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Section IV: Principles of Pain Management
Opioid dose titration
Long-acting medications
Opioid rotation/equianalgesia
Addictive disease
Interventional therapies
Non-pharmacological techniques
Nursing role
Core
Principles of Opioid Dose Titration
Sustained release medications
Immediate-release for breakthrough pain
Distinguish types of breakthrough pain
Core
Principles: Use of Opioid Rotation
Use when one opioid is ineffective, even with
adequate titration
Use when adverse effects are unmanageable
Core
Principles of Equianalgesia
Determine equal doses when changing drugs or
routes of administration
Reduce by 25% when changing drugs
Use of morphine equivalents
Core
Treatment of Pain in Persons With
Addictive Behaviors
Team meetings with interdisciplinary approach
Set realistic goals
Set limits
Use nonopioids as able
Consider tolerance
Core
Treatment of Pain in Persons With
Established Addictive Disease (cont.)
Avoid parenteral injections, if possible
Prevent withdrawal
Treat depression and other psychiatric disorders
Use alternate opioid if on methadone for
maintenance
Core
Other Issues
Polypharmacy
Cost
Compounding
Core
Cancer Therapies to Relieve Pain
Radiation
Surgery
Chemotherapy
Hormonal therapy
Bisphosphonates
Core
Interventional Therapies
Neurolytic blocks
Neuroablative procedures
Vertebroplasty/kyphoplasty
Core
Non-Pharmacologic Strategies
Physical
Psychosocial
Complementary &
Integrative
Rehabilitation
Relaxation
Acupuncture
Exercise
Meditation
Qigong
Heat or cold
Hypnosis
TENS
(transcutaneous
electrical nerve
stimulation)
Music
Therapeutic
massage
Biofeedback
Reiki
Systematic
desensitization
Cognitive-behavioral
therapy
Core
Summary
Pain relief is contingent on adequate assessment
and use of both drug and non-drug therapies
Pain extends beyond physical causes to other
causes of suffering and existential distress
Interdisciplinary care
Core
Core