Assessment of cancer pain in a patient with communication difficulties: a case report

Abstract

BackgroundThe number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy.Case presentationA 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient’s tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient’s score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient’s tortured expression and reduced his Abbey Pain Scale score. Following this, the patient’s vital signs continued to be stable, and he was transferred to the referral institution.ConclusionsManagement of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient’s latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient’s care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.

Dor Total Em Pacientes Oncológicos: Uma Revisão Integrativa Da Literatura

“…Compreendendo a dor do paciente com câncer como uma manifestação de um sintoma complexo, Mello, Almeida, Pruinelli e Lucena (2019), Okimasa et al (2016), Perez et al (2016) e Valadares et al (2014) sinalizam que a avaliação para o apropriado tratamento da dor total pode ser algo extremamente desafiador, exigindo-se múltiplas especialidades para tal abordagem, associados a instrumentos avaliativos que possibilitem que a dor seja analisada de forma multidimensional. A integração desses fatores possibilita melhor gerenciamento da dor do câncer e favorece maior êxito no alívio do sintoma.…”

“…No entanto, nem sempre a integração desses cuidados acontece. A dor mesmo sendo o sintoma mais prevalente nos pacientes encaminhados para as equipes de cuidados paliativos e essa significando ser uma abordagem reconhecida como uma realidade para o manejo da dor do câncer, percebe-se que ainda existem entraves na oferta da assistência e na avaliação desse sintoma (Mello et al, 2019;Okimasa et al, 2016;Valadares et al, 2014). Alguns pacientes, infelizmente, não são submetidos a nenhum instrumento avaliativo que possa nortear a prescrição medicamentosa para a dor sinalizada por eles, possibilitando que muitos venham a óbito, sentindo dor (Valadares et al, 2014).…”

Compromised end‐of‐life syndrome: Concept development from the condition of adults and older adults in palliative care

“…Pain (Gupta, Sahi, Bhargava & Tawar , 2015;Lee et al, 2015;Okimasa et al, 2016;Pina, Sabri & Lawlor , 2015;Posternak et al, 2016;Rau et al, 2015;Song et al, 2015;Xu et al, 2015).…”

“…Pain and suffering (Okimasa et al, 2016); Pain, depression, fatigue, and sleep disorder (Posternak et al, 2016); Pain, depression, and psychosocial suffering (Lee et al, 2015); Pain, nausea, vomiting, and constipation (Song et al, 2015); Pain, suffering, anxiety, and depression (Pina et al, 2015); Pain, sleep disorder, and fatigue (Gupta et al, 2015); Pain, fatigue, sleep/mood disorders, depression, cachexia, and anxiety (Rau et al, 2015); Pain, weakness, sleep disorder, fatigue, and dyspnea (Xu et al, 2015).…”

Physicians’ and nurses’ experience of using the Abbey Pain Scale (APS) in people with advanced cancer: a qualitative content analysis

“…The APS has previously been translated and culturally standardised for use in Sweden, the Abbey Pain Scale-SE (APS-SE) [23]. Other than a single case report describing the use of the APS with one cancer patient [24], we found no previous studies on the use of APS in patients with advanced cancer. This study aimed to explore physicians' and nurses' experience of using the APS-SE in people with advanced cancer.…”