Corticosteroids in Pain Management
Topical Analgesia in Pain Management
Anesthesia, Neurosurgery in Pain Management
Opioid Adverse Effects
Corticosteroids in Pain Management
Uses of Corticosteroids
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Corticosteroids are frequently helpful and commonly used in advanced illness
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They may be useful for a variety of symptoms, including:
- Increased intracranial pressure
- Visceral pain (obstruction of a viscous and/or capsular distention)
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Drug and Dosage Recommendations
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Dexamethasone is the drug of choice due to its:
- Long half-life (>36 hours)
- Minimal mineralocorticoid effect
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It can be administered once a day in doses of 2 to 20 mg or more
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Adverse Effects
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Steroid psychosis should be considered if an agitated delirium ensues
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Other toxicities that are possible with long-term use but are seldom a problem in the setting of advanced disease include:
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Problem Solving: Case Example Involving Corticosteroids (Case 9)
David is a 67-year-old farmer with colon cancer metastatic to liver. He has complained of increasing right upper quadrant pain. Examination reveals a tender liver, but no shifting dullness to percussion of his abdomen. How would you manage David’s pain?
Click here for the Answer
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Topical Analgesia in Pain Management
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Even simple procedures such as venipuncture may be painful
- Topical anesthetic creams should always be considered
- If trained, patients can always apply these analgesics in advance of office visits
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Open wounds may also be a source of considerable pain, particularly during dressing changes or debridement
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If incident pain is significant, consider topical analgesics such as 10% lidocaine endotracheal spray or nitrous oxide puffers
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Anesthesia, Neurosurgery in Pain Management
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For difficult to manage, persistent pain, anesthesia or neurosurgical colleagues may be able to provide considerable pain relief through:
- Other selective procedures
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Consider referring patients with:
- Upper abdominal pain due to pancreatic disease