Fernández Angélica, Rodríguez Cardona Ximena, Cardenas Rey Claudia Jimena, Moreno-Quijano Catalina, Rodriguez Martínez Carlos Hernán
Pain Medicine and Palliative Care, Instituto Nacional de Cancerología, Universidad de la Sabana, Bogotá, Colombia.
Universidad Industrial de Santander, Bucaramanga, Colombia.
SAGE Open Med Case Rep. 2023 Feb 28;11:2050313X231157483. doi: 10.1177/2050313X231157483. eCollection 2023.
Difficult visceral cancer pain is defined as pain that does not improve with conventional non-pharmacological and pharmacological strategies, including opioids and adjuvants, and occurs in up to 15% of patients with cancer. In oncological practice, we must be prepared to establish strategies for dealing with such complex cases. Different analgesic strategies have been described in the literature, including managing refractory pain through palliative sedation; however, this might become a dilemma from a clinical and bioethical point of view in end-of-life situations. We present the case of a young male patient with moderately differentiated intestinal-type adenocarcinoma of the left colon, with intra-abdominal sepsis, and for whom despite the multimodal treatment for difficult visceral cancer pain, the pain was refractory leading to palliative sedation. Difficult visceral cancer pain is a pathology that affects the quality of life of patients and is a challenge for pain specialists, for both pharmacological and non-pharmacological management.
难治性内脏癌痛被定义为采用包括阿片类药物和辅助药物在内的传统非药物和药物策略后疼痛仍未改善的疼痛，在高达15%的癌症患者中出现。在肿瘤学实践中，我们必须准备好制定应对此类复杂病例的策略。文献中描述了不同的镇痛策略，包括通过姑息性镇静来处理难治性疼痛；然而，从临床和生物伦理学角度来看，在临终情况下这可能会成为一个两难困境。我们报告了一例年轻男性患者，患有左半结肠中分化肠型腺癌并伴有腹腔内感染，尽管对难治性内脏癌痛进行了多模式治疗，但疼痛仍难以控制，最终导致了姑息性镇静。难治性内脏癌痛是一种影响患者生活质量且对疼痛专家在药物和非药物管理方面都构成挑战的病症。
