cancer pain management joanne chung. outline causes for pain basic concepts in cancer pain...
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Cancer Pain Management
Joanne Chung
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Causes of cancer pain
Direct tumour involvement Changes in body structure Anti-cancer therapy, including analgesi
a Causes unrelated to caner No immediate cause
Barriers
Common misconceptions Organizational aspects Work demands in the clinical area Limitation of prescribing Interprofessional pain education Patient barriers
Patient barriers
Expected to have pain No control over pain Problems with opioid and other analge
sics Wait as long as possible for a pain killer Culturally/socially unacceptable Be a good patient ...
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Basic Concepts in Pain Management
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Analgesic ladder
(WHO, 1998)
A basic drug list (WHO, 1994)
Category Parent drug Alternatives
Non-opioids aspirin paracetamol
Weak opioids codeine dextroproxyphene
Strong opioids morphine methadonepethedinebuprenorphinehydromorphonelevorphanol
Category Parent drug Alternatives
Adjuvants
Anticonvulsants carbamazepine phenytoin
Neuroleptics prochorperazinehaloperiodol
chlorpromazine
Anxiolytics diazepamhydroxyzine
Antidepressants amitriptyline
Corticosteriods prednisolone dexamethasone
An illustration: The WHO analgesic ladder for cancer pain management
AnalgesicsDrug of choice Alternative
Step 1 pain non-opioid drug adjuvant
aspirin or NSAID acetaminophen
Step 2 pain persistsor increases
weak opioid drug non-opioid drug adjuvant
codeine oxycodone
Step 3 pain persistsor increases
strong opioid drug non-opioid drug adjuvant
morphine methadone
Approximate equinalgesic doses of opioid analgesics
ParenteralOral
morphine 10 mg 30 mg
buprenorphine 0.3 mg 0.4 mg
codeine - 240 mg
diamorphine (heroin) 5-8 mg 20 mg
ydromorphone 1.5 mg 7.5 mg (or PR)
levorphanol 2 mg 4 mg
methadone 10 mg 20 mg
oxycodone - 30 mg (or PR)
pentazocine 60 mg 180 mg
pethidine (merepidine) 75 mg 300 mg
tramadol 80 mg 120 mg
(For information)
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Individual
Painphenomena
Totalpain
Intensity
The Lens Model
Psychosocial
Emotional
Pharmacological
Functional
Beliefs and m
eanings
Cultural lens
Independent variables
Mediatingvariables
Dependentvariable
A brief description on CCPAT
A summated rating scale Inclusion of pain intensity dimension Weights are allocated to each dimension by
magnitude scaling Six dimensions (functional,
pharmacological, pain beliefs and meanings, psychosocial, emotional and pain intensity) are measured
The total scores obtained is the Sum (Total Pain Intensity)
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Gate Control Theory (Carr & Mann, 1998)
DistractionHumourImageryWell beingRelaxation
WarmthCoolnessMassageTENS
(McGuire, Yarbro & Ferrell, 1995)A multidimensional approach
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Outcome criteria for cancer pain management
General impression of ‘best – worst’ Satisfaction with pain relief
treatment received Average pain score over a week Reduction in analgesic consumption Reduction in emergency room visit
Effects on activities of daily living Interference with activity Overall general health since treatment Physical findings (e.g. strength of mus
cles, weight loss) Laboratory results (e.g. blood sugar, co
rtisol, cytokines)
Outline
Causes for pain Basic concepts in cancer pain
management Mainstay of treatment – use of drug Assessment Principle of non-invasive pain relief
methods Outcome measures A cancer pain management (& associated
symptom) protocol
Pain and symptom management algorithm Assessment Evaluation