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DR HANNAH GUNN CONSULTANT IN PALLIATIVE MEDICINE NORTHUMBRIA HEALTHCARE & MARIE CURIE HOSPICE NEWCASTLE Analgesic Trade Secrets.

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Presentation on theme: "DR HANNAH GUNN CONSULTANT IN PALLIATIVE MEDICINE NORTHUMBRIA HEALTHCARE & MARIE CURIE HOSPICE NEWCASTLE Analgesic Trade Secrets."— Presentation transcript:

1 DR HANNAH GUNN CONSULTANT IN PALLIATIVE MEDICINE NORTHUMBRIA HEALTHCARE & MARIE CURIE HOSPICE NEWCASTLE Analgesic Trade Secrets

2 Session Outline Defining pain Types of pain  Noceceptive  Neuropathic  Total WHO Analgesic Ladder Adjuvants  Case histories

3 Defining Pain

4 What is pain?

5 Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage International Association for the Study of Pain (IASP) 1986

6 What is pain? Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage International Association for the Study of Pain (IASP) 1986 Pain is what the patient says hurts

7 Types of Pain

8 Nociceptive Pain Neuropathic Pain

9 Types of Pain Nociceptive Pain  Transmitted by undamaged nervous system  Opioid receptors involved  Impulse  spinal cord  higher centres  WHO analgesic ladder Neuropathic Pain  Transmitted by damaged nervous system  Partial opioid sensitive  Associated with hyperalgesia and allodynia  WHO analgesic ladder  Adjuvants

10 Total Pain

11 Psycho- logical Financial Spiritual Social Physical Emotional

12 Total Pain Psycho- logical Financial Spiritual Social Physical Emotional

13 Pain Management Strategy

14  Modify pathological process  Surgery  Radiotherapy  Chemotherapy  Choose an analgesic  WHO analgesic ladder  Adjuvants  Side effects  Non-drug management of pain  Address all the domains of total pain  Heat pads, TENS  Lifestyle modification  Home equipment  Walking aides  Care package

15 WHO analgesic ladder

16 3.Strong opioid 2.Mild/ Moderate opioid 1.Paracetamol +/- NSAID Choice of drug based on severity of pain NOT on stage of disease

17 Adjuvants

18 When is an analgesic not an analgesic? When it’s an adjuvant! Anti- epileptic Anti- depressant Anti- spasmodic Muscle relaxants Steroid Bisphosphonate Ketamine Methadone

19 3.Strong opioid 2.Mild/ Moderate opioid 1.Paracetamol +/- NSAID Choice of drug based on severity of pain NOT on stage of disease

20 Common Adjuvants Raised intracranial pressure Corticosteroids Nerve compression Liver capsule pain Soft tissue infiltration Neuropathic pain (including tenesmoid pain) Anti-depressants (eg amitriptyline) & Anti-convulsants ( eg. Gabapentin) ColicAntispasmodic ( eg buscopan) Muscle cramp/spasmMuscle relaxants (eg baclofen) Bone painBisphosphonates

21 Case 1 Joan, 63 year old woman Diagnosed with left breast cancer 2 years ago  Mastectomy  Radiotherapy and chemotherapy  Ongoing hormone therapy Presents to GP with RUQ pain, worse on inspiration, ‘like I’ve pulled a muscle’ Some vomiting, especially later in day, large volumes, hiccoughs and belching

22 Liver Capsule Pain Aetiology  Liver metastases Presentation  RUQ pain  Stretch quality  Can vary with respiration Management  Dexamethasone 8-16mg mane with PPi cover

23 Case 2 Brian, 74 year old man 8 year history of prostate cancer Admitted with severe lower back pain, increasing for last few weeks, now unable to walk due to pain

24 SPINAL CORD COMPRESSION

25 Bone Pain Aetiology  Bone infiltration  Pathological fractures Presentation  Severe pain  Associated with site of metastases Management  WHO analgesic ladder  Adjuvant analgesics  Dexamethasome 8-16mg mane with PPi cover  Bisphosphonate infusion  Gabapentin or amitriptyline Paracetamol and NSAID and morphine

26 Summary

27 Pain is what the patient says hurts WHO analgesic ladder Adjuvants Review, review, review

28 Pain is what the patient says hurts WHO analgesic ladder Adjuvants Review, review, review Ask your friendly neighbourhood palliative care team!

29 Thank You!


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