Used with permission from:
The Southern California Cancer Pain Initiative
c/o City of Hope National Medical Center
1500 E. Duarte Road
Duarte, California 91010
Phone: 626-359-8111 ext. 63840
Email: sccpi@coh.org
SOURCES OF PAIN

PAIN SOURCE
PAIN CHARACTER
DRUG CLASS/EXAMPLES

Myofacial/Somatic Pain

 Constant and well localized
Muscle relaxants
Acetaminophen/NSAIDS

Visceral Pain

 Injury to symapthetically innervated organs.  Pain is vague in quality.  Deep, dull, aching.  Referred pain. Opioids

Bone Pain



 Axial skeleton with thoracic and lumbar spine most common


 - Radiation Therapy
- NSAIDS:
    Vioxx, Celebrex, Motrin, Naproxen, Trisilate,
     Orudis, Dolobid, Toradol
- Corticosteroids
- Biphosphonates

Neuropathic Pain
Nerve Damage
Dysesthesia



 Injury to some element of the nervous system (plexus or spinal root).  Systhesia, burning, tingling, numbing, shooting electrical pain. May not respond well to opioid analgesics.


 - Tricyclic Antidepressants
      Amitriptyline (Elavil), Desipramine (Norpramin,
      Pertofrane) for burining pain
- Anticonvulsants:
      Neurontin, Tegretol or Klonopin
- Corticosteroids
- Anti-arrythmic (Mexiletine)
- Opioids

Nonsteroidal anti-inflammatory drugs for bone pain and antidepressants or anticonvulsants are but two of many potential co-analgesices. Corticosteroids, neroleptic agents, bisphosphonates and calcitonin, and some anxiolytic agents may be useful in selected patient populations. Avoid benzodiazepines unless primary anxiety disorder persists after pain is relieved.

Back to the Top


OPIOID SIDE EFFECT MANAGEMENT
Constipation


 Senokot-S or Pericolace 2 tabs bid.  May increase to 4 tabs bid.  If no BM in 2 days must add a laxative (Dulcolax, Milk of Magnesia or Lactulose).  Lactulose effectiveness is dose related.  Start at 4 tbsp. Q 4 hrs until BM.  Especially when constipation is opioid related.

 
Nausea/Vomiting


 

 Compazine 10mg po q 6 hr. PRN or 25 mg suppository PR q 6 hr. PRN. May add Ativan 0.5 mg q 6 hr. po/sl, PRN or Reglan 10 mg po qid.  If oral route cannot be tolerated or is inneffective check with MD for alternative routes.
Scopolamine TD patch is effective for opioid related nausea q 72 hrs.
Equianalgesic Chart

Back   ||  Back to the Top  ||  Home
The information on this website is shared for educational purposes only and is not a substitute for medical evaluation,
consultation or treatment by a qualified professional. DPI disclaims any liability or responsibility for accuracy,
completeness and usefulness of this material.

©2003 Delaware Pain Initiative