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Palliative Surgery pp 49–57Cite as

Pain Management

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Abstract

The principles of management of pain after palliative surgery are essentially the same as after any type of surgery. However, there are certain aspects for patients undergoing palliative surgery that need increased vigilance. Patients are often taking opioids for moderate to severe pain (“strong” opioids) which requires careful assessment and a detailed perioperative management plan, providing analgesia but minimising risk of withdrawal, uncontrolled pain and overdose. Multimodal analgesia should be utilised in an opioid-reducing strategy. It is imperative that pain and possible adverse perioperative sequelae should not compromise a quick recovery to allow the patient to have high-quality end-of-life care. Neuraxial blockade, continuous peripheral nerve block techniques and other analgesic adjuvants should be considered. Patient-controlled analgesia offers the flexibility in opioid delivery to adapt to the changing and difficult analgesic needs of this population.

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References

  1. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain. 2007;132(3):312–20.

    Article  PubMed  Google Scholar 

  2. Williams JE. Acute pain management in cancer patients taking regular opioid medication. In: Farquhar-Smith P, Wigmore T, editors. Anaesthesia, intensive care and pain management for the cancer patient. 1st ed. Oxford: Oxford University Press; 2011. p. 181–6.

    Google Scholar 

  3. De PM, Cahana A. Medical management of acute pain in patients with chronic pain. Expert Rev Neurother. 2012;12(11):1325–38.

    Article  Google Scholar 

  4. Quinlan J, Carter K. Acute pain management in patients with persistent pain. Curr Opin Support Palliat Care. 2012;6(2):188–93.

    Article  PubMed  Google Scholar 

  5. Costantini R, Affaitati G, Fabrizio A, Giamberardino MA. Controlling pain in the post-operative setting. Int J Clin Pharmacol Ther. 2011;49(2):116–27.

    Article  CAS  PubMed  Google Scholar 

  6. McDaid C, Maund E, Rice S, Wright K, Jenkins B, Woolacott N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess. 2010;14(17):1–153. iii–iv.

    CAS  PubMed  Google Scholar 

  7. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005;94(4):505–13.

    Article  CAS  PubMed  Google Scholar 

  8. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth. 2002;88(2):215–26.

    Article  CAS  PubMed  Google Scholar 

  9. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS Drug Rev. 2006;12(3–4):250–75.

    Article  CAS  PubMed  Google Scholar 

  10. Pickering G, Loriot MA, Libert F, Eschalier A, Beaune P, Dubray C. Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clin Pharmacol Ther. 2006;79(4):371–8.

    Article  CAS  PubMed  Google Scholar 

  11. Mallet C, Daulhac L, Bonnefont J, Ledent C, Etienne M, Chapuy E, et al. Endocannabinoid and serotonergic systems are needed for acetaminophen-induced analgesia. Pain. 2008;139(1):190–200.

    Article  CAS  PubMed  Google Scholar 

  12. Pickering G, Esteve V, Loriot MA, Eschalier A, Dubray C. Acetaminophen reinforces descending inhibitory pain pathways. Clin Pharmacol Ther. 2008;84(1):47–51.

    Article  CAS  PubMed  Google Scholar 

  13. Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth. 2005;94(5):642–8.

    Article  CAS  PubMed  Google Scholar 

  14. Botting RM. Inhibitors of cyclooxygenases: mechanisms, selectivity and uses. J Physiol Pharmacol. 2006;57 Suppl 5:113–24.

    PubMed  Google Scholar 

  15. Diaz G, Flood P. Strategies for effective postoperative pain management. Minerva Anestesiol. 2006;72(3):145–50.

    CAS  PubMed  Google Scholar 

  16. Khan M, Fraser A. Cox-2 inhibitors and the risk of cardiovascular thrombotic events. Ir Med J. 2012;105(4):119–21.

    CAS  PubMed  Google Scholar 

  17. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth. 2002;88(2):199–214.

    Article  CAS  PubMed  Google Scholar 

  18. Farquhar-Smith P. Anatomy, physiology and pharmacology of pain. Anaesth Intensive Care Med. 2008;9:3–7.

    Article  Google Scholar 

  19. Tracey I. Neuroimaging of pain mechanisms. Curr Opin Support Palliat Care. 2007;1(2):109–16.

    Article  PubMed  Google Scholar 

  20. Scott K. How analgesics work. In: Cox F, editor. Perioperative pain management. Hoboken: Wiley Blackwell; 2009.

    Google Scholar 

  21. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–20.

    PubMed  Google Scholar 

  22. Palmer PP, Miller RD. Current and developing methods of patient-controlled analgesia. Anesthesiol Clin. 2010;28(4):587–99.

    Article  PubMed  Google Scholar 

  23. Ballantyne JC, Carr DB, Chalmers TC, Dear KB, Angelillo IF, Mosteller F. Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials. J Clin Anesth. 1993;5(3):182–93.

    Article  CAS  PubMed  Google Scholar 

  24. Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;4, CD003348.

    PubMed  Google Scholar 

  25. Nelson L, Schwaner R. Transdermal fentanyl: pharmacology and toxicology. J Med Toxicol. 2009;5(4):230–41.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Neil MJ. Clonidine: clinical pharmacology and therapeutic use in pain management. Curr Clin Pharmacol. 2011;6(4):280–7.

    Article  CAS  PubMed  Google Scholar 

  27. Elia N, Culebras X, Mazza C, Schiffer E, Tramer MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159–67.

    CAS  PubMed  Google Scholar 

  28. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Niesters M, Dahan A. Pharmacokinetic and pharmacodynamic considerations for NMDA receptor antagonists in the treatment of chronic neuropathic pain. Expert Opin Drug Metab Toxicol. 2012;8(11):1409–17.

    Article  CAS  PubMed  Google Scholar 

  30. Eilers H, Philip LA, Bickler PE, McKay WR, Schumacher MA. The reversal of fentanyl-induced tolerance by administration of "small-dose" ketamine. Anesth Analg. 2001;93(1):213–4.

    Article  CAS  PubMed  Google Scholar 

  31. Mitra S. Opioid-induced hyperalgesia: pathophysiology and clinical implications. J Opioid Manag. 2008;4(3):123–30.

    PubMed  Google Scholar 

  32. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;1, CD004603.

    PubMed  Google Scholar 

  33. Zhang J, Ho KY, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth. 2011;106(4):454–62.

    Article  CAS  PubMed  Google Scholar 

  34. Dahl JB, Mathiesen O, Kehlet H. An expert opinion on postoperative pain management, with special reference to new developments. Expert Opin Pharmacother. 2010;11(15):2459–70.

    Article  CAS  PubMed  Google Scholar 

  35. Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth. 2011;107(6):859–68.

    Article  CAS  PubMed  Google Scholar 

  36. Gupta A. Wound infiltration with local anaesthetics in ambulatory surgery. Curr Opin Anaesthesiol. 2010;23(6):708–13.

    Article  PubMed  Google Scholar 

  37. Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology. 2005;103(5):1079–88.

    Article  CAS  PubMed  Google Scholar 

  38. Guay J. The benefits of adding epidural analgesia to general anesthesia: a metaanalysis. J Anesth. 2006;20(4):335–40.

    Article  PubMed  Google Scholar 

  39. Marret E, Remy C, Bonnet F. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg. 2007;94(6):665–73.

    Article  CAS  PubMed  Google Scholar 

  40. Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth. 2010;105 Suppl 1:i86–96.

    Article  PubMed  Google Scholar 

  41. Power I, McCormack JG, Myles PS. Regional anaesthesia and pain management. Anaesthesia. 2010;65 Suppl 1:38–47.

    Article  PubMed  Google Scholar 

  42. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215–25.

    Article  CAS  PubMed  Google Scholar 

  43. Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819–41.

    Article  PubMed  Google Scholar 

  44. Ludwick-Rosenthal R, Neufeld RW. Stress management during noxious medical procedures: an evaluative review of outcome studies. Psychol Bull. 1988;104(3):326–42.

    Article  CAS  PubMed  Google Scholar 

  45. Wilson-Barnett J. Interventions to alleviate patients’ stress: a review. J Psychosom Res. 1984;28(1):63–72.

    Article  CAS  PubMed  Google Scholar 

  46. Doering S, Behensky H, Rumpold G, Schatz DS, Rossler S, Hofstotter B, et al. Videotape preparation of patients before hip replacement surgery improves mobility after three months. Z Psychosom Med Psychother. 2001;47(2):140–52.

    CAS  PubMed  Google Scholar 

  47. Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM. Acute pain management: scientific evidence. 3rd ed. Melbourne: ANZCA/FRM; 2010.

    Google Scholar 

  48. Johnson ML, Bagley J. Transcutaneous electrical nerve stimulation in perioperative settings. In: Cox F, editor. Perioperative pain management. Hoboken: Wiley-Blackwell; 2009.

    Google Scholar 

Further Readings

  • Cox F. Perioperative pain management. Hoboken: Wiley-Blackwell; 2009.

    Google Scholar 

  • Davies PS, D’Arcy Y. Cancer pain management. New York: Springer; 2013.

    Google Scholar 

  • Farquhar-Smith P, Wigmore T. Anaesthesia, intensive care, and pain management for the cancer patient. Oxford: Oxford University Press; 2011.

    Google Scholar 

  • Pasero C, McCaffery M. Pain assessment and pharmacologic management. St. Louis: Elsevier Mosby; 2011.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anaesthetics and Pain, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Suzanne Chapman RGN, MSc, BSc & Paul Farquhar-Smith MA, FRCA, PhD, FFPMRCA, FFICM

Authors
  1. Suzanne Chapman RGN, MSc, BSc
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  2. Paul Farquhar-Smith MA, FRCA, PhD, FFPMRCA, FFICM
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Corresponding author

Correspondence to Paul Farquhar-Smith MA, FRCA, PhD, FFPMRCA, FFICM .

Editor information

Editors and Affiliations

  1. Department of General Surgery, Mount Gambier General Hospital, Flinders University—Rural Medical School, Mount Gambier, South Australia, Australia

    Matthias W. Wichmann

  2. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia

    Guy Maddern

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© 2014 Springer-Verlag Berlin Heidelberg

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Chapman, S., Farquhar-Smith, P. (2014). Pain Management. In: Wichmann, M., Maddern, G. (eds) Palliative Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-53709-7_5

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  • DOI: https://doi.org/10.1007/978-3-642-53709-7_5

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-53708-0

  • Online ISBN: 978-3-642-53709-7

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