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Hematologic malignancies make up about 9% of the new cancer cases in the USA in 2013. Of the new hematologic cancer cases, approximately 53% were lymphoma, 32% were leukemia, and 15% were myeloma. The management of pain in hematologic cancers presents a constellation of problems that are distinctly different from those associated with solid tumors. We will review four cases of patients who presented with pain associated with hematologic cancer that illustrate the unique complexity and breadth of the problems to be addressed. We will then discuss considerations that should be taken that affect the assessment of risks and the selection of analgesic treatment, and the monitoring of clinical response.
Methadone is familiar to most laypersons as a treatment for heroin addiction, dispensed at special clinics. Methadone is also a powerful, inexpensive, and effective analgesic, but it has many unique and potentially lethal aspects that have to be well understood before using it for pain relief. Addiction treatment with methadone requires a special license, but any provider who can prescribe Schedule II medications can write for methadone for pain. Unfortunately, because no special training is required to prescribe methadone and because poor insurance coverage is leading to the increased use of inexpensive methadone, there has been a tragic dramatic increase in opioid deaths attributed to methadone. This chapter reviews the indications, contraindications, drug interactions, metabolism, genetic issues, ethics, and initial evaluation and treatment for methadone.
Edited by internationally recognized pain experts, this unique book describes 73 real life clinical cases, each followed by discussion of pathogenesis, work-up, differential diagnosis and treatment options. Cases are divided into seven sub-topics: neurologic disorders, spinal disorders, musculoskeletal pain, visceral pain, headache and facial pain, cancer pain, and special topics such as pain in children and older adults. Discussions follow a question-and-answer format, facilitating learning and also enabling self-testing. Chapters are written by the foremost national and international leaders in the field of pain management, many of whom are pain program directors. Case Studies in Pain Management is an excellent learning source for trainees in pain management and a must-read for pain practitioners.
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