Cancer Pain Management, Palliative Interventions, Neurolytic Blocks, and Advanced Pain Syndromes — WACS Viva & Clinical Scenarios (Pre-Op & Pain Clinic Rotation)

Exam-style cancer pain management, palliative interventions, neurolytic blocks, and advanced pain syndromes viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 58-year-old male with locally advanced, unresectable carcinoma of the body of the pancreas presents to your pain and palliative care clinic with excruciating, constant, boring epigastric pain radiating straight through to his mid-back (VAS 10/10). He is currently taking oral immediate-release morphine 20 mg every 4 hours, but his pain remains uncontrolled, and he suffers from severe constipation and daytime somnolence. How do you systematically assess and optimize his systemic opioid regimen, calculate breakthrough pain doses, and plan a definitive fluoroscopy- or CT-guided celiac plexus neu
• SCENARIO 2: A 52-year-old female with Stage IV carcinoma of the cervix with bilateral pelvic wall involvement and rectovaginal fistula presents with agonizing, burning, and cramping deep pelvic and perineal pain. She is bedridden and crying from pain. Oral morphine titration is limited by intolerable nausea, vomiting, and cognitive clouding. Outline your comprehensive interventional pain management strategy, detailing the anatomical approach, technique, contrast verification, and complications of a superior hypogastric plexus block combined with a ganglion impar block.
• SCENARIO 3: A 64-year-old male with metastatic prostate adenocarcinoma to the thoracic and lumbar spine presents with severe back pain (VAS 9/10) that acutely worsens upon movement, accompanied by sudden difficulty walking and bilateral lower extremity hyperreflexia. Plain X-rays show a pathological compression fracture of T8. How do you evaluate and manage this patient for suspected malignant spinal cord compression (MSCC), optimize his neuropathic and somatic pain, and coordinate urgent oncological interventions?
• SCENARIO 4: A 60-year-old female with advanced metastatic breast cancer is receiving 120 mg of oral slow-release morphine twice daily plus 20 mg of immediate-release morphine for breakthrough pain. She is brought to the clinic by her family because she has developed severe multifocal myoclonus, visual hallucinations, confusion, and generalized cutaneous allodynia. Her pain score is paradoxically higher (VAS 9/10). Diagnose her condition, explain its underlying mechanism, and detail your step-by-step opioid rotation/switching protocol to transdermal fentanyl or methadone.