Cleminson Bruce - CONTEMPORARY PRINCIPLES OF PAIN MANAGEMENT (Hospice, Palliative Care & Pain Control - WCD - 04_Feb)


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Bruce CLEMINSON, Macmillan Palliative Care Education Facilitator, Fellow of the Royal College of General Practitioners & Member, European Association for Palliative Care, Shetland, United Kingdom
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Брюс КЛЕМИНСОН, Координатор образовательных программ по паллиативной помощи центра Мак Миллан, член Королевской коллегии врачей общей практики, Шетландские острова, Великобритания

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Cleminson Bruce - CONTEMPORARY PRINCIPLES OF PAIN MANAGEMENT (Hospice, Palliative Care & Pain Control - WCD - 04_Feb)

  1. 1. Contemporary principles of pain management Moscow – February 4th 2013 Dr Bruce Cleminson MB FRCGPMacmillan Palliative Care education facilitator
  2. 2. Pain is a universal experience in human lifeIt may be caused by many different situations & illnesses70% of people with terminal illness from any cause will experience pain
  3. 3. 1 out of 4 peopleat the time of their cancer diagnosis have pain
  4. 4. 3 out of 4 peoplewith far advanced cancer have pain
  5. 5. In Europe – at least 3 out of 4 peopledie of some kind of terminal illness
  6. 6. about 70% of peopledying of any kind of terminal illness have pain
  7. 7. So, more then half of us here … and our patients … will have significant pain during our lifetime
  8. 8. Careful assessment is essentialMost terminal patients have 3 or more pains at any time – each needing assessment.use an assessment tool - The Brief Pain InventoryThis approach helps us understand the mechanism ofthe pain, and helps us know which medicine or approach to use.
  9. 9. For people with painThere are WHO guidelines, written by international specialists for the treatment of pain.
  10. 10. For moderate to severe pain Morphine is usually neededFor non physical pain a different approach is neededWhatever the illness, the stage, or the cause of the pain, patients with moderate to severe physical pain, should receive Morphine, if needed.An example
  11. 11. The WHO 3 step analgesic ladder (1986/1996) step 3 - strong opioid (+/- adjuvants) eg morphine step 2 - weak opioid (+/- adjuvants) eg Tramadol step 1 - simple analgesic eg paracetamol / ibuprofen
  12. 12. Tramadol can relieve mild to moderate pain but not severe painAn example;
  13. 13. Morphine can relieve moderate to severe painMorphine by mouth or injection are equally effectiveThe correct dose is the dose that relieves the painThere is no upper limit to the Morphine dosage50% of terminally ill cancer patients with pain need 60 mgs or more of oral morphine per day
  14. 14. Morphine formulationsNormal release oral morphine 1 – useful for bringing pain under control. 2 - useful for break-through painNormal release Morphine and Morphine by injection only have an action lasting 4 hoursSo they need to be given every 4 hours for effective Pain reliefMorphine injections are mainly used when the patient cannot take morphine by mouth
  15. 15. Sustained release MorphineSustained release Morphine is used for maintaining already established pain controlSustained release Morphine (MST) needs to be given regularly every 12 hours
  16. 16. For patients and their families, oral Morphine is easier and more pleasantFor the staff and carers, oral Morphine is less demanding on their time
  17. 17. Successful Pain Management …can be achieved in 80 – 90% of patients in a cost effective way … provided there is:The availability of Morphine and alternative WHO step 3 opioids for moderate to severe painEducation for healthcare professionals & the publicSpecific healthcare policiesIntegration of palliative care and hospice services
  18. 18. Doctors and patients fears about Morphine … 1 – Will the Morphine kill the patient? 2 - will the Morphine cause addiction? 3 – will the Morphine cause excessive sedation? 4 – will the Morphine dose escalate rapidly? An example
  19. 19. Morphine is effective safe & cheaper than most of its alternatives
  20. 20. In summaryWhat are the contemporary principles of pain management?Recognise the extent of the problemAssessment of the painUnderstanding the mechanism of the painSelecting the appropriate treatment optionReassess the pain to confirm effectivenessThe necessary drugs need to be availableEspecially all 3 formulations of MorphinePalliative radiotherapy needs to be accessibleMedical education is needed to ensure quality carePublic education to have the confidence to receive this care
  21. 21. Spaceba