He accumulated a lot of abdominal fluid and had trouble breathing. After trying various drugs, the medical team settled on morphine which the patient was most comfortable with. A few days later, the patient developed pneumonia with fever. He died peacefully shortly after that.

Discuss recommended interventions for your case study for the symptom you have selected, based on the data you have reviewed, and how you will evaluate outcomes.

I would like to divide the patient's case in two: the pain he felt after his first post-cancer experience and the intermediate years before he was readmitted; and the pain that he felt with the remission of the cancer.

Stage 1:

The patient had pain even before he was admitted to hospital. Recommended interventions then would have been over the counter drugs. There are 4 over the counter analgesics available in the U.S.A.: acetaminophen, aspirin, ibuprofen, and naproxen. Taken as recommended, they are beneficial in that they are economical, effective for mild to moderate pain, inflammation, and fever, and are relatively safe. The problem is that their accessibility causes consumers to often overdose on them and use them in conjunction with multiple other common medications. (Fendrick, Pan, & Johnson, 2008). For these reasons, the patient would need to discuss with the doctor and would need to be monitored. Over the counter analgesics work by blocking pain through intervention at the periphery (Melzack & Wall, 1982). They show contradictory results of effect. For more information regarding each type, see Terrie, Y, C. A pharmacist's guide to OTC therapy Pharmacy Times.

The patient could have also used homeopathy and herbs. Homeopathy (used for acute as well as for 'regular disease and to strengthen the immune system), according to the brunt of scientific evidence works in the same way that a placebo does (Ernst, 2002). In other words, the patient could use it for pain reduction and he may be helped whether or not the drug actually works. Homeopathic practitioners attribute mechanisms to the fact that certain highly diluted preparations cause healthy people to exhibit symptoms that are similar to those exhibited by the patient.

As regards herbology, some herbs can be useful leading, for instance, to relief of depression and stress which is common during cancer. Some herbs carry empirical evidence regarding their effectiveness, whilst others have been disproved, and still others remain unresolved. Large amounts of herbs can, however, result in poisoning and should, therefore, be used with caution.

Some practitioners state acupuncture to be helpful. Acupuncture may not be helpful for all the nociceptive symptoms of cancer, but it has been conclusively revealed to diminish nausea and certain types of pain, but otherwise several review articles conclude it to have a placebo effect (Ernst, 2006).

Massage therapy works by manipulating superficial and deeper layers of muscle and tissue and by promoting relaxation; in this way it can also be helpful in alleviating the pain of a very stressful disease. Message therapy has an overall effect on the body, clearing pathways, facilitating smoother blood flow, and lowering heart rate as well as blood pressure, causing the muscles to relax ( [web].)

Basic strategies of pain control (include nonsteroidal anti-inflammatory drugs and aspirin that block pain through intervention at the periphery, transcutaneous electrical nerve stimulation (TENS), acupuncture, or spinal-cord stimulation (that inhibit pain at the spinal cord and brain), and psychotherapy (that shapes brain messages). (Melzack & Wall, 1982). Some, and a combination of these interventions could have been used by caregivers of the patient in both his first and second phase (Web MD).

The Second Stage.

As shown from the above case study, the fentanyl transdermal patch did not help the patient. This may have largely been due to the body's inability to absorb the medication due to the intensive amount of chemotherapy and radiation that the patient had received. Another medication that may have helped may be Medical marijuana which is available in both cigarette form and as Dronabinol i.e. As a capsule. I would have given it to the patient in this form.

As shown, too with the first two articles, (McMillan & Small (2007) and Rosedale & Fu (2010)), end of life cancer treatment needs an inclusive and holistic offering for pain reduction. This includes paying attention to the concept of 'total pain" which is comprised of four components: physical noxious stimuli, affect or emotional discomfort, interpersonal conflicts, and no acceptance of one's own dying. Leleszi et al. (2005) addresses each of these four components of pain and how to adequately treat them. Doing so may have helped the medical team provide a more optimal form of pain management and at an earlier time.


Case studies in pain management. Cancer Pain

Ernst, E. (2002), A systematic review of systematic reviews of homeopathy, British Journal of Clinical Pharmacology 54 (6): 577 -- 82

Fendrick, M., Pan, D., & Johnsonn G. (2008). OTC analgesics and drug interactions: clinical implications. Osteopath Med Prim Care. 2: 2.

Ferrell, B & Coyles, N (2010) Oxford Textbook of Palliative Nursing Oxford University Press, USA

Leleszi, J. et al. (2005) Pain Management in End-of-Life Care J. Am Osteopath Assoc 105 6S-11S How does massage therapy work?

Mcmillan, S.C., & Small, B.J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare. Oncology Nursing Forum, 34, 313-321.

Melzack, R., & Wall, P. (1982). The challenge of pain. New York: Basic Books, Inc., Publishers.

Pittler, MH & Ernst, E (2008). Complementary Therapies for Neuropathic and Neuralgic Pain: Systematic Review. Clinical Journal of Pain. 24 (8): 731 -- 733.

RehabReamSite: Types of Pain.

Rutecki, G. (2011) End-of-Life Care in the Long-Term Cancer Survivor. The Center for Bioethics.

Rosedale, M., & F, M.R. (2010). Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncology Nursing Forum, 37, E28-E33.,

Weinbert, Robert…