(精选)CANCER PAIN MANAGEMENT教学课件.pptVIP

CANCER PAIN MANAGEMENT;Pain control should encompass “total pain” ? Pain management specialists should not work in isolation ? Education is fundamental to good pain management ;A survey of physicians actively involved in cancer care 1/3 wait until prognosis 6 months before giving maximal analgesia (Von Roenn et al. 1993) ? A study of 81 doctors only 5% could convert a parenteral dose of morphine to an equivalent of MST they were unfamiliar with palliative use of radiation (Mortimer and Bartlett 1997). ? ;Cancer pain has increased worldwide an ageing population ? WHO - 4 million people in the world have cancer pain Site of primary tumour important Pain not usually significant in early disease 1/3 with metastatic disease have significant pain Most patients with end stage disease have pain 50% patients report 70% pain relief with analgesics ;Breakthrough pain ? Transitory exacerbation of severe pain on a background of otherwise stable chronic pain in a patient on regular opioids Incidence about 63% Median number 4 severe breakthroughs per day Median duration 30 minutes Incident pain is breakthrough pain related to movement (Portenoy Hagen, 1990) ; Basic pain management principles ?Decrease pain and improve quality of life Do no further harm Allow patient and carers choices Use resources as effectively as possible ;Disease modification Surgery Radiation Chemotherapy Biological therapy ;Basic pain management Oral opioid analgesics Adjuvant analgesics WHO principles Neuropathic pain Individual variation Opioid switching ;;Difficult cancer pain may need specialist pain management ? The WHO guidelines fail in 10-15% patients ? This may be due to: - opioid resistance intolerable drug side effects inability to deliver drugs effectively e.g. GI problems ;Alternatives ? local anaesthetic/steroid somatic/sympathetic nerve blocks neurolytic blocks spinal ITDD neuro-destructive surgical procedures Combined approach aimed at several different levels with