Pain Management Flashcards
What percentage of cancer patients with early stage disease experience pain?
30-40%
What percentage of cancer patients with advanced stage disease experience pain?
75-90%
What is the difference between nociceptive and neuropathic pain?
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
How might a patient describe neuropathic pain?
Burning, electric shock with associated numbness and tingling
What pain medication would. We be careful about giving to a patient with a history of ischaemia cardiomyopathy?
NSAIDs and amitriptyline
At what weight might we need to consider lowering the paracetamol dose?
<50kg
Generally how do we prescribe analgesia to cancer patients?
We give regular analgesia with PRN doses for break through pain
What is the risk of addiction when using opioids for pain management?
Very low- addiction is rare if its being taken for pain
What are some common side effects of opioids when used for analgesia?
Constipation, dry mouth, sedation/disorientation, N+V
How long do the symptoms of dry mouth and constipation associated with opiates last?
As long as the patient is taking the medication
How long do the symptoms of N+V last when taking opiates?
Should settle in about a week of starting opiates
How long do the sedating effects of opiates last?
Usually settles in a few days of taking the opiates
How common is respiratory depression in patients being prescribed opiates?
Very rare and may be a sign of AKI as they are renally excreted
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?
Dexamethasone is helpful for liver capsule pain (capsule around liver becomes stretched)
What are the three types of analgesia?
Non-opiates, opiates and adjuvants
What would be a helpful way of prescribing PRN pain medication to prevent a patient having to wait for hours for another dose?
E.g PRN 1 hourly/ max 6 PRNs in 24 hours without medical review
What are adjuvant analgesics?
Drugs where their primary indication is not analgesia but they can be used for this purpose
In a cancer patient, what must always be prescribed alongside an NSAID?
PPI
After applying a fentanyl patch, how long does it take to reach a steady state in the body?
12-24 hours
How long will fentanyl say in the body after removing a fentanyl patch?
12-24 hours
How much morphine would be equivalent when converting a patient from 200mg of codeine?
Morphine: codeine = 1:10
20mg morphine: 200mg codeine
A patient who has oramorph PRN 10mg is requiring as a subcutaneous injection. How many mg subcut will be equivalent to their oral PRN?
SC dose: oramorph = 1:2
SC 5mg = oramorph 10mg
Why would we not prescribe ondansetron as an antiemetic in palliative patients generally?
It is quite constipating
