At Hyatt Regency Pune

10-13 Aug, 2017

Workshop on Cancer Pain Management 

Time
 Topic
  Speakers
10:15am -10:30am  
Cancer pain introduction, epidemiology,  pathophysiology,  types. 
Samarjit Dey
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 Case 1 
A 25-year old man has been hospitalized for 2 weeks with newly diagnosed lymphoblastic lymphoma. He is being treated with combination chemotherapy with curative intent. 10 days after the start of chemotherapy he develops severe pain on swallowing – upper GI endoscopy reveals herpes simplex esophagitis. He is unable to eat solid foods due to the pain although he can swallow some liquids. The pain is described as 10/10 and is not relieved by acetaminophen with oral morphine 10 mg tablet ordered q6h. The patient repeatedly asks for something for pain just after 3/4 hours of each doses and is often heard moaning. The physician is concerned about using opioid more frequently because of respiratory depression. The patient had a history of poly-drug abuse including opioids, although none in the last two years. The nurses feel that he is an addict. You have received a referrel for managing the pain.
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  10:30am - 10:35am
  Case Presentation: 1
  Arif Ahmed
 10:35am - 10:45am
 Different Opioid use disorders. Assessing addiction potential. CDC guidelines of prescribe opioids. WHO ladder   different Opioid use disorders. Assessing addiction potential. CDC guidelines of prescribe opioids. WHO ladder  
 Priyanka Dev 
10:45am - 10:55am
  Discussion with audience:  1. approach & assessment  2. Treatment consideration  3. Monitoring in pain management in OPD and IPD
  Arif Ahmed
   10:55am- 11:05am
 Opioid formulations worldwide, equianalgesic doses. Probable risk of respiratory depression in cancer patients,
  Anjali Kolhe
.
Case 2   
A 50 y/o man with non-small cell lung cancer develops slowly progressive right-sided
pelvic pain in the region of known pelvic metastases. He describes dull-aching pain rated 8/10 in the lateral pelvis and sharp shooting pain that radiates down the left leg. The pain limits mobility and awakens the patient from sleep. He has no focal motor or sensory deficits. An X-ray shows a large lytic metastasis in the lateral pelvis. He is referred to a radiation oncologist who recommends a course of palliative XRT at 300 cGY per day for 10 days (total dose 3000 cGY). The patient has been taking Morphine immediate release, 20mg every 4 hours, which worked until the past week. Now this dose only decreases his pain from 8/10 to 6/10 for 1-2 hours at best.  What shall be appropriate to provide him relief?

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  11:05am- 11:10am 
 Presentation: Case 2 
Pravin Talwar   
   11:10am- 11:20am   
 Palliative chemotherapy and radiotherapy, in Cancer Pain Management .  General overview
 Gaurab Maitra 
11:20am-
11:30am
 Discussion: 1. Classify this patient’s pain type. Further Investigation?  2. How effective is XRT 3. How to use WHO ladder here? 4. If these modalities fails, then what interventions are possible?
Pravin Talwar  
 11:30am - 11:40am
 Intra thecal pump [practical points in short]. Polyanalgesic conscious guideline. 
 Gaurav Nirwani Goyal 
 11:40am - 12:00pm

Neurolysis for cancer pain 

 Lakshmi Koyyalagunta
.
Case 3  
A 58 year old woman was diagnosed as a case of right breast cancer and had undergone simple mastectomy 8 months back. Surgery was followed by radiotherapy. Post radiotherapy, patient developed severe pain of right shoulder and upper arm. Patient was taking morphine 60 mg orally BID with 50 mg amitriptyline daily and gabapentin 900 mg daily in divided doses. At present her pain intensity rating is 3/10 but she complains of dizziness. She is also a known case of CKD stage 3A. 

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12:00pm- 12:15pm 
 Presentation: Case 3  
Post radiation plexopathy. Incidences and investigative modalities. 
 Samarjit Dey
 12:15pm - 12:25pm
 Discussion: 1. what is the approach? 2. Rule out differentials. 3. Physical examination 4. CKD consideration 5. What if present treatment fails? 
 Samarjit Dey 
 12:25pm - 12:40pm  
 Spinal cord stimulation in neuropathic cancer pain patients – present literature support 
 Manish Raj
12:40pm - 1:00 pm 

Spinal

Metastasis Radiofrequency with Spinal Augmentation
 M. Mathews