City of Hope Pain & Palliative Care Resource Center

III.   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.       Economou, D. (2006). Breakthrough pain management. International Oncology Network, First Quarter (2006), 18-21.

2.       Ferrell, B. (2002).  Issues in cancer pain management: Models of success.  Cancer Practice, 10, Supl 1.

3.       Mazanec, P., Ferrell, B. R., & Wellman, C. (2000). Pain in advanced cancer: Assessment and management.  Journal of Clinical Outcomes Management, 7(10), 47-58.

4.       Ferrell, B. R., Juarez, G., & Borneman, T. (1999). Use of routine and breakthrough analgesia in home care.  Oncology Nursing Forum, 26(10), 1655-1661.

5.       Ferrell, B. R., & McCaffery, M. (1997). Nurses’ knowledge about equianalgesia and opioid dosing.  Cancer Nursing, 20(3), 201-212.       

6.       McCaffery, M., & Ferrell, B. R. (1996). Ethical issues in the use of placebos in cancer pain management.  Oncology Nursing Forum, 23(10), 1587-1593.        

7.       Hitchcock, L. S., Ferrell, B. R., & McCaffery, M. (1994). The experience of chronic nonmalignant pain.  Journal of Pain and Symptom Management, 9, 312-318.

       
      Recommended Publications

1.       Pain Assessment and Pharmacologic Management (Release date 6/21/2010)
          -     Pasero, C., & McCaffery, M. (2010). PA: Elsevier.  ISBN #: 0323056962.                

2.       Wall and Melzack's Textbook of Pain Online, 5th Edition  (Text with continually updated online reference)
           -    McMahon, S. & Koltzenburg, M. (2005).  PA: Elsevier.  ISBN #: 0443067910.

2.       Principles & Practice of Pain Medicine, 2nd Edition 
          -     Warfield, C. A. & Bajwa, Z. H. (2004).  IA: McGraw-Hill Professional. ISBN #: 0071443495

3.       Handbook of Pain Management
          -     Melzack, R. & Wall, P. D. (2003).  PA: Elsevier.  ISBN #: 0443072019.         

4.       Manual of Pain Management, 2nd Edition
          -     Warfield, C. A. & Fausett, H. J. (2002).  NY: Lippincott Williams & Wilkins. ISBN #: 0781723132.

5.       Pain: Clinical Manual, 2nd Edition
          -     McCaffery,  M. & Pasero, C. (1999).  MO: CV Mosby. ISBN #: 081515609X.  

       
        Educational Materials/Curriculum

1.       2009 Laminated Equianalgesic Pocket Card – Southern California Cancer Pain Initiative (SCCPI)
          -     Equianalgesic Pocket Card order form

2.       Algorithm Packet
          -      Cancer Pain Algorithm Tools,  Du Pen, Inc., WA
          -      NCCN Clinical Pathway Guidelines in Oncology, National Comprehensive Cancer Network, Jenkintown, PA
          -      Pediatric Pain & Symptom Management Algorithms for Palliative Care,  Children's Hospital, Seattle, WA
          -      Symptom Management Algorithms for Palliative Care, Providence Yakima Medical Center Pharmacy & Hospice of Yakima, WA

3.       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. 

4.       Clinical Management of Neuropathic Pain: A Problem-Based, Interactive Module – StopPain.org
            -     This innovative learning module demonstrates the assessment of a patient with neuropathic pain, the development of a clinical strategy, and the selection of an initial therapeutic strategy.  

5.      Fact Sheets – International Association for the Study of Pain (IASP), Seattle, WA
         Available in Spanish, French, Portuguese, Russian, Arabic, and Chinese.
         -             Cancer Pain
         -             Cancer Pain Treatment
         -             Epidemiology of Cancer Pain
         -             Pharmacological Management of Cancer Pain
         -             Treatment-Related Pain

6.      Fast Facts – End of Life/Palliative Education Resource Center (EPERC), Madison, WI             
             Over 200 Fast Facts.  There is also a PDA version and a Discussion Blog. 
          -       Cancer Related Fatigue 
          -       Converting to/from Transdermal Fentanyl 
          -       Opioid Dose Escalation 
          -       Subcutaneous Opioid Infusions 
          -       Opioid Infusion Titration Orders 
          -       Opioid Withdrawal          
          -       Patient Controlled Analgesia in Palliative Care
          -       PRN Range Analgesic Orders 
          -       Urine Drug Testing 

7.      Health Facts for You  – UW Health, Madison, WI   
         Over 30 categories of patient education materials developed by University of Wisconsin Hospitals & Clinics experts.       
        -     Oral Transmucosal Fentanyl Citrate 
          -      Opioid Withdrawal 
          -      PRN Range Analgesic Orders       

8.        Meperidine - Drug Usage Evaluation Packet
           -     Meperidine Usage Policy – St. Francis Medical Center, Cape Girardeau, MO
           -     Guidelines for the Appropriate Use of Meperidine – Medical University of South Carolina, SC
           -     Guidelines for Use of Meperidine – University of Wisconsin Hospital and Clinics, Madison, WI
           -     Meperidine Usage Policy – University of Pittsburgh Medical Center Presbyterian (UPMCP). Pittsburgh, PA  

9.        Pain Assessment and Management – Children's Hospital of Wisconsin, Madison, WI       

10.      Patient Contracts
           -     A packet written by Margo McCaffery including a discussion of the use of contracts with patients receiving opioids.

       
      Guidelines/Clinical Pathways

1.       A Self-Directed Learning Model: Epidural Analgesia  – University of Wisconsin Hospital and Clinics, Madison, WI

2.       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.  

3.       Agency for Healthcare Research and Quality (AHRQ) Pain Guidelines        
           -      Adult Pain Management: Operative Procedures in English & Spanish
           -      Acute Pain Management in Infants, Children, and Adolescents: Operative Procedures in English & Spanish         
           -      Acute Pain Management: Operative or Medical Procedures and Trauma
           -      Clinical Practice Guidelines 
           -      Management of Cancer Pain                

4.      Building an Institutional Commitment to Pain Management: The Wisconsin Resource Manual, 2nd Edition
           -     This manual is based on the recommendations for institutional change set forth by the American Pain Society (APS) quality improvement guidelines. It provides a comprehensive plan as well as over 100 sample resource tools contributed by leaders in pain quality improvement around the country. It includes a CD ROM with the Sample Resource Tools formatted in Microsoft Wordฎ and a Pain Management Quality Improvement Microsoft Accessฎ Database.

5.       Cancer Pain Algorithm – Dr. Stuart Du Pen & Anna Du Pen
           -      Global Cancer Pain Algorithm
           -      Pain Assessment
           -      Constipation
           -      Oversedation
           -      Reassessment
           -      Flow Chart
           -      Progress Note   

6.       Cancer Pain and Pain Management – Memorial Sloan-Kettering Cancer Center, New York, NY 

7.       Cancer Pain Management Basics – University of Texas MD Anderson Cancer Center, Houston, TX
           -         Cancer Pain Treatment Guidelines
           -          Common Concerns About Pain Treatment
           -          Pain Management Education & Support

8.        Cancer Pain Management Critical Pathway – University of Wisconsin Hospital & Clinics, Madison, WI

9.        Care of the Patient Receiving Conscious Sedation – Canadian Society of Gastroenterology Nurses & Associates          

10.      Conscious Sedation/Analgesia for Adults Policy and Procedure – Pain Management Educator & Consultant Chris Pasero, RN, MSNc

11.      Core Curriculum for Pain Management Nursing – American Society of Pain Management Nurses (ASPMN)        

12.      Definitions Related to the Use of Opioids for the Treatment of Pain 
           -      From the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine.  

13.      Global Year Against Cancer Pain Fact Sheets – International Association for the Study of Pain (IASP), Seattle, WA
           Available in Spanish, French, Portuguese, Russian, Arabic, and Chinese.
           -          Cancer Pain
           -          Epidemiology of Cancer Pain
           -          Cancer Pain Treatment
           -          Pharmacological Management of Cancer Pain
           -          Treatment-Related Pain

14.      Guideline for the Management of Acute Pain in Sickle-Cell Disease – American Pain Society  

15.      Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis – American Pain Society

16.      Health Information Sheets on Pain Procedures – St. Vincent Hospital and Health Center, Billings, MT 
           -      Dorsal Column Stimulator (DCS) or Spinal Cord Stimulator (SCS)
           -      Epidural Steroid Injection          
           -      Epidurolysis (Racz Procedure)        
           -      Facet Joint Injection     
           -      Intrathecal Pump Implant (Spinal Morphine Pump)
           -      Lumbar Sympathetic Block   
           -      Radio Frequency Lesioning
           -      Sacro-Iliac Joint Injection
           -      Stellate Ganglion Injection

17.      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 fro an American Pain Society and American Academy of Pain medicine Clinical Practice Guideline

18.      Packet of Clinical Pathway Examples –  Via Christi Regional Medical Center & St. Francis Campus, Wichita, KS
           -      Clinical Pathway for Acute Pain Management - Adult
           -      Clinical Pathway for Acute Pain Management - Pediatric
           -      Clinical Pathway for Collaborative Care Acute Pain Management 

19.      Pain Management – California Board of Registered Nursing  
            -      Pain Management Policy 
            -      The Nurse's Role in Pain Management       

20.       Pain Management Packet – Harrison Hospital, Bremerton, WA
            -      Materials produced by the Pain Management Task Force including the Patient Admission Record, Morphine Continuous Infusion Standing Orders, Epidural Catheter Standing Orders, PCA Physician Order Sheet, Description of the Pain Task Force and Nursing Division Patient Care Guidelines.

21.      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.

22.      Pain Management Standards
           -      Nursing Responsibilities for Pain Management  – University of Wisconsin Hospital & Clinics, Madison, WI 
           -      Mission Statement for Pain Management Center – Fox Chase Cancer Center, Philadelphia, PA

23.      Patient Care Guidelines –  University of San Francisco Medical Center, San Francisco, CA 
           -      Basic Pain Education for Nurses, including Principles and Pain Management with Analgesics
           -      Intra Spinal Medication Delivery

24.      Placebo Usage Packet ($5.00/Packet)
           -      Arnstein, P. (2006). Placebo: No Relief for Ms. Mahoney's Pain. Working with the patient, family, and staff to diminish pain. American Journal of Nursing, 106 (2), 54-66.
           -      Rich, B. (2003). A placebo for the pain: A medico-legal case analysis.  Pain Medicine, 4(4), 366-372.
           -      McCaffery, M., & Ferrell, B. R. (1997). Guest Editorial - Pain and placebos: Ethical and professional issues.  Orthopaedic Nursing, Sept./Oct., 5(16), 8-12.
           -      Ferrell, B. R., & McCaffery, M. (1996). Current placebo practice and policy.  ASPMN Pathways, 5(1), 12-14.
           -      McCaffery, M., Ferrell, B. R., & Turner, M. (1996). Ethical issues in the use of placebos in cancer pain management. Oncology Nursing Forum, 3(10), 1587-1593.               
           -      Placebo Bibliography
           -      ASPMN Position Statement on the Use of Placebos for Pain Management

25.      Policy and Procedure Packet 
           -      Continuous Subcutaneous Opioid Infusion – University of Wisconsin, Madison, WI
                  This policy describes the initiation and maintenance of a continuous subcutaneous opioid infusion.
           -      Standard of Nursing Practice: Opiate Infusions – Fox Chase Cancer Center, Philadelphia, PA
                  This nursing practice governs the policy and procedures of opiate infusions.\

26.       Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 6^th 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.

27.      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                

28.      Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RDS/CRPS) – 2^nd Edition            

29.      Resources to Help Organizations Implement Standards of Pain Management – WHO Pain & Palliative Care Communications Program

30.      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

31.      Symptom Management Algorithms: A Handbook for Palliative Care, 3^rd Edition

        Key References     

1.        A Physician's Guide to Pain and Symptom Management in Cancer Patients, 2nd Edition
          -       Abrahm, J. L. (2005).  MD: Johns Hopkins University Press. ISBN #: 0801881005.  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.

1.        American Pain Society
           -      Position Statements

2.        American Pain Society and American Society for Pain Management Nursing
           -      The Use of ‘As Needed’ Range Orders for Opioid Analgesics in the Management of Acute Pain

3.        American Society for Pain Management Nursing 
           -     Use of Placebos for Pain Management

4.        California Board of Registered Nursing
           -     Conscious Sedation
          

                                 (See also Patient and Family Education )