Cancer pain

Question 1

How would bone pain in cancer present and be treated?

Answer 1

• dull ache over a large area

- treated with NSAIDs, radiotherapy and bisphosphonates (e.g. pamidronate infusion

Question 2

Features and treatment of visceral pain?

Answer 2

• Dull, deep seated poorly localised pain
• some can be spasmodic (bladder spasms/ bowel colic)
• dull pain:
  analgesic ladder
• visceral stretch pain: (liver capsule etc) NSAIDs/ corticosteroids
• colic pain:
  anticholinergics such as subcut hyoscine butylbromide
• bladder spasms:
  oral oxybutynin

Question 3

treatment of headache due to raised ICP?

Answer 3

• corticosteroids (16mg dexamethasone)
• NSAIDs
• paracetamol

Question 4

features and treatment of neuropathic pain?

Answer 4

• pain in area of abnormal sensation
• localised to dermatomes
• pins and needles/ burning
• antidepressants (amitriptyline (10-75 mg))
• anticonvulsants
  ( gabapentin 100- 1200mg/ pregabalin) compression of a nerve may be helped by corticosteroids

Question 5

what are strong opioids side effects?

Answer 5

• constipation
• n and v occur in 1/3 patients (prescribe anti-emetic)
• drowsiness
• confusion/ visual hallucinations
• respiratory depression

Question 6

what other medications should be prescribed to combat the side effects of morphine?

Answer 6

• co-danthramer (laxative)

- haloperidol/ anti-emetic

Question 7

why might a patient have prolonged side effects?

Answer 7

• renal impairment

Question 8

how long does immediate release morphine take to work and last? how long does slow release morphine last?

Answer 8

• immediate release tablets take 20-30 minutes and lasts 4 hours
• slow release tablets (zomorph/ MST) are 12 hourly

Question 9

what is the usual starting dose of MST when up- titrating from co-codamol?

when would patients possibly require lower doses?

Answer 9

• 20 mg BD

- elderly or renal impaired

Question 10

• how would a patient on 30mg oral morphine BD be changed to SC infusion of morphine?

Answer 10

• 20mg SC diamorphine over 24 hours

- morphine sulphate would be 30mg as only 2x as potent

Question 11

how long does a fentanyl patch last?

Answer 11

• 72 hours

Question 12

What is a good second line opioid if morphine not tolerated?

Answer 12

• oxycodone (can be given immediate release oxynorm or slow release oxycontin)