Pain management

Question 1

why emphasis on pain mx in cancer tx

Answer 1

• persistent
• multiple aetiologies
• impairs function
• threatens independence
• invokes fear of death and suffering

Question 2

types of analgesics

Answer 2

opioid
non-opioid
adjuvants

Question 3

what is nociceptive pain?

Answer 3

normal nervous system,
identifiable lesion causing tissue damage
Somatic: originates from skin/muscles/bone
SHARP, well localised

Visceral: originates from hollow viscus or
solid organ
diffuse ache, hard to localise

Question 4

what is neuropathic pain?

Answer 4

malfunctioning nervous
system; nerve structure is damaged

stabbing, shooting, burning, stinging,
allodynia, numbness, hypersensitivity

Question 5

When is it more appropriate to use celecoxib over ibuprofen?

Answer 5

If there is GI risk but no risk to CV

Question 6

drugs for neuropathic pain?

Answer 6

AMITRIPTYLINE start 10-25mg nocte
* GABAPENTIN 300mg TDS introduce over
3/7
* PREGABALIN 75mg BD

Question 7

side effects of drugs for neuropathic pain?

Answer 7

confusion
amitryp -> care if CVS = hypotension
pregablin -> sedation, care if renally excreted

Question 8

advice for neuropathic pain relief?

Answer 8

explanation of different types of pain:
-neuropathic pain isnt from a certain organ or place in body but from the nerves themselves, difficult to manage under normal pain relief but there is specific pain relief that will help target the nerves
full benefit will b felt after 5 days
may need further titration

Question 9

Dexamethasone use as pain relief:

Answer 9

raised ICP
liver mets
SVCO

Question 10

common initial SE of opioids

Answer 10

N&V
* Drowsiness
* Light-headedness/unsteadiness
* Cognitive impairment

Question 11

common on-going SE of opioids

Answer 11

constipation
dry mouth

Question 12

less common SE of opioids

Answer 12

Neurotoxicity; hyperalgesia,
allodynia, myoclonus, delirium,
hallucinations
* Sweating
* Urinary retention
* Pruritus

Question 13

rare SE of opioids

Answer 13

resp depression
pyschological dependence

Question 14

what worries to patients have re: opioids

Answer 14

addiction
tolerance
end of road/last resort
severe side effects

Question 15

bone met pain management

Answer 15

NSAIDS
radiotheraoy
bisphosphonates - with calcium supplements (as bisphosphonates drive calcium into cells so can cause hypocalciema)

Question 16

what is the conversion of codeine: morphine

Answer 16

10:1

Question 17

available forms of morphine

Answer 17

Immediate release (IR)
* Oramorph liquid
10mg/5ml, 100mg/5ml

Slow release (SR)
* Zomorph capsules BD
(10, 30, 60, 100, 200mg)
* MST tablets BD
(5, 10, 15mg)

Parenteral (for SC use)
* Morphine sulphate for injection
* 1mg/ml (1ml, 5ml & 10ml amps)
* 10mg/ml, 15mg/ml, 20mg/ml

Question 18

morphine conversion from oral to SC

Answer 18

2:1

Question 19

morphine conversion from oral to IV

Answer 19

3:1

Question 20

what is fentanyl 12mcg/24 patch equivalent to in morphine?

Answer 20

30-60mg of morphine in 24hours

Question 21

why is fentanyl patch good option

Answer 21

• doesnt need good GIT absorption as straight into bloodstream
• non-renal excretion
• will take 12-24 hours to reach steady state but can give other medication until that is established

Question 22

what also needs prescribed alongside opioid?

Answer 22

laxative
anti-emetic

Question 23

signs of opioid toxicity

Answer 23

pinpoint pupils
hallucinations
drowsniess
vomitting
confusion
myoclonic jerks
resp depression

Question 24

what needs to be written in TTO for controlled drugs

Answer 24

drug name
drug form
drug strength
total amount in numbers and words
eg take morphine SR 30mg BD for 14 days
supply 28 (twenty-eight) morphine SR 30mg capsules