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

Case report


  • Regina Astari Tjoegito Udayana University, Denpasar, Indonesia/Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar, Indonesia
  • Ida Aju Kusuma Wardani Udayana University, Denpasar, Indonesia/Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar, Indonesia


acute lymphoblastic leukemia (ALL), pain, relaxation, supportive psychotherapy


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.


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American Cancer Society. (2019). Cancer in children. From: child ren-cancer

Balliot, J., Morgan, M., & Cherven, B. (2019, December). Caring for the pediatric, adolescent, or young adult patient with acute lymphoblastic leukemia. In Seminars in Oncology Nursing (Vol. 35, No. 6, p. 150956). WB Saunders.

Bassan, R., Gatta, G., Tondini, C., & Willemze, R. (2004). Adult acute lymphoblastic leukaemia. Critical reviews in oncology/hematology, 50(3), 223-261.

Ducore, J. M., Waller, D. A., Emslie, G., & Bertolone, S. J. (1983). Acute psychosis complicating induction therapy for acute lymphoblastic leukemia. The Journal of pediatrics, 103(3), 477-480.

Gökbuget, N., & Hoelzer, D. (2009, January). Treatment of adult acute lymphoblastic leukemia. In Seminars in hematology (Vol. 46, No. 1, pp. 64-75). WB Saunders.

Herman, H., Ardani, I. G. A. I., Aryani, L. N. A., Windiani, I. G. A. T., Adnyana, I. G. N. S., & Setiawati, Y. (2022). Signs and symptoms of depression in children and adolescents with type 1 diabetes mellitus: A case report. International Journal of Health and Medical Sciences, 5(1), 150-153.

Hoffbrand, A. V., Moss, P. A. H. & Pettit, J. E. (2017). Essential Haematology. 5th. Asia: Blackwell Publishing. pg. 129-181

Howard, S. C., & Pui, C. H. (2002). Endocrine complications in pediatric patients with acute lymphoblastic leukemia. Blood Reviews, 16(4), 225-243.

Indonesian Ministry of Health (1993). Guidelines for the Classification and Diagnosis of Mental Disorders in Indonesia (PPDGJ) III. III. Directorate General of Medical Services Ministry of Health., editor. Department of Health

Jabbour, E. J., Faderl, S., & Kantarjian, H. M. (2005, November). Adult acute lymphoblastic leukemia. In Mayo Clinic Proceedings (Vol. 80, No. 11, pp. 1517-1527). Elsevier.

Kozier, B., Erb, G., Berman, A., & Snyder, S. J. (2010). Buku ajar fundamental keperawatan: konsep, proses, dan praktik. jakarta: EGC.

Kozlowska, K., & Khan, R. (2018). A developmental, body-oriented intervention for children and adolescents with medically unexplained chronic pain. Clinical Child Psychology and Psychiatry, 16(4), 575–598

Mustika, I. W., Candra, I. W., & SC, N. Y. (2017). The Relationship between the Level of Spiritual and Self-Esteem on Depression towards Patients with Diabetes Mellitus. International Research Journal of Engineering, IT and Scientific Research, 2(7), 125-133.

Paul, S., Kantarjian, H., & Jabbour, E. J. (2016, November). Adult acute lymphoblastic leukemia. In Mayo Clinic Proceedings (Vol. 91, No. 11, pp. 1645-1666). Elsevier.

Perry, A. G., & Potter, P. A. (2010). Mosby's Pocket Guide to Nursing Skills and Procedures-E-Book. Elsevier Health Sciences.

Pieters, R., & Carroll, W. L. (2008). Biology and treatment of acute lymphoblastic leukemia. Pediatric Clinics of North America, 55(1), 1-20.

Plasschaert, S. L., Kamps, W. A., Vellenga, E., de Vries, E. G., & de Bont, E. S. (2004). Prognosis in childhood and adult acute lymphoblastic leukaemia: a question of maturation?. Cancer treatment reviews, 30(1), 37-51.

Preti, H. A., O'Brien, S., Giralt, S., Beran, M., Pierce, S., & Kantarjian, H. M. (1994). Philadelphia-chromosome-positive adult acute lymphocytic leukemia: characteristics, treatment results, and prognosis in 41 patients. The American journal of medicine, 97(1), 60-65.

Ristiyanto, E., & Hartoyo, M. (2016). Efektivitas Terapi Relaksasi Slow Deep Breathing (Sdb) Dan Relaksasi Benson Terhadap Penurunan Intensitas Nyeri Pasien Kanker Di Rs Tugurejo Semarang. Karya Ilmiah.

Sari, F. Y. (2019). Analysis Of Implementation of Nursing Process Related to Pain Management with Patient Satisfaction In Tanjungpura University Hospital. Nursing Journal Vol.8, 2

Songer, D. (2005). Psychotherapeutic approaches in the treatment of pain. Psychiatry (Edgmont), 2(5), 19.

Vargas-Schaffer, G., & Cogan, J. (2014). Patient therapeutic education: placing the patient at the centre of the WHO analgesic ladder. Canadian Family Physician, 60(3), 235-241.

World Health Organization. WHO. (2018). International Agency for Research on Cancer.



How to Cite

Tjoegito, R. A., & Wardani, I. A. K. (2023). Pharmacological and psychotherapy pain management in adult acute lymphoblastic leukemia (ALL) with depressive organic disorder patient: Case report. International Journal of Health & Medical Sciences, 6(3), 158-163.