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Clinical Pain Management: Cancer Pain

International Herald Tribune March 29, Midazolam should be considered first-line choice[ 31 ]. Both pharmacologic and nonpharmacologic approaches should be considered to treat pain in elderly at the end of life.

It is difficult to make specific recommendations about the long-term use of complementary and alternative therapies but it is important that clinicians not leave patients with a sense of hopelessness as a result of their efforts to discourage unapproved but benign therapies. The sequential use of analgesics drugs according the WHO ladder is a relatively inexpensive yet effective method for relieving pain. All opioids are considered effective and are used in cancer and non-cancer pain management, but no well designed specific studies in the elderly patient are available.

To relieve suffering in the imminently dying patient palliative sedation may be a valid palliative care option. National Center for Biotechnology Information , U. N Am J Med Sci.

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Roberta Rigo Dalacorte , MD. Find articles by Roberta Rigo Dalacorte. Find articles by Julio Cesar Rigo. Find articles by Amauri Dalacorte. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Background: The treatment of older adults with pain is complex and affected by age-related changes in pharmacokinetics and pharmacodynamics. Aims: Given the large number of older persons with pain at the end of life and the few data about this issue, the objective of this article is to review the treatment of pain in this population. Results: There are evidences of undertreatment among elderly people.

Conclusions: The sequential use of analgesics drugs and opioids are considered effective and relatively inexpensive for relieving pain, but no well designed specific studies in the elderly patient are available.

Clinical Pain Management : Cancer Pain: 2nd Edition (Hardback) - Routledge

Keywords: Chronic pain, end of life care, older people, pharmacologic and nonpharmacologic approaches. Introduction The phenomenon of population aging has been observed throughout the world and Brazil is one of the countries with the fastest rates of aging. Pain assessment in the elderly The two most commonly used scales for adults are a verbal descriptor scale i. Open in a separate window. Nonpharmacologic therapy of pain Pain can be alleviated in elderly through the careful use of analgesic drags combined with nonpharmacologic strategies. Physical therapies The role of physiotherapists in palliative care is primarily defined by expert opinion, which is not backed up by good quality evidence.

Physical therapy techniques used in pain control: Massage: Touch is probably the oldest method of relieving pain and discomfort. Psychological therapies Formal cognitive-behavioral therapies are helpful for many older adults with persistent pain. Complementary and alternative therapies Unrelieved persistent pain commonly causes patients to seek relief with alternative medicine, including homeopathy, acupuncture, healing touch, and music therapy.

Pharmacologic therapy of pain Inferences about the type and mechanisms that may be responsible for the pain are helpful in the evaluation and the management of pain syndromes[ 23 ]. Nociceptive pain The use of analgesics for the treatment of acute pain is the same as for non-palliative care patients. Table 4 Adjuvant drugs.

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Table 5 Recommendations of the American Geriatric Society for opioid use in the elderly. Elderly's particularities and cautions The pain management in older individuals follows the same principles as in younger patients. Table 7 Drugs for neuropathic pain [ 3 , 26 , 30 ]. Palliative sedation Palliative sedation therapy PST is a controversial issue.

Conclusions Both pharmacologic and nonpharmacologic approaches should be considered to treat pain in elderly at the end of life. References 1. Treatment considerations for elderly and frail patients with neuropathic pain. Mayo Clin Proc.

Pain management in cancer patients

Management of pain in elderly patients with cancer. Unrestricted opiate administration for pain and suffering at the end of life: knowledge and attitudes as barriers to care. J Palliat Med. Management of chronic nonmalignant pain with nonsteroidal antiinflammatory drugs. Management of cancer pain: adults. Cancer Pain Guideline Panel.

Agency for Health Care Policy and Research. Am Fam Physician. The management of persistent pain in older persons. J Am Geriatr Soc. Pain in severe dementia: self-assessment or observational scales?


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Rev Bras Cancerol. Jolliffe J, Bury T. The effectiveness of physiotherapy in the palliative care of older people. The Chartered Society of Physiotherapy. The impact of physiotherapy intervention on functional independence and quality of life in palliative patients. Cancer Forum. Breitbart W. Psychiatric management of cancer pain.


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Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med. NIH Consensus Conference. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.

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Clinical Pain Management: Cancer Pain

Toggle navigation Additional Book Information. Description Table of Contents Editor s Bio. Summary First published in , Clinical Pain Management is a comprehensive textbook for trainee and practicing specialists in Pain Management and related areas, presenting readers with all they need to know to provide a successful pain management service.