Pain Management

Question 1

What percentage of cancer patients with early stage disease experience pain?

Answer 1

30-40%

Question 2

What percentage of cancer patients with advanced stage disease experience pain?

Answer 2

75-90%

Question 3

What is the difference between nociceptive and neuropathic pain?

Answer 3

Nociceptive is pain occurring with a stimulus and is transmitted through a normal nervous system
Neuropathic is pain due to damage to the nerves themselves

Question 4

How might a patient describe neuropathic pain?

Answer 4

Burning, electric shock with associated numbness and tingling

Question 5

What pain medication would. We be careful about giving to a patient with a history of ischaemia cardiomyopathy?

Answer 5

NSAIDs and amitriptyline

Question 6

At what weight might we need to consider lowering the paracetamol dose?

Answer 6

<50kg

Question 7

Generally how do we prescribe analgesia to cancer patients?

Answer 7

We give regular analgesia with PRN doses for break through pain

Question 8

What is the risk of addiction when using opioids for pain management?

Answer 8

Very low- addiction is rare if its being taken for pain

Question 9

What are some common side effects of opioids when used for analgesia?

Answer 9

Constipation, dry mouth, sedation/disorientation, N+V

Question 10

How long do the symptoms of dry mouth and constipation associated with opiates last?

Answer 10

As long as the patient is taking the medication

Question 11

How long do the symptoms of N+V last when taking opiates?

Answer 11

Should settle in about a week of starting opiates

Question 12

How long do the sedating effects of opiates last?

Answer 12

Usually settles in a few days of taking the opiates

Question 13

How common is respiratory depression in patients being prescribed opiates?

Answer 13

Very rare and may be a sign of AKI as they are renally excreted

Question 14

What medication is helpful in managing the pain of a patient with metastatic melanoma with liver metastases who is complaining of RUQ pain and has tender hepatomegaly?

Answer 14

Dexamethasone is helpful for liver capsule pain (capsule around liver becomes stretched)

Question 15

What are the three types of analgesia?

Answer 15

Non-opiates, opiates and adjuvants

Question 16

What would be a helpful way of prescribing PRN pain medication to prevent a patient having to wait for hours for another dose?

Answer 16

E.g PRN 1 hourly/ max 6 PRNs in 24 hours without medical review

Question 17

What are adjuvant analgesics?

Answer 17

Drugs where their primary indication is not analgesia but they can be used for this purpose

Question 18

In a cancer patient, what must always be prescribed alongside an NSAID?

Answer 18

PPI

Question 19

After applying a fentanyl patch, how long does it take to reach a steady state in the body?

Answer 19

12-24 hours

Question 20

How long will fentanyl say in the body after removing a fentanyl patch?

Answer 20

12-24 hours

Question 21

How much morphine would be equivalent when converting a patient from 200mg of codeine?

Answer 21

Morphine: codeine = 1:10
20mg morphine: 200mg codeine

Question 22

A patient who has oramorph PRN 10mg is requiring as a subcutaneous injection. How many mg subcut will be equivalent to their oral PRN?

Answer 22

SC dose: oramorph = 1:2
SC 5mg = oramorph 10mg

Question 23

Why would we not prescribe ondansetron as an antiemetic in palliative patients generally?

Answer 23

It is quite constipating