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Monday, May 13, 2013
  Clinical Accuracy Spoken Here  

Pain Management:
Always Identify Etiology

Identifying the etiology of pain is important to its management. Clinicians treating patients with cancer should recognize common cancer pain syndromes, since prompt diagnosis and treatment reduces the morbidity associated with unrelieved pain. Failure to assess pain is a critical factor leading to under-treatment.

Assessment involves the clinician and the patient. Assessment should occur at:

  • Regular intervals after initiation of treatment.
  • Each new report of pain.
  • After pharmacologic/non-pharmacologic intervention, e.g., 15 to 30 minutes after parenteral drug therapy, or 1 hour after oral administration.

[Reference: Pain Management, Module E, Cancer Pain]
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  Excellence in Case Mgmt  

Pain Management:
Excellence in Assessment

Distinct cultural and linguistic components may need to be incorporated into a multidimensional assessment of pain. Family members who act as proxies typically report higher levels of pain than patient self-reports. A retrospective review found high agreement with assessments performed by bedside nurses when pain was not present or was mild but poor agreement for moderate or severe pain. Clinicians should document outcomes of pain therapy in two ways:

  • Decreased pain intensity
  • Improvement in psychosocial functioning

Measuring patient satisfaction is less helpful because of patients' potentially low expectations for pain control.

[Reference: Pain Management, Module E, Cancer Pain]
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  Improving Patient Care...  

Pain Management:
Pain Prevention Strategy

If cancer pain occurs, there should be prompt oral administration of drugs in this order:

  • non-opioids (aspirin and paracetamol); then, as necessary,
  • mild opioids (codeine); then
  • strong opioids such as morphine, until the patient is free of pain

To calm fears and anxiety, adjuvant drugs should be used. To maintain freedom from pain, drugs should be given "by the clock" every 3-6 hours, rather than "on demand".

This approach is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective.

[Reference: Pain Management, Module A, Pathophysiology of Pain]
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Tom RasmussenTom Rasmussen
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