7.1 Fundamental principles of cancer pain management

Question 1

What are the pain initiators (NTs) and which are central and peripheral

Answer 1

Glutamate: cetrral
Substance P: central
bradykinin: peripheral
Prostaglandins: peripheral

Question 2

What are the pain inhibitors?

Answer 2

Serotonin
Endorphins
Enkephalins
Dynorphin

Question 3

What are the three factors that influence he gate control theory?

Answer 3

Amount of activity in pain fibres
Amount of activity in other peripheral fibres
Messages that descend from the brain

Question 4

What ‘opens’ the pain gate?

Answer 4

Extent of injury 
Inappropriate activity level 
Anxiety or worry 
Tension 
Depression 
Focusing on pain 
boredom

Question 5

What ‘closes’ the pain gate

Answer 5

Medications 
Counter stimulation (heat, massage) 
Positive emotions 
Relaxation/rest 
Intense concentration or distraction 
Involvement and interest in life activities

Question 6

What is the treatment of mild to moderate pain?

Answer 6

Non opioids - aspirin, NSAIDs or paracetamol

Question 7

What is the treatment for moderate to severe pain?

Answer 7

Mild opioids (codeine) with or without non opioids

Question 8

What is the treatment for severe pain?

Answer 8

Strong opioids (morphine) with or without non opioids

Question 9

What changes the personal context of pain?

Answer 9

Previous treatment experiences
Impact on QoL
Expectations of relief