Welcome to St Clare Hospice

Welcome

Pain control: getting it right

Hospice in-patient care

Hospice Day Therapy

Hospital Palliative Care

Community Palliative Care

Case Studies

Close

Outline

Pain control: getting it rightPain control: getting it right

john.zeppetella@stclarehospice.org.ukjohn.zeppetella@stclarehospice.org.uk

53% all stages of disease53% all stages of disease 59% of patients on active anticancer treatment59% of patients on active anticancer treatment 64% of patients with metastatic, advanced or terminal 64% of patients with metastatic, advanced or terminal

diseasedisease 33% of patients who had been cured of cancer33% of patients who had been cured of cancer More than 33% graded pain as moderate or severeMore than 33% graded pain as moderate or severe

Scope of the problemScope of the problem

van den Beuken-van Everdingen et al. 2007van den Beuken-van Everdingen et al. 2007

PhysicalPhysical SocialSocial PsychologicalPsychological SpiritualSpiritual

Total painTotal pain

Cancer painCancer pain

Acute painAcute pain Recent onset, transient, Recent onset, transient, identifiable cause identifiable cause

Chronic painChronic pain Persistent or recurrent pain, beyond usual course of acute

illness or injury

Breakthrough painBreakthrough pain Transient pain, severe or excruciating, over baseline of

moderate pain

PathophysiologyPathophysiology

Neuropathic painPain initiated or causedby a primary lesion or

dysfunction in theperipheral or central

nervous system

Nociceptive painPain caused by

an inflammatory ornon-inflammatory

response to anoxious stimulus

NOCICEPTIVE PAINNOCICEPTIVE PAIN

SOMATICSOMATIC

SUPERFICIALSUPERFICIAL

VISCERALVISCERAL

DEEPDEEP

PathophysiologyPathophysiology

NEUROPATHIC PAINNEUROPATHIC PAIN

NERVE INJURYNERVE INJURY

PERIPHERALPERIPHERAL

NERVE COMPRESSIONNERVE COMPRESSION

SYMPATHETICALLY SYMPATHETICALLY MAINTAINEDMAINTAINEDCENTRALCENTRAL

PathophysiologyPathophysiology

PathophysiologyPathophysiology

CharacteristicsCharacteristics MechanismsMechanisms ExamplesExamples

SomaticSomatic Constant, aching, Constant, aching, gnawing.gnawing.

Well localisedWell localised

Activation of nociceptors Activation of nociceptors in cutaneous or deep in cutaneous or deep tissuestissues

Skin metastasesSkin metastases

VisceralVisceral Constant, aching, poorly Constant, aching, poorly localised often referredlocalised often referred

Activation of nociceptors Activation of nociceptors due to infiltration due to infiltration compressioncompression

Pancreatic cancerPancreatic cancer

Lung/liver metastasesLung/liver metastases

NeuropathicNeuropathic Paroxysmal, shooting or Paroxysmal, shooting or shock-like pain . shock-like pain . Background of burning Background of burning or constrictionor constriction

Spontaneous and Spontaneous and paroxysmal discharges in paroxysmal discharges in PNS and CNSPNS and CNS

Tumour compressionTumour compression

Post-surgical incisionPost-surgical incision

Multiple painsMultiple pains

0

5

10

15

20

25

30

35

40

0 1 2 3 4 5 6 7 8

No

of

pati e

nts

No

of

patie

nts

No of painsNo of pains

AetiologyAetiology%

Pat

ient

s

SiteSite QualityQuality Exacerbating factorsExacerbating factors Relieving factorsRelieving factors Temporal patternsTemporal patterns

AssessmentAssessment

Exact onsetExact onset Associated symptomsAssociated symptoms Interference with activities Interference with activities

of daily livingof daily living Response to analgesicsResponse to analgesics

Foley KM. Oxford Textbook of Palliative Medicine 2004Foley KM. Oxford Textbook of Palliative Medicine 2004

Assessment toolsAssessment tools

Pain charts Visual analogue scales Pain diaries Questionnaires

CliniciansClinicians PatientsPatients Health care systemHealth care system

BarriersBarriers

Managing cancer painManaging cancer pain

Hormone therapyHormone therapy

AnalgesicsAnalgesics

ChemotherapyChemotherapy

SurgerySurgery

RadiotherapyRadiotherapy

Anaesthetic proceduresAnaesthetic procedures

Adjuvant analgesicsAdjuvant analgesics