Total Pain Management and a Malignant Wound: The Importance of Early Palliative Care Referral

Independent Research on Cancer Pain Management in the Setting of Early Palliative Care: A Flywheel to Counteract General Opioid Misuse and Abuse

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197097 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7097

Author(s):

Elena Bandieri ◽

Leonardo Potenza ◽

Fabio Efficace ◽

Eduardo Bruera ◽

Mario Luppi

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

World Health ◽

Evidence Based ◽

Cancer Pain Management ◽

Who Analgesic Ladder ◽

Early Palliative Care ◽

Positive Effects ◽

Analgesic Ladder

The increased recognition of the high prevalence and important burden of cancer pain and the documentation of a large proportion of patients receiving inadequate analgesic treatment should have reinforced the need for evidence-based recommendations. The World health Organization (WHO) guidelines on cancer pain management—or palliative care—are traditionally based on a sequential, three-step, analgesic ladder according to pain intensity: nonopioids (paracetamol or nonsteroidal anti-inflammatory drugs) to mild pain in step I; weak opioids (eg, codeine or tramadol) to mild-moderate pain in step II; and strong opioids to moderate-severe pain in step. III. Despite the widespread use of this ladder, unrelieved pain continues to be a substantial concern in one third of patients with either solid or hematologic malignancies. The sequential WHO analgesic ladder, and in particular, the usefulness of step II opioids have been questioned but there are no universally used guidelines for the treatment of pain in patients with advanced cancer and not all guideline recommendations are evidence-based. The American Society of Clinical Oncology and the European Society of Medical Oncology have recommended the implementation of early palliative care (EPC), which is a novel model of care, consisting of delivering dedicated palliative service concurrent with active treatment as early as possible in the cancer disease trajectory. Improvement in cancer pain management is one of the several important positive effects following EPC interventions. Independent well-designed research studies on pharmacological interventions on cancer pain, especially in the EPC setting are warranted and may contribute to spur research initiatives to investigate the poorly addressed issues of pain management in non cancer patients.

Download Full-text

A Case in Which Total Pain Management by a Palliative Care Team Relieved Previously Intractable Physical Pain

Haigan ◽

10.2482/haigan.51.835 ◽

2011 ◽

Vol 51 (7) ◽

pp. 835-839

Author(s):

Hiromichi Yamane ◽

Takuya Yano ◽

Shigeki Umemura ◽

Yasuhiro Shiote ◽

Daijiro Harada ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Palliative Care Team ◽

Care Team ◽

Physical Pain ◽

Total Pain

Download Full-text

Collusion: The facade and its implications on total pain management in palliative care

Indian Journal of Palliative Care ◽

10.4103/ijpc.ijpc_81_20 ◽

2021 ◽

Vol 27 (1) ◽

pp. 176

Author(s):

Bincy Mathew ◽

BidhuKalyan Mohanti ◽

Saipriya Tewari ◽

Vedant Kabra ◽

Pushpinder Gulia ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Total Pain

Download Full-text

Pain management

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0008 ◽

2019 ◽

pp. 237-316

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Care Practice ◽

Total Pain ◽

Holistic Understanding ◽

Central Tenet ◽

The Common ◽

Palliative Setting

This chapter covers the theoretical and practical basis of managing patients with pain in the palliative setting. It includes a review of the common pharmacological, non-pharmacological and anaesthetic approaches to managing pain as well as emphasizing that all good care must be based on a holistic understanding. The concept of total pain has become a central tenet of palliative care practice. It recognizes that cancer pain is often a complex, chronic pain with multiple, coexisting causes. Effective management of cancer pain requires a multidisciplinary approach that addresses the patient’s concerns and fears, as well as treating the physical aspects of pain. As a result, the provision of analgesics should be combined with the provision of emotional, social, and spiritual supports.

Download Full-text