Download Welcome to St Clare Hospice

Welcome to St Clare Hospice
Outline

Welcome

Pain control: getting it right

Hospice in-patient care

Hospice Day Therapy

Hospital Palliative Care

Community Palliative Care

Case Studies

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Pain control: getting it right
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Scope of the problem
 53% all stages of disease
 59% of patients on active anticancer treatment
 64% of patients with metastatic, advanced or terminal
disease
 33% of patients who had been cured of cancer
 More than 33% graded pain as moderate or severe
van den Beuken-van Everdingen et al. 2007
Total pain
 Physical
 Social
 Psychological
 Spiritual
Cancer pain
 Acute pain
Recent onset, transient,
identifiable cause
 Chronic pain
Persistent or recurrent pain,
beyond usual course of acute
illness or injury
 Breakthrough pain
Transient pain, severe or
excruciating, over baseline of
moderate pain
Pathophysiology
Nociceptive pain
Neuropathic pain
Pain caused by
an inflammatory or
non-inflammatory
response to a
noxious stimulus
Pain initiated or caused
by a primary lesion or
dysfunction in the
peripheral or central
nervous system
Pathophysiology
NOCICEPTIVE PAIN
VISCERAL
SOMATIC
SUPERFICIAL
DEEP
Pathophysiology
NEUROPATHIC PAIN
NERVE COMPRESSION
PERIPHERAL
NERVE INJURY
CENTRAL
SYMPATHETICALLY
MAINTAINED
Pathophysiology
Characteristics
Mechanisms
Examples
Somatic
Constant, aching,
gnawing.
Well localised
Activation of nociceptors
in cutaneous or deep
tissues
Skin metastases
Visceral
Constant, aching,
poorly localised often
referred
Activation of nociceptors
due to infiltration
compression
Pancreatic cancer
Lung/liver metastases
Neuropathic Paroxysmal, shooting or Spontaneous and
Tumour compression
shock-like pain .
paroxysmal discharges in Post-surgical incision
Background of burning
PNS and CNS
or constriction
Multiple pains
40
35
30
25
20
15
10
5
0
0
1
2
3
4
5
6
7
8
% Patients
Aetiology
100
90
80
70
60
50
40
30
20
10
0
Caused by tumour
Caused by
treatment
Caused by
cancer/debility
Caused by
concurrent disorder
Assessment
 Site
 Exact onset
 Quality
 Associated symptoms
 Exacerbating factors
 Interference with activities
 Relieving factors
of daily living
 Response to analgesics
 Temporal patterns
Foley KM. Oxford Textbook of Palliative Medicine 2004
Assessment tools
 Pain charts
 Visual analogue scales
 Pain diaries
 Questionnaires
Barriers
 Clinicians
 Patients
 Health care system
Managing cancer pain
Chemotherapy
Radiotherapy
Hormone therapy
Adjuvant analgesics
Analgesics
Surgery
Anaesthetic procedures