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CLINICIAN’S CORNER PERSPECTIVES ON CARE AT THE CLOSE OF LIFE Managing an Acute Pain Crisis in a Patient With Advanced Cancer “This Is as Much of a Crisis as a Code” Natalie Moryl, MD The assessment and management of an acute pain crisis in Nessa Coyle, NP, PhD the setting of advanced illness is challenging. Using the Kathleen M. Foley, MD case of Mr X, a 33-year-old man with advanced metastatic mucinous adenocarcinoma of the appendix and “15 out of THE PATIENT’S STORY 10” pain, we explore the issues of acute pain and its man- Mr X is a 33-year-old man with a 4-year history of meta- agement. We define a pain crisis as an event in which the static mucinous adenocarcinoma of the appendix. Over the patient reports pain that is severe, uncontrolled, and caus- course of his illness, Mr X completed several cycles of che- ing distress for the patient, family members, or both. Our motherapy and had several percutaneous draining osto- mies for small-bowel obstruction due to peritoneal carci- management strategy focuses on making a pain diagno- nomatosis. His most recent admissions were triggered by sis, differentiating reversible from intractable causes of pain, protracted nausea and
JAMA – American Medical Association
Published: Mar 26, 2008
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