Pain Management

Classifications of Pain

Nociceptivedestroyed tissue activates nociceptive nerve fibers physical, chemical, pressure, thermal destruction1. Somatic injury to skin, muscle, soft tissue, bone very incidental or movement related localized constant or intermittent gnawing, aching, sharp with movement 2. Visceral less localized constant referred aching, squeezing, cramping

Neuropathic injury to nerve tissue central, peripheral, autonomic radiates along nerves or nerve roots Feels like: burning dysesthesia (numb, tingling), hyperalgesia (exagerrated response to painful stimulus) lancinating/ piercing/stabbing allodynia (pain from stimulus that doesn't usu cause pain)

Mixeddue to combo of :- physical destruction of tissue- inflammation caused by/ in response to tumors that activate nerves 

pain is subjective experience multiple domains

PHYSICALUse : Brief Pain InventoryAssess: location pattern of occurence quality aggravating or relieving factors raditation of pain severity and variation in severity affects on ADLs pain tx and analgesic hx - adverse effects, compliance breakthrough pain - incident & spontaneous Present & past medical hx. Look for: delirium, cognitive failure, dementia (affects expression of pain) chronic pain (ie OA or diabetic neuropathy) exposure to neurotoxic antineoplastic agents complicated cancer pain syndromes (malignant leptomeningeal spread, plexus involvement, pathological fractures) infection or abscess hepatic or renal impairment medication interactions

LOOK UP: malignant leptomeningeal spread plexus involvement pathological fractures concomitant  infection abscess assessment in cognitively impaired

PSYCHOLOGICAL depression, anxiety limited understanding of illness fear of opiods anger towards HCP or health care system personality or psychiatric disorder loss of body image poor coping  denial hx drug or alcohol abuse

SOCIALfinancial issuesculture, religionfamily issues: discord or dysfunction guilt  lack of understanding illness denial or unrealistic expectations

COMPLICATION CANCER PAINAssessment & management can be complicated in: younger pts neuropathic pain incidental/ episodic pain presence of psych distress substance abuse disorder severe pain at start

PAIN IN THE COGNITIVELY IMPAIRED look at behaviours available assessment tools not validated or reliable

Education pt & Family origin of pain type of pain initial management - titration expected adverse effects - management of pain monitoring address fear of opiods

Prevent & Minimize Adverse Effectsuse combination of educations & drugs

Matching Pain Severity to AnalgesicUSE: WHO 3-Step ladder

LOOK UPtotal pain

LOOK UPtotal pain

Prescribe around-the-clock dose & breakthrough/rescue doses

Consider Adjuvants

Classifications of Pain

Pain Assessment

Management - Principles