Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pain Syndromes Pancreatic Cancer 1125

■Psychogenic factors may perpetuate, exacerbate or result from the

pain syndrome

■Exam findings depend on cause of pain

■See separate entries for findings w/ back or neck pain, peripheral

neuropathy or visceral disease

tests

■Lab & imaging studies depend on likely cause

differential diagnosis

■Nature of pain & associated symptoms & signs suggest likely cause

management

■Depends on cause of pain & clinical context

■For neuropathic pain, use tricyclic agents, topiramate or gabapentin

■For chronic pain & in terminally ill, pain should be controlled rapidly

& as completely as possible, w/ adequate doses of opiates if needed;

give medication on regular schedule; titrate dose upward rapidly;

give opiates if NSAIDs are insufficient

■Surgical procedures (eg, nerve blocks, dorsal rhizotomy or central

ablations) or

■Modulatory procedures (eg, transcutaneous electrical nerve stimu-

lation) may be helpful; consider referral to multidisciplinary pain

clinic

specific therapy

■Treat underlying cause

follow-up

■Depends on cause

complications and prognosis

■Depend on cause

PANCREATIC CANCER

ANSON W. LOWE, MD

history & physical

Risk Factors

■Environmental

■An increased risk is associated with cigarette smoking