Cancer pain management in the chemically dependent patient

Passik, Steven D.; Kirsh, Kenneth L.; Mullen, Vincent

doi:10.1017/cbo9780511550096.019

Cited by 1 publication

(3 citation statements)

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“…Details of the patient's social support and ability to function in society should be obtained, realizing that a diagnosis of malignancy often puts an additional strain on already tenuous social support systems for those with substance use (3). Other implications of current substance use may be an increased mistrust of the medical system, a decreased compliance with treatment, and the possibility of interactions between the street drugs and prescribed medications (2,3). Mr. I.M.…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that between six and 15 percent of the US population have substance-use disorders and, presumably, the situation would be similar in Canada (1,2). Certainly, there is more work that should be done to further elucidate the epidemiology of substance use specifically within the cancer patient population.…”

Section: Introductionmentioning

confidence: 99%

“…Certainly, there is more work that should be done to further elucidate the epidemiology of substance use specifically within the cancer patient population. Interestingly, just three percent of consults seen by the psychiatry service at the Memorial Sloan-Kettering Cancer Center in 1990 were related to issues of substance use (2). This indicates that there may be under-reporting in some settings for a variety of reasons.…”

Section: Introductionmentioning

confidence: 99%

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Cancer Pain Control in the Setting of Substance Use: Establishing Goals of Care

Burton-Macleod

Fainsinger

2008

J Palliat Care

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Mr. I.M. was a 62-year-old man with a presumptive diagnosis of non-small-cell lung cancer. He also had a long history of alcohol and street drug use, including cocaine and morphine. His other comorbidities included: COPD, liver disease secondary to alcohol use, hepatitis C, peptic ulcer disease, degenerative disc disease, and chronic pain after a remote traumatic episode. A left upper lobe lesion was first noted on chest x-ray in October 2002. Over the following year, he was investigated on two different admissions for weight loss and hemoptysis, but each time he refused biopsy of the lung mass. During the second admission, appointments were made for the patient to follow up with oncology, but he did not attend these appointments. Three years after the initial abnormal chest x-ray, he was assessed for hospice placement. At this time, Mr. I.M. was staying at a single men's shelter in the inner city area. Each day he had been dispensed eight tablets of MS Contin 60 mg and eight tablets of Percocet by the nurse at the single men's shelter. He was assessed by the regional palliative care team (5). It was felt that he would benefit from admission to the tertiary palliative care unit for further workup and symptom control prior to transfer to a hospice. The patient agreed to this and was admitted the following day. On arrival, when asked what his expectations were of this stay, he stated only that he just needed a place to stay. When assessed on admission, he complained of pain, his description of which was vague in location and nature. He also had shortness of breath on exertion, cough, and hemoptysis. Drowsiness and myoclonus suggestive of opioid-induced neurotoxicity were observed. It was suggested that he be rotated to methadone. He agreed and a three-day methadone rotation was begun.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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