IV. Pain and Symptom Management      
       B.  Pharmacology/ Policies and

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. 
  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
  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.
     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 
    Cultural Aspects of Pain Management  
    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? 
       - 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 
       - 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
    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
    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
    IV KetAMINE for Perioperative Analgesia
       - Management of Opioid Induced

       - Multimodal Analgesia
       - Opioid-Induced Nausea
       - Opioid Withdrawal     
       - Oral Transmucosal Fentanyl Citrate  
       - Patient Controlled Epidural Analgesia 
       - PRN Range Analgesic Orders

     The Correct Way to Write “Titrate to
          Comfort” Orders

       - Transdermal Fentanyl
       - Transitional Analgesia
       - Transverses Abdominis Plane (TAP)
    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
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
  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 for 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
  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 
  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
  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
 Key References
  1. A Physician's Guide to Pain and Symptom Management in Cancer Patients, 3rd Edition
    - Abrahm, J. L. (2014).  MD: Johns Hopkins v 
      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
  2. Common Regional Nerve Blocks - University of Wisconsin Hospital & Clinics
    - Quick guide developed by UWHC Acute Pain

      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)
        (See also Patient and Family Education)

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