Assessment of cancer pain in a patient with communication difficulties: a case report

• Published in: Journal of medical case reports Vol. 10; no. 1; p. 148
• Main Authors: Okimasa, Seiji, Saito, Yasufumi, Okuda, Hiroshi, Fukuda, Toshikatsu, Yano, Masatsugu, Okamoto, Yuzo, Ono, Eiji, Ohdan, Hideki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-06-2016; BioMed Central
• Subjects: Abdomen; Aged; Aged patients; Aging; Alcohol-Induced Disorders; Bone Neoplasms - secondary; Brain Diseases; Cancer; Cancer pain; Cancer Pain - diagnosis; Cancer Pain - drug therapy; Cancer Pain - etiology; Case Report; Communication Disorders; Communicative disorders; Dementia; Diagnosis; Humans; Influence; Liver Neoplasms - secondary; Lung Neoplasms - secondary; Male; Metastasis; Nonverbal communication; Pain management; Pain Measurement - methods; Palliative care; Palliative Care - methods; Patients; Physiological aspects; Rectal Neoplasms - complications; Rectal Neoplasms - diagnostic imaging; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Society; Stents; Tomography, X-Ray Computed; Japan; Case report; Japan; Pain scale; Palliative care; Cancer pain; Cognitive impairment; Dementia
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-016-0935-2

The number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy.
A 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. We had been requested to remove wires that had been used for the closure of his chest in a coronary artery bypass grafting procedure. However, on admission, a tortured expression and abdominal distention were observed, along with emaciation. We diagnosed terminal stage cancer, and palliative care was offered. An abdominal computed tomographic scan revealed rectal cancer with stenosis and invasion to the adjacent tissues. A metallic stent was inserted, leading to reduction of the abdominal distention and an improvement of tachycardia. However, the patient's tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient's score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient's tortured expression and reduced his Abbey Pain Scale score. Following this, the patient's vital signs continued to be stable, and he was transferred to the referral institution.
Management of cancer pain in elderly patients with mutual understanding difficulties must be performed carefully. In the case of our patient, staff at the referral institution informed us of the patient's latent torture, and we applied the Abbey Pain Scale. There was some confusion and uncertainty regarding clinical management throughout the patient's care; however, his condition eventually stabilized. We believe the application of the Abbey Pain Scale assists in the relief of cancer pain. However, accumulation of further cases and experiences to verify this assessment is required.