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Analgesic Trade Secrets

Analgesic Trade Secrets. Dr Hannah Gunn Consultant in Palliative Medicine Northumbria Healthcare & Marie Curie Hospice Newcastle. Session Outline. Defining pain Types of pain Noceceptive Neuropathic Total WHO Analgesic Ladder Adjuvants Case histories. Defining Pain. What is pain?.

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Analgesic Trade Secrets

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  1. Analgesic Trade Secrets Dr Hannah Gunn Consultant in Palliative Medicine Northumbria Healthcare & Marie Curie Hospice Newcastle

  2. Session Outline • Defining pain • Types of pain • Noceceptive • Neuropathic • Total • WHO Analgesic Ladder • Adjuvants • Case histories

  3. Defining Pain

  4. What is pain?

  5. What is pain? • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage • International Association for the Study of Pain (IASP) 1986

  6. What is pain? • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage • International Association for the Study of Pain (IASP) 1986 • Pain is what the patient says hurts

  7. Types of Pain

  8. Types of Pain • Nociceptive Pain • Neuropathic Pain

  9. Types of Pain • Nociceptive Pain • Transmitted by undamaged nervous system • Opioid receptors involved • Impulse  spinal cord  higher centres • WHO analgesic ladder • Neuropathic Pain • Transmitted by damaged nervous system • Partial opioid sensitive • Associated with hyperalgesia and allodynia • WHO analgesic ladder • Adjuvants

  10. Total Pain

  11. Total Pain

  12. Total Pain

  13. Pain Management Strategy

  14. Pain Management Strategy • Modify pathological process • Surgery • Radiotherapy • Chemotherapy • Choose an analgesic • WHO analgesic ladder • Adjuvants • Side effects • Non-drug management of pain • Address all the domains of total pain • Heat pads, TENS • Lifestyle modification • Home equipment • Walking aides • Care package

  15. WHO analgesic ladder

  16. Choice of drug based on severity of pain NOT on stage of disease

  17. Adjuvants

  18. When is an analgesic not an analgesic? Methadone Ketamine Anti-spasmodic When it’s an adjuvant! Steroid Anti-epileptic Bisphosphonate Muscle relaxants Anti-depressant

  19. AdjuvantDrugs AdjuvantDrugs Choice of drug based on severity of pain NOT on stage of disease

  20. Common Adjuvants

  21. Case 1 • Joan, 63 year old woman • Diagnosed with left breast cancer 2 years ago • Mastectomy • Radiotherapy and chemotherapy • Ongoing hormone therapy • Presents to GP with RUQ pain, worse on inspiration, ‘like I’ve pulled a muscle’ • Some vomiting, especially later in day, large volumes, hiccoughs and belching

  22. Liver Capsule Pain • Aetiology • Liver metastases • Presentation • RUQ pain • Stretch quality • Can vary with respiration • Management • Dexamethasone 8-16mg mane with PPi cover

  23. Case 2 • Brian, 74 year old man • 8 year history of prostate cancer • Admitted with severe lower back pain, increasing for last few weeks, now unable to walk due to pain

  24. SPINAL CORD COMPRESSION

  25. Bone Pain Paracetamol and NSAID and morphine • Aetiology • Bone infiltration • Pathological fractures • Presentation • Severe pain • Associated with site of metastases • Management • WHO analgesic ladder • Adjuvant analgesics • Dexamethasome 8-16mg mane with PPi cover • Bisphosphonate infusion • Gabapentin or amitriptyline

  26. Summary

  27. Pain is what the patient says hurts • WHO analgesic ladder • Adjuvants • Review, review, review

  28. Pain is what the patient says hurts • WHO analgesic ladder • Adjuvants • Review, review, review • Ask your friendly neighbourhood palliative care team!

  29. Thank You! HannahGunn@nhs.net

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