复旦大学：《肿瘤学概论 Basics of Clinical Oncology》课程PPT教学课件（英文）基本临床肿瘤学症状管理和姑息治疗 Basic Clinical Oncology-Symoptom Management and Palliative Care

Fudan University Shanghai cancer Center K Basic Clinical Oncology Symoptom Management and Palliative care》 an Fudan University cancer center Cheng wen-Wu Arrrr 复旦大学上海医学院肿瘤学糸

复旦大学上海医学院肿瘤学系 Fudan University Shanghai Cancer Center 《Basic Clinical Oncology￾Symoptom Management and Palliative Care》 Pain Fudan University Cancer Center Cheng Wen-Wu

Who am .cheng On-O Director of palliative care department Shanghai cancer hospital, Fudan university Traditional Chinese Medicine(Shanghai) and palliative care(MD Anderson cancer center, Texas)

Who am I? •Cheng Wen-Wu • Director of palliative care department, Shanghai cancer hospital, Fudan university. • Traditional Chinese Medicine (Shanghai) and palliative care (MD Anderson cancer center, Texas)

Overview of pain major symptoms in cancer patients: either early or advanced stage global common problem: 30%to 50% of new cancer patients; advanced patients reach 70% to 90%

Overview of pain • major symptoms in cancer patients: either early or advanced stage • global common problem: 30% to 50% of new cancer patients ; advanced patients reach 70% to 90%

Definition of pain an unpleasant sensory and emotional experience associated with actual or potential tissue injury or described in terms of such damage injury"suffering or distress

Definition of pain •"an unpleasant sensory and emotional experience associated with actual or potential tissue injury or described in terms of such damage." • “injury” and “suffering or distress

“ Pain is whatever the experience the person says it is existing whenever patient says it does The patient' s chief complaint should be believed

• “Pain is whatever the experience the person says it is, existing whenever patient says it does” • The patient's chief complaint should be believed

mpact of pain The interaction of pain with concurrent symptoms such as anorexia, nausea, constipation, delirium, dyspnea, depression, anxiety and insomnia, and so on The patients and their families might think that the intensification of pain is a harbinger of impending death

Impact of pain • The interaction of pain with concurrent symptoms such as anorexia, nausea, constipation, delirium, dyspnea, depression, anxiety and insomnia, and so on. • The patients and their families might think that the intensification of pain is a harbinger of impending death

Causes of pain Tumor:(1 tumor compression and invasion to adjacent organs tissue, nerves, bones or blood vessels or metastasis. (2) inflammation caused by tumor-induced mediators(e. g, interleukin, bradykinin) and so on Treatment-related: (1 Postsurgical pain syndrome(eg thoracotomy, mastectomy, amputation surgery, surgical scars and nerve damage). 2 Postchemotherapy pain (eg, polyneuropathy, osseous necrosis, thrombophlebitis and mucositis).3 Postradiation pain(eg, local damage neural fibrosis, medullary lesions bone necrosis and mucositis)

Causes of pain • Tumor: ① tumor compression and invasion to adjacent organs, tissue, nerves, bones or blood vessels or metastasis.② inflammation caused by tumor-induced mediators (e.g, interleukin, bradykinin) and so on. • Treatment-related: ① Postsurgical pain syndrome (eg, thoracotomy, mastectomy, amputation surgery, surgical scars and nerve damage).② Postchemotherapy pain (eg, polyneuropathy, osseous necrosis, thrombophlebitis and mucositis).③ Postradiation pain (eg, local damage, neural fibrosis, medullary lesions, bone necrosis and mucositis)

Cancer-related pain: the pain is caused by some symptoms such as constipation, pressure sores and muscle spasm Non- physiological pain:① Spiritual pain② Psychological trauma Non-cancer pain: non-cancer-related pain(eg myofascial, musculoskeletal problems) There are two or more causes of pain in most of advanced cancer patients

• Cancer-related pain: the pain is caused by some symptoms such as constipation, pressure sores and muscle spasm. • Non-physiological pain: ① Spiritual pain.② Psychological trauma. • Non-cancer pain: non-cancer-related pain (eg, myofascial, musculoskeletal problems). • There are two or more causes of pain in most of advanced cancer patients

Type of pain Duration: acute(transient) and chronic (more than 3 months) pain Pathophysiological mechanisms and characteristics: nociceptive and neuropathie pain

Type of pain • Duration: acute (transient) and chronic (more than 3 months) pain, • Pathophysiological mechanisms and characteristics: nociceptive and neuropathic pain

Assessment of pain What should we assess? CLINICAL manifestations and PSYCHOLOGICAL problems Why should we assess? “① IAGNOSIS and TREATMENT Any else be added? SOCIOLOGICAL and PSYCHOLOGICAL factors

Assessment of pain • What should we assess? • clinical manifestations and psychological problems. • Why should we assess? “diagnosis” and “treatment”. • Any else be added? Sociological and psychological factors