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Principles of Pain

ManagementDOMINO B. PUSON RN MN

What is your idea on how to

treat pain in palliative care?WRITE YOUR OPINION ON ¼ SHEET OF PAPER

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Contents

Etiology of Pain

Assessment of Pain

Barriers of Pain Management

Misconceptions about pain

Overview of Approaches to Pain Management

“”

Pain is now recognized as

the fifth vital sign in all

care setting…MATTESON & MCCONNEL

4 out 10 dying patients report having severe pain most of the time.

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Two type of pain

Nociceptive – responds to analgesics

Somatic or visceral pain

Neuropathic pain – drug therapy is

complex, require treatment by a pain

specialist

Conditions that adds up to pain

Pressure ulcers

Joint contractures

Bowel obstructions

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“”

An outdated belief is that

older people are less

sensitive to pain.HPNA, 2003C

Assessment

What to do when there is pain

Determine the location and radiation, character and intensity.

Understanding the patients viewpoint

“Are there any other symptoms associated with pain?”

“How long have you been having this pain?”

“Does anything make the pain better?

“Are you currently taking other medications

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Pain Assessment Tools

Pain Assessment Tool in Confused Older Adults (PATCOA)

Check List of Nonverbal

Pain Indicators (CNPI)

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Assignment

Encode in a short bondpaper the management of the following symptom following pain

Dyspnea

Anxiety

Nausea and Vomiting

Constipation

Anorexia and Cachexia

Depression

Delirium

Common Misconception

about PainTHE HOSPICE WORKER WILL FACE SEVERAL IMPORTANT

MISCONCEPTIONS ABOUT PAIN…

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Differences of Pain

Acute Pain

Associated with changes in vital signs

Sweating, anxiety and facies

Cancer-associated Chronic Pain

Develop adapting coping mechanism – humor, distraction by conversation, music art, writing or watching television

May not look like having pain

Common Misconceptions about

Cancer-Associated Pain

All cancer is painful

The amount of pain is related to the extent of the cancer

Strong pain medicines cause addiction

Taking pain medicine too early will interfere with it working “when you really need it.”

People who complains are not good patients.

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Management of Pain

Nonpharmacologic ApproachesTHE MOST COMMON FORM OF PAIN MANAGEMENT

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Physical Modalities

Cutaneous stimulation

Massage

Thermal manipulation

Vibration

Pressure exercises

Immobilization

Transcutaenous electrical nerve stimulation (TENS)

acupuncturre

Psychosocial Modalities

Relaxation and imagery

Distraction and reframing

Education

Psychotherapy

Support groups

Pastoral Counselling

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Pharmacologic Approaches

Selection of Medications for Pain

Management

Nonsteroidal anti-inflammatory drugs

(NSAIDs)

Agonist, antagonist, and mixed agonist-

antagonist opioids

Adjuvant analgesics (anticonvulsants –

antidepressants)

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NSAIDs They are subject to the “ceiling

effect” in their analgesic efficacy

There are unique toxicity in special

populations

There is no data that one class of

NSAID is more efficacious than

another or that one is less toxic

OpioidsMorphine Sulphate

Hydromorphone

Fentanyl

Meperidine – not

recommended for chronic

pain

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Adjuvant Analgesics for Cancer-

Associated Pain

Dexamethasone added to morphine

Antidepressants

Imipramine

Doxepin

Nortriptiline

Amitriptyline

Anticonvulsants

Phenytoin

Carbamazepine

Adjuvant Analgesics for Cancer-

Associated Pain

Local Anesthetics / Antiarrythmics

Mexiletine

Tocainide

Lidocaine

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Principles of Pain

ManagementDOMINO B. PUSON RN MN