Notes: remember pain assessment has already been done. Concentrate on the management of pain
- Effective Pain management must be holistic – define what this is
- Introduce WHO pain ladder and the concepts of using it
- Opioid pharmacology
- how to use morphine / oral and parenteral / titration
- introduce other opioids eg Fentanyl
- managing opioid side effects
- Breakthrough pain
- Adjuvant analgesics
- Neuropathic pain
- Paracetamol
- NSAID’s
- Steroids
- Anti – cancer treatments (radiotherapy/chemotherapy etc)
- Interventional pain management (keep it simple)
- Availability of medications/accessibility
- Non-pharmacological
- How does it work
- What types are there (acupuncture/ relaxation / meditation / etc)
- Psychological care of the patient
- Impact of pain on the patient
- Discharge home
Outcome for audience:
Understand holistic nature of pain Management (biopsychosocial model)
Treat pain with opioids and adjuvants
Manage side effects of opioids
Know when and what options for non-pharmacological strategies
References:
- Starting Step III opioids for moderate to severe pain in cancer patients: Dose titration: A systematic review. Pa° l Klepstad et al Palliative Medicine 25(5) 424–430
- How well is cancer pain treated? Kathleen M Foley Memorial Sloan-Kettering Cancer Center, USA, Palliative Medicine 25(5) 398–401
- Is oral morphine still the first choice opioid for moderate to severe cancer pain? A systematic review within the European Palliative Care Research Collaborative guidelines project. Augusto Caraceni. Palliative Medicine 25(5) 402–409
- A comparative Efficacy of Amitirptyline, Gabapentin and Pregabalin in Neuropathic Cancer Pain: A prospective randomized doublin-blind placebo-controlled study. AJHPM 2011, Mishra et al.