pain management 1 and introduction to palliative care 8/2020

1. Pain management 1
Presented by :
Ass. Lecturer . Heba bakri
clinical oncology department AUH

2. AGENDA
• Palliative care general scope and hospice
• Pain def. , magnitude of the problem
• pathophysiology
- Types
- Pathways
- Receptors
- Neurochemicals
- Gate theory (video )
• Wrap up

3. palliative care general scope

4. Cicely Saunders, (22 June 1918 – 14 July
2005) was an English nurse, social worker, physician and writer.
She is noted for her work in terminal care research and her role
in the birth of the hospice movement, emphasising the
importance of palliative care in modern medicine and she is the
founder of St. Christopher's Hospice for the terminally ill in
1967

5. Elisabeth Kübler-Ross (July 8, 1926 – August 24, 2004) was a
Swiss-American psychiatrist, a pioneer in near-death studies, and author of the
internationally best-selling book, On Death and Dying (1969), where she first
discussed her theory of the five stages of grief, also known as the "Kübler-Ross
model .
Elisabeth was named by Time (magazine) as one of the "100 Most Important
Thinkers" of the 20th Century in 2007 and she was the recipient of nineteen
honorary degrees.
By July 1982 Kübler-Ross taught 125,000 students in death and dying courses
in seminaries, medical schools, hospitals, and social-work institutions.

6. Dr Balfour Mount Born in 14 April 1939, is a
Canadian urologic-cancer surgeon . In January 1973, was influenced
by a discussion group of Elisabeth Kubler-Ross' book On Death and
Dying to lead a study of the conditions at Montreal's Royal Victoria
Hospital.
In September 1973, after visiting Cicely Saunders' St. Christopher's
Hospice he helped to create a similar ward within the Royal Victoria
Hospital and coined the term "palliative care".
He became the founding Director of the Royal Victoria Hospital
Palliative Care Service, the Palliative Care McGill in 1990 and the
McGill Programs in Integrated Whole Person Care in 1999.
He is considered the father of palliative care in North
America.

7. The doctor has battled disease for years in
personal as well as professional ways – first
testicular cancer at 24, just after graduating
from Queen’s medical school, back when the
cure rate for that type of cancer was only about
33 percent.
Then in 2000, cancer attacked his esophagus,
requiring surgery, radiation, and
chemotherapy.
This cancer later spread to his neck, leading to
his tracheostomy in 2007.
The most important quote *I was trained to kill the suffering, “not the
person who is suffering.”

10. WHO Definition of Palliative Care
• Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated with life-
threatening illness, through the prevention and relief of suffering by
means of early identification and impeccable assessment and treatment
of pain and other problems, physical, psychosocial and spiritual.

22. Levels of palliative care

23. Palliative care team

24. Evidence based medicine palliative care sicce
2010 till now and continuing

28. 2- Pain

31. Definition of pain

32. Magnitude of the problem
• Pain is common in cancer patients, particularly in the advanced stage of
disease.
• The most comprehensive systematic review indicates pain prevalence
ranging from 33% in patients after curative treatment, to 59% in
patients on anticancer treatment and to 64% in patients with metastatic,
advanced or terminal disease
• Pain has a high prevalence earlier in disease in specific cancer types such
as pancreatic (44%) and head and neck cancer (40%) .

33. Impact of pain on daily life

34. Benefits of pain

36. Classification of pain

47. Characters of pain

49. Pathways of pain sensation

50. Nocireceptors in skin

65. Mechanism of pain

69. • Palliative care is essential and integrated part in management of cancer
and should be introduced since diagnosis as it is evidence based can
increase survival of our patients
• Palliative care team includes (oncologist , nutritionist , clinical
pharmacist , psychotherapist, social workers and certified nurse )
• Pain def. acc to IASP is un pleasant sensory and emotional experience
and associated with tissue damage & is common in cancer patients
particularly in the advanced stage of disease.
• Understanding pathophysiology (pathways and 4 pahses of senstation
of pain) helps in understanding management with accurate diagnosis
of pain type

70. • Pain is classified acc to time (acute and chronic ) and receptors
(neuropathic and Nocireceptors ) with examples , subtypes and
characters which are the targets of pain killer agents
• Fibers sharing in transmission differ acc . To (myelination , speed ,
site) the fastest is Ad fibers acute pain , C one for chronic pain
• Neurotransmitters ( neurochemicals ) are imp.
• Developing or inhibiting pain by action potential and
hyperpolarization respectively.