Pain in Palliative Care: Assessment

Question 1

aims to relieve suffering and improve quality of living and dying in those pts diagnosed with progressive incurable illness

Answer 1

palliative care

Question 2

which of the following is false about palliative care?
1. it addresses physical,. psych, social, and spiritual needs
2. it is End of life care
3. it improves QoL, mood ,and survival compared to standard care pts
4. it can prevent unnecessary or overaggressive tx at EOL

Answer 2

2- at any point of a life limiting disease

Question 3

when should palliative care be offered?

Answer 3

if pt is expected to die in next 12 mths or if pt is symptomatic (even if not dead in 12mths)

Question 4

Who requires palliative care?

Answer 4

Cancer pts
Noncancer pts: ESRD, COPD, PF, PD, MS, ALS, ESLD, AIDs, Alzheimers, pediatrics MD

Question 5

the biggest component of palliative care is

Answer 5

communication

Question 6

Consult service are for levels

Answer 6

R1-C2

Question 7

TPCU stands for

Answer 7

tertiary palliative care unit

Question 8

TPCU are for levels

Answer 8

M1-C2

Question 9

hospice is for levels

Answer 9

C1-C2`

Question 10

EOL care is for levels

Answer 10

C2

Question 11

list 3 palliative care providers

Answer 11

Family physicians in community- is a mandatory rotation n family medicine residency program at the UoA
Hospital doctors and specialists- is an elective for med students/ other residency programs (oncology, cardio, neuro, GI, ID, pulmonology, nephro, surgery, emerg, anesthesia, geriatrics, psych)
Community consult team (PEOLC)
Palliative specialists and residents
Pharmacists in both institutional and community settings
Nurses and allied professionals in community and hospital (OT, pT, etc)
Chaplains, social workers, music therapists, psychologists, psychiatrists
Family, friends, pets, volunteers

Question 12

paliative care is a mandatory rotation in

Answer 12

family medicine residency program at UoA

Question 13

___% pts with advanced cancer experience pain-___% rate their pain as mod-severe

Answer 13

85%
67%

Question 14

what pts are more likely to experience neuropathic pain?

Answer 14

cancer, AIDs,MND

Question 15

T or F: 85% of pain in palliative pop can be controlled

Answer 15

T

Question 16

causes of pain n palliative pts

Answer 16

terminal illnesses like cancer
preexisting pain conditions like fibromyalgia, DM

Question 17

what are some direct causes of pain from cancer

Answer 17

invasion of tissues, organs, bones = nociceptive somatic or visceral pain
invasion of nerves = neuropathic pain
paraneoplastic phenomena, altered nerve conduction

Question 18

invasion of tissues, organs, bones causes ____ pain

Answer 18

nociceptive

Question 19

Invasion of nerves causes ____ pain

Answer 19

neuropathic

Question 20

what are some indirect causes of cancer pain

Answer 20

constipation, obstruction, fissures

Question 21

what are some treatment causes of cancer pain

Answer 21

chemo (neuropathies), radiation (burns, pain flare), surgical complications (infections wounds, phantom pain)

Question 22

what are some family/ pt barriers to good pain control

Answer 22

Opioids (addictions/ SEs/ loss of efficacy over time)
Stoicism, Fear that complaining will annoy caregivers
Financial concerns
Cognitive impairment
Lack of compliance

Question 23

what are some HCP barriers to good pain control

Answer 23

Skills required
Fear of addictions + reprimand
Failure to recognize multidimensionality of pain
Underestimating extent of pain

Question 24

what is total pain

Answer 24

pain experience originates from a number of sources including physical, social, psychological, and/or spiritual domains = must assess all domains + classify to treat appropriately

Question 25

what PPS % are the majority of palliative pts at

Answer 25

20-30, 40% if early palliative care

Question 26

what is the ESASr

Answer 26

9+ sx rating on numerical rating scale of 0-10

Question 27

the more white the ESASr graph, the ____ the functioning

Answer 27

better

Question 28

why is the ESASr graphed?

Answer 28

to visualize how sx are improving/ worsening over time

Question 29

what are the 4 questions of CAGE?

Answer 29

Cut down on drinking
Annoyed you by criticizing drinking?
Guilty about drinking
Need a drink first thing in the morning as an Eyeopener?
Score >2/4 = + CAGE

Question 30

name some tests for cognition

Answer 30

Folstein’s mini mental state exam
Confusion assessment method (CAM)
mini-Cog (clock drawing and memory)
Blessed orientation memory concentration est (BOMC)
MOCA (executive fxn)- unable to use rn = use SLUMS as alt

Question 31

what is the ECS-CP

Answer 31

Edmonton classification system for cancer pain

Question 32

how does the ECS-CP report pain

Answer 32

mech of pain
incidence of pain
psych distress
addictive behaviour
cognitive function

Question 33

Nc=

Answer 33

nociceptive pain

Question 34

Ne =

Answer 34

neuropathic pain

Question 35

Nx =

Answer 35

unable to classify

Question 36

Io =

Answer 36

no incident pain

Question 37

Ii

Answer 37

incident pain

Question 38

Ix

Answer 38

unable to classify

Question 39

Po =

Answer 39

no PD

Question 40

Pp

Answer 40

PD present

Question 41

Px

Answer 41

unable to classify

Question 42

Ao=

Answer 42

no addictive behaviour

Question 43

Aa

Answer 43

addictive behaviour present

Question 44

Ax

Answer 44

unable to classify addictive behaviour

Question 45

what is Co

Answer 45

no cog problems

Question 46

Ci is

Answer 46

partial cog fxn impairment

Question 47

Cu is

Answer 47

total cog fx impairment

Question 48

Cx is

Answer 48

unable to classify cog impairment

Question 49

what does NcIiPxAaCi mean

Answer 49

nociceptive pain
incident pain
unable to classify psyc distress
addictive behaviours present
partial cog fxn impairment