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Pain in Hospice Patients

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by

Nick Schwedock

on 25 June 2013

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Transcript of Pain in Hospice Patients

Pain Management in Hospice Patients
Pain Management in Hospice Patients
1. Assessment of Pain
2. Choice of Pain Medicine
3. Dosing
4. Dosing Conversions and Equivalency
5. Opioid Side Effects and Caveats
6. Non Pharmaceutical Approaches to Pain
Assessment of Pain
Why?: Most Pain can be brought under adequate control.
Choice of Pain Med
Mild: Tylenol / Motrin (NSAIDS)
High risk of adverse effects in Palliative Care
Mod - Severe: Opioids

Opioids:
Morphine, Oxycontin, Hydormorphone, Methadone, Fentanyl, Meperidine, Codeine, Hydrocodone
Dosing
1. Baseline Dosing Around the Clock
2. 10-30% of total daily dose as PRN
q 1-2 hours if PO
q 30 min if IV
For PCA, the hourly rate q 15min
Adjust Baseline daily to cover for PRN


Dosing Conversions and Equivalency
Opioid Side Effects and Caveats
Respiratory Depression
Rare to cause unless CO2 retainer
Relieves Air Hunger
Sedation First

Non Opioids
Nsaids
Bisphosphonates
Steroids
TCA
SNRI
Anticonvulsants
Topicals
Anticholinergics
Nerve Blocks
Spinal Infusions
Surgery
Radiation
History
1. Patient
2. Caregiver
3. Family
Exam
Quality
Somatic
Constant, Dull, Aching, Localized, Changing with Movement
Visceral
Deep, Aching, Cramping, Poorly Localized
Neuropathic
Burning, Shooting, Tingling, Shock-Like
0-10
Other Symptoms
1. Dyspnea / Air Hunger
2. GI
3. Delerium / Agitation
Renal
Liver
Cost
BASELINE
BREAKTHROUGH
Conversions
Oral > Transcutaneous > Subcutaneous > IV
Convert
Reduce by 25-75%
Constipation
Common
Stimulants or Osmotics
Softeners not as effective
Nausea
Myoclonus
Delirium
Elderly
do not withhold
Addiction
Addiction
Physical Dependence
Tolerance
Psuedoaddiction
Nonpharmacological
Massage Therapy
Biofeedback
Music
Distraction
Humor
Therapeutic Touch
Chiropractic Manipulation
Pet Therapy
TENS
Acupuncture
Local Heat / Cold
Education about Illness
Hypnosis
Guided Imagery
Cognitive and Behavioral Therapy
Somatic
Neuropathic
Visceral
Full transcript