Pain Management in patients with cancer

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  1. Nocieceptive pain
    results from injury to tissues
  2. 2 types of nociceceptive pain
    somatic or visceral pain
  3. Neuropathic pain
    results from injury to peripheral nerves
  4. how does neuropathic pain respond to opioids?
  5. which is easier to treat? neuropathic or nociceptive?
  6. What is the management strategy for people with cancer in pain?
    • ask
    • believe
    • choose
    • deliver
    • empower
  7. why is important to empower patients with control of their treatment?
    it can give the patient some small measure of control back
  8. what factors do you use to assess pain intensity?
    • onset and temporal pattern
    • location
    • quality
    • intensity
    • modulating factors
    • pervious treatment
    • impact
  9. What are the barriers to assessment of pain?
    • inaccurate reporting by patient
    • under-reporting by patient
    • language and cultural barriers
  10. what are the drug therapies for treating pain in caner patients?
    • Nonopiod analgesics
    • opioid analgesics
    • adjuvant analgesics
  11. what is the first step in the analgesic ladder and what is used to treat it?
    mild to moderate pain - nonopiod analgesic and NSAIDs and acetaminophen
  12. what is the second step in the analgesic ladder and what is used to treat it?
    more severe pain - add opioid analgesic, oxycodone, hydrocodone
  13. what is the third step in the analgesic ladder and what is used to treat it?
    severe pain - substitute powerful opioid like morphine and fentanyl
  14. What are are the Nonopioid analgesics?
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
    • acetaminophen (Tylenol)
  15. why should you not use meperidine(Demerol)
    it can be a neurotoxin and you can get seizures
  16. what is the preferred drug for all cancer patients?
    pure opioid agonists
  17. routes of administration
    • oral
    • rectal
    • transdermal
    • intravenous and subcutaneous
    • intramuscular
    • intraspinal
    • intraventricular
    • patient-controlled analgesia
  18. what is the side effects of opioid analgesics?
    • respiratory depression
    • constipation
    • sedation
    • nausea and vomiting
    • other side effects
  19. what is adjuvant analgesics used for?
    used to complement the effects of opioids but not used as substitutes
  20. what are the types of adjuvant analgesics?
    • tricyclic antidpressants
    • anti seizure drugs
    • local anesthetics
    • antidysrhythmics
    • CNS stimulants
    • Antihistamines
    • Clugocorticoids
    • Bisphosphonates
  21. Why do you give CNS stimulants as adjuvant analgesics?
    give stimulants so that they are not as sleepy
  22. Invasive Procedures
    • Neurolytic nerve block
    • Neurosurgery
    • Tumor surgery
    • Radiation therapy
  23. types of Physical interventions
    • heat
    • cold massage
    • exercise
    • acupuncture
    • transcutaneous electrical nerve stimulation
  24. psychosocial interventions
    • relaxation and imergery
    • cognitive distraction
    • peer support
  25. What do you have to watch out for in Elderly patients when treating pain?
    • heightened drug sensitivity
    • Undertreatment of pain
    • Increased risk of side effects and adverse interactions
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Pain Management in patients with cancer
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