Pain management in cancer Flashcards
In what percentage of cancer patients in pain present?
In 20-50% at diagnosis
In up to 75% with advanced disease
However, pain can be completely relieved in 80-90% using WHO guidelines
Goal of therapy = complete pain relief
What are the general principles of pain management?
EEMMA
Evaluation Explanation Mx Monitoring Attention to detail
What is involved in the evaluation step of pain management?
Diagnosis of cause. of symptom based on:
history: PQRST
- Palliative factors
- Provocative factors
- Quality
- Radiation
- Severity
- Temporal factors
examination
ix
Use pain chart
What is involved in the explanation step of pain management?
Explain underlying mechanism of pain and treatment options
Give patients choice where possible
What is involved in the mx step of pain management?
keep treatment as simple as poss give clearly written guidelines consider non-drug and drug treatments seek help if situ doesn't improve never say 'theres nothing more we can do'
What is involved in the monitoring step of pain management?
R/v often
Monitor response to treatment
Undesirable effects
Development of new symptoms
What is involved in the attention to detail step of pain management?
do not assume things
continually ask why
What is the definition of pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
What can pain be modulated by?
Patients mood, morale and the meaning of the pain for the patient
What factors affect the pain threshold?
Lowered = insomnia, fatigue, anxiety, fear, anger, depression, isolation
Raised = sleep, understanding, relaxation, companionship, analgesics, anxiolytics, antidepressants
What are the different types of pain?
Nociceptive - caused by stimulation of nerve endings. Responds to opioids
Neuropathic - caused by nerve compression or destruction. Described as burning, tingling or shooting. Less likely to respond to opioids
‘Total pain’
Looking at physical, psychological, social and spiritual contributors to pain in the patients life
What are the different options for pain management?
- modification of pathological process (chemo, radio, hormone therapy, surgery)
- analgesics (opioid, non-opioid, adjuvant)
- non-drug methods
- > physical (massage, heat, TENS)
- > psychological (relaxation, CBT)
- Interruption of pain pathways (local anaesthesia, neurolysis, neurosurgery)
- modification of way of life (aids for daily living, OT/ physio involvement)
It is useful to aim at graded pain relief, eg:…
- pain free at night
- pain free at rest
- pain free on movement
