Managing complex pain

Question 1

Effective pain relief can be achieved in 80% by adhering to five simple guidelines;

By the ?: give ? where possible.
By the ?: give at ? ? for continuous relief.
By the ?: following the WHO pain ?.
For the ?: there are no ? opiate dosages.
With attention to detail: patient ? is very important with regard to ?, ? and side-effects.

Answer 1

mouth
oral
clock
fixed intervals
ladder
ladder
individual
standard
education
dosage
timing

Question 2

Strong Opioids;

5-?mg/?h oromorph with, ?p.r.n. breakthrough dose is a good start.
? doses at night can help patients to ?.
Increase the doses by ?% if pain is controlled but does not last ? hours.

Answer 2

10
4h
equal
double
sleep
50
4

Question 3

Strong Opioids;

Once the patients 24h requirement has been established, the prescription
can be changed to a ??preparation, with 1/?th
of the ? dose as a breakthrough dose.
o E.g. ?, with ? for breakthrough pain.

Answer 3

MR
1/6
daily
zomorph
oramorph

Question 4

Strong Opioids;

If the patient cannot tolerate the oral route, ? ? may be used, or ? patches.
o Fentanyl patches should only be started under ? ?.

Answer 4

sc diamorphine
fentanyl
specialist supervision

Question 5

If the pain is not responsive to opioids, adjuvants may be used;

SSRls if associated with ?.
? ?(for tension-type pain or spasticity)
Amitriptyline / ? for ? pain.

Answer 5

depression
m relaxants
gabapentin
neuropathic

Question 6

N&V;
? covers most causes, then ?etc.

Constipation;
- As per opioid induced constipation; ? plus ?.

Breathlessness;
?, supplementary ?.

Answer 6

cyclizine
metoclopramide
senna plus lactulose
morphine
O2

Question 7

Pruritis;
?, ? in Jaundice.

Secretions;
? ?

Agitation;
?.

Answer 7

chloramphenamine
cholestyramine
hyoscine butyl/hydro-bromide
midazolam