Pancreatic ca pain

[mc3, ASN, RN]

Please help. I am a nurse with Hospice, and recently cared for a patient who had pancreatic cancer. She had a fairly large tumor wrapped around her mesenteric artery, amongst other mets to liver, lung and stomach. There's a long story behind this, but I just have a simple question. At end of life, our team MD stated that the pt's pain was indeed at a certain level, and we were adequately treating the pain at that level, i.e. a "baseline" level. He contended that when she was having BTP, it was because the mesenteric artery was in a spasm, causing increased pain which, once it stopped it's spasms, the pain would return to it's "baseline" level. Thus, he would not increase the patient's basal dose of medicine, he preferred to instead utilize the BTP to control the pain. I maintain that pain is pain, and if a patient is requiring anywhere from 6 to 19 bolus doses in a 24 hr period, they need an increase in the basal rate. They should not have to wake up from pain, or show signs of distress. I'll withhold any opinion for now. Just wanted to know, who is correct?

Thanks,

mc3

[riverguy]

I agree with you. I also am working as a hospice nurse and the basal rate should have been increased, especially if 19 bolus doses needed to be given in a 24 hr period. Comfort at the end of life is our goal as hospice nurses and if a pt needs that many boluses, then a med change or increase needs to happen for their comfort.