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Questions and Answers

Apa tujuan dari perawatan paliatif?

Meningkatkan kualitas hidup pasien, pengasuh, dan keluarga sambil mengelola gejala umum dan spesifik penyakit.

Mana saja yang termasuk dalam jenis-jenis nyeri?

  • Nyeri neuropatik (correct)
  • Sindrom nyeri campuran (correct)
  • Nyeri psikogenik (correct)
  • Nyeri nosiseptif (correct)

    • Pengobatan analgetik opioid merupakan pilihan pertama untuk nyeri nosiseptif.

    False

    Apa saja faktor-faktor yang memengaruhi persepsi nyeri pada orang tua?

    <p>Faktor-faktor yang memengaruhi persepsi nyeri pada orang tua meliputi: kesepian, depresi, kecemasan, gangguan tidur, kebutuhan perawatan kesehatan yang meningkat, isolasi, ketergantungan, dan kehilangan.</p> Signup and view all the answers

    Apa saja tantangan dalam menilai nyeri pada pasien lanjut usia?

    <p>Tantangan dalam menilai nyeri pada pasien lanjut usia meliputi: anggapan bahwa nyeri adalah hal yang wajar seiring bertambahnya usia, ketakutan akan kecanduan obat penghilang rasa sakit, gangguan sensorik dan kognitif, dan kurangnya pelaporan nyeri.</p> Signup and view all the answers

    Apa saja perubahan fisiologis pada lansia yang terkait dengan nyeri?

    <p>Penurunan kadar protein serum</p> Signup and view all the answers

    Jelaskan tentang tangga analgesik WHO?

    <p>Tangga analgesik WHO merupakan pedoman untuk mengelola nyeri berdasarkan tingkat keparahannya. Tahap pertama menggunakan analgesik nonopioid, tahap kedua menambahkan opioid lemah, dan tahap ketiga menggunakan opioid kuat.</p> Signup and view all the answers

    Apa saja obat non-opioid yang digunakan untuk analgesik adjuvant?

    <p>Obat non-opioid yang digunakan untuk analgesik adjuvant meliputi: antidepresan, antikonvulsan, kortikosteroid, dan obat/terapi modifikasi penyakit.</p> Signup and view all the answers

    Jelaskan tentang mekanisme kerja kortikosteroid sebagai analgesik adjuvant?

    <p>Mekanisme kerja kortikosteroid sebagai analgesik adjuvant meliputi: menghambat sintesis prostaglandin, mempengaruhi suasana hati dan nafsu makan, dan memiliki efek antitumor pada gangguan proliferasi limfoid, kanker payudara, dan kanker prostat.</p> Signup and view all the answers

    Apa indikasi penggunaan kortikosteroid sebagai analgesik adjuvant?

    <p>Indikasi penggunaan kortikosteroid sebagai analgesik adjuvant meliputi: nyeri akibat peningkatan tekanan intrakranial, kompresi sumsum tulang belakang ekstradural, kompresi dan invasi tumor pada akar saraf atau saraf tepi.</p> Signup and view all the answers

    Mengapa tidak disarankan untuk menggunakan plasebo dalam pengobatan nyeri?

    <p>Tidak etis</p> Signup and view all the answers

    Jelaskan tentang mekanisme kerja opioid.

    <p>Opioid bekerja dengan mengikat reseptor opioid di otak dan sumsum tulang belakang, sehingga mengurangi aktivitas saraf yang menghantarkan sinyal nyeri.</p> Signup and view all the answers

    Apa saja jenis-jenis opioid berdasarkan kekuatannya?

    <p>Jenis-jenis opioid berdasarkan kekuatannya meliputi: opioid kuat, opioid sedang, dan opioid lemah.</p> Signup and view all the answers

    Opioid tidak memiliki efek samping.

    <p>False</p> Signup and view all the answers

    Apa saja efek samping yang perlu diwaspadai pada penggunaan opioid?

    <p>Efek samping yang perlu diwaspadai pada penggunaan opioid meliputi: konstipasi, mual, muntah, sedasi, depresi pernapasan, miose, euforia, dan psikomimetik (halusinasi, delusi)</p> Signup and view all the answers

    Bagaimana cara mengatasi efek samping opioid seperti konstipasi?

    <p>Penanganan konstipasi akibat penggunaan opioid bisa dengan menggunakan laksatif stimulan.</p> Signup and view all the answers

    Apa saja rute pemberian morfin?

    <p>Rute pemberian morfin meliputi: oral, intravena, intramuskular, subkutan, rektal, spinal, dan intraventrikel.</p> Signup and view all the answers

    Apa saja keuntungan menggunakan morfin campuran sebagai analgesik oral?

    <p>Keuntungan menggunakan morfin campuran sebagai analgesik oral meliputi: biaya rendah, penyerapan yang baik, toleransi yang baik, mudah diberikan sendiri, mudah diberikan pada berbagai interval, efektif pada mayoritas pasien, fleksibilitas dosis, dan tidak berakumulasi secara toksik.</p> Signup and view all the answers

    Apa saja jenis morfin yang tersedia?

    <p>Jenis morfin yang tersedia meliputi: morfin sulfat, morfin hidroclorida, dan morfin retard.</p> Signup and view all the answers

    Apa yang dimaksud dengan opiophobia?

    <p>Ketakutan terhadap opioid</p> Signup and view all the answers

    Apa saja penyebab opiophobia pada pasien?

    <p>Penyebab opiophobia pada pasien meliputi: ketakutan akan kematian, ketakutan tidak memiliki pilihan pengobatan lain, ketakutan akan kecanduan, alergi, ketidakefektifan, serta ketidakmampuan untuk mentoleransi efek samping.</p> Signup and view all the answers

    Morfin dapat digunakan untuk mengatasi berbagai jenis nyeri, termasuk nyeri kronis.

    <p>True</p> Signup and view all the answers

    Jelaskan tentang mekanisme kerja morfin sebagai analgesik.

    <p>Morfin bekerja dengan mengikat reseptor opioid µ, yang terletak di sistem saraf pusat (SSP), sehingga meredakan nyeri.</p> Signup and view all the answers

    Apa saja efek samping morfin yang harus diwaspadai?

    <p>Efek samping morfin yang harus diwaspadai meliputi: konstipasi, mual, muntah, sedasi, depresi pernapasan, miose, euforia, dan psikomimetik (halusinasi, delusi).</p> Signup and view all the answers

    Morfin merupakan pilihan pertama untuk mengatasi nyeri kanker.

    <p>True</p> Signup and view all the answers

    Apa saja ciri-ciri opioid yang efektif untuk mengatasi nyeri kanker?

    <p>Opioid yang efektif untuk mengatasi nyeri kanker memiliki ciri-ciri: memiliki spektrum yang luas, tersedia dalam berbagai rute pemberian, dan mudah didapat.</p> Signup and view all the answers

    Apa saja jenis opioid lain yang digunakan untuk mengatasi nyeri kanker?

    <p>Jenis opioid lain yang tersedia meliputi: diamorfin, metadona, fentanyl, oksikodon, dan hidromorfon.</p> Signup and view all the answers

    Metadona memiliki efek samping yang lebih ringan dibandingkan dengan morfin.

    <p>False</p> Signup and view all the answers

    Apa saja efek samping metadona yang perlu diwaspadai?

    <p>Efek samping metadona yang perlu diwaspadai meliputi: konstipasi, mual, muntah, sedasi, depresi pernapasan, miose, euforia, psikomimetik, dan QT interval memanjang.</p> Signup and view all the answers

    Bagaimana cara mengatasi efek samping opioid?

    <p>Efek samping opioid dapat diatasi dengan: menyesuaikan dosis, mengganti jenis opioid, dan memberikan obat tambahan untuk mengatasi efek samping spesifik.</p> Signup and view all the answers

    Jelaskan tentang terapi non-obat untuk mengatasi nyeri?

    <p>Terapi non-obat untuk mengatasi nyeri meliputi: pendidikan, latihan fisik, terapi fisik dan okupasi, chiropractic, akupunktur, relaksasi, meditasi, hipnosis, terapi perilaku kognitif (CBT), dan teknik mind-body.</p> Signup and view all the answers

    Apa saja manfaat dari terapi non-obat untuk nyeri?

    <p>Semua jawaban di atas benar</p> Signup and view all the answers

    Nyeri yang tidak ditangani dapat menyebabkan kerusakan fungsi dan kualitas hidup yang berkurang.

    <p>True</p> Signup and view all the answers

    Apa saja konsekuensi dari nyeri yang tidak ditangani secara tepat?

    <p>Konsekuensi dari nyeri yang tidak ditangani secara tepat meliputi: kerusakan fungsi (misalnya, penurunan mobilitas), gangguan tidur, peningkatan beban finansial dan perawatan, dan penurunan kualitas hidup.</p> Signup and view all the answers

    Jelaskan tentang pengelolaan nyeri kanker!

    <p>Pengelolaan nyeri kanker melibatkan penggunaan tangga analgesik WHO dan terapi adjuvan, serta pengelolaan efek samping obat penghilang rasa sakit.</p> Signup and view all the answers

    Study Notes

    Pharmacology & Therapy: Analgesic and Morphine in Palliative Care

    • Goal of Palliative Care: Improve overall quality of life for patients, caregivers, and families while managing both general and disease-specific symptoms simultaneously while the patient is receiving curative or life-prolonging treatment.
    • Pain Management: Knowledge of pain classification is crucial to determine the appropriate medication treatment for each patient.
    • Interdisciplinary Approach: An interdisciplinary team approach in patient care proves beneficial when addressing more psychological symptoms.

    Pain & Therapy 01

    • Effective Pain Management Plan: Includes assessment of patient description, quality, precipitating/relieving factors, affected region, impact on function, and any time-related aspects.
    • Non-Communicative Patients: Nonverbal indicators such as grimacing, agitation, restlessness, or resistance to personal care.

    Pain & Therapy 02

    • Nociceptive Pain: Results from stimulation of pain receptors. Somatic pain arises from damage to body tissue (well-localized); visceral pain originates from internal organs (poorly localized).
    • Neuropathic Pain: Results from nerve dysfunction or lesions in the central or peripheral nervous systems.
    • Mixed Pain Syndromes: These involve multiple or unknown mechanisms (e.g., headaches, vasculitic syndromes).

    Pain & Therapy 03 (Nociceptive Pain)

    • Pain Description: Achy, throbbing, and dull.
    • Treatment (Tx): Non-opioid analgesics (acetaminophen) are preferred for pain of this type as they are generally safer than NSAIDs for patients with hepatic or renal impairment.
    • Palliative Care Consideration: In palliative care settings, around-the-clock opioid use is often preferred over "as needed" to maintain a consistent pain level.

    Pain & Therapy 04 (Neuropathic Pain)

    • Neuropathic Pain Characteristics: Tingling, sharp, burning, electric shock-like, or numbness. Caused by damage to the central or peripheral nervous system.
    • First-Line Tx: Adjuvant agents like TCAs, SNRIs, and calcium channel alpha-2-delta ligands (gabapentin, pregabalin).
    • Second-Line Tx: Traditional analgesics (opioids, tramadol).
    • Third-Line Tx: Morphine or oxycodone.

    Pain & Therapy 05

    • Multimodal Treatment Approach: Different treatments are combined based on the type of pain (e.g., neuropathic, musculoskeletal, visceral) - involving pharmacological, physical rehabilitation, and cognitive behavioral therapy, where combined.
    • Interventional Tx.: May be considered if appropriate to address pain.
    • Tx. Planning Considerations: Evaluation of patient factors including age, comorbidities, current medications, and laboratory abnormalities, as well as financial resources.

    Pain & Therapy 06 (Acute and Chronic Pain)

    • Acute Pain Tx: NSAIDs, acetaminophen, or opioids.
    • Chronic Pain Tx.: First-line for neuropathic pain includes antidepressants (SNRIs or TCAs), anticonvulsants (sodium channel blockers, CCBs, GABA agonists), which impact the descending inhibitory pathway.
    • Localized Pain Tx: Topical agents such as capsaicin and local anesthetics can be helpful for localized pain sites.

    Pain & Therapy 07 (Chronic Musculoskeletal Pain)

    • Chronic Musculoskeletal Pain Tx.: In addition to non-pharmacological techniques (e.g., heat, ice), opioids can be used in acute settings (immediately after injury or surgery).
    • Localized Pain Tx.: Topical treatments (NSAIDs, capsaicin), injections for trigger points, and duloxetine for musculoskeletal pain (LBP or OA pain).
    • Visceral Pain Tx.: Antidepressants or opioids are considered, often with somatosensory pathway involvement.
    • Additional Therapies: Consider anticonvulsants to alleviate central sensitization and hyperalgesia.

    Pain & Therapy (Multimodal Tx. & Monitoring)

    • Multimodal Therapy: Essential for managing various types of pain.
    • Patient Monitoring: Critical to monitor for adverse effects of NSAIDs (dyspepsia, renal impairment), antidepressants (dry mouth, constipation, urinary retention), and anticonvulsants (drowsiness, dizziness) and any cognitive dysfunction.
    • Opioid Considerations: Monitor patients on opioids carefully for potentially long-term and potentially life-threatening adverse effects (osteoporosis, hypogonadism), asking about constipation, drowsiness, and other symptoms (nausea, vomiting).
    • Peripheral Nociceptors: Decreased number and function of peripheral nociceptors (nerve endings that respond to noxious stimuli) with aging.
    • Sensory Thresholds: Sensory thresholds for thermal and vibrational stimuli increase with age.
    • Pain Receptors: A decrease in pain receptors (e.g., Pacini's corpuscles, Meissner's/Merkle's disks) is observed.
    • Endogenous Analgesic Response: Decreased endogenous analgesic response (endorphins) in older patients.
    • Peripheral Nerves (Myelinated & Unmyelinated): Changes in myelinated and unmyelinated nerves, including reduced density, increase in abnormal and degenerating fibers, and slower conduction velocity.
    • Substance P: Reduced substance P content.
    • Central Nervous System: Reduced number of neurons in the dorsal horn, alterations in endogenous inhibition (hyperalgesia), and decreased levels of certain neurochemicals (catecholamines, acetylcholine, GABA, and serotonin) in the brain.

    Factors Affecting Pain Perception in Older Adults

    • Pain Beyond the Local Area: Pain can extend beyond the injury site affecting overall quality of life.
    • Loneliness as a Predictor: Feeling lonely is a predictor of psychological distress in older adults
    • Intimate Relationships & Dependency: Lack of intimate relationships, dependency, and loss increase loneliness in older adults.
    • Loneliness and Lower Pain Thresholds: Loneliness is associated with a lower pain threshold.
    • Loneliness and Risk of Depression: Loneliness is a risk factor for depression.

    Challenges in Pain Assessment for Older Adults

    • Myths about Aging: Common misconceptions about pain being "natural" with aging can affect patient reporting.
    • Fear of Addiction: Fear of addiction can discourage patients from reporting and seeking treatment for pain.
    • Sensory and Cognitive Impairment: Sensory and cognitive impairments affect how older adults perceive and report pain.

    Pain Treatment : Physiologic Changes

    • Decreased Renal Function: Significantly impacts medication dosage and selection.
    • Decreased Vascular Volume (VD): Reduced plasma volume affects fluid and electrolytes requiring dosage adjustments.
    • Decreased Liver Function: Reduced liver mass and HBF, as well as enzyme activity, impacts medication metabolism and clearance.
    • Decreased Serum Protein Concentrations: Has significant consequences on the body's use of medications.
    • Decreased Pulmonary Function: Impacts lung capacity affecting the rate of medication metabolism.

    Pain Treatment : WHO Cancer Pain Ladder

    • Ladder Stages: The WHO pain ladder outlines a tiered approach to analgesic use, progressing from non-opioids to stronger opioids as pain severity increases.
    • Step 1 : Non-opioid analgesics +/- adjuvants
    • Step 2 : Opioid analgesics of mild to moderate pain with +/- adjuvants.
    • Step 3 : Strong opioid analgesics of moderate to severe pain with +/- adjuvants.

    Pain Treatment 01: Nonopioid Analgesics for Older Adults

    • Acetaminophen: Treatment of choice for osteoarthritis but exhibits an analgesic ceiling effect. Maximum daily dose is limited to 4 grams. Note : maximum daily dose for Acetaminophen is 4 gm in 24 houres not a single dose.

    Pain Treatment 02: Nonselective & COX-2 Inhibitors

    • Nonselective NSAIDs: Inhibit prostaglandin synthesis but pose risks for GI bleeding, renal impairment, and platelet dysfunction.
    • Selective COX-2 Inhibitors: Offer reduced GI side effects but carry their own potential risks; not as readily available as nonselective NSAIDs in some regions.

    Pain Treatment : Using Non-Opioid Adjuvant Medications

    • Wide Variety of Medications: Various medication classes used for neuropathic, bone, and visceral pain alone or in combination with other pain management therapies.
    • Optimized Opioid Therapy: Optimal opioid treatment, where appropriate, often includes other pain management therapies to decrease pain and adverse reactions to opioids.
    • Adjuvant Considerations: Clinicians must be knowledgeable to ensure effective pain management.

    Pain Treatment : Adjuvant Analgesics 1. Corticosteroids

    • Mechanism of Action (MOA): Inhibits prostaglandin synthesis, affects mood and appetite, and has anti-tumour effects in lympho-proliferative disorders.
    • Indications: Raised intracranial pressure (ICP), extradural spinal cord compression, tumour compression of nerve roots, and certain types of cancer.
    • Preparations: Prednisolone, dexamethasone, hydrocortisone.

    Pain Treatment : Adjuvant Analgesics 1. Corticosteroids (continued)

    • Adverse Effects (Se): Cushingoid facies, oropharyngeal candidiasis, cardiovascular effects (HTN, thrombosis), gastrointestinal problems, proximal myopathy, osteoporosis, skin changes, fluid retention, hypoadrenalism, and various neuropsychological or psychiatric symptoms.

    Pain Treatment : Adjuvant Analgesics 2. Progestogen

    • Medroxyprogesterone acetate, megestrol acetate: Indicated as analgesics for metastatic breast, prostate, endometrial, and renal cancers.

    Pain Treatment : Adjuvant Analgesics 3. Anticonvulsants

    • Indications: Neuropathic pain with specific options such as carbamazepine, sodium valproate, and clonazepam (low cross-resistance).
    • Adverse Effects (SE): Include drowsiness, sedation, ataxia, and dizziness, as well as certain specific adverse effects for certain anticonvulsants (eg., carbamazepine-induced leukopenia).

    Pain Treatment : Adjuvant Analgesics 4. Antidepressants

    • Indication: Neuropathic pain, with particular focus on types with constant burning and dysesthetic qualities, and those accompanying depression symptoms.
    • Management: Lower doses than typical antidepressant use (eg 50-75mg of amitriptyline), with slow titration to find a effective dose. Note : TCAs (eg Amitriptyline) often provide superior efficacy compared to newer non-TCA antidepressants in managing neuropathic pain.

    Pain Treatment : Adjuvant Analgesics 5-8

    • Neuroleptics (e.g., Chlorpromazine, Haloperidol): Provide analgesic support and reduction of anxiety, improving night-time sedation, typically indicated for delirium and nausea.
    • Anxiolytic Drugs (e.g., Diazepam, Lorazepam): Can be helpful in managing muscle spasms, particularly acute musculoskeletal pain. Note: benzodiazepines can manage a variety of anxiety and spasm types.
    • Antihistamines (e.g., Hydroxyzine): Offer opioid-sparing effects and can reduce anxiety and sedation, often used in pain cases especially with opioid use.
    • Psychostimulants (e.g., Cocaine, Amphetamines): Increase the effects of opioid-based pain management but can be associated with significant side-effects and should probably be avoided for most pain use cases.
    • Oral Local Anesthetics (e.g., Mexiletine, Lidocaine patch): Can aid in managing neuropathic pain.
    • Muscle Relaxants (e.g., Diazepam, Baclofen, Dantrolene): Help manage muscle spasms that exacerbate pain symptoms.

    Pain Treatment : Adjuvant Analgesics 9 and 10

    • Clonidine: Indicated for refractory neuropathic pain.
    • Nifedipine: Used to manage sympathetic types of pain.
    • Capsaicin: A topical application that depletes substance P neurons in the area.
      Note: these are good for specific types of pain not wide-ranging pain
    • Bisphosphonates: Used for bone pain management, particularly in situations like hypercalcemia or metastatic bone disease.
    • Radioisotopes (e.g., Strontium-89): Employed for relieving bone pain.

    Medication Management: Deprescribing

    • Goal: Improve overall patient care by minimizing unnecessary polypharmacy (taking too many medications). Focuses on reducing non-beneficial medications.
    • Criteria: Identifying drugs without clear indication (i.e., no clinical or demonstrated benefit), as well as factors such as reduced risk-benefit ratio, avoiding potentially dangerous drug interactions.

    Special Challenges in Late-Stage Pain Management

    • Symptom Recognition: Recognizing dysphagia, pulseless radial, breathing changes, death rattle, cyanosis, are crucial for planning and intervention considerations in terminal care. . Symptom Management: Attention must be given to emerging symptoms (e.g., delirium, dyspnea, fatigue) to maintain comfort and patient dignity in palliative care.

    Non-Drug Treatments

    • Education: Education provides patients with knowledge about pain management options and self-help strategies.
    • Exercise: Tailored exercise programs improve function and quality of life.
    • Physical Therapies: Physical (and occupational) therapies, chiropractic practices, and acupuncture can help manage pain symptoms.
    • Mind-Body Practices: Practices like meditation, relaxation techniques, hypnosis, enhance pain tolerance and management, as well as improving quality of life.

    Consequences of Untreated Cancer Pain

    • Impaired Function: Pain can lead to decreased mobility and deconditioning, making daily tasks challenging for patients.
    • Sleep Deprivation: Chronic pain typically disrupts sleep patterns, potentially leading to depression and mood changes.
    • Financial Burdens: Increased healthcare utilization often burdens families and caregivers financially.
    • Diminished Quality of Life: Social isolation limits enjoyment of daily life and amplifies existing distress.

    Cancer Pain Management

    • Initial Treatment: Based on pain severity, initial treatment strategy prioritizes non-opioids (such as acetaminophen and NSAIDs) for milder pain.
    • Moderately/Severe Pain: Strong opioids (e.g., morphine, oxycodone, hydromorphone, fentanyl) are considered when pain intensity exceeds a certain threshold. Neuropathic pain associated with cancer needs additional co-analgesics (such as anti-depressants or anticonvulsants).

    Cancer Pain Management (Continued)

    • Use of Adjuvant Medications: Co-analgesics (such as anticonvulsants, antidepressants, and corticosteroids) enhance pain control, often when the pain is not managed by opioids alone or has neuropathic pain characteristics.
    • Breakthrough Pain Treatment: Short-acting opioid medications are useful for controlling pain that flares up between scheduled doses of longer-acting opioids.
    • Invasive Procedures: Nerve blocks and other invasive surgeries can potentially manage refractory pain situations.
    • Managing Constipation: Stool softeners, laxatives, and methylnaltrexone can help manage opioid-induced constipation.
    • Managing Sedation: Methylphenidate and modafinil are stimulant medications useful to counter the sedation associated with opioid use in treating pain.
    • Managing Itching : Antihistamines and alternative approaches can help manage itching when related to opioid use.
    • Managing Nausea : Anti-emetics are important medication classes that reduce nausea associated with opioid use.
    • Managing Dysphoria and Cognitive Impairment: Specific antipsychotic medications (e.g., haloperidol, metoclopramide) can manage dysphoria and cognitive impairment associated with opioid use.
    • Managing Myoclonus: Anti-convulsants and benzodiazepines are often used in managing myoclonus frequently associated with opioid use

    Opioid Management Strategies

    • Deprescribing: Reducing medication use based on reduced need after the acute phase of pain or by assessing the overall risk-benefit ratio.
    • Rotation to methadone: Methadone may be useful option in order to manage or alleviate opioid-associated side-effects.
    • Dosage adjustment: Adjusting dosage to achieve optimal pain control while minimizing side effects.
    • Non-Pharmacological Approaches: Using non-drug therapy to help manage the pain.

    Cancer Pain : Specific Opioid Choices and Routes (Continued)

    • Hydromorphone: IV hydromorphone is an excellent choice for opioid-dependent patients needing pain relief and avoid potential metabolite accumulation problems that could occur when the kidneys are not functioning as well. This can be particularly useful in the palliative care setting.
    • Fentanyl: Often used and often preferred for transdermal use (patches) as a reliable and convenient method for controlled administration of opioids.
    • Kadian: Kadian is a sustained-release (ER) morphin capsule used frequently as controlled administration.
    • Pain Management Ladder: Carefully use a graded approach to opioid use and selection, often starting with weaker opioid drugs such as hydrocodone from the outset.

    Cancer Pain : Other Opioid Choices

    • Methadone: Suitable in patients who have difficulty with other conventional opioids or have chronic pain due to its prolonged duration of action.
    • Oxycodone: A wider therapeutic window in comparison with other opioid analgesics, especially suited to moderate pain.
    • Pentazocine: Not the best choice for cancer pain due to several concerns especially about psychotomimetic and other side effects, often compared to other better options.
    • Pethidine: Rapidly absorbed and often used for severe acute pain situations, but not ideal for chronic or persistent pain management given relatively short-lived efficacy and potential for serious adverse reactions.

    Drug Prescribing Considerations for Palliative Care

    • Prioritize the Needs of the Patient: Focus on what is best for the patient and family.
    • Appropriate Explanation: Give thorough information on the pros and cons of drug therapy.

    Specific Pain Management Techniques, Principles, and Considerations

    • Patient Opiophobia: Addressing patient anxieties and concerns associated with opioid use.
    • Non-pharmacological management of pain: Education and support should always be prioritized for all pain management strategy.

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