Guidelines onPain Management

Guidelines on Pain Management P. Bader (chair), G. De Meerleer, D. Echtle, V. Fonteyne, K. Livadas, A. Paez Borda, E.G. Papaioannou, J.H. Vranken © European Association of Urology 2010 Table of ConTenTs Page 1. INTRODUCTION 6 1.1 The Guideline 6 1.1.1 Methodology 6 1.2 Publication history 6 1.3 Level of evidence and grade of guideline recommendations 6 1.4 References 7 2. BACKGROUND 7 2.1 Definition of pain 7 2.2 What is suffering? 7 2.3 Nociception and innervation 8 2.4 Neuropathic pain 8 2.5 Innervation of the urogenital system 8 2.6 Pain evaluation and measurement 8 2.6.1 Pain evaluation 8 2.6.2 Assessing pain intensity and quality of life (QoL) 9 2.7 References 10 3. CANCER PAIN MANAGEMENT (GENERAL) 11 3.1 Classification of cancer pain 11 3.1.1 References 11 3.2 General principles of cancer pain management 11 3.3 Non-pharmacological therapies 12 3.3.1 Surgery 12 3.3.1.1 References 12 3.3.2 Radionuclides 13 3.3.2.1 3.3.2.2 3.3.2.3 3.3.2.4 3.3.2.5 Clinical background 13 Radiopharmaceuticals: physical characteristics 13 Indications and contraindications 13 Contraindications 14 References 14 3.3.3 Radiotherapy for metastatic bone pain 15 3.3.3.1 3.3.3.2 3.3.3.3 3.3.3.4 3.3.3.5 3.3.3.6 3.3.3.7 3.3.3.8 Clinical background 15 Mechanism of pain relief by radiotherapy 16 Imaging 16 Radiotherapy scheme 16 Spinal cord compression 16 Pathological fractures 17 Side-effects 17 References 17 3.3.4 Physical/psychological therapy 20 3.3.4.1 3.3.4.2 3.3.4.3 Physical therapies 20 Psychological therapies 21 References 21 3.4 Pharmacotherapy 21 3.4.1 Antibiotics 21 3.4.1.1 Reference 21 3.4.2 Chemotherapy 21 3.4.2.1 Reference 21 3.4.3 Bisphosphonates 21 3.4.3.1 3.4.3.2 3.4.3.3 Mechanisms of action 21 Effects and side-effects 22 References 22 3.4.4 Systemic analgesic pharmacotherapy - the analgesic ladder 22 3.4.4.1 3.4.4.2 3.4.4.3 Non-opioid analgesics 23 Opioid analgesics 23 References 27 3.4.5 Treatment of neuropathic pain 29 2 UPDATE MARCh 2009 3.4.5.1 3.4.5.2 3.4.5.3 3.4.5.4 3.4.5.5 3.4.5.6 3.4.5.7 3.5 Quality of life Antidepressants 29 Anticonvulsant medication 30 Topical analgesics 30 NMDA receptor antagonists 31 Other drug treatments 31 Invasive analgesic techniques 31 References 33 35 3.5.1 References 36 3.6 Conclusions 36 4. PAIN MANAGEMENT IN UROLOGICAL CANCERS 36 4.1 Pain management in prostate cancer patients 36 4.1.1 Clinical presentation 36 4.1.2 Pain due to local impairment 36 4.1.2.1 4.1.2.2 4.1.2.3 4.1.2.4 4.1.2.5 Invasion of soft tissue or a hollow viscus 36 Bladder outlet obstruction 36 Ureteric obstruction 36 Lymphoedema 37 Ileus 37 4.1.3 Pain due to metastases 37 4.1.3.1 Bone metastases 37 4.1.4 Systemic analgesic pharmacotherapy (the analgesic ladder) 40 4.1.5 Spinal cord compression 41 4.1.6 hepatic invasion 41 4.1.7 Pain due to cancer treatment 41 4.1.7.2 Chronic pain associated with hormonal therapy 41 4.1.8 Conclusions 41 4.1.9 Recommendations at a glance (stage M1) 42 4.1.10 References 42 4.2 Pain management in transitional cell carcinoma patients 45 4.2.1 Clinical presentation 45 4.2.2 Origin of tumour-related pain 45 4.2.2.1 4.2.2.2 Bladder TCC 45 Upper urinary tract TCC 45 4.2.3 Pain due to local impairment 45 4.2.3.1 4.2.3.2 Bladder TCC 45 Upper urinary tract TCC 46 4.2.4 Pain due to metastases 46 4.2.5 References 46 4.3. Pain management in renal cell carcinoma patients 47 4.3.1 Clinical presentation 47 4.3.2 Pain due to local impairment 47 4.3.3 Pain due to metastases 47 4.3.4 References 48 4.4 Pain management in patients with adrenal carcinoma 49 4.4.1 Malignant phaeochromocytoma 49 4.4.2 Treatment of pain 49 4.4.2.1 4.4.2.2 Adrenocortical carcinomas 49 Treatment of the pain depending on its origin 49 4.4.3 References 50 4.5 Pain management in penile cancer patients 50 4.5.1 Clinical presentation 50 4.5.2 Pain due to local impairment 51 4.5.2.1 Soft-tissue and hollow-viscus invasion 51 4.5.3 Lymphoedema 51 4.5.4 Pain due to metastases 51 4.5.4.1 Anticancer management for pain relief 51 4.5.5 Conclusions 51 4.5.6 References 51 UPDATE MARCh 2009 3 4.6 Pain management in testicular cancer patients 51 4.6.1 Clinical presentation 51 4.6.2 Pain due to local impairment 51 4.6.3 Pain due to metastases 51 4.6.4 References 52 4.7 Recommendations at a glance 52 5. POST-OPERATIVE PAIN MANAGEMENT 53 5.1 Background 53 5.2 The importance of effective post-operative pain management 53 5.2.1 Aims of effective post-operative pain management: 53 5.3 Pre- and post-operative pain management methods 54 5.3.1 Pre-operative patient preparation: 54 5.3.2 Pain assessment 54 5.3.3 Pre-emptive analgesia 54 5.3.4 Systemic analgesic techniques 54 5.3.4.1 5.3.4.2 5.3.4.3 5.3.4.4 5.3.4.5 5.3.4.6 Non-steroidal anti-inflammatory drugs (NSAIDs) 54 Paracetamol 55 Metamizole (dipyrone) 56 Opioids 56 Patient-controlled analgesia (PCA) 57 Opioid equi-analgesic doses 57 5.3.5 Regional analgesic techniques 58 5.3.5.1 5.3.5.2 5.3.5.3 5.3.5.4 5.3.5.5 5.3.5.6 Local anaesthetic agents 58 Epidural analgesia 58 Patient-controlled epidural analgesia (PCEA) 58 Neural blocks 59 Wound infiltration 59 Continuous wound instillation 59 5.3.6 Multi-modal analgesia 59 5.3.7 Special populations 59 5.3.7.1 5.3.7.2 5.3.7.3 5.3.7.4 Ambulatory surgical patients 59 Geriatric patients 60 Obese patients 60 Other groups 60 5.3.8 Post-operative pain management teams 60 5.4 Specific pain treatment after different urological operations 61 5.4.1 Extracorporeal shock wave lithotripsy (ESWL) 61 5.4.2 Endoscopic procedures 61 5.4.2.1 5.4.2.2 5.4.2.3 Transurethral procedures 61 Percutaneous endoscopic procedures 62 Laparoscopic procedures 62 5.4.3 Open surgery 63 5.4.3.1 5.4.3.2 5.4.3.3 5.4.3.4 5.4.3.5 5.4.3.6 Minor operations of the scrotum/penis and the inguinal approach 63 Transvaginal surgery 63 Perineal open surgery 64 Transperitoneal laparotomy 64 Suprapubic/retropubic extraperitoneal laparotomy 65 Retroperitoneal approach - flank incision - thoracoabdominal approach 66 5.5 Dosage and method of delivery of some important analgesics 66 5.5.1 NSAIDs 66 5.5.2 Drugs with antipyretic effect 67 5.5.3 Selective COX-2 inhibitor 67 5.5.4 Opioids 67 5.6 Peri-operative pain management in children 67 5.6.1 Peri-operative problems 67 5.6.2 Post-operative analgesia 68 5.7 References 69 4 UPDATE MARCh 2009 6. NON-TRAUMATIC ACUTE FLANK PAIN 74 6.1 Background 74 6.2 Initial diagnostic approach 74 6.2.1 Symptomatology 74 6.2.2 Laboratory evaluation 74 6.2.3 Diagnostic imaging 75 6.2.3.1 6.2.3.2 6.2.3.3 Ultrasonography 75 Intravenous urography (IVU) 75 Unenhanced helical CT (UhCT) 75 6.3 Initial emergency treatment 77 6.3.1 Systemic analgesia 77 6.3.2 Local analgesia 77 6.3.3 Supportive therapy 77 6.3.4 Upper urinary tract decompression 78 6.4 Aetiological treatment 78 6.4.1 Urolithiasis 78 6.4.2 Infectious conditions 78 6.4.3 Other conditions 78 6.4.3.1 6.4.3.2 6.4.3.3 6.4.3.4 6.4.3.5 6.4.3.6 6.5 References Uretero-pelvic junction obstruction 78 Papillary necrosis 78 Renal infarction 78 RVT 78 Intra- or peri-renal bleeding 78 Testicular cord torsion 78 79 7. ABBREVIATIONS USED IN ThE TEXT 82 UPDATE MARCh 2009 5 ... - tailieumienphi.vn