principles of pain management - idomino
TRANSCRIPT
3/17/2013
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Principles of Pain
ManagementDOMINO B. PUSON RN MN
What is your idea on how to
treat pain in palliative care?WRITE YOUR OPINION ON ¼ SHEET OF PAPER
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Contents
Etiology of Pain
Assessment of Pain
Barriers of Pain Management
Misconceptions about pain
Overview of Approaches to Pain Management
“”
Pain is now recognized as
the fifth vital sign in all
care setting…MATTESON & MCCONNEL
4 out 10 dying patients report having severe pain most of the time.
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Two type of pain
Nociceptive – responds to analgesics
Somatic or visceral pain
Neuropathic pain – drug therapy is
complex, require treatment by a pain
specialist
Conditions that adds up to pain
Pressure ulcers
Joint contractures
Bowel obstructions
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“”
An outdated belief is that
older people are less
sensitive to pain.HPNA, 2003C
Assessment
What to do when there is pain
Determine the location and radiation, character and intensity.
Understanding the patients viewpoint
“Are there any other symptoms associated with pain?”
“How long have you been having this pain?”
“Does anything make the pain better?
“Are you currently taking other medications
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Pain Assessment Tools
Pain Assessment Tool in Confused Older Adults (PATCOA)
Check List of Nonverbal
Pain Indicators (CNPI)
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Assignment
Encode in a short bondpaper the management of the following symptom following pain
Dyspnea
Anxiety
Nausea and Vomiting
Constipation
Anorexia and Cachexia
Depression
Delirium
Common Misconception
about PainTHE HOSPICE WORKER WILL FACE SEVERAL IMPORTANT
MISCONCEPTIONS ABOUT PAIN…
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Differences of Pain
Acute Pain
Associated with changes in vital signs
Sweating, anxiety and facies
Cancer-associated Chronic Pain
Develop adapting coping mechanism – humor, distraction by conversation, music art, writing or watching television
May not look like having pain
Common Misconceptions about
Cancer-Associated Pain
All cancer is painful
The amount of pain is related to the extent of the cancer
Strong pain medicines cause addiction
Taking pain medicine too early will interfere with it working “when you really need it.”
People who complains are not good patients.
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Management of Pain
Nonpharmacologic ApproachesTHE MOST COMMON FORM OF PAIN MANAGEMENT
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Physical Modalities
Cutaneous stimulation
Massage
Thermal manipulation
Vibration
Pressure exercises
Immobilization
Transcutaenous electrical nerve stimulation (TENS)
acupuncturre
Psychosocial Modalities
Relaxation and imagery
Distraction and reframing
Education
Psychotherapy
Support groups
Pastoral Counselling
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Pharmacologic Approaches
Selection of Medications for Pain
Management
Nonsteroidal anti-inflammatory drugs
(NSAIDs)
Agonist, antagonist, and mixed agonist-
antagonist opioids
Adjuvant analgesics (anticonvulsants –
antidepressants)
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NSAIDs They are subject to the “ceiling
effect” in their analgesic efficacy
There are unique toxicity in special
populations
There is no data that one class of
NSAID is more efficacious than
another or that one is less toxic
OpioidsMorphine Sulphate
Hydromorphone
Fentanyl
Meperidine – not
recommended for chronic
pain
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Adjuvant Analgesics for Cancer-
Associated Pain
Dexamethasone added to morphine
Antidepressants
Imipramine
Doxepin
Nortriptiline
Amitriptyline
Anticonvulsants
Phenytoin
Carbamazepine
Adjuvant Analgesics for Cancer-
Associated Pain
Local Anesthetics / Antiarrythmics
Mexiletine
Tocainide
Lidocaine
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Principles of Pain
ManagementDOMINO B. PUSON RN MN