Pain management in palliative care

Barnard, Alan; Gwyther, Elizabeth

doi:10.1080/20786204.2006.10873406

Cited by 7 publications

(13 citation statements)

References 1 publication

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“…Multidisciplinary approach using assessment tools and personal interviews aid proper and thorough workup for pain . Eliciting history thoroughly gives complete information with regards to pain and a mnemonic described by Barnard et al “PQRST” aids this process where P stands for precipitating/alleviating factors, Q for quality of pain, R for radiation of pain, S for site and severity of pain, and T for timing/onset of pain, constant/intermittent pain . Various pain assessment tools such as Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, and Edmonton Symptom Assessment System (ESAS) were used in ESRD patients in the past, however, Visual Analoge Scale (VAS) of modified ESAS was found to be valid in this patient population …”

Section: Pain Assessment In Esrdmentioning

confidence: 99%

“…The initial step in the management of pain in ESRD patients is to elicit a good history regarding PQRST factors and VAS assessment for intensity of pain. This follows a pain specialist/palliative care consultation, patient and family counseling, discussion about treatment options and correction of reversible causes . Finally, decision has to be made whether patient requires nonpharmacological or pharmacological management …”

Section: Management Of Pain In Esrdmentioning

confidence: 99%

“…This includes exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy . Topical application of nonsteroidal antiinflammatory drugs (NSAID's) and local anesthetics such as lidocaine helps to alleviate the pain in situations like needling of arteriovenous fistulas, musculoskeletal, and neuropathic pains …”

Section: Management Of Pain In Esrdmentioning

confidence: 99%

“…This involves utilization of WHO guidelines for analgesia, which consists of five principles By the mouth— use of oral analgesia whenever possible. By the clock —use of analgesia at regular fixed intervals for effective pain control around the clock. By the ladder— use of WHO three‐step analgesic ladder model (Figure ) which guides to start at low dose and slowly titrated to achieve effective pain control, with addition of new drug if necessary. …”

Section: Management Of Pain In Esrdmentioning

confidence: 99%

“…Pain is a complex syndrome with multifactorial etiology, which often overlaps, and at times poses a challenge to the treating physicians. Pain is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” It can be broadly classified as acute or chronic depending on the duration, and can be further sub‐classified into nociceptive (somatic or visceral), neuropathic, or psychogenic . Pain in ESRD patients is multidimensional as it involves biological factors such as cramping, pruritus, dyspnea, etc., and psychological factors such as anxiety, depression, and poor social support …”

Section: Introductionmentioning

confidence: 99%

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Management of pain in end‐stage renal disease patients: Short review

Raina

Krishnappa

Gupta

2017

Hemodialysis International

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Pain management in end stage renal disease (ESRD) patients is a complex and challenging task to accomplish, and effective pain and symptom control improves quality of life. Pain is prevalent in more than 50% of hemodialysis patients and up to 75% of these patients are treated ineffectively due to its poor recognition by providers. A good history for PQRST factors and intensity assessment using visual analog scale are the initial steps in the management of pain followed by involvement of palliative care, patient and family counseling, discussion of treatment options, and correction of reversible causes. First line should be conservative management such as exercise, massage, heat/cold therapy, acupuncture, meditation, distraction, music therapy, and cognitive behavioral therapy. Analgesics are introduced according to WHO guidelines (by the mouth, by the clock, by the ladder, for the individual, and attention to detail) using three-step analgesic ladder model. Neuropathic pain can be controlled by gabapentin and pregabalin. Substitution/addition of opioid analgesics are indicated if pain control is not optimal. Commonly used opioids in ESRD patients are tramadol, oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Methadone, fentanyl, and buprenorphine are the ideal analgesics in ESRD. However, complex pain syndrome requires multidrug analgesic regimen comprising opioids, non-opioids, and adjuvant medication, which should be individualized to the patient to achieve adequate pain control.

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Section: Pain Assessment In Esrdmentioning

confidence: 99%

Section: Management Of Pain In Esrdmentioning

confidence: 99%

Section: Management Of Pain In Esrdmentioning

confidence: 99%

Section: Management Of Pain In Esrdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of pain in end‐stage renal disease patients: Short review

Raina

Krishnappa

Gupta

2017

Hemodialysis International

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Pain

Brennan

2022

Evidence‐Based Nephrology

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Exploring Trismus Management in Australia: A Mixed Methods Evaluation of Surveys and Interviews With Health Professionals

Charters,

Venchiarutti,

Dunn

et al. 2024

Head & Neck

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ObjectiveThis study evaluates how health care professionals manage trismus in Australia and identifies facilitators and barriers experienced by clinicians in routine patient care.MethodsA mixed‐methods approach was used to evaluate the experience of clinicians. Medical, nursing, and allied health practitioners in Australia were invited to participate if they had treated patients with trismus in the last 5 years. Participants completed an investigator‐designed survey and were invited to participate in a semi‐structured audio‐recorded interview to explore practice in more depth. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed thematically using an inductive, data‐driven approach.ResultsFifty‐six clinicians (38 speech pathologists, 9 physiotherapists, 7 medical doctors, 1 nurse, and 1 osteopath) completed the survey, 12 of which also participated in an interview. The most common assessment tool was a commercially available measurement tool (Therabite or Orastretch), the most common treatment approach was stacked tongue depressors, and the most common exercise regimen was a 30‐ s stretch 25 times per day. Common barriers to trismus management included the high cost of devices, lack of clinical experience, and lack of training opportunities outside their institution. Clinician‐perceived facilitators were different modes of information provision and time to consider the exercise instructions and rationale. Several clinicians relied on telehealth to reach patients in remote locations and improve efficiency.ConclusionA range of clinicians treat trismus arising from a variety of conditions. Training opportunities are critical for clinicians to develop and extend their skills in assessing and treating trismus.Impact StatementThe morbidity associated with trismus, and the absence of a clinical guideline or consensus document warrants careful consideration as to the translation of evidence into the clinical context.

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Pain management in palliative care

Cited by 7 publications

References 1 publication

Management of pain in end‐stage renal disease patients: Short review

Management of pain in end‐stage renal disease patients: Short review

Pain

Exploring Trismus Management in Australia: A Mixed Methods Evaluation of Surveys and Interviews With Health Professionals

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