Acute Medicine | Palliative care | Drug management of pain: core knowledge

Drug management of pain: core knowledge
Session overview
Description
This session outlines an integrated approach to pain management considering the WHO analgesic ladder and also highlighting the importance of an individualised approach.

This session was reviewed by Richard Kitchen, and was last updated in May 2021.

Learning objectives
By the end of this session you will be able to:

• represent the WHO analgesic ladder in diagram form
• give examples of drugs used at each stage of the ladder and why they are used
• outline some of the uses and limitations of the analgesic ladder
• define and list some common adjuvant analgesics used in pain management
• recognise other pain management interventions that can be used in conjunction with drugs on the analgesic ladder

Prerequisites
Before commencing this session you should complete:

• Assessment of pain (215-0407)
• Principles of pain management (215-0408)

Symptom management of pain starts with a thorough clinical assessment and diagnosis, based on the understanding of the pathophysiology of the pain. Pain may have more than one cause. It may be malignant, non-malignant or due to treatment. Often the most effective symptom control measure is that aimed at removing or treating the underlying cause e.g. palliative radiotherapy.

Drug management of pain should not be delayed while waiting for disease-modifying treatment. It is often continued during and after such treatment, either because medication is still required for the original cause, albeit at smaller doses, or for other causes of chronic pain. For others, drugs will be the mainstay of management; for example, if the cause of pain is not clear and the burden of further investigations/treatment outweighs the potential benefits to that patient.

This session discusses how clinicians can use the WHO analgesic ladder to help them manage pain, using a few widely known pain relieving drugs. It explains the place of adjuvant drugs and gives information about starting and titrating morphine. The session also shows how an integrated approach to pain management incorporates addressing psychosocial, spiritual and emotional concerns.