Palliative Care and Cancer Pain Management

Question 1

What is palliative care?

Answer 1

Palliative care: an approach that improves the quality of life of pts and their families facing the problem associated with life0threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual

Question 2

Who might benefit from a palliative care approach?

Answer 2

• any stage of any illness where symptoms are distressing for the patient and family: physical, psychosocial, spiritual
• end of life care - symptoms and distress are common as people are dying: pts, friends, family need support
• provided by a large multidisciplinary team - all working together for the patient and family

Question 3

What is the most common route for cancer pain management?

Answer 3

WHO analgesic ladder

1. mild pain - non-opiods (NSAIDs/paracetamol) with or w/out adjuvent analgesics (nerve pain control)
2. mild to moderate pain - all of step 1. drugs plus an opiod e.g. tramadol, codeine, dihydrocodeine
3. moderate to severe pain - all of step 1, stop step 2 opiod and change for a stronger opiod e.g. morphine, oxycodone, fentanyl, methadone

Question 4

Give examples of non-opiods:

Mild opiods:

Strong opiods:

Adjuvant analgesics:

Answer 4

Non-opiods: paracetamol, NSAIDs (aspirin, ibuprofen, diclofenac, naproxen, etoricoxib, celecoxib)

Mild opiods: codeine, dihydrocodeine, tramadol

Strong opiods: morphine, oxycodone, fentanyl, diamorphine, buprenorphine, methadone

Adjuvant analgesics: tricyclic antodepressants (amitryptyline, nortriptyline), anticonvulsants (gabapentin, pregabalin), serotonin noradrenaline reuptake inhibitors (duloxetine)

Question 5

What is the granny test?

Answer 5

• imagine how you would wish a fellow healthcare professional to approach uour granny

Be open, honest, resectful and kind - as you would with any other patient

Treat people as individuals with choices to make

Don’t make assumptions - ask for their opinion

Make reasonable adjustments for physical and emotional difficulties arising from advanced disease