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Providing Palliative Care for Two: Managing Cancer-Related Pain During Pregnancy

Journal: Journal of Pain and Symptom Management Date: 2025/05, 69(5):Pages: e672-e673. doi: Subito , type of study: case report

Full text    (https://www.jpsmjournal.com/article/S0885-3924(25)00428-2/fulltext)

Keywords:

cancer [76]
case report [708]
conference abstract [120]
female [597]
OMT [3750]
osteopathic manipulative treatment [3770]
pain management [33]
palliative care [19]
pregnancy [169]
women [553]

Abstract:

Outcomes: 1. Participants will self-report the importance of a trans-disciplinary approach to the provision of palliative care for gravid patients with newly diagnosed cancer. 2. Participants will self-report the ability to identify the components of a multi-modal therapeutic approach to treatment of nociceptive and neuropathic cancer-related pain in gravid patients. Key Message: The management of cancer-related pain during pregnancy presents unique challenges related to providing safe treatment for a gravid patient. Given the potential risks to the developing fetus, few research studies have been conducted in the pregnant population. In this presentation, we highlight the importance of pharmacological and nonpharmacological therapies for efficacious pain management during pregnancy. Cancer during pregnancy is a rare occurrence, with a prevalence of 1 per 1000 pregnancies annually [1]. There is a lack of peer-reviewed literature on management of cancer-related pain in gravid patients. Zerfas, McGinn, & Smith (2023) delineate the importance of identifying the mechanism of pain to develop a pharmaco-therapeutic approach to the treatment of cancer-related pain during pregnancy [2]. Managing pain in this population presents a unique challenge for clinicians in determining the most appropriate therapies for pain control. Studies suggest that the frequency of cancer in pregnancy is anticipated to increase due to a higher prevalence of delayed childbearing [1,3]. This warrants additional studies on effective management of cancer-related pain in gravid patients. Case Description: In this case presentation, we aim to delineate the multimodal approach to pain management applied in the care of a 35-year-old G4P3 female with rectal adenocarcinoma in the second trimester of pregnancy. The patient initially presented with constipation and worsening pain in her sacrum, buttock, and perineal muscles, which gradually impaired her functional status. She underwent flexible sigmoidoscopy and biopsy for clinical diagnosis, followed by open creation of a distal transverse loop colostomy. Her pain was managed perioperatively by Palliative Care with short-acting oral opioids and duloxetine. Massage therapy, acupuncture, osteopathic medicine, social work, spiritual care, and psychology were also incorporated into her plan of care, with positive outcomes observed. An image-guided impar nerve block (to coccygeal 2-3 ganglia) was performed with minimal pain relief endorsed. Given mixed neuropathic and nociceptive cancer-related pain in the setting of pregnancy, the patient was initiated on methadone, which was titrated to effect for long-acting pain relief. Conclusion: This case presentation highlights the importance of multimodal therapies and collaboration with a trans-disciplinary team to foster effective palliative care in gravid patients with cancer-related pain.


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