7.1 (9.3) Definition and assessment of chronic pain in advanced disease

Question 1

What is the definition of pain by International Association for the Study of Pain

Answer 1

The International Association for the Study of Pain (IASP, 2011) defines pain as an ‘unpleasant sensory and emotional EXPERIENCE associated with actual or potential TISSUE DAMAGE, or described in terms of such damage’.

Question 2

Define chronic pain (3 ways)

Answer 2

Pain which persists beyond the usual course of HEALING, or

Pain associated with CHRONIC pathological ILLNESS which causes continuous pain, or

Pain which recurs at INTERVALS for months or years

Question 3

What are 2 categories of chronic cancer pain? List 3 mechanisms of each category

Answer 3

Category 1: Chronic cancer pain
1. Visceral cancer pain
2. Bone cancer pain
3. Neuropathic cancer pain
4. Other

Category 2: Chronic post-treatment pain
1. Post cancer medicine
2. Post radiation
3. Post surgery
4. Post other cancer treatments

Question 4

What is the correlation between observed behaviour and patient reports of pain severity?

Answer 4

POOR as individual response to pain varies considerably. All pain-related behaviour, including verbal report, is influenced by its perceived meaning, and an individual’s culture, ethnicity, and mood

Question 5

What does the concept of total pain acknowledge?

Answer 5

The concept of ‘total pain’ acknowledges the physical, psychological, social, and spiritual influence on a patient’s perception of pain, and the multidimensional effects it has on a person’s life. Without attention to all these areas, pain relief is unlikely to be optimal

Question 6

What is nociceptive pain? What is neuropathic pain?

Answer 6

Nociceptive pain is defined as ‘pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors’ (IASP, 2011) –> somatic or visceral

In contrast, neuropathic pain is defined by the Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP as ‘pain caused by a lesion or disease of the somatosensory nervous system’ –> peripheral or central

Question 7

What is breakthrough pain? What are two complications of its presence?

Answer 7

Breakthrough pain is the term most widely used to describe VARIATIONS in quality, intensity, and timing of pain on a BACKGROUND of stable pain control. It can be predictable, unpredictable, spontaneous, or evoked with the same quality or a different quality to the baseline pain.

2 complications: poorer quality of life and be depressed

Question 8

How does uncontrolled pain impact patients (list 4 ways)

Answer 8

Interferes with:
sleep
activity/daily functioning
interaction with others
psychological and existential distress
QOL

Question 9

What are the six cancers associated with the highest prevalence of pain?

Answer 9

brain
head and neck
lung
pancreas
bone
lymphoma

Question 10

What are the four broad mechanisms for pain etiologies (relating to underlying disease)

Answer 10

Direct effect of underlying advanced disease

Indirect effect of the disease (i.e. pressures sores)

Treatment of disease

Disorder unrelated to primary disease (i.e. OA)

Question 11

Patients with neuropathic pain will experience 4 complications MORE than patients with nociceptive pain - what are these complications?

Answer 11

Increased pain intensity
Increased time to achieve analgesia
Increased opioid requirements

Decreased QOL
Decreased performance status
Negative impact on daily living

Question 12

What does somatic pain represent? What are two words that may be used to describe it?

Answer 12

Somatic pain - arises from injury to the soft tissues and bone

Somatic pain: Aching, sharp, throbbing, well localized.

Question 13

What does visceral pain represent? What are two words that may be used to describe it?

Answer 13

Visceral pain -injury to an internal organ, hollow viscous

Descriptors: gnawing, cramping, pressure, deep pain, poorly localized.

Commonly referred (e.g. shoulder tip pain from diaphragm irritation)

Question 14

List four factors that predict the appearance of complex pain (resulting in a longer time to achieve pain control)

Answer 14

pain intensity
neuropathic pain
incident pain

younger patients
psychological distress
interference on patients day to day function

Question 15

What are three validated tools to assess pain?

Answer 15

Visual Analogue Scale
Brief pain inventory
McGill Pain Questionnaire

Visual, categorical numerical, and categorical verbal rating scales are validated and used as tools to measure intensity of pain (VAS - visual analogue scale)

Wong Baker Faces scale in children

Question 16

Under what circumstances is it more likely to undertreat pain (list 2)

Answer 16

when MD and patient rating of pain severity is discrepant
when patients have a better performance status
when pts are in the early stages of their disease.