Cancer Pain
Assessment
Location, Severity, Temporal Course, Characteristics, Meds
Other symptoms, impact on functioning, impact on mood
Analgesic Ladder
Non-Opioid -> Weak opioid (Codein/Tramadol) -> Strong opioid (Morphine)
Opioid Use
Physical Depenedence
Body adapts to presence of opioids, and withdrawal symptoms are seen if opioids are stopped
Tolerance
Normal Physiological Phenomenon
Addiction
Pathogic, psychological condition
Route
Oral is first choice, Parenteral and Transdermal, rectal are alternate forms
Parenteral indications
Severe pain, dysphagia, intractable N/V, diminished GI absorption, Intestinal obstruction, Terminal care
Side effects
Constipation, nausea, Somnolence
Less common: opioid neurotoxicity, Dry mouth, urinary retention, Sweating, pruritis, postural hypotension, Respiratory depression
Adjuvant Meds
Steoids: SCC, Increased ICP, neuropathic Pain
AED (Gapapentins): Neuropathic pain
TCA, SNRIs: Neuropathic pain
Biphosphonates: Bone Pain
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