancer pain 7,16 . WHO states that morphine and its derivatives are underutilized worldwide and in Brazil.…”

“…In this sense, there is the category "Non-pharmacological methods for cancer pain management by the nursing team", where studies bring interventions such as therapeutic massage, spiritual support and comfort measures, such as changing position in bed. There is also an article mentioning interventionist procedures 16 . Massage seems to be useful to relieve pain and improve mental health, although there are still questions about the efficacy of this protocol.…”