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Russell Portenoy, MD
RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified) )| Communities: All Cancers | Answers: 8 |
| Member Since: Jun. 2012 |
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Professional Statement
Dr. Russell Portenoy is chairman of the Department of Pain Medicine and Palliative Care and the Gerald J. Friedman Chair in Pain Medicine and Palliative Care at Beth Israel Medical Center, New York. He is the Chief Medical Officer of MJHS Hospice and Palliative Care and Professor of Neurology and Anesthesiology at the Albert Einstein College of Medicine.
Dr. Portenoy is past-president of the American Academy of Hospice and Palliative Medicine and past-president of the American Pain Society. He previously chaired the American Board of Hospice and Palliative Medicine. He is a recipient of the Lifetime Achievement Award and the National Leadership Award of the American Academy of Hospice and Palliative Medicine, has received both the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation and the Distinguished Service Award from the American Pain Society, and was given the Founder’s Award by the American Academy of Pain Medicine.
Dr. Portenoy has been Editor in Chief of the Journal of Pain and Symptom Management for more than two decades and is editor for the palliative care section of The Oncologist. He serves on numerous other editorial boards. He has written, co-authored, or edited 20 books and more than 525 papers and book chapters on topics in pain and symptom management, opioid pharmacotherapy, and palliative care.
Dr. Portenoy is past-president of the American Academy of Hospice and Palliative Medicine and past-president of the American Pain Society. He previously chaired the American Board of Hospice and Palliative Medicine. He is a recipient of the Lifetime Achievement Award and the National Leadership Award of the American Academy of Hospice and Palliative Medicine, has received both the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation and the Distinguished Service Award from the American Pain Society, and was given the Founder’s Award by the American Academy of Pain Medicine.
Dr. Portenoy has been Editor in Chief of the Journal of Pain and Symptom Management for more than two decades and is editor for the palliative care section of The Oncologist. He serves on numerous other editorial boards. He has written, co-authored, or edited 20 books and more than 525 papers and book chapters on topics in pain and symptom management, opioid pharmacotherapy, and palliative care.
Professional Info
Credential: MD
Primary specialty: Hospice / Palliative Care
Secondary specialty: Pain Medicine
Medical school: University of Maryland School of Medicine
Residency: Albert Einstein College of Medicine
Fellowship: Memorial Sloan-Kettering Cancer Center
Practice address:
First Avenue at 16th Street
New York, NY
10003
Practice phone number: (212) 844-1505
RussellPortenoyMD Activities
Recent surveys suggest that oncologists may have a good basic knowledge of cancer pain management, but also need more education to use the available pain treatments more effectively. Oncologists strongly believe that pain management and palliative care are essential “best practices.” They want education to improve their own “generalist-level” skills and they want access to “specialist-level” care through the availability of consultation services for pain management and palliative care, as well as hospice services. At Beth Israel Medical Center in NY, the interdisciplinary team in the Palliative Care Division of the Department of Pain Medicine and Palliative Care works closely with the Cancer Center’s supportive care program to provide access to professional education and a broad array of services for patients.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
There are three categories of pain medications: “Non-opioid” drugs include the many nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen) and acetaminophen. So-called “adjuvant drugs” are a large group of drug classes and individual drugs that are mostly on the market to manage conditions other than pain but have been found through studies and experience to be analgesic in some situations. The adjuvant analgesics that are used in cancer pain management most frequently include the corticosteroids (such as dexamethasone), the analgesic antidepressants (such as duloxetine and desipramine), and the anticonvulsants (such as gabapentin and pregabalin). Finally, “opioids” are drugs that bind to opioid receptors in the body; the pure mu agonist opioids, the prototype of which is morphine, are the major drugs used to treat acute pain and chronic pain due to active cancer.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
When a pure mu agonist opioid such as morphine is used for chronic pain, the dose must be individualized. This is done by repeatedly adjusting the dose, increasing it by a safe amount while monitoring pain relief and side effects. This is called “dose titration” and is an essential process to ensure effective opioid therapy.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
Opioids always should be prescribed using what is now called a “universal precautions” approach, which refers to the assessments that are needed to minimize the risk of drug abuse, addiction and diversion. Opioids are potentially abusable drugs, and although most cancer patients are responsible drug takers, clinicians must be on the alert for those patients who do not follow instructions, may be abusing the prescribed drug or others, may have the disease of addiction, or may be engaging in diversion of the drug for profit. Universal precautions start with the history. The clinician should inquire about a patient’s current and past use of alcohol or other drugs, his or her family’s use of alcohol or drugs, and the existence of psychological disorders that may predispose to drug-related problems. Based on the history, the clinician should decide how closely a patient should be monitored to ensure that instructions will be followed. In some cases, little special monitoring is needed; in others, the clinician will ask for a range of monitoring processes, including drug screens to make sure that illicit drugs are not being used, pill counts, use of one pharmacy, co-treatment by an addiction specialist, or others.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
If a patient with active cancer who is prescribed an anti-inflammatory drug continues to experience pain, an opioid should be tried. A patient prescribed a short-acting opioid formulation “as needed” who continues to experience pain should be offered a pure mu agonist drug, typically in a long-acting formulation. The latter drugs can undergo dose adjustments most easily, and a dose typically can be found that will offer a favorable balance between analgesia and side effects. There is great variation in the response of an individual patient to pain-relieving drugs, and although the reasons for this are not clear, the clinical implication is that a patient who is doing poorly with one drug should be considered for a switch to another. This is true of all analgesic drug categories. When opioid treatment is considered for a switch to another, this is known as “opioid rotation.” Sometimes, several opioids must be tried before the best one is found.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
There is an international consensus that treatment with an opioid drug should be considered the mainstay approach for moderate or severe chronic cancer pain related to active disease. Patients with relatively mild pain may do well with an anti-inflammatory drug or acetaminophen, but when pain is more severe, treatment with an opioid usually is offered. In the patient who is opioid-naïve, this therapy typically begins with a short-acting drug, such as a hydrocodone-acetaminophen combination tablet, which often is prescribed “as needed.” When pain has persisted despite access to a short-acting drug, or is very severe from the start, treatment usually involves the prescription of a so-called pure mu agonist opioid, such as morphine. These drugs usually are prescribed in long-acting formulations, such as pills that can be taken once or twice per day, or a patch that is changed every two to three days. Patients who have neuropathic pain may be considered for an early trial of one of the drugs used for these conditions. These drugs, which collectively are called “adjuvant analgesics,” include many classes and individual agents, most of which are marketed for reasons other than pain. An adjuvant analgesic may be offered first if neuropathic pain occurs in the setting of cancer that is very indolent or in remission.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
Pain is subjective and clinicians first assess the effectiveness of analgesic interventions by asking patients about the severity of the pain. This is usually done by using a simple scale, most often a numeric scale of “0” to “10”. The clinician may ask: “How severe has your pain been, on average, during the past week, using a scale of zero to ten, where zero is “no pain” and ten is “worst possible pain?” This measurement of pain intensity is very important but does not represent the entire picture. Pain is associated with other symptoms, such as fatigue and insomnia, and has a range of adverse consequences, such as depression and functional decline. For this reason, the clinical assessment of the outcomes associated with pain management should include questions about many other issues related to quality of life.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
Chronic pain may affect patients with active cancer and survivors. Among those with active cancer, about one-third who have relatively less advanced disease and more than two-thirds who have more advanced illness will report chronic pain. The epidemiology of pain in the survivor community is poorly understood, but early reports suggest that chronic pain may affect more than one-third of these patients.
There are three categories of chronic pain that affect patients who are living with active cancer: 1) pain related to the tumor itself; 2) pain related to anti-cancer therapies; and 3) pain unrelated to the tumor or its treatment. About two-thirds of patients with chronic pain have pain related to the tumor itself. The most common type is bone pain from metastatic disease. Bone pain can affect any part of the body and is often multifocal. It is a common cause of so-called “incident pain,” which his defined as breakthrough pain that occurs with voluntary activity. Neuropathic pain also is common among patients with cancer, affecting 30-40% of those with pain. Neuropathic pain may be related to tumor involvement of nerves, or may be caused by cancer treatments, including surgery, chemotherapy and radiation.
There are three categories of chronic pain that affect patients who are living with active cancer: 1) pain related to the tumor itself; 2) pain related to anti-cancer therapies; and 3) pain unrelated to the tumor or its treatment. About two-thirds of patients with chronic pain have pain related to the tumor itself. The most common type is bone pain from metastatic disease. Bone pain can affect any part of the body and is often multifocal. It is a common cause of so-called “incident pain,” which his defined as breakthrough pain that occurs with voluntary activity. Neuropathic pain also is common among patients with cancer, affecting 30-40% of those with pain. Neuropathic pain may be related to tumor involvement of nerves, or may be caused by cancer treatments, including surgery, chemotherapy and radiation.
New answer by RussellPortenoyMD (Physician - Hospice / Palliative Care (Verified))
1
Answer |
10 months ago
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