This series of two articles explores the challenge of managing pain in patients with advanced malignant and non-malignant disease. Pain is a common symptom in advanced disease. Despite guidance from organisations such as the World Health Organisation, cancer pain is often inadequately managed. Managing pain in non-malignant conditions, such as end stage cardiac failure, presents an even greater challenge to healthcare professionals. This first article discusses epidemiology, definitions, pathophysiology, assessment, non-pharmacological approaches, the analgesic “ladder”, and opioids. The second article will examine the use of non-opioids, anaesthetic techniques, and analgesia in dying patients as well as discussing future directions.
- EAPC, European Association of Palliative Care
- NMDA, N-methyl-D aspartate
- OTFC, oral transmucosal fentanyl citrate
- SIGN, Scottish Intercollegiate Guidelines Network
- TENS, transcutaneous nerve stimulation
- WHO, World Health Organisation
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