Cancer Pain management Hesam modin hariri,MD Palliative & supportive care center.

Cancer Pain management

Hesam modin hariri,MDPalliative & supportive care center

به نام خداوند جان و خرد

Definition of pain

“Pain is an unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage”

Physical

Psychological

Social

Spiritual

TOTAL PAIN

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 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):• Extension into soft tissues• Visceral involvement• Bone involvement• Nerve compression• Nerve injury• Raising intracranial pressure

Causes Related to the cancer

• e.g. muscle spasm, lymphoedema, constipation, bedsores

Related to anticancer treatment • e.g. chronic postsurgical scar pain,

chemotherapy-induced mucositis Concurrent disorder

• e.g. spondylosis, osteoarthritis

Evaluation1. Believe the patient’s report of pain2. Initiate discussions about pain3. Evaluate the severity of the pain4. Take a detailed history of the pain5. Evaluate the psychological state of the patient6. Perform a careful physical examination7. Order & personally review any necessary

investigations8. Consider alternative methods of pain control9. Monitor the results of treatment

Approaches to pain management in cancer patients Psychological approaches:

Understanding Companionship Cognitive behavioural therapies

Modification of pathological process: Radiotherapy Hormone therapy Chemotherapy Surgery

Drugs: Analgesics Antidepressants Anticonvulsants Anxiolytics Neuroleptics

Interruption of pain pathways:

Local anaestheticsNeurolytic agentsNeurosurgery

Immobilization:Modification of daily activitiesRestCervical collar or corsetPlastic splints or slingsOrthopedic surgery

“Drug treatment is the mainstay of cancer pain management”

WHO guidelines for analgesics use to control cancer pain

P̶By mouthP̶By the clockP̶By the ladderP̶For the individualP̶Attention to detail

World Health Organization. Cancer pain relief.

Analgesic given on PRN basis

1 4 8 12 16 20 24

PRN Analgesic

Analgesic given by the clock

1 4 8 12 16 20 24

By the clock analgesic

Breakthrough pain

Baseline pain

Analgesic given by the clock

1 4 8 12 16 20 24

By the clock analgesic

Breakthrough pain

PRN analgesic

Baseline pain

1Non-opioid

±Adjuvant

2Weak opioid

±Non-opioid ±Adjuvant

3Strong opioid± Non-opioid± Adjuvant

Pain

Pain persisting or increasing

Pain persisting or increasing

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)

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