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Palliative > Pain And Suffering > Flashcards

Pain And Suffering Flashcards

1
Q

Suffering

A
  • 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
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2
Q

How to respond to suffering

A
  • never assume you know the cause
  • be present
  • uncover meaning, sources of strength, purpose
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3
Q

Common symptoms

A
  • pain
  • fatigue
  • constipation
  • nausea
  • vomiting
  • delirium
  • depression/ suffering
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4
Q

Barriers to pain control: patients and family

A
  • 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
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5
Q

Barriers to pain control: HCP

A
  • inadequate assessment
  • lack of patient education
  • improper dosing
  • side effects of analgesic
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6
Q

Pain

A
  • unpleasant sensory and emotional experience r/t actual or potential tissue damage
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7
Q

Assessment of pain: subjective and objective

A
  • moaning
  • grimacing
  • vocal
  • sweating
  • ⬆ HR and BP
  • fast breathing
  • guarding
  • clutching
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8
Q

Acute pain

A
  • sudden

- plus all of the symptoms

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9
Q

Chronic pain

A
  • sometimes unnoticed
  • accompanied by depression
    “Flat affect”
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10
Q

Pain assessment

A 
P- palliating/ provoking factors
Q- quality 
R- radiate/ rate
S- severity/ site/ symptoms
T- timing/ tolerance
U- understanding
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11
Q

Types of pain

A
  • nociceptive
  • somatic
  • visceral
  • neuropathic
  • dyesthetic
  • neuralgic
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12
Q

Somatic pain

A
  • may be dull or sharp
  • worse with movement
  • aching, often constant
  • well localized
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13
Q

Visceral pain

A
  • organs
  • constant or cramping
  • poorly localized
  • aching, deep
  • *often associated with autonomic symptoms
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14
Q

Dyesthetic pain

A
  • burning/ tingling
  • PVD, peripheral neuropathy
  • constant, radiates
    E.g. Shingles
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15
Q

Neuralgic pain

A
  • shooting/ stabbing
  • shock-like
  • paroxysmal or great waves
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16
Q

Total pain

A
  • psychosocial/ spiritual
  • overwhelmed feeling
  • cant accurately describe the pain
  • pain as “all over”
  • ⬆ dose of analgesia produce toxicity or little relief
  • improve with socialization
17
Q

Opioids

A

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

1) codeine
2) oxycodone
3) percocet

18
Q

Dysthesia

  • hyperalgesia
  • allodynia
A

Dysthesia- unpleasant abnormal sensation whether spontaneous or evoked

Hyperalgesia- exaggerated response to stimulus causing normal pain

Allodynia- pain to not normally painful stimuli

19
Q

Breakthrough pain

A

Intermittent flare of pain

Breaks through baseline analgesia

20
Q

Incidental pain

A
  • severe transitory increase in pain
  • caused by moving, coughing, BM, positioning, wound dressing
  • bone mets
21
Q

Adjuvants

A
  • 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
22
Q

Transdermal patch

A
  • takes effect 12-24 hours

- remains til 16 hours even after removal

23
Q

Ideal agent for BT pain

A
  • short acting
  • early peak
  • rapid onset
  • short duration
  • Potent, pure opioid agonist
  • easily administered
  • SL routes
24
Q

Incident pain

  • barriers
  • approach
A

Barriers:

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

Approach

  • treat underlying cause
  • same as BT pain ideal agents
25
Q

Meds for incident pain

A

Fentanyl (100x morphine) and Sufentanyl (1000x morphine)

-mucosal absorption: intranasal and SL

26
Q

Bone Pain

A

NSAIDS, opioids, corticosterioid, biphosphonates

Radiation tx:

  • single or multiple
  • effective immediately, for 4-6 weeks
27
Q

Neuropathic pain mgmt:

A

Opioids, TCA, anticonvulsant, steroids, NMDAs (methadone, dextromethasone, ketamine), anesthetic

Radiation tx

Interventional tx:

  • nerve block
  • spinal analgesia
28
Q

Alternative therapies for pain

A
  • acupuncture
  • guided imagery
  • relaxation technique/ meditation
  • cognitive/behavioural therapy
  • herbal
  • magnets
  • therapeutic massage
29
Q

Common side effects of opioid

A
  • constipation
  • nausea/vomiting
  • xerostomia
  • somnolence

Less common:

  • delirium/ seizures/ hallucinations
  • retention
  • pruritus

Rare:
-respiratory depression

30
Q

Opioid Induced Neurotoxicity (OIC)

A

Symptoms:

  • myoclonus
  • hyperalgesia/ allodynia
  • delirium
  • rapidly ⬆ dose req.
  • pain doesn’t make sense
31
Q

OIC treatment

A
  • benzodiazepines for myoclonus
  • switch opioids or ⬇ dose
  • hydration
32
Q

Tolerance

A

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

33
Q

Physical Dependence

A

Normal response to chronic admin of opioid

Withdrawal symptoms: yawning, ⬆HR, sweating, insomnia, cramps, dilated pupil

-⬇ dose 20-30% /day

34
Q

Addiction

A

Psychological Dependence

Drug-seeking behaviour

CAGE questionnare

Palliative (4 decks)

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