Palliative care

doi:10.1093/med/9780199235636.003.0020

Oxford Desk Reference: Oncology (1 edn)

Thankamma V Ajithkumar (ed.) et al.

https://doi.org/10.1093/med/9780199235636.001.0001

Published online:

01 October 2011

Published in print:

01 June 2011

Online ISBN:

9780191725760

Print ISBN:

9780199235636

- Copyright Page
  - Notes
  - Notes
- Preface
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Detailed contents
  - Notes
  - Notes
- List of abbreviations
  - Notes
  - Notes
- List of contributors
  - Notes
  - Notes
1 Introduction
- Notes
- Notes
2 Clinical approach to suspected cancer
- Notes
- Notes
3 Concepts of multidisciplinary management
- Notes
- Notes
- Notes
5 Oncological emergencies
- Notes
- Notes
6 Special situations in oncology
- Notes
- Notes
- Pain management Pain management
  - Pharmacological Interventions Pharmacological Interventions
    - Step one: non-opioid analgesia Step one: non-opioid analgesia
    - Step two: weak opioid Step two: weak opioid
    - Step three: strong opioids Step three: strong opioids
    - Strong opioid titration Strong opioid titration
    - Strong opioids Strong opioids
      - Morphine Morphine
      - Diamorphine (di-acetylmorphine) Diamorphine (di-acetylmorphine)
      - Oxycodone Oxycodone
      - Hydromorphone Hydromorphone
      - Fentanyl Fentanyl
      - Alfentanil Alfentanil
      - Buprenorphine Buprenorphine
      - Methadone Methadone
      - Transdermal buprenorphine Transdermal buprenorphine
    - Choice of strong opioid Choice of strong opioid
    - Transdermal opioids Transdermal opioids
    - Opioid toxicity (Fig. ) Opioid toxicity (Fig. )
    - Clinical features of opioid toxicity Clinical features of opioid toxicity
    - Management of opioid toxicity Management of opioid toxicity
    - Opioid switching Opioid switching
    - Adjuvant analgesics Adjuvant analgesics
    - Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs
  - Neuropathic pain Neuropathic pain
    - Anticonvulsants Anticonvulsants
    - Antidepressants Antidepressants
    - Ketamine Ketamine
    - Topical lignocaine Topical lignocaine
    - Neuropathic cancer pain—treatment strategy Neuropathic cancer pain—treatment strategy
  - Cancer-induced bone pain Cancer-induced bone pain
    - Treatment of CIBP Treatment of CIBP
    - Bisphosphonates Bisphosphonates
    - Anaesthetic interventions Anaesthetic interventions
      - Choice of drug Choice of drug
  - Non-pharmacological interventions Non-pharmacological interventions
  - Further reading Further reading
- Nausea and vomiting Nausea and vomiting
  - Clinical approach Clinical approach
  - Investigations Investigations
  - Possible causes of nausea and vomiting in cancer Possible causes of nausea and vomiting in cancer
  - Management Management
  - Non-pharmacological measures Non-pharmacological measures
  - First-line antiemetics First-line antiemetics
    - Haloperidol Haloperidol
    - Cyclizine Cyclizine
    - Metoclopramide Metoclopramide
    - 5-HT₃ antagonists 5-HT₃ antagonists
  - Second-line antiemetics Second-line antiemetics
    - Levomepromazine Levomepromazine
    - Dexamethasone Dexamethasone
  - Further reading Further reading
- Malignant bowel obstruction Malignant bowel obstruction
  - Investigations Investigations
  - Management Management
    - Steroids Steroids
    - Somatostatin analogue (octreotide) Somatostatin analogue (octreotide)
    - Antiemetics Antiemetics
    - Venting gastrostomy Venting gastrostomy
    - Nasogastric intubation Nasogastric intubation
  - Malignant bowel obstruction: a strategy Malignant bowel obstruction: a strategy
  - Further reading Further reading
- Constipation Constipation
  - Causes Causes
  - Management Management
- Diarrhoea Diarrhoea
  - Management Management
    - Supportive Supportive
    - Loperamide Loperamide
    - Octreotide Octreotide
    - Antibiotics Antibiotics
    - Opioids Opioids
- Hiccups Hiccups
  - Common causes Common causes
  - Management Management
    - Gastric distension and GORD Gastric distension and GORD
    - Smooth muscle relaxants Smooth muscle relaxants
    - Central hiccup reflex suppression Central hiccup reflex suppression
- Depression Depression
  - Diagnosis Diagnosis
  - Principles of management Principles of management
  - Drug treatments Drug treatments
    - Citalopram Citalopram
    - Mirtazapine Mirtazapine
    - Venlafaxine Venlafaxine
    - Psychostimulants, e.g. methylphenidate Psychostimulants, e.g. methylphenidate
  - Further reading Further reading
- Delirium Delirium
  - Causes of delirium in cancer patients Causes of delirium in cancer patients
  - Diagnosis of delirium Diagnosis of delirium
    - Informal methods Informal methods
    - Formal methods Formal methods
  - Treatment of delirium Treatment of delirium
  - Further reading Further reading
- Oral care Oral care
  - Xerostomia Xerostomia
    - Treatment Treatment
  - Oral infections Oral infections
    - General principles of management General principles of management
      - Fungal Fungal
      - Bacterial Bacterial
      - Viral Viral
- Cancer-related fatigue Cancer-related fatigue
  - Epidemiology Epidemiology
  - Causes Causes
  - Treatment Treatment
  - Further reading Further reading
- Cancer cachexia Cancer cachexia
  - Epidemiology Epidemiology
  - Pathophysiology Pathophysiology
  - Treatments Treatments
  - Further reading Further reading
- Breathlessness Breathlessness
  - Epidemiology Epidemiology
  - Pathophysiology Pathophysiology
  - Common causes Common causes
  - Management Management
    - General principles General principles
      - Correct reversible causes Correct reversible causes
      - Cancer specific treatment Cancer specific treatment
      - Drainage of effusions Drainage of effusions
      - Oxygen therapy (Booth et al. ) Oxygen therapy (Booth et al. )
      - Opioids Opioids
      - Benzodiazepines Benzodiazepines
  - Further reading Further reading
- Cough Cough
  - Management Management
    - General principles General principles
    - Expectorants Expectorants
    - Cough suppressants (antitussives) Cough suppressants (antitussives)
- Haemoptysis Haemoptysis
- Symptom clusters Symptom clusters
  - Further reading Further reading
- End of life care End of life care
  - Recognition of end of life Recognition of end of life
  - Signs of dying Signs of dying
  - General principles of end of life care General principles of end of life care
  - Principles of drug use in end of life care Principles of drug use in end of life care
  - Specific symptom control Specific symptom control
    - Pain Pain
    - Dyspnoea Dyspnoea
    - Anxiety/restlessness Anxiety/restlessness
    - Delirium/acute-confusional state (Table ) Delirium/acute-confusional state (Table )
    - Respiratory secretions Respiratory secretions
    - Mouth care Mouth care
    - Fluids and parenteral nutrition Fluids and parenteral nutrition
  - Psychological aspects of end of life care Psychological aspects of end of life care
  - Dignity therapy Dignity therapy
  - How long? How long?
  - The bitter or angry patient The bitter or angry patient
  - Post-death care Post-death care
  - Conclusion Conclusion
  - Further reading Further reading
    - Internet resource Internet resource
- Notes
- Notes
8 Clinical management of cancer: flowcharts
- Notes
- Notes
9 Appendix
- Notes
- Notes
- Index
  - Notes
  - Notes

Chapter

7 Palliative care

Get access

https://doi.org/10.1093/med/9780199235636.003.0020

Pages

639–668

Published:

June 2011

Extract

Pain management

Pharmacological Interventions

In general, cancer pain management should be focused on the three-step WHO analgesic ladder for cancer pain relief (Ventafridda et al. 1997) (Fig. 7.1.1) This strategy should, however, be integrated with other methods, as appropriate, of cancer pain control. This includes tumoricidal therapy, radiotherapy, palliative surgery, physiotherapy, occupational therapy, anaesthetic interventions, psychosocial care, and any other care which adds to pain relief. It can be more appropriate with some patients to miss step two of the ladder and simply prescribe low-dose step three (strong opioid) which can mean fewer drug changes. In specialist units, the WHO ladder will relieve up to 80% of cancer pain.

...

Step one: non-opioid analgesia

The most common non-opioid analgesic used is paracetamol, usually prescribed 1g four times daily. The side effects of paracetamol are minimal and it is generally effective in mild pain. As paracetamol works differently from opioids, it is usual to continue it even on the second and third steps of the analgesic ladder. Non-steroidal anti-inflammatory drugs (NSAIDs) are an alternative or addition to paracetamol at each step.

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More

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Contents

7 Palliative care

Extract

Pain management

Pharmacological Interventions

Step one: non-opioid analgesia

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Contents

7 Palliative care

Extract

Pain management

Pharmacological Interventions

Step one: non-opioid analgesia

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