Scenario : a 40 y/o female was Diagnosed with CA of the Liver about 1 week ago.

Question

Scenario: a 40 y/o female was Diagnosed with CA of the Liver about 1 week ago. Preliminary findings suggest that the CA has not spread. She is hospitalized today because of severe abdominal pain which is not relieved by any type of OTC analgesics. Current treatment consists of possible surgery if CA is localized, chemo and radiation. She is still undergoing evaluation of what is the best approach for her.. Her team of physicians cannot agree on the plan of action regarding pain control. Some say Oral Tylenol # 3 another says Demerol while another believes in a more natural integrated approach…. such as bio feedback, pain meds, Nutritional changes, Mind Body Spirit Approach, spiritual counselling. The patient is angry with the Dx. She cries and becomes very angry intermittently. She is demanding that her pain be addressed and is very dissatisfied with her CA team members.

Question: What are your thoughts regarding how to address her physical pain? Do you confront the doctors, work with the patient, the social worker, the chaplain? Should the pt be given heavy duty analgesia so soon into her CA Dx? What about addiction, or resistance to stronger meds down the line? At this point, no one knows if the CA is terminal.

Explanation / Answer

The clients physical pain may be exaggerated by her emotions associated with dignosis. First step would be to assess the pain intensity using pain scale and provide psychological counseling alongwith alternative therapies like relaxation techniques or guided imagery. The next step would be to confront the doctors to know what they are planning for the patient exactly so that the patient may be assured of the expected treatment and will also help to relieve her anxiety. After collecting the past history of use of opiods, the use of weak opiods may be suggested initially to overcome the fear of addiction. If these does not work, the third step can be to inform the patient about other modalities of pain control including accupuncture, chiropractic treatment and also provide sources of information about these therapies.

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