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Renal Cell Cancer

Oncological Pain Management
  • Why does pain remain refractory to usual measures in some patients?
    • Non-physiological Causes
      • existential suffering, 
      • spiritual distress, 
      • addiction, and 
      • psychological secondary gain. 
    • Physiological Causes
      • Opiates induced Hyperalgesia
  • Why does opiate therapy worsen the pain in some patients?
    • Opiates induced Hyperalgesia : is a phenomenon whereby exposure to opioids sensitizes a patient to a pain stimulus, causing a paradoxical increase in pain
    • Central activation of the N-methyl-d-aspartate (NMDA) receptor has been suggested as one possible cause, and administration of NMDA antagonists (ketamine and methadone) has been recommended when opioid-induced hyperalgesia is suspected. 
  • Reference:
  • Case 17-2015: A 44-Year-Old Woman with Intractable Pain Due to Metastatic Lung Cancer