0511 - Principles of Pain Management in Cancer

Question 1

What are the common causes of pain in cancer?

Answer 1

Tumour - 80%
Treatment - 15%
Not-tumour related 5%

Question 2

What are the aspects of pain that need to be managed?

Answer 2

Physical aspects - cancer pain, somatic symptoms
Psychological - Frustrations, depression, anxiety
Social - Financial, place in family, job loss
Spiritual - Meaning of disease, life

Question 3

What are the possible treatment principles for pain management?

Answer 3

By the clock - Give them regularly, and treat breakthrough pain as required.
By the easiest way - Give by mouth/transdermal
By the ladder - Give them according to pain intensity/up the opioids on the analgesic ladder as required/conditioned.
For individual patient - Adapted to organ function/co-morbidity/age. Need to monitor and be aware of side effects.

Question 4

Briefly outline the WHO pain ladder

Answer 4

Mild/moderate - Give non-opioids, paracetamol, NSAIDs, Aspirin
Moderate/severe - Give mild opioids (e.g. codeine) with or without non-opioids
Severe - Strong opioids (e.g. morphine), with or without non-opioids