Page 179 Guide to Pain Management in Low-Resource Settings

Lung Cancer with Breathing Problems 167

and exchange. Other drugs such as haloperidol, cannabi- Case report—part fi ve
nol, and doxepin help to reduce the psychological distress
and agitation. Besides pharmacotherapy, the treatment Mr. K. has returned home and is mostly resting in a com-
of cutaneous trigger zones by massage, cognitive and be- fortable chair in the living room. His wife and two of the
havioral distraction, and even simply directing fresh air three children live with him in the house. Neighbors and
toward the face stimulating trigeminal receptors, with a some other family members visit quite regularly so that
direct infl uence on breathing frequency, are means that the patient participates in what is going on around him to
lead to reproducible relief of suff ering. Th e availability of a certain extent. Mr. K. has started to smoke again (about
morphine, oxygen, and a fan may therefore be the most three cigarettes on a good day), which he claims “does not
important means and, most of the time, are suffi cient to make any diff erence” at this point and reminds him of the
control even advanced stages of dyspnea. “good old days” when he was a young postman in his origi-
nal home town. Smoking also gets him to walk a few steps,
Besides dyspnea, what else should because his family insists that smoking is only allowed
be considered in the treatment of outside. Th e family doctor regularly visits the patient twice
a week. He has instructed Mrs. K. and one of the sons to
lung cancer?
administer morphine via a subcutaneous route using ti-
Most often lung cancer is a progressive disease accom- tration doses in case of pain or dyspnea, which has been
panied by complications caused by tumor metasta- occurring several times during the evenings and nights.
ses and general physical exhaustion. Th ese complica- One day Mr. K. stumbles on his way back to his chair
tions often go along with pain and dyspnea and lead to and is afraid of falling again after this incident. Th e next
enormous psychological suff ering, which needs to be day he does not leave his bed and seems to be more dis-
addressed by appropriate treatment and honest infor- oriented than ever. Th e visiting community nurse admin-
mation about the therapeutic options. In this way it is isters a sedative drug to the more and more agitated Mr.
possible to infl uence the patient’s perspective regarding K. and calls for the family doctor. When the doctor comes
his or her personal quality of life. in the next day, the general condition of Mr. K. has wors-
• Th e wide range of treatments targeting the diff er- ened. He dreams heavily, is feverish, and shows seizures of
ent possible complications include: his right arm and his face. Th e doctor decides to leave Mr.
• Medication (e.g., analgetics, antibiotics, broncho- K. in Barbar, since he sees no further options for specifi c
dilators, corticosteroids). treatment, as he explains patiently to the anxious family.
• Substitution of albumin, erythrocytes, electro- Again a sedative is given subcutaneously, and the patient’s
lytes, fl uids, and caloric agents. agitation subsides, which helps the family to remain at his
• Radiotherapy (to treat lytic bone lesions, tumor side constantly, though weeping a lot. At the end of this
obstruction of central airways, superior vena cava day, Mr. K. dies without regaining consciousness or show-
syndrome, or intracranial pressure). ing signs of agitation or suff ering, especially dyspnea.
• Surgical, endoscopic, and intravascular inter-
ventions. Pearls of wisdom
Complementary treatment off ers exercise
(physiotherapy), psychological or spiritual support, Understand that:
as well as receptive and imaginative therapies (mas- • Lung cancer is a life-threatening disease.
sage, musical therapy, and active relaxation tech- • Th e character of breathing problems helps you to
niques). A great number of patients carrying progres- decide on their treatment.
sive lung cancers die from the complications of their • Lung cancer causes pain problems, which can be
illness rather than from the lung cancer itself. During treated.
the fi nal period of life, supporting and comforting the • Palliative care can be given to patients with lung
patient by lowering anxiety, agitation, weakness, pain, cancer.
and dyspnea is most important. When clinicians have • Morphine and a fan may, in most cases, be suffi -
provided comprehensive instructions and are available cient to prevent the patient from suff ocating.
as a backup if needed, this support may be provided by • Th e necessary dose of morphine is not given
family members at home. as milligrams per kilogram of body weight, but