Pain Management at the End of Life - Lauer

Question 1

What does the mnemonic LOCATES stand for?

Answer 1

• L: Location of the pain and radiation
• O: Other associated symptoms (nausea, numbness)
• C: Character of the pain (sharp, dull, throbbing)
• A: Aggravating and alleviating factors
• T: Timing, duration, pattern
• E: Environment where the pain occurs
• S: Severity of the pain (0-10)

Question 2

What does the extended pain evaluation mnemonic PAPA stand for?

Answer 2

• P: Past history with pain and medications
• A: Allergies to medications
• P: Preconceived notions
• A: Anticipated course

Question 3

What is the best way to treat pain?

Answer 3

• Use long-acting pain med for baseline pain
• Use short-acting for breakthrough pain

Question 4

What is “The Pain Code” in End of Life care?

Answer 4

• —Pain is an emergency
• —Get them comfortable as fast as safely possible
• —Don’t “walk away” from a patient until they are comfortable
  
  • (keep them in the back of your mind)

Question 5

How can you tell if your patient is not overdosed?

Answer 5

If your patient is awake and talking to you they are not overdosed.

Question 6

What is incomplete cross-tolerance?

Answer 6

• Get tolerant to Morphine (given in surgery)
  
  • Do not get tolerance to Dilaudid
  • So you cut the dose in half when switching to Dilaudid

Question 7

What are the four provider concerns with Methadone?

Answer 7

• Stigma in community
  
  • given to heroin addicts in recovery
• Abuse potential
• Difficult to dose
  
  • can be crushed, IV form, consistant long-acting pain control
• Long QT syndrome

Question 8

How do you dose Methadone?

Answer 8

• Do no use conversion calculators
  
  • inaccurate
• Very long half-life
  
  • slow on, slow off (t_1/2 = four days)
• START LOW. GO SLOW.
  
  • be cautious