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A Husni Tanra
Department of Anesthesiology, Intensive Care and Pain Management Faculty of Medicine Hasanuddin University MAKASSAR
A Patients perspective
One of the worst aspect of cancer pain is that it`s a constant reminder of the disease and of death .. My dreams is for a medication that can relieve my pain while leaving me alert and with no side effects
Jeanne Stover, 1992
Physical dimension
Psycological dimention
Organic Pain
Psychological Pain
3,5 million people suffering from cancer pain with or without satisfacttory treatment every day
TOTAL PAIN
BIOPSYCHOSOCIOCULTUROSPIRITUAL
WHO 1986
Symptoms of debility
Side-effects of theraphy Non-cancer pathology Cancer
Loss of social position Loss of job prestige and income Loss of role in family Chronic fatigue and insomnia Sense of helpessness Disfigurement
DEPRESSION
ANGER
Unavailable doctors
Irritability Therapeutic failure
Fear of hospital or nursing home Worry about family Fear of death Spiritual unrest
Fear of pain Family finances Loss of dignity and bodily control Uncertainty about future
Elisabeth K.Ross (1969) on death and dying. BEHAVIOUR CHANGES IN CANCER PATIENTS
1. DENY
2. ANGER
3. BARGAINING 4. DEPRESSION
5. ACCEPTANCE
Psychological Disturbances
Pain
Suffering
Financial Concerns
Fear Of Death
Nociceptive Pain
Nociceptive pain means, pain with nociception Nociceptive means, activity of afferent neurons induced by a noxious stimulus TRANSDUCTION
TRANSMISSION
MODULATION
PERCEPTION
TRANSDUCTION
Process whereby noxious stimuli are translated into Heat electrical activity at the sensory endings of nerves.
Pressure
Chemical
Transmission
TRANSMISSION
Refers to the propagation
of impulses throughout
MODULATION
Process whereby endogenous
Modulation
analgesic systems can modify nociceptive transmission. These endogenous systems (opioid, seretonergic, and noradrenergic) exhibit their inhibitory influence at the dorsal horn.
Plays important role to the
individual perception.
Perception
Final process whereby transduction, transmission, and modulation interact with the uniqueness of the individual to create the final subjective feeling that we call pain.
Pain Perception Brain
activation of nociceptors release algesic substances (spesially prostaglandins) Management : Aspirin Acetaminophen NSAID Continous activation of nociceptors may produce sensitization of N.S. (peripherally & centrally)
Example :
Radiation Radiation fibrosis of brachial or lumbosacral plexus Radiation myelophaty Radiation-induced peripheral nerve tumors Mucositis Radiation necrosis of bone
3.Pain indirectly related or unrelated to cancer Myofascial pains Osteoporosis Postherpetic neuralgia Debiliting (decubitus ulcer) Etc
ABCDE Mnemonic for Pain Assessment and Management Ask about pain regularly Believe the patient reports of pain Choose pain control appropriately Deliver in a timely, logical and coordinated
patient Use the simplest dosage schedules and the least invasive means An NSAIDs or acetaminophen should be used in the pharmacologic management of mild to modertae peripheral cancer pain, unless there is a contraindication
codein
STEP 1 Nonopioid
appropriate
Adjuvant Drugs
Corticosteroids : Dexamethasone, Prednison Anticonvulsant : Carbamazepine, Gabapentin, etc Antidepressant : Amytriptiline, Doxepine Neuroleptics : Methotrimeprazine Antihistamines : Hydroxyzine Local anesthetic/antiarrhytmics : Lidocaine Psycho-stimulans : Dextroamphetamine Laxatives : Bisacodyl, Lactulose, etc Antiemetics : Droperidol, Metoclopropamide, etc
20 mg tab
+ adjuvant
06.00 18.00
If we could notable to cure the cancer patients, never deny cancer pain, and let them die free of pain and with IMAN As a doctor, one should keep in mind :
CONCLUSION
1. Pain is a common problem and a major symptom of cancer patients.
2. Pain is one of the most feared aspect and can cause to suicide
3. Cancer pain can be organic or psychological pain