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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