STATS:
WHO states 5.5 M cancer survivor with poorly managed pain.
- 38% reported 5+ on VAS.
- 66% have advanced cancer (? what stage is)
- 35% have pain with treatments
- 39.5% after radical surgeries.
Evidence shows that Pain decreases immune system:
- decreased Natural killers, decreased t-cell activation and decreased macrocyte recruitments
thus pain management for cancer population is very important.
Evidence shows that stress decreases immune system
- decreased Natural killers, decreased t-cell activation and decreased cortisol releasing hormone
?? do Opioids decrease immune response?
- MOP receptors tend to suggest yes : decreased ACH decreased corticosteroids, decreased sympathetics.
- MOP also related to Angiogenesis and migration and proliferation of cells.
- some suggest yes.
episodic increased pain:
Surgery: increased risk fo spread d/t tumor manipulation, and anigogenesis (VEGF) associated with healing.
Alternative options
GOALS: decreased systemic exposure, decreased pain ( return to homeostasis) decreased mental stress
- suggestions: Blocks usually only done with surgery, varied results
- adjunct medications: NSIADS seem to decreased immunosuppression of the opioids
- regular NSAIDs risk apply: GIB, Renal, Cardiotoxicity
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