Back to the case…
Mr. M tells you that his pain has progressed over the past 3 months, is located diffusely in his abdomen, and that it is not positional. He rates the pain as 8-9/10 and says that 30 mg of MSIR decreases the pain to a 7/10 and is effective for about 2-3 hours. He has tried hot and cold packs without effect. The pain interferes with his sleep and ability to visit comfortably with his family and friends. He believes the worsening pain is caused by the cancer spreading.
His current medications include:
- MS Contin 60 mg Q12 and MSIR 30 mg po Q4 prn
- Compazine 10 mg TID prn nausea
- Diltiazem SR 180 mg QD
- Colace 100 mg TID and MOM 30cc BID prn
Physical Exam: Appears in moderate distress. T99, BP 150/70, P90, RR16; HEENT, chest, cardiac exam are normal. Abdomen is mildly distended, bowel sounds are normal, there is diffuse tenderness to palpation with no masses or organomegaly. Extremities are normal.