Palliative care

7 Palliative care





Pain management


Pain control is an important component of cancer management and uncontrollable pain is the major fear for many cancer patients. More than 80% of patients with advanced cancer suffer pain and around 20% of pain in cancer patients may be attributed to surgery, radiotherapy and chemotherapy. Pain control involves two important steps: assessment of pain and management of pain.




Management of pain


The management of pain includes analgesics as well as non-pharmacological measures. The World Health Organization (WHO) analgesic ladder (Figure 7.1) has been the gold standard in the management of pain and has been shown to eliminate pain in 80% of patients. The remaining 20% have complex pain which may require specialist interventions. Measures used in complex pain include neuro-anaesthetic interventions, palliative surgery, radiotherapy, chemotherapy, physiotherapy, occupational therapy, and psychosocial care.




Analgesics


Commonly used analgesics are given in Table 7.1. Strong opioids are started at a low dose and titrated according to the clinical need (Box 7.2). Morphine is the strong agent of choice and oral administration is preferred. Transdermal preparations are useful only in stable pain. Some agents may only be prescribed by specialists in palliative care medicine or anaesthetia.






Adjuvant analgesics


Adjuvant analgesics (Table 7.2) are a useful complement to regular analgesics in complex pain. These include anticonvulsants, antidepressants, antispasmodics, bisphosphonates, steroids, muscle relaxants and N-methyl-D-aspartate antagonist (ketamine).


Table 7.2 Adjuvant analgesics

















Indication Drug Dosage
Neuropathic pain Dexamethasone 8–16 mg daily
Gabapentin 100–300 mg (nocte) Titrate to 600 mg TDS
Amitriptyline

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Jun 18, 2016 | Posted by in ONCOLOGY | Comments Off on Palliative care

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