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IV. Pain and Symptom Management

       B.  Pharmacology/ Policies and
           Procedures

This section includes pain management reference cards, algorithm packets, along with flowsheets to record pain assessment and management as well as Meperidine usage guidelines. For more information see Patient and Family Education.

       City of Hope Publications

  1. Paice, J. A., & Ferrell, B. R. (2011). The management of cancer pain. CA: A Cancer Journal for Clinicians, 61(3), 157-182.           DOI: 10.3322/caac.20112.
     
  2. Borneman, T., Koczywas, M., Sun, V. C., Piper, B. F., Uman, G., & Ferrell, B. (2010). Reducing patient barriers to pain and fatigue management. Journal of Pain and Symptom Management, 39(3), 486-501. DOI: 10.1016/j.jpainsymman.2009.08.007.
     
  3. Borneman, T., & Ferrell, B. R. (2010). Maximizing cancer pain management. Coping with Cancer, 24(1), 15-15.
     
  4. Sun, V., Boreman, T., Piper, B., Koczywas, M., & Ferrell, B. (2008). Barriers to pain assessment and management in cancer survivorship. Journal of Cancer Survivorship, 2(1), 65-71. DOI: 10.1007/s11764-008-0047-0.
     
  5. Otis-Green, S., Lucas, S., Spolum, M., Ferrell, B., & Grant, M. (2008). Promoting excellence in pain management and palliative care for social workers. Journal of Social Work in End-of-Life & Palliative Care, 4(2), 120-134. 
    DOI:     10.1080/15524250802353942. 
     
  6. Ferrell, B., Levy, M. H., & Paice, J. (2008). Managing pain from advanced cancer in the palliative care setting. Clinical Journal of Oncology Nursing, 12(4), 575-581. DOI: 10.1188/08.CJON.575-581.
     

       
      Recommended Publications

  1. Pain Assessment and Pharmacologic Management   
    -     Pasero, C., & McCaffery, M. (2010). PA: Elsevier.  ISBN #: 0323056962.                
    -     Sections III (Nonopioid Analgesics), IV (Opioid Analgesics), and V (Adjuvant Analgesics). 
     
  2. Oxford Textbook of Palliative Medicine, 4th Edition
    -     Hanks, G., Cherny, N. I., Christakis, N. A., Fallon, M., Kaasa, S., & Portenoy, R. K. (Eds.) (2010). NY: Oxford University Press. ISBN#978-0-19-857029-5.
     -     Section 10.1 The Management of Pain, pages 587-800.
     
  3. van Wilgen, C. P., & Keizer, D. (2010). The sensitization model to explain how chronic pain exists without tissue damage. Pain Management Nursing. DOI: 10.1016/j.pmn.2010.03.001.
     
  4. Miaskowski, C. (2010). Outcome measures to evaluate the effectiveness of pain management in older adults with cancer. Oncology Nursing Forum, 37(5), 27-32. DOI: 10.1188/10.ONF.S1.27-32.
     
  5. Marceau, L. D., Link, C. L., Smith, L. D. (2010). In-clinic use of electronic pain diaries: Barriers of implementation among pain physicians. Journal of Pain and Symptom Management, 40(3), 391-404. DOI: 10.1016/j.jpainsymman.2009.12.021.
     
  6. Brant, J. M. (2010). Practical approaches to pharmacologic management of pain in older adults with cancer. Oncology Nursing Forum, Supplement to 37(5), 17-26. DOI: 10.1188/10.ONF.S1.17-26.
     
  7. von Gunten, C. F., Bruera, E., Pirrello, R. D., & Portenoy, R. K. (2010). New opioids: Expensive distractions or important additions to practice? Journal of Palliative Medicine, 13(5), 505-511. DOI: 10.1089/jpm.2010.9815.
     
  8. Lentz, J., McMillan, S. C. (2010). The impact of opioid-induced constipation on patients near the end of life. Journal of Hospice and Palliative Nursing, 12(1), 29-38. DOI: 10.1097/NJH.0b013e3181cde1d2.
     
  9. Lovell, M. R., Forder, P. M., Stockler, M. R., Butow, P., Briganti, E. M., Chye, R., et al. (2010). A randomized controlled trial of a standardized educational intervention for patients with cancer pain. Journal of Pain and Symptom Management, 40(1), 49-59. DOI: 10.1016/j.jpainsymman.2009.12.013.
     
  10. Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing
    -     McPherson, M. L. (2009). Bethesda, MD: American Society of Heath System-Pharmacists. ISBN # 978-1585281985.

                  
 Educational Materials/Curriculum

  1. Case Studies and Faculty Guides – Wisconsin Cancer Pain Initiative
    - Cancer Pain Role Model Program Case     – Includes 7 case studies and faculty guides for each to use in teaching basic pharmacology principles related to pain  
    - Case Studies - Home Health      – Includes 5 case studies and faculty guides for each to use in teaching basic pharmacology principles related to pain.
     
  2. Fast Facts and Concepts – Palliative Care Nework of Wisconsin (PCNOW)
    Over 200 Fast Facts.      There is also a PDA version and a Discussion Blog.  
        -       Bisphosphonates for Bone Pain #113
        -           Calculating Opioid Dose Conversions #036
        -           Choosing an Oral Opioid Combination
                  Product #051
        -       Converting to/from Transdermal Fentanyl  #002
        -           Cultural Aspects of Pain Management #078
        -           Controlled Release Oxycodone #080
        -           Epidural Analgesia #85
        -       Gabapentin for Neuropathic Pain #049
        -       Intrathecal Drug Therapy for Pain #098
        -       Is it Pain or Addiction? #068
        -       Ketamine Use in Palliative Care #132
        -       Meperidine for Pain: What’s all the Fuss? #071
        -       Methadone for Neuropathic Pain #171
        -       Methadone for the Treatment of Pain #075
        -       Methadone: Starting Dosing Information #086
        -       Morphine and Hastened Death #008
        -       Neuroexcitatory Effects of Opioids: Treatment     
                 #058
        -       Non-Tricyclic Antidepressants for Neuropathic
                 Pain #187
        -           Once Daily Oral Morphine Formulations #166
        -       Opioid Allergic Reactions #175
        -       Opioids and Nausea #025
        -       Opioid Dose Escalation #020
        -       Opioid Infusion Titration Orders #072
        -           Opioid Infusions in the Imminently Dying
                 Patient #054
        -       Opioid Use in Renal Failure #161
        -           Opioid Withdrawal #095   
        -       Oral Opioid Orders—Good and Bad
                 Examples #074
        -       Oral Oxymorphone #181
        -       Oral Transmucosal Fentanyl Citrate #103
        -       Pain Management in Nursing Homes: Analgesic
                  Prescribing Tips #089
        -       Parenteral Lidocaine for Neuropathic Pain #180
        -           Patient Controlled Analgesia in Palliative Care 
                 #092
        -           Phantom Limb Pain #212
        -           PRN Range Analgesic Orders  #070
        -           Radiopharmaceuticals for Painful Osseous    
                 Metastases #116
        -           Short-Acting Oral Opioid Dosing Intervals #018
        -       Steroids in the Treatment of Bone Pain #129
        -           Subcutaneous Opioid Infusions #028
        -           Sublingual Morphine #053
        -           Tapentadol #228
        -           The Legal Liability of Under-Treatment of
                  Pain     #063       
        -           The Lidocaine Patch #148
        -           Topical Opioids for Pain #185
        -       Why Patients Do Not Take Their Opioids #083
        -       Writing Discharge/Outpatient Opioid    
                 Prescriptions #094        
           
  3. Health and Nurtition Facts for You  – UW Health, University of Wisconsin Hospital & Clinics, Madison, WI
         More than 2,200 topics are available, from medication instructions to nutrition information.  
        -           4% Topical Lidocaine
         -           Coping with Pain  
         -           Establishing Pain Relief Goals  
         -           Intravenous Lidocaine for Perioperative Pain  
         -           IV KetAMINE for Perioperative Analgesia
         -        Management of Opioid Induced Constipation
         -        Multimodal Analgesia
          -       Opioid-Induced Nausea
         -       Opioid Withdrawal 
         -       Oral Transmucosal Fentanyl Citrate  
          -       Patient Controlled Epidural Analgesia (PCEA)
         -       PRN Range Analgesic Orders
         -           The Correct Way to Write “Titrate to Comfort”
                 Orders
         -       Transdermal Fentanyl
         -       Transitional Analgesia
         -           Transverses Abdominis Plane (TAP)Block                             
             -       Urine Drug Testing (UDT)          
     
  4. Patient Contracts /Agreements
    -     For full explanation, sample agreements, and newer terminology regarding the use of opioid agreements see Appendix B, Pasero, C. & McCaffery, M. (2010). Pain Assessment and Pharmacologic Management. MO: St Louis, Elsevier Mosby.         ISBN# 978-0-323-05696-0.           
            
  5. Two-sided Pain and Symptom Management Reference Cards – City of Hope Division of Nursing Research and Education
    - Pain Management Guidelines      
     - Quick Reference Guide for Symptom Management  

        
      Guidelines/Clinical Pathways

  1. Achieving Balance in Federal & State Pain Policy – Pain & Policy Studies Group (PPSG) 
    - Evaluation guide presents a framework that has been developed to understand and to evaluate policies at the federal and state level.
      
  2. Palliative Care and Pain Management – Memorial Sloan-Kettering Cancer Center, New York, NY              
     
  3. Care of the Patient Receiving Conscious Sedation – Canadian Society of Gastroenterology Nurses & Associates           
     
  4. Cleveland Clinic Guide to Pain Management – Michael Stanton-Hicks, MD 
    - In The Cleveland Clinic Guide to Pain Management, Dr. Michael Stanton-Hicks presents critical information about the scientific studies and progress in regulating and managing pain and how a healthy mind-body relationship can change the experience of chronic pain.
     
  5. Conscious Sedation/Analgesia for Adults Policy and Procedure – Pain Management Educator & Consultant Chris Pasero 
    -     Developed by Christine Pasero, RN, BSN, MHSAc, a Pain Management Consultant, this guideline is intended to assist in developing a policy and procedure to help insure safe administration of conscious sedation.  
     
  6. Core Curriculum for Pain Management Nursing – American Society of Pain Management Nurses (ASPMN)    
       
  7. Opioid Treatment Guidelines – Journal of Pain
    - Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain – American Pain Society and the American Academy of Pain Medicine
    -     Opioids for Chronic Noncancer Pain: Prediction and Identification of Aberrant Drug-Related Behaviors: A Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline
    -     Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence f    or an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline
     
  8. Pain Management – California Board of Registered Nursing  
    - The Nurse's Role in Pain Management        
     
  9. Pain Management Resource Manual – Virginia Commonwealth University, Richmond, VA  
    - Continuous Infusions , PCA via Epidural Catheters, Pediatric Patients Receiving Epidural Analgesia, Narcotic Control, Nursing Care of the Patient Receiving TENS, Subcutaneous Infusion/PCA, Application and Destruction of Fentanyl Transdermal Patches and other procedures.
     
  10. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 6th Edition – American Pain Society
    - Packed with a wealth of updated information in an easy-to-use format with concise information about appropriate drug selection, dosing variation among patient populations, rapid treatment of breakthrough pain, and side effect minimization.
     
  11. Protocols for Practice: Creating a Healing Environment –  American Association of Critical Care Nurses (AACN)
    -Pain Management in the Critically Ill  
    -Interventions to Decrease Family Anxiety 
    -Family and Pet Visitation in the Critical Care Unit       
             
  12. Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RDS/CRPS) – 2nd Edition           
     -Download guidelines from Reflex Sympathetic 
      Dystrophy Syndrome Association (RSDSA)      
     
  13. Resources to Help Organizations Implement Standards of Pain Management – WHO Pain & Palliative Care Communications Program
    -    Index of issues from Cancer Pain Release from 1988 through 2009.
    -    Many excellent articles on pain management and palliative care for both adults and pediatrics.
     
  14. Society of Critical Care Medicine Guidelines
    - Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult 
    - Guidelines and levels of care for pediatric  intensive care units
     
  15. Symptom Management Algorithms: A Handbook for Palliative Care, 3rd Edition

          
      Other Organizations Links

         Agency for Healthcare Research and Quality (AHRQ)
         American Society of Pain Management Nurses   

         Be Med Wise 

         Low Cost Prescription Drugs: Patient Assistant Programs

         International Association for the Study of Pain (IASP)  
         National Cancer Comprehensive Network
         National Consensus Project for Quality Palliative Care

         Pain & Policy Studies Group  

        
      Key References     

  1. A Physician's Guide to Pain and Symptom Management in Cancer Patients, 3rd Edition
    - Abrahm, J. L. (2014).  MD: Johns Hopkins University Press. ISBN #: 9781421414034.  An excellent resource that should be used to prevent and treat suffering as health care professionals accompany the patient and family through the experience of living with cancer.
     
  2. Common Regional Nerve Blocks - University of Wisconsin Hospital & Clinics
    - Quick guide developed by UWHC Acute Pain Service


      Position Statements/Standards
  1. American Society for Pain Management Nursing  
    - Use of Placebos for Pain Management
     
  2. California Board of Registered Nursing
    - Conscious Sedation 
     
  3. International Association for the Study of Pain (IASP)
    -      Guidelines

          

                                 (See also Patient and Family Education)

 

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