Welcome to St Clare Hospice
Jan 13, 2016
Welcome to St Clare Hospice
Welcome
Pain control: getting it right
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Pain control: getting it rightPain control: getting it right
[email protected]@stclarehospice.org.uk
53% all stages of disease53% all stages of disease 59% of patients on active anticancer treatment59% of patients on active anticancer treatment 64% of patients with metastatic, advanced or terminal 64% of patients with metastatic, advanced or terminal
diseasedisease 33% of patients who had been cured of cancer33% of patients who had been cured of cancer More than 33% graded pain as moderate or severeMore than 33% graded pain as moderate or severe
Scope of the problemScope of the problem
van den Beuken-van Everdingen et al. 2007van den Beuken-van Everdingen et al. 2007
PhysicalPhysical SocialSocial PsychologicalPsychological SpiritualSpiritual
Total painTotal pain
Cancer painCancer pain
Acute painAcute pain Recent onset, transient, Recent onset, transient, identifiable cause identifiable cause
Chronic painChronic pain Persistent or recurrent pain, beyond usual course of acute
illness or injury
Breakthrough painBreakthrough pain Transient pain, severe or excruciating, over baseline of
moderate pain
PathophysiologyPathophysiology
Neuropathic painPain initiated or causedby a primary lesion or
dysfunction in theperipheral or central
nervous system
Nociceptive painPain caused by
an inflammatory ornon-inflammatory
response to anoxious stimulus
NOCICEPTIVE PAINNOCICEPTIVE PAIN
SOMATICSOMATIC
SUPERFICIALSUPERFICIAL
VISCERALVISCERAL
DEEPDEEP
PathophysiologyPathophysiology
NEUROPATHIC PAINNEUROPATHIC PAIN
NERVE INJURYNERVE INJURY
PERIPHERALPERIPHERAL
NERVE COMPRESSIONNERVE COMPRESSION
SYMPATHETICALLY SYMPATHETICALLY MAINTAINEDMAINTAINEDCENTRALCENTRAL
PathophysiologyPathophysiology
PathophysiologyPathophysiology
CharacteristicsCharacteristics MechanismsMechanisms ExamplesExamples
SomaticSomatic Constant, aching, Constant, aching, gnawing.gnawing.
Well localisedWell localised
Activation of nociceptors Activation of nociceptors in cutaneous or deep in cutaneous or deep tissuestissues
Skin metastasesSkin metastases
VisceralVisceral Constant, aching, poorly Constant, aching, poorly localised often referredlocalised often referred
Activation of nociceptors Activation of nociceptors due to infiltration due to infiltration compressioncompression
Pancreatic cancerPancreatic cancer
Lung/liver metastasesLung/liver metastases
NeuropathicNeuropathic Paroxysmal, shooting or Paroxysmal, shooting or shock-like pain . shock-like pain . Background of burning Background of burning or constrictionor constriction
Spontaneous and Spontaneous and paroxysmal discharges in paroxysmal discharges in PNS and CNSPNS and CNS
Tumour compressionTumour compression
Post-surgical incisionPost-surgical incision
Multiple painsMultiple pains
0
5
10
15
20
25
30
35
40
0 1 2 3 4 5 6 7 8
No
of
pati e
nts
No
of
patie
nts
No of painsNo of pains
AetiologyAetiology%
Pat
ient
s
SiteSite QualityQuality Exacerbating factorsExacerbating factors Relieving factorsRelieving factors Temporal patternsTemporal patterns
AssessmentAssessment
Exact onsetExact onset Associated symptomsAssociated symptoms Interference with activities Interference with activities
of daily livingof daily living Response to analgesicsResponse to analgesics
Foley KM. Oxford Textbook of Palliative Medicine 2004Foley KM. Oxford Textbook of Palliative Medicine 2004
Assessment toolsAssessment tools
Pain charts Visual analogue scales Pain diaries Questionnaires
CliniciansClinicians PatientsPatients Health care systemHealth care system
BarriersBarriers
Managing cancer painManaging cancer pain
Hormone therapyHormone therapy
AnalgesicsAnalgesics
ChemotherapyChemotherapy
SurgerySurgery
RadiotherapyRadiotherapy
Anaesthetic proceduresAnaesthetic procedures
Adjuvant analgesicsAdjuvant analgesics