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Pain Management

Pain from Pleurodesis

11/18/2008

Question:

My husband had R VATS Pleurodesis (mechanical and talc) On June 5, 2008. Pleural bx positive poorly differiated squamous cell ca.(Laryngeal ca primary) He still has pain and is taking oxy, lyrica, and zanaflex. He has temporary intercostal nerve blocks (have discussed permanent blocks) that sort of relieve some of the pain, but he still needs meds. He actually has to sit perfectly still sometimes to help reduce pain. He says pain is almost always a 5, everyday spells of 10 or greater. Is it "normal" to have pain from pleurodesis procedure this far out....does blocking the nerves just reduce pain...or is the pain from the cancer in the pleura? His tx is weekly erbitux and is currently enrolled in clinical trial for crossover to experimental drug.....the CT scan (Sept) impression stated ca had shrunk ....they follow primary nodule. The shrinkage % met stable disease guidelines. Would you advise any other approaches to pain control in this situation? Is this typical pleural/lung ca pain? Thank you

Answer:

I would advise discussing either an alcohol block to the intercostal nerves or placing an intrathecal pump with morphine (visit Medtronic website) with your husband's doctor.  

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Response by:

Hammam Akbik, MD, FIPP Hammam Akbik, MD, FIPP
Formerly, Assistant Professor of Anesthesia
College of Medicine
University of Cincinnati