In 1986 the World Health Organization (WHO) presented the analgesic ladder as a framework that physicians could use when developing treatment plans for cancer pain. The 5 points for the correct use of analgesics are as follows: i. Oral administration of analgesics. The oral form of medication should be privileged whenever possible. ii. Analgesics should be given at regular intervals. To relieve pain adequately, it is necessary to respect the duration of the medication’s efficacy and to prescribe the dosage to be taken at definite intervals in accordance with the patient’s level of pain. The dosage of medication should be adjusted until the patient is comfortable. iii. Analgesics should be prescribed according to pain intensity as evaluated by a scale of intensity of pain. This point is important because pain-relief medications should be prescribed after clinical examination and adequate assessment of the pain. The prescription must be given according to the level of the patient’s pain and not according to the medical staff’s perception of the pain. If the patient says that he has pain, it is important to believe him. This point makes reference to the levels of the analgesic ladder that will be explained in detail further below. iv. Dosing of pain medication should be adapted to the individual. There is no standardized dosage in the treatment of pain. Every patient will respond differently. The correct dosage is one that will allow adequate relief of pain. The posology should be adapted to achieve the best balance between the analgesic effect and the side effects. v. Analgesics should be prescribed with a constant concern for detail. The regularity of analgesic administration is crucial for the adequate treatment of pain. Once the distribution of medication over a day is established, it is ideal to provide a written personal program to the patient. In this way the patient, his family, and medical staff will all have the necessary information about when and how to administer the medications. 12. What complications can occur post operatively if pain is poorly managed? Poorly managed postoperative pain can lead to complications and prolonged rehabilitation. Uncontrolled acute pain is associated with the development of chronic pain with reduction in quality of life. 13. Look up the following medications and identify the indications, mechanism of action, correct type of IV administration procedure to be followed, side effects and relevant practice points associated with each. a. Morphine (eg , 1mg/ml via PCA) Indications – Morphine is an opioid pain medication. An opioid is sometimes called a narcotic. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain. This form of morphine is not for use on an as-needed basis for pain. Morphine is not for treating short-term pain just after surgery unless you were already taking morphine before the surgery.
- Fall '12