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"Should you shield the valleys from the windstorms, you would never see the beauty of their canyons."

ELISABETH KUBLER-ROSS

Recognising Common Pain Patterns

There are some common pain patterns that are worth learning to recognise and differentiate clinically. There are:

Recognising these common pain patterns allows the appropriate use not only of strong opioids, but also of co-analgesics. It allows early identification of situations where other treatment modalities such as radiotherapy have a major role. It also allows explanation to patient and family and establishes confidence that the symptom is being addressed skilfully and professionally. This is an important first step in engaging patient and family in a jointly agreed management plan.

Managing Some Common Pain Patterns

The first step is always to follow the WHO analgesic ladder , rapidly moving if needed to a strong opiod. However in bone pain, nerve pain, colic and cutaneous pain, additional interventions are almost always necessary. Don't delay initiating these additional measures (such as radiotherapy for bone pain). Again it comes back to the importance of a clear diagnosis of the pain and good anticipatory care.

Interventions for the different pain patterns:

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Pain Pattern Morphine Responsiveness Useful Co-Analgesics Other Interventions
Visceral Pain Usually completely responsive* Not usually required Not usually required
Bone Pain Often good response NSAID's
Sometimes steroids
RADIOTHERAPY
Bisphosphonate infusions
Surgical stabilisation
Nerve Pain Partial response Steroids
Tricyclic antidepressant
Anticonvulsants
Sometimes radiotherapy
Early referral for specialist advice
Colic Partial response Hyoscine butylbromide (buscopan) (Rarely) Surgical relief of obstruction
Cutaneous Pain Often little response (Case reports of topical use being helpful) NSAID'S
Topical local anaesthetics
Radiotherapy
Eradicating infection
Appropriate dressings
For pressure sores prevention is better than cure

*Pancreatic pain is the exception, probably because of early involvement of retroperitoneal tissue. As well as morphine, try NSAID’S, steroids and consider early referral to a pain anaesthetic service for coeliac plexus or splanchnic nerve block.

© Dr. Eileen Palmer, Dr John Howarth Palliative Care for the Primary Health Care Team (2005) Quay Books ISBN 1856422291
Palliative Care Pain Pack 2. Dr Eileen Palmer 2008

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Important News

Important Changes in Cumbria Palliative Care Prescribing Practice

Cumbria is changing practice, from 1st April 2011.

The Area Prescribing Committee has recommended the following changes:

  • All strong opioids are to be prescribed by brand name
  • "Just in Case" prescribing is to be encouraged and promoted
  • Morphine is to replace diamorphine as the subcutaneous injectable strong opioid of choice for palliative care patients in Cumbria

21/03/2011

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North Cumbria Pallative Care website

The award winning North Cumbria Palliative Care website continues to receive around 30,000 page views a year. This is 82 page views every single day of the year, 2,500 hits every month, without any publicity or advertising program.

1/3/2011

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