Pain And Suffering

Question 1

Suffering

Answer 1

• severe distress that is highly personal, individual, and subjective
• from actual or potential threat
• invokes sadness, hopelessness, isolation, despair, worry
• multidimensional: from physical, social, psychological, spiritual and existential dimensions
• “voiceless” or not being heard

Question 2

How to respond to suffering

Answer 2

• never assume you know the cause
• be present
• uncover meaning, sources of strength, purpose

Question 3

Common symptoms

Answer 3

• pain
• fatigue
• constipation
• nausea
• vomiting
• delirium
• depression/ suffering

Question 4

Barriers to pain control: patients and family

Answer 4

• don’t understand medications
• don’t understand how med are to be taken effectively
• think pain is a necessary part of cancer
• stigma around drug use: “moral failure” to use opioids
• side effects of analgesia
• geo and access
• ⬇ LOC

Question 5

Barriers to pain control: HCP

Answer 5

• inadequate assessment
• lack of patient education
• improper dosing
• side effects of analgesic

Question 6

Pain

Answer 6

• unpleasant sensory and emotional experience r/t actual or potential tissue damage

Question 7

Assessment of pain: subjective and objective

Answer 7

• moaning
• grimacing
• vocal
• sweating
• ⬆ HR and BP
• fast breathing
• guarding
• clutching

Question 8

Acute pain

Answer 8

• sudden

- plus all of the symptoms

Question 9

Chronic pain

Answer 9

• sometimes unnoticed
• accompanied by depression
  “Flat affect”

Question 10

Pain assessment

Answer 10

P- palliating/ provoking factors
Q- quality 
R- radiate/ rate
S- severity/ site/ symptoms
T- timing/ tolerance
U- understanding

Question 11

Types of pain

Answer 11

• nociceptive
• somatic
• visceral
• neuropathic
• dyesthetic
• neuralgic

Question 12

Somatic pain

Answer 12

• may be dull or sharp
• worse with movement
• aching, often constant
• well localized

Question 13

Visceral pain

Answer 13

• organs
• constant or cramping
• poorly localized
• aching, deep
• *often associated with autonomic symptoms

Question 14

Dyesthetic pain

Answer 14

• burning/ tingling
• PVD, peripheral neuropathy
• constant, radiates
  E.g. Shingles

Question 15

Neuralgic pain

Answer 15

• shooting/ stabbing
• shock-like
• paroxysmal or great waves

Question 16

Total pain

Answer 16

• psychosocial/ spiritual
• overwhelmed feeling
• cant accurately describe the pain
• pain as “all over”
• ⬆ dose of analgesia produce toxicity or little relief
• improve with socialization

Question 17

Opioids

Answer 17

1) Morphine
2) Dilaudid
3) transdermal Fentanyl
4) Sufentanyl
5) Methadone

1) codeine
2) oxycodone
3) percocet

Question 18

Dysthesia

• hyperalgesia
• allodynia

Answer 18

Dysthesia- unpleasant abnormal sensation whether spontaneous or evoked

Hyperalgesia- exaggerated response to stimulus causing normal pain

Allodynia- pain to not normally painful stimuli

Question 19

Breakthrough pain

Answer 19

Intermittent flare of pain

Breaks through baseline analgesia

Question 20

Incidental pain

Answer 20

• severe transitory increase in pain
• caused by moving, coughing, BM, positioning, wound dressing
• bone mets

Question 21

Adjuvants

Answer 21

• NSAIDS- best combined with opioid for bone and muscle pain
• anticonvulsant- better than TCA for neuralgic
• TCA- nerve/neuralgic pain/ makes u drowsy
• corticosteroids- ⬇inflammation
• radiation- shrink tumor size
• biphosphonates- resorption of Calcium
• chemo agents

Question 22

Transdermal patch

Answer 22

• takes effect 12-24 hours

- remains til 16 hours even after removal

Question 23

Ideal agent for BT pain

Answer 23

• short acting
• early peak
• rapid onset
• short duration
• Potent, pure opioid agonist
• easily administered
• SL routes

Question 24

Incident pain

• barriers
• approach

Answer 24

Barriers:

• takes time for effective pre med
• little warning of incident

Approach

• treat underlying cause
• same as BT pain ideal agents

Question 25

Meds for incident pain

Answer 25

Fentanyl (100x morphine) and Sufentanyl (1000x morphine) -mucosal absorption: intranasal and SL

Question 26

Bone Pain

Answer 26

NSAIDS, opioids, corticosterioid, biphosphonates Radiation tx: - single or multiple - effective immediately, for 4-6 weeks

Question 27

Neuropathic pain mgmt:

Answer 27

Opioids, TCA, anticonvulsant, steroids, NMDAs (methadone, dextromethasone, ketamine), anesthetic Radiation tx Interventional tx: - nerve block - spinal analgesia

Question 28

Alternative therapies for pain

Answer 28

- acupuncture - guided imagery - relaxation technique/ meditation - cognitive/behavioural therapy - herbal - magnets - therapeutic massage

Question 29

Common side effects of opioid

Answer 29

- constipation - nausea/vomiting - xerostomia - somnolence Less common: - delirium/ seizures/ hallucinations - retention - pruritus Rare: -respiratory depression

Question 30

Opioid Induced Neurotoxicity (OIC)

Answer 30

Symptoms: - myoclonus - hyperalgesia/ allodynia - delirium - rapidly ⬆ dose req. - pain doesn't make sense

Question 31

OIC treatment

Answer 31

- benzodiazepines for myoclonus - switch opioids or ⬇ dose - hydration

Question 32

Tolerance

Answer 32

Reduced potency due to repeated administration of opioids, ⬆ dose to produce pain relief

Question 33

Physical Dependence

Answer 33

Normal response to chronic admin of opioid Withdrawal symptoms: yawning, ⬆HR, sweating, insomnia, cramps, dilated pupil -⬇ dose 20-30% /day

Question 34

Addiction

Answer 34

Psychological Dependence Drug-seeking behaviour CAGE questionnare