Pain management

Question 1

what is pain

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

what percent of cancer patient at end of life have pain

Answer 2

54%
60-65% related to direct tumor
20-25% related to cancer treatment
10-15% unrelated to cancer

Question 3

current status of pain

Answer 3

• Less research conducted in other chronic illness
• Inadequate pain relief hastens death
• Pain relief is essential at end of life
• Within scope of nursing practice and standards of care

Question 4

barriers to pain relief?

Answer 4

Professionals
Health care systems
Risk Evaluation and Mitigation Strategy (REMS)
Patients/families

Question 5

Clinical Practice Guidelines for Quality Palliative Care: Issue of Pain

Answer 5

• Consider Culture
• Educate the family/caregiver
• Address suffering
• Refer to providers with specialized skill
• Interdisciplinary Care
• Assessment should be regular and on-going
• Pain level should be acceptable to patient and family
• Document response
• Identify and address barriers
• For controlled substances, implement a risk management plan

Question 6

goal in assessing and managing pain?

Answer 6

Providing adequate pain and symptom control
Decrease distress caused by pain in the patient and family
Provide an acceptable sense of control
Relieve caregiver burden
Strengthen relationships
Optimize QOL
Enhance meaning of life and illness, providing personal growth

Question 7

pain va suffering at the end of life

Answer 7

Existential distress
Dimensions of QOL
Requires interdisciplinary approach

Question 8

patients at risk for under treatment

Answer 8

Children and older adults
Non-verbal or cognitively impaired
Patients who deny pain
Non-English speaking
Different cultures
History of addictive disease

Question 9

Max, 37 year old male with metastatic colorectal cancer
Iraqi War Veteran- lost his leg in combat
Married with 2 children
Oncologist is anxious to start chemotherapy
No discussion by the surgeon or oncologist about “goals of care”

Answer 9

Issues Related to Pain
Incisonal pain poorly managed
Stump phantom pain has never been addressed
Patient is afraid of “narcotics” and becoming addicted
Wife is afraid he will become tolerant of drugs
Surgeon is sending him home with oxycodone and lorazepam