Pharmacological and psychotherapy pain management in adult acute lymphoblastic leukemia (ALL) with depressive organic disorder patient

Background: Acute Lymphoblastic Leukemia (ALL) or also called Acute Lymphocytic Leukemia is a cancer of the blood and bone marrow. ALL is strongly related to pain due to the nature of the disease where leucocyte cells infiltrate organs causing pain, and also due to some of its treatments which can cause pain as a side effect. Case report: A female patient, aged 45 years, consulted the Consultation-Liaison Psychiatry, sub-Palliative Department with a complaint of pain. The patient felt severe pain, intermittent but kept getting worse over time, with VAS of 7-8 causing her to feel weak and have difficulty sleeping, with a history of Paracetamol and Codeine as analgetic. When the pain peaked, the patient felt weak and sometimes crying for no reason. She became more emotional since her illness and she’s not an emotional person before. Patients also tend to get tired and lost enthusiasm in doing activities. Patient with anankastic personality character, acting out, and sublimation defense mechanism, was diagnosed with Organic Depressive Disorder (F06.32); ALL ECOG2, mild anemia, suspect CAD with differential diagnosis of ischemic due to supply & demand mismatch (anteroseptal ischemia), uterine mass et causa suspected leukemic infiltration with differential diagnosis of uterine myoma.