Hesam C. Esfahani [email protected] Lecture 8 Code Refactoring CSC301-Winter 2011.
Cancer Pain management Hesam modin hariri,MD Palliative & supportive care center.
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Transcript of 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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