Pain Management

Question 1

How can the three stage model explain pain patterns in EOL care?

Answer 1

1. they face the threat of death
2. there’s a universal depression once they know the disease will cause death
3. they develop coping mechanisms and accept imminent death

pain occurs in 2

Question 2

In what way should treatment be matched to pain?

Answer 2

match it to timing, duration and pattern

you don’t want to overtreat it!

Question 3

Describe the WHO pain ladder.

Answer 3

1. start with non opioid
2. add an adjuvant specific to type of pain
3. add opioid

after that - increase the opioid

Question 4

What sort of drug administration should you start with?

Answer 4

enteral! if the gut workse, use it

oral, buccal, sublingual, rectal

Question 5

Describe the “pain code”

Answer 5

treat pain as an emergency
get the patient comfortable as fast as safely possible
don’t “walk away” from a patient untilt hey’re comfortable

Question 6

typical dosing of drugs is based on what?

Answer 6

half life

Question 7

Describe dosing by maximum blood concentration

Answer 7

if the first dose doesn’t work, you redose at the PEAK of the pain control and keep doing that until you get up to the optimum blood concentration - after that you can space out doses

Question 8

What’s the equivalent dosing between morphine IV and morphine oral?

Answer 8

3x

Question 9

What’s the equivalent dosing between hydromorphone oral and morphine oral?

Answer 9

mutliply the hydromorphone by 4 for the morphine oral

Question 10

What’s the equivalent dosing between hydromophone IV and hydromorphon oral?

Answer 10

multiple IV by 5

Question 11

What are the concenrs about methadone?

Answer 11

stigma in community
abuse poential
difficult to dose
long QT syndrome

Question 12

Why should you never use a dose converter to dose methadone?

Answer 12

because it’s not linear - it will have different effects at different concentrations

Question 13

How does methadone differ from other opiates in terms of kinetics?

Answer 13

very long half life, so slow on, slow off (four days)

Question 14

At what dose of methadone should you check and EKG?

Answer 14

30 mg

Question 15

What are the side effects of the opiates?

Answer 15

constipation
nausea
delirium
myoclonus
urinary retention
itching
hyperalgesia

Question 16

What are the 6 commandments of pain treatment?

Answer 16

1. think about total pain
2. treat pain as an emergency
3. continuous pain should be treated continuously
4. plan for unexpected with breathrough
5. keep it simple
6. have a bowel regimen