Flashcards in Pain Management Deck (113)
Is cancer pain a manageable concern?
Yes, in most cases
What % of cancer pain can be relieved relatively simply, with oral analgesics and adjuvant drugs?
What is the problem with inadequate pain control in cancer?
It may exacerbate other problems
What other problems might be exacerbated by inadequate pain control in cancer?
Why might pain affect compliance in cancer?
It is more difficult for a patient in pain to continue with demanding cytotoxic treatments and hospital visits
What should be done when a patient presents with cancer pain?
A careful history should be taken to identify any reversible or remediable causes of the patient's pain
What might cancer pain derive from?
- Tumour progression and related pathology
- Procedural intervention
- Treatment toxicity
- MSK issues
Specifically, what are the most common causes of pain in cancer patients?
- Peripheral neuropathies secondary to chemotherapy or tumour invasion
- Tissue injury secondary to radiotherapy
- Chronic post-surgical incisional pain
- Bone metastases
- Visceral pain
What can aggravate cancer pain?
- Other physical symptoms
- Psychological symptoms
- Social factors
- Spiritual or existential suffering
- Medical crisis
What other physical symptoms can exacerbate cancer pain?
- Loss of appetite
What psychological symptoms can exacerbate cancer pain?
What happens even though cancer pain is manageable?
It is often undertreated
this card is bit dodgy sorry lol
What medical failures most commonly contribute to uncontrolled cancer pain?
- Inadequate assessment
- Failure to detect general distress
- Lack of systemic approach to analgesia
- Lack of knowledge of opioid pharmacology
How can inadequate assessment lead to uncontrolled cancer pain?
Can result in misdiagnosis of the cause and type of pain
How can failure to detect general distress lead to uncontrolled cancer pain?
Lowers pain threshold
Give an example of when lack of knowledge of opiate prescribing can lead to uncontrolled cancer pain
Failure to anticipate and prevent side effects
Why is it important to understand the patient's pain in cancer
Because treatment must be tailored for the individual, according to the nature, likely mechanisms, and subjective component of pain
Is a diagnosis of cancer a sufficient explanation for the patient feeling pain?
What is the result of a diagnosis of cancer being an insufficient explanation for the patient experiencing pain?
You need to determine what is the actual cause
What might pain of a sudden onset suggest in cancer?
- Acute complication of the malignancy
- Unrelated cause, e.g. new pathological fracture, mucositis due to radiotherapy
What might chronic escalating pain be caused by in cancer?
Underlying disease progression, e.g. soft tissue or nerve root infiltration
What are the different natures of pain?
What are the characteristics of somatic pain?
Typically localised and persistent
Give 2 examples of causes of somatic pain in cancer
- Bone metastases
- Localised inflammation such as cellulitis
What are the characteristics of visceral pain?
Usually poorly localised, of variable intensity, and often occurring with associated symptoms such as nausea
Give 2 examples of causes of visceral pain in cancer
- Hepatic metastases
- Malignant abdominal lymphadenopathy
What are the characteristics of neuropathic pain?
- Classically described as 'shooting pain' or 'burning'
- Usually follows a nerve distribution
- Typically less responsive to opiate therapy
Give an example of a cause of neuropathic pain in cancer
Compression of spinal nerve root
What is the result of pain having a strong affective component?
It is greatly influenced by mood and morale