Symptom Control: Pain and Delirium

Question 1

Neuropathic pain only partially responsive to opioid

Answer 1

TCA e.g. Amitriptyline

Question 2

What are the types of pain and how do they feel?

Answer 2

Somatic (localised)
visceral (deep ache or intermittent colicky)
bone (deep, dull)
Neuropathic (burning, stabbing)

Question 3

Outline WHO pain management ladder

Answer 3

Step 1: paracetamol or NSAIDs
Step 2: codeine or tramadol
Step 3: morphine or oxycodone or methadone or fentanyl

(fentanyl makes vom)

Note NSAIDs - risk in elderly, renally impaired