mpact of pain The interaction of pain with concurrent symptoms such as anorexia, nausea, constipation, delirium, dyspnea, depression, anxiety and insomnia, and so on The patients and their families might think that the intensification of pain is a harbinger of impending death
Impact of pain • The interaction of pain with concurrent symptoms such as anorexia, nausea, constipation, delirium, dyspnea, depression, anxiety and insomnia, and so on. • The patients and their families might think that the intensification of pain is a harbinger of impending death
Causes of pain Tumor:(1 tumor compression and invasion to adjacent organs tissue, nerves, bones or blood vessels or metastasis. (2) inflammation caused by tumor-induced mediators(e. g, interleukin, bradykinin) and so on Treatment-related: (1 Postsurgical pain syndrome(eg thoracotomy, mastectomy, amputation surgery, surgical scars and nerve damage). 2 Postchemotherapy pain (eg, polyneuropathy, osseous necrosis, thrombophlebitis and mucositis).3 Postradiation pain(eg, local damage neural fibrosis, medullary lesions bone necrosis and mucositis)
Causes of pain • Tumor: ① tumor compression and invasion to adjacent organs, tissue, nerves, bones or blood vessels or metastasis.② inflammation caused by tumor-induced mediators (e.g, interleukin, bradykinin) and so on. • Treatment-related: ① Postsurgical pain syndrome (eg, thoracotomy, mastectomy, amputation surgery, surgical scars and nerve damage).② Postchemotherapy pain (eg, polyneuropathy, osseous necrosis, thrombophlebitis and mucositis).③ Postradiation pain (eg, local damage, neural fibrosis, medullary lesions, bone necrosis and mucositis)
Cancer-related pain: the pain is caused by some symptoms such as constipation, pressure sores and muscle spasm Non- physiological pain:① Spiritual pain② Psychological trauma Non-cancer pain: non-cancer-related pain(eg myofascial, musculoskeletal problems) There are two or more causes of pain in most of advanced cancer patients
• Cancer-related pain: the pain is caused by some symptoms such as constipation, pressure sores and muscle spasm. • Non-physiological pain: ① Spiritual pain.② Psychological trauma. • Non-cancer pain: non-cancer-related pain (eg, myofascial, musculoskeletal problems). • There are two or more causes of pain in most of advanced cancer patients
Type of pain Duration: acute(transient) and chronic (more than 3 months) pain Pathophysiological mechanisms and characteristics: nociceptive and neuropathie pain
Type of pain • Duration: acute (transient) and chronic (more than 3 months) pain, • Pathophysiological mechanisms and characteristics: nociceptive and neuropathic pain
Assessment of pain What should we assess? CLINICAL manifestations and PSYCHOLOGICAL problems Why should we assess? “① IAGNOSIS and TREATMENT Any else be added? SOCIOLOGICAL and PSYCHOLOGICAL factors
Assessment of pain • What should we assess? • clinical manifestations and psychological problems. • Why should we assess? “diagnosis” and “treatment”. • Any else be added? Sociological and psychological factors