Analgesic Trade Secrets
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DR HANNAH GUNN CONSULTANT IN PALLIATIVE MEDICINE NORTHUMBRIA HEALTHCARE & MARIE CURIE HOSPICE NEWCASTLE Analgesic Trade Secrets
description
Analgesic Trade Secrets. Dr Hannah Gunn Consultant in Palliative Medicine Northumbria Healthcare & Marie Curie Hospice Newcastle. Session Outline. Defining pain Types of pain Noceceptive Neuropathic Total WHO Analgesic Ladder Adjuvants Case histories. Defining Pain. What is pain?. - PowerPoint PPT Presentation
Transcript of Analgesic Trade Secrets
DR HANNAH GUNN
CONSULTANT IN PALLIATIVE MEDICINE
NORTHUMBRIA HEALTHCARE & MARIE CURIE HOSPICE NEWCASTLE
Analgesic Trade Secrets
Session Outline
Defining painTypes of pain
Noceceptive Neuropathic Total
WHO Analgesic LadderAdjuvants
Case histories
Defining Pain
What is pain?
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
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
Types of Pain
Types of Pain
Nociceptive Pain Neuropathic Pain
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
Total Pain
Total Pain
Total Pain
Pain Management Strategy
Pain Management Strategy
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
WHO analgesic ladder
Choice of drug based on severity of pain NOT on stage of disease
Adjuvants
When is an analgesic not an analgesic?
When it’s an adjuvant!Anti-
epileptic
Anti-depressant
Anti-
spasmodi
c
Muscle relaxants
Steroid
Bisphosphonate
Ketamine
Methadone
Choice of drug based on severity of pain NOT on stage of disease
Common Adjuvants
Raised intracranial pressure
CorticosteroidsNerve compression
Liver capsule pain
Soft tissue infiltration
Neuropathic pain(including tenesmoid pain)
Anti-depressants (eg amitriptyline) & Anti-convulsants ( eg. Gabapentin)
Colic Antispasmodic ( eg buscopan)
Muscle cramp/spasm Muscle relaxants (eg baclofen)
Bone pain Bisphosphonates
Case 1
Joan, 63 year old womanDiagnosed 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
Liver Capsule Pain
Aetiology Liver metastases
Presentation RUQ pain Stretch quality Can vary with respiration
Management Dexamethasone 8-16mg mane with PPi cover
Case 2
Brian, 74 year old man8 year history of prostate cancerAdmitted with severe lower back pain,
increasing for last few weeks, now unable to walk due to pain
SPINAL CORD COMPRESSIO
N
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
Summary
Pain is what the patient says hurtsWHO analgesic ladderAdjuvantsReview, review, review
Pain is what the patient says hurtsWHO analgesic ladderAdjuvantsReview, review, review
Ask your friendly neighbourhood palliative care team!
