Blog #13

Ané Gutter

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Prepare a short “lecture” of not longer than 5 minutes (200 words), explaining to a patient what pain is, its possible causes, why different people experience pain differently and what the generally important principles of pain management and referral involve. The videos above will also be of value to complete this assignment.

• Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage = subjective experience
• Perception of pain is influenced by the patient's mood, morale and the meaning the pain has for the patient.

ACUTE VS CHRONIC PAIN:

Acute:	Chronic:
ACUTE – Fast pain due to damage caused by an injury and tends to only last a short time. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.	CHRONIC – Slow pain Pain caused by changes to nerves and continues long after the injury or treatment is over and can range from mild to severe. Chronic pain can be unpredictable to treat, but painkillers or other pain control methods can often successfully control it.

Nerve pain is caused by pressure on nerves or the spinal cord, or by damage to nerves. It is also called neuropathic pain. People often describe nerve pain as burning, shooting, tingling, or as a feeling of something crawling under their skin. It can also occur after other cancer treatments such as radiotherapy or chemotherapy.

Bone pain : The cancer cells within the bone damage the bone tissue and cause the pain. People often describe this type of pain as aching, dull or throbbing.

Soft tissue pain from a body organ or muscle. For example, you may have pain in your back caused by tissue damage to the kidney. You can't always pinpoint this pain, but it is usually described as sharp, cramping, aching, or throbbing.

Phantom pain in a part of the body that has been removed. For example, pain in an arm or leg that has been removed due to sarcoma or osteosarcoma. Or pain in the breast area after removal of the breast (mastectomy). Phantom pain is very real and people sometimes describe it as unbearable.

Referred pain from an organ in the body may be felt in a different part of the body. This is called referred pain. For example, a swollen liver may cause pain in the right shoulder, even though the liver is under the ribs on the right side of the body. This is because the liver presses on nerves that end in the shoulder.

CANCER PAIN MANAGEMENT:

• Regular medication
  • paracetamol or ibuprofen (anti-inflammatory)
  • opioid drugs, chosen to suit each person and to minimise side effects.
  • Combining medications

Radiotherapy, surgery, hormone therapy and chemotherapy – if successful in reducing tumour size – may also relieve pain.

Other techniques that may be helpful include relaxation therapies and acupuncture.

TREATMENT CHOICES:

• The location of the pain
• The severity of the pain
• The type of pain – such as sharp, tingling or aching.
• Whether the pain is persistent or comes and goes.
• What activities or events make the pain worse?
• What activities or events make the pain better?
• Current medications
• How much current medications ease the pain?
• The impact the pain has on lifestyle, such as poor  quality of sleep or loss of appetite.

Mild to moderate pain:

• Non-opioid analgesic

• Aspirin, paracetamol or Ibuprofen.

• With or without adjuvant

persistent or worsening of pain:

Moderate pain:

• Weak opioid analgesic

• Codeine, dextropropoxyphene, tramadol or buprenorphine

• With or without a non-opioid

• Aspirin, paracetamol or Ibuprofen.

• With or without adjuvant

Severe pain:

• Strong opioid analgesic:

• Morphine, hydromorphone, oxycodone or trapentadol.

• With or without a non-opioid

• Aspirin, paracetamol or Ibuprofen.

• With or without adjuvant