270
Unit 3
Applying concepts from the nursing process
Pain assessment
Evaluate aetiology
? New pain
→
Diagnostic work-up
? Amenable to radiotherapy
? Amenable to chemotherapy
? Amenable to regional neurolysis
Evaluate location
? Consistent with known tumour sites
? Non-malignant pain
Evaluate pain character
Evaluate pain intensity
Select coanalgesic therapy
Anticipate drug choices based
on pain severity (0–10 scale)
Nociceptive
Coanalgesic therapy
with NSAID
Neuropathic
Coanalgesic therapy
with tricyclic
antidepressants,
antiseizure agents,
corticosteroids
Strong opioid
(e.g. morphine)
Opioid
(e.g. oxycodone)
With coanalgesics
continue non-opioid
Efficacy with currrent regimen
with no side effects
No change
Efficacy with currrent regimen
with side effects
Maximise coanalgesics
Inadequate efficacy with currrent
regimen with no side effects
Titrate opioid
Maximise coanalgesics
Method of patient contact
Frequency of patient contact
Patient reported pain intensity (0–10 scale)
0–3
PRN
4–6
2–3
×
wk
7–10
qd
Home care visit
Inadequate efficacy with currrent
regimen with side effects
Address side effects
Titrate opioids
Maximise coanalgesics
Non-opioid
(e.g. APAP)
7–10
4–6
0–3
Evaluate aetiology
Evaluate location, intensity, character
Reassessment
Frequency of patient contact should be related to pain intensity and side effects
Method of patient contact should be related to acuity and patient function
Return to drug choice decisions after each assessment
? New pain; return to pain assessment
Drug choice decisions
Evaluate efficiency of previous therapy
Evaluate side effects (current and history)
Select agents according to pain assessment
Consider for debilitated
patients who have difficulty
coming to a clinic
Consider for patients with
limited caregiver support
Consider routine visits for
patients with complex
pain-management strategies
Telephone follow-up
Consider status—postdrug
changes as a re-evaluation
Consider frequent phone
assessment for rapidly
changing situation
Consider for mostly stable
patients as a check-in
Clinic visit
Consider any time physical
exam and diagnostics
would assist treatment
planning
Consider routine visits for
patients with complex
pain-management
strategies
Figure 11-7
The cancer pain algorithm (highest-level view) is a decision-tree model for pain treatment that was developed as an
interpretation of the AHCPR Guideline for Cancer Pain, 1994. Redrawn with permission from DuPen, A. R., DuPen, S., Hansberry, J., et al.
(2000). An educational implementation of a cancer pain algorithm for ambulatory care. Pain Management Nursing, 1(4), 118.
