Transcript Cancer Pain management

Cancer Pain
management
Hesam modin hariri,MD
Palliative & supportive care center
‫به نام خداوند‬
‫جان و خرد‬
Definition of pain
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“Pain is an unpleasant sensory and
emotional experience associated with
actual and potential tissue damage or
described in terms of such damage”
Physical
Social
TOTAL PAIN
Spiritual
Psychological
Prevalence
 64%
in patients with metastatic or
advanced stage disease
 59% in patients on anticancer treatment
 33% in patients after curative treatment
The experience of pain can
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Induce depression
Exacerbate anxiety
Interfere with social performance and
impair the quality of relationships.
Negatively impact on physical capability.
Prevent work & reduce income.
Challenge existential beliefs.
Constantly impact on the patient’s
experience of pain.
Causes
Cancer itself (this is by far the most
common):
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Extension into soft tissues
Visceral involvement
Bone involvement
Nerve compression
Nerve injury
Raising intracranial pressure
Causes
Related to the cancer
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e.g. muscle spasm, lymphoedema,
constipation, bedsores
Related to anticancer treatment
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e.g. chronic postsurgical scar pain,
chemotherapy-induced mucositis
Concurrent disorder
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e.g. spondylosis, osteoarthritis
Evaluation
1.
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Believe the patient’s report of pain
Initiate discussions about pain
Evaluate the severity of the pain
Take a detailed history of the pain
Evaluate the psychological state of the patient
Perform a careful physical examination
Order & personally review any necessary
investigations
Consider alternative methods of pain control
Monitor the results of treatment
Approaches to pain management
in cancer patients
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Psychological approaches:
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Modification of pathological
process:
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Understanding
Companionship
Cognitive behavioural therapies
Radiotherapy
Hormone therapy
Chemotherapy
Surgery
Drugs:
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Analgesics
Antidepressants
Anticonvulsants
Anxiolytics
Neuroleptics
Interruption of pain pathways:
Local anaesthetics
Neurolytic agents
Neurosurgery
Immobilization:
Modification of daily
activities
Rest
Cervical collar or corset
Plastic splints or slings
Orthopedic surgery
“Drug treatment is the mainstay of
cancer pain management”
WHO guidelines for analgesics
use to control cancer pain
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By mouth
By the clock
By the ladder
For the individual
Attention to detail
World Health Organization. Cancer pain relief.
PRN Analgesic
1
4
8
12
16
20
Analgesic given on PRN basis
24
By the clock
analgesic
Breakthrough
pain
Baseline pain
1
4
8
12
16
Analgesic given by the clock
20
24
PRN analgesic
By the clock
analgesic
Breakthrough
pain
Baseline pain
1
4
8
12
16
Analgesic given by the clock
20
24
3
Strong opioid
± Non-opioid
± Adjuvant
Pain persisting
or increasing
2
Weak opioid
± Non-opioid
± Adjuvant
Pain persisting
or increasing
1
Pain
Non-opioid
± Adjuvant
WHO. Cancer Pain Relief. 1996.
The risk of respiratory depression from opioid
analgesic is more myth than fact”
‫مرکز جامع مراقبتهای‬
‫حمایتی و تسکینی‬
‫بیمارستان حضرت سید‬
‫الشهدا (ع)‬
‫به‬
‫زودی‬