When the game is hard, more complex weapons are needed

Sebastiano Mercadante; Claudio Adile; Patrizia Ferrera; Fausto Giuliana

doi:10.1136/bmjspcare-2021-003518

When the game is hard, more complex weapons are needed

BMJ Support Palliat Care. 2022 Mar 8:bmjspcare-2021-003518. doi: 10.1136/bmjspcare-2021-003518. Online ahead of print.

Authors

Sebastiano Mercadante^{1

2}, Claudio Adile³, Patrizia Ferrera³, Fausto Giuliana²

Affiliations

¹ Pain relief and supportive care, La Maddalena, Palermo, Italy terapiadeldolore@lamaddalenanet.it.
² Palliative Care, La Maddalena Cancer Center, Palermo, Italy.
³ Pain relief and supportive care, La Maddalena, Palermo, Italy.

PMID: 35260432
DOI: 10.1136/bmjspcare-2021-003518

Abstract

Objectives: The aim of this paper is to illustrate how to manage a very difficult pain condition.

Methods: This is a clinical note of a complex approach using multiple analgesic regimens to effectively afford challenging pain situations.

Results: A man underwent an opioid dose titration, followed by dose stabilisation for some months. Then he underwent two opioid substitutions, unsuccessfully. A spinal analgesia provided good analgesia for a prolonged period of time, necessitating variable interventions to counteract the evolving, challenging clinical situation.

Conclusions: The description of this case illustrates the need of a high level of experience and knowledge to elaborate complex strategies step by step every time the pain syndrome was worsening. Recommendations are unlikely in these extreme circumstances, and treatment should be based on continuous clinical counteraction to the evolving clinical conditions.

Keywords: cancer; hospice care; pain; pharmacology; supportive care; terminal care.