title: Medication-focused approach to total pain: poor symptom control, polypharmacy, and adverse reactions.
abstract: Neuropathic pain, known to have poor opioid response, can be difficult to control. Although several classes of adjuvant medications are believed to be of benefit in managing neuropathic pain, they have potential side effects that occasionally outweigh their benefits. The psychospiritual suffering of patients with advanced cancer may heighten the distress associated with physical symptoms. If undiagnosed, this may lead to increases in dose and the number of medications administered in the hope of better symptom control. This case report describes the successful interdisciplinary management of an advanced cancer patient whose multiple drug therapy had added to rather than alleviated his distress by causing more side effects than symptom relief.
authors.affiliation: Palliative Medicine Consultant, Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Mohammad Zafir
authors.initials: MZ
authors.lastname: Al-Shahri
authors.forename: Emilio Herrera
authors.initials: EH
authors.lastname: Molina
authors.forename: Doreen
authors.initials: D
authors.lastname: Oneschuk
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D010166:Palliative Care / Q000379:methods*; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000556:secondary; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D018931:Antineoplastic Agents, Hormonal; D009294:Narcotics