Troubleshooting Difficult Pain
If pain control is difficult, it is worth asking:
- Is it the prescriber?
- Is it the patient?
- Is it the pain?
1. Difficult Pain - is it the prescriber?
- Am I following basic prescribing guidelines?
- Am I using the WHO analgesic ladder?
- Have I titrated the morphine dose up individually for this patient according to clinical response?
- Have I used appropriate formulations of morphine at the correct dose and the correct dosing interval?
- Have I used co-analgesics and other interventions appropriately?
2. Difficult Pain - is it the patient?
- Is my patient taking the medication?
- Are there fears / concerns or differing perceptions / priorities we have not recognised and addresses?
- Does this pain have a significant psychosocial or spiritual component?
- Is it worse when certain family members are there?
- Is there co-existing depression?
- Is there a lot of fear?
3. Difficult Pain - is it the pain?
- Is this a genuinely difficult pain?
- Common examples of difficult pain are pancreatic pain, nerve pain and incident pain (often from bone metastases in load bearing areas).
- If so, have I discussed my approach with the specialist palliative care service?
© Dr. Eileen Palmer, Dr John Howarth Palliative Care for the Primary Health Care Team (2004) Quay Books ISBN 1856422291