Pain (Analgesic Ladder (Step 1 = Non-opioids
Paracetamol, Step 2 = Weak…
Step 3 = Strong opioids
- Fentanil / Alfentanil
Either a dull ache over a large area or a well localised tenderness over the bone. Often worse on weight bearing or with movement.
- NSAIDs e.g. diclofenac 50mg TDS
Dull, deep seated, poorly localised pain. There may be tenderness over a particular organ. May be spasmodic such as bladder spasm or bowel colic.
- Follow analgesic ladder
- Liver capsule pain: NSAIDs or corticosteroids
- Colic: anticholinergics such as S/C hyoscine butylbromide for bowel colic and oral oxybutynin for bladder spasm
Pain in an area of abnormal sensation which may be localised to specific dermatomes or over a wider area. There may be altered sensation such as numbness or hyperaesthesia and autonomic changes such as pallor or sweating. 'Pins and needles' or 'burning'.
- Antidepressants (amitriptyline 10-75mg nocte)
- Anticonvulsants (gabapentin 100-1200mg TDS) (pregabalin 25-300mg BD)
- Compression of a nerve - corticosteroids may help
Total personal experience which may be caused by:
- The disease itself
- the treatment
- A concurrent disease
- Effects on sleep, work, mood
- Current treatment
- Treatments tried and results
- Understanding of illness