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A practical guide to the management of medical emergencies - part 9

Đau sắc nét địa phương cũng khiêu khích không ác tính gây ra bởi nguồn cảm hứng là phổ biến (ví dụ như thuyên tắc phổi và viêm phổi) Đau kém địa phương với nội tạng bị ảnh hưởng và có thể tham khảo các trang web khác | CHAPTER 82 529 Characteristics of Tissue affected Mechanism of pain pain comments Pleura and Infiltration of pleura Well-localized sharp pain peritoneum or peritoneum by tumor provoked by inspiration Non-malignant causes are common e.g. pulmonary embolism and pneumonia Visceral pain Pain from deep structures of chest abdomen or pelvis Pain poorly localized to the affected viscera and may refer to other sites. May be tender to palpation over affected organ Non-malignant causes are common Nerve compression pain Compression of nerve by tumor or bone Neuropathic pain Altered spinal and central neurotransmitter levels caused by nerve damage Pain may be continuous e.g. tumor compression or intermittent e.g. skeletal instability but only investigation will differentiate the cause Reduced sensation or paresthesiae are common Unpleasant sensory change e.g. burning cold numb stabbing in the distribution of a peripheral nerve or nerve root. Often accompanied by hypersensitivity or allodynia pain on light touch May involve the sympathetic system and have a vascular distribution accompanied by sympathetic changes pallor or flushing sweating or absence of sweating Continued 530 SPECIFIC PROBLEMS HEMATOLOGY ONCOLOGY Characteristics of Tissue affected Mechanism of pain pain comments o Irt c .0 ỊÍ V ặ Ẹ o Central nervous system Spinal cord compression p. 339 Cerebral metastases Spinal pain is usually first feature Motor and sensory signs occur later Sphincter disturbance is a late sign Headache on lying flat vomiting drowsiness focal neurological deficit TABLE 82.6 Other causes of pain in the patient with cancer Mechanism Comment Chemotherapy Pain may be associated with the infusion of chemotherapy. Peripheral neuropathy and severe mucositis can also occur although these take longer to develop Radiotherapy Can cause inflammation and ulceration of exposed mucous membranes e.g. gut vagina bladder Myelopathy may occur following radiation of the cervical and thoracic spinal cord tends