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American Journal of Hospice and Palliative Medicine®
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Medication-focused approach to total pain: Poor symptom control, polypharmacy, and adverse reactions

Mohammad Zafir Al-Shahri, MD

Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Emilio Herrera Molina, MD

Regional Palliative Care Program, Extremadura, Spain

Doreen Oneschuk, MD

Division of Palliative Care, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada

Neuropathic pain, known to have poor opioid response, can be difficult to control.1-3 Although several classes of adjuvant medications are believed to be of benefit in managing neuropathic pain, they have potential side effects that occasionally outweigh their benefits.4-7 The psychospiritual suffering of patients with advanced cancer may heighten the distress associated with physical symptoms.8-10 If undiagnosed, this may lead to increases in dose and the number of medications administered in the hope of better symptom control. This case report describes the successful interdisciplinary management of an advanced cancer patient whose multiple drug therapy had added to rather than alleviated his distress by causing more side effects than symptom relief.

Key Words: pain • cancer • symptom control • polypharmacy • opioid • adverse reaction • medication

American Journal of Hospice and Palliative Medicine®, Vol. 20, No. 4, 307-310 (2003)
DOI: 10.1177/104990910302000414
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