1. Section IV: Principles of Pain Management
Opioid dose titration
Long-acting medications
Opioid rotation/equianalgesia
Addictive disease
Interventional therapies
Non-pharmacological techniques
Nursing role

2. Principles of Opioid Dose Titration
Sustained release medications
Immediate-release for breakthrough pain
Distinguish types of breakthrough pain

3. Principles: Use of Opioid Rotation
Use when one opioid is ineffective, even with adequate titration
Use when adverse effects are unmanageable

4. Principles of Equianalgesia
Determine equal doses when changing drugs or routes of administration
Reduce by 25% when changing drugs
Use of morphine equivalents

5. Treatment of Pain in Persons With Addictive Behaviors
Team meetings with interdisciplinary approach
Set realistic goals
Set limits
Use nonopioids as able
Consider tolerance

6. Treatment of Pain in Persons With Established Addictive Disease (cont
Avoid parenteral injections, if possible
Prevent withdrawal
Treat depression and other psychiatric disorders
Use alternate opioid if on methadone for maintenance

7. Other Issues
Polypharmacy
Cost
Compounding

8. Cancer Therapies to Relieve Pain.
Radiation
Surgery
Chemotherapy
Hormonal therapy
Bisphosphonates

9. Interventional Therapies
Neurolytic blocks
Neuroablative procedures
Vertebroplasty/kyphoplasty

10. Non-Pharmacologic Strategies
Physical
Complementary & Integrative
Psychosocial
Rehabilitation
Relaxation
Acupuncture
Exercise
Meditation
Qigong
Heat or cold
Hypnosis
Therapeutic massage
TENS (transcutaneous electrical nerve stimulation)
Music
Reiki
Biofeedback
Systematic desensitization
Cognitive-behavioral therapy

11. Summary
Pain relief is contingent on adequate assessment and use of both drug and non-drug therapies
Pain extends beyond physical causes to other causes of suffering and existential distress
Interdisciplinary care