Pain management

2019 ◽  
pp. 237-316
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Care Practice ◽  
Total Pain ◽  
Holistic Understanding ◽  
Central Tenet ◽  
The Common ◽  
Palliative Setting

This chapter covers the theoretical and practical basis of managing patients with pain in the palliative setting. It includes a review of the common pharmacological, non-pharmacological and anaesthetic approaches to managing pain as well as emphasizing that all good care must be based on a holistic understanding. The concept of total pain has become a central tenet of palliative care practice. It recognizes that cancer pain is often a complex, chronic pain with multiple, coexisting causes. Effective management of cancer pain requires a multidisciplinary approach that addresses the patient’s concerns and fears, as well as treating the physical aspects of pain. As a result, the provision of analgesics should be combined with the provision of emotional, social, and spiritual supports.

Opioid use disorder and chronic pain: challenges for palliative care practice

2019 ◽  
Vol 25 (9) ◽  
pp. 453-457
Author(s):  
Brenda Peters-Watral
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Substance Use ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Use Disorder ◽  
Care Practice ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

Pain in Europe

2018 ◽  
Author(s):  
Christopher Eccleston ◽  
Bart Morlion ◽  
Christopher Wells
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Final Section ◽  
International Association ◽  
Main Section ◽  
Cancer Pain Management ◽  
The World

There are over 740 million people living in the 37 countries who are members of the European Pain Federation of chapters of the International Association for the Study of Pain. The editors introduce the field of pain management, in particular the work of over 20,000 people in acute (largely injury related) pain, chronic pain including cancer pain management, and palliative care. We then describe how the book European Pain Management is structured. There are three sections: an introduction to the world of pain and the epidemiology of pain. The main section, which is 37 chapters long, reports describing the practice of pain management in each country, the challenges and innovations. And a final section looks at specific issues that cut across all nations, and ends with a concluding analysis of the statue of European Pain Management.

scholarly journals Attitudes Toward Opioid Use for Chronic Pain: A Canadian Physician Survey

2003 ◽  
Vol 8 (4) ◽  
pp. 189-194 ◽  
Author(s):  
Patricia K Morley-Forster ◽  
Alexander J Clark ◽  
Mark Speechley ◽  
Dwight E Moulin
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Physician Education ◽  
Care Practice ◽  
Pain Patient ◽  
Computer Assisted ◽  
Opioid Use ◽  
Severe Chronic Pain ◽  
Noncancer Pain

OBJECTIVES: To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians' attitudes toward the current management of chronic pain in Canada.DESIGN: A computer-assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).SETTING: A survey was conducted by Ipsos-Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.RESULTS: In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first-line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either nonsteriodal anti-inflammatory drugs (29%) or acetaminophen (16%). Thirty-five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.CONCLUSIONS: Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One-half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.

scholarly journals Acupuncture for palliative cancer pain management: systematic review

2021 ◽  
pp. bmjspcare-2020-002638
Author(s):  
Juan Yang ◽  
Dietlind L Wahner-Roedler ◽  
Xuan Zhou ◽  
Lesley A Johnson ◽  
Alex Do ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Included Study ◽  
Favourable Effect ◽  
Levels Of Evidence ◽  
Patients With Cancer ◽  
Level 3 ◽  
Randomised Controlled

BackgroundPain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.ObjectiveTo critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.MethodsMultiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.ResultsFive studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.ConclusionsAcupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

Chronic Pain Management as a Barrier to Pediatric Palliative Care

2013 ◽  
Vol 30 (8) ◽  
pp. 764-767 ◽  
Author(s):  
Lindsay A. Thompson ◽  
Elizabeth Meinert ◽  
Kimberly Baker ◽  
Caprice Knapp
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Pediatric Palliative Care ◽  
Chronic Pain Management

Pain treatment and prevention in pediatric palliative care

2021 ◽  
pp. 292-311
Author(s):  
Stefan J. Friedrichsdorf
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Visceral Pain ◽  
Pain Treatment ◽  
Symptom Control ◽  
Pediatric Palliative Care ◽  
Serious Illness ◽  
Psychological Therapies ◽  
Total Pain ◽  
The Usa

Annually, at least 21 million children could benefit from pediatric palliative care (PPC) and 8 million would need specialized PPC services. In the USA alone, more than 40,000 children aged 0–19 years die annually; 55% of them are infants younger than 1 year of age. Pain is common, under-recognized, and under-treated, especially in children with progressive neurodegenerative and chromosomal conditions with central nervous system impairment. Unrelieved pain is also common in children with advanced serious illness during the end-of-life period, and, when treated, the therapy is commonly ineffective. Treating pain in children with serious illness is not profoundly different than advanced pain management for children with complex acute conditions or diseases such as major trauma, burns, cancer, or those with sickle cell disease in vaso-occlusive crisis. It is important to appreciate that children with serious illness are more likely to simultaneously suffer from acute pain, neuropathic pain, visceral pain, total pain, and chronic pain. As such, multimodal analgesic (i.e., multiple agents, interventions, rehabilitation, psychological modalities, and integrative (“nonpharmacologic,” e.g., behavioral, physiological, and psychological) therapies that act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality must be employed. Opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone, remain the mainstay medications to effectively treat pain in children with serious illness. However, medications alone are often insufficient for optimal pain control. In fact, the paradigm shift away from “medications only” toward offering “multimodal analgesia” to children with serious illness experiencing pain, including addressing chronic pain/primary pain disorders and total pain has become a “game changer” in advancing PPC to ensure that patients can live as long as possible, as well as possible.

Principles of Assessment and Pain Management and Procedures in Pain Management

2018 ◽  
Author(s):  
Francisco A. Loaiciga ◽  
Suresh Reddy
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Interdisciplinary Approach ◽  
Care Practice ◽  
Clear Understanding ◽  
Pain Mechanisms ◽  
Single Presentation ◽  
Basic Concepts ◽  
Outpatient Settings ◽  
Real Challenge

Pain has been a major concern in both inpatient and outpatient settings, particularly in patients with advanced diseases. In recent years, considerable progress has been made in the understanding of both acute and chronic pain mechanisms. The bio psychosocial experience of pain, whether it is a mixture or a single presentation of it’s different components, physical, psychological, social, or spiritual, may present a real challenge to both the patient and the treating team, and thus a clear understanding of it’s complexity, is of prime importance. Effective pain management involves an interdisciplinary approach using multimodal techniques, with the goal being to relieve the patient’s suffering. This chapter discusses basic concepts related to pain and its approach in routine palliative care practice.

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