total pain Flashcards
If patient is Fully active, able to carry on all predisease performance without restriction, what is his/her ECOG score?
0
If patient is Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work, what is his/her ECOG score?
1
If patient is Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking, what is his/her ECOG score?
2
If patient is Capable of only limited self-care; confined to bed or chair more than 50% of waking hours, what is his/her ECOG score?
3
If patient is completely disabled, cannot carry out any self-care, totally confined to bed/chair, what is his/her ECOG score?
4
If patient is dead, what is his/her ECOG score?
5
What is palliative care?
An approach which focuses on improving QOL of patients suffering from life-limiting illness
By providing relief from physical, emotional and spiritual suffering
Principles of palliative care
Providing relief from distressing symptoms through early identification, assessment and treatment
Affirming life and regard dying as a normal process
Intending to neither hasten nor postpone death
Integrating psychosocial, emotional and spiritual aspects into holistic care of patient
Supporting family and caregivers during patient’s illness and after patient’s death
Which medication route is most preferred?
Subcutaneous route also preferred as less invasive compared to IV or IM routes
Drug dosages have to be adjusted in a palliative patient due to:
impacted drug metabolism and elimination due to deterioration of patient’s liver and renal function
What is Off-label prescription?
when prescribed a drug that is approved to treat a condition different than your condition
When is the use of an off-label prescription needed?
positive effects on symptom control
Example of off-label prescription
Hyoscine Butylbromide (Buscopan)
Dimensions of pain
Physical, psychological, social, spiritual
Pain assessment SOCRATES SMM
Site
Onset
Characteristics
Radiation
Associated factors (any other symptoms)
Time
Exacerbating and relieving factors
Severity
Sleep/Function
Mood (Does the pain affect your mood?)
Meaning (What does the pain mean to you?)
Use numeric scale / faces rating scale
Causes of pain (Physical)
Nociceptive
Neuropathic
What is nociceptive pain?
Pain from tissue injury (lacerating, stinging, heavy, suffocating)
Somatic: tumour invasion of bone, joint, muscle or connective tissue
Visceral- e.g. bowel obstruction, liver infiltration or compression of vital organs)
What is neuropathic pain?
Pain from nerve injury (usually followed after nociceptive); (numbness, pins and needles, burning, aching, throbbing, pulling) e.g. if patient has left iliac artery stenosis, tumours pressing on spine, lots of nerves
Peripheral: tumour compression of peripheral nerves
Central: multiple sclerosis, stroke
Social causes of pain
Loss of family role
Restricted social activities
Psychological causes of pain
Anxiety
Equating pain relief (morphine) with dying
Sense of inevitability of future severe pain
Reminder of ill role
Anger, despair and hopelessness
Spiritual causes of pain
Loss of sense of purpose and identity
Feeling of being punished
Pharmacotherapeutic Intervention basic principles (by mouth)
- the least invasive and safest method.
Pharmacotherapeutic Intervention basic principles (by IV)
- reserved for those not able to take orally or unable to absorb drugs via gastrointestinal tract
Pharmacotherapeutic Intervention basic principles (by clock)
- most oral analgesics act only for 4 hours or less,
- should be prescribed 4 hourly to achieve therapeutic effects.
