Pain is a common complaint among patients with cancer, especially patients with head and neck cancer. Pain can be acute, as a consequence of surgery, or chronic, as in shoulder disability secondary to accessory nerve sacrifice (Figure 23-2).52,53 Pfister and colleagues found a 31 percent prevalence of frequent or persistent pain in a cross-sectional analysis of 194 treated patients, 67 percent of which was moderate or great in intensity. Pain scores tend to improve with time in this population, but a small but significant percentage have persistent, often disabling pain. A study by Chaplin and Morton showed that the presence of pain diminished from 48 percent at diagnosis to 26 percent after treatment. Interestingly the prevalence of shoulder pain increased with time.54

The precise cause of pain and its perception cannot be identified in all cases. A study by Chua and colleagues showed that pain in HNC patients is related to cancer recurrence (35%), treatment sequelae (30%), multiple etiologies (25%), and unrelated causes (10%).55 The most common pain type is mixed nociceptive and neuropathic (37.5%), but nociceptive pain alone (32.5%), myofacial (13%), neuropathic (7.5%) and other mixed types of pain (7.5%) also occur. The character and severity of pain is influenced by the location of the cancer, type of treatment and time after treatment.56

Studies have shown a direct correlation between the presence of pain and lower quality of life in patients with head and neck cancer, with the most significant impact on general well-being and psychosocial distress.54 Accordingly, QOL improvements can be impacted by the use of effective pain control schema. Cancer pain management paradigms have been established to allow a directed approach to pain control. The use of the WHO analgesic ladder is highly successful in controlling HNC-associated pain, with all but two patients experiencing relief in a study of 62 consecutive terminal HNC patients.57 Finally, integral to pharmacologic interventions is the use of adjunctive measures, such as intervention for depression, and physical therapy in patients with shoulder disability.

Figure 23-2. The deformity following radical neck dissection.

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10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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