Pain due to advanced cancer or its management
- Bone metastases
- Incident pain
- Increased intracranial pressure (ICP)
- Malignant wounds
- Mucositis
- Nerve or nerve root compression or infiltration, such as:
- central pain
- peripheral neuropathy secondary to treatment
- plexopathy
- spinal cord compression
- Pathological fracture
- Skeletal muscle spasm
- Smooth muscle spasm
- Tumour:
- Visceral:
- obstruction
- pain
- perforation
Pain syndromes in end-stage, non-malignant disease
- Calciphylaxis
- Contractures
- End-stage:
- ischaemic heart disease
- peripheral vascular disease
- Pressure areas
- Visceral perforation
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Chronic non-malignant pain
- Chronic widespread pain, such as fibromyalgia
- Diabetic peripheral neuropathy
- Headache
- Inflammatory arthritis
- Non-malignant spinal pain
- Osteoarthritis
- Postherpetic neuralgia
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Biopsychosocial model of pain
- Epidemiology of cancer pain
- Non-drug treatment of pain
- Pathophysiology of pain
- Pharmacology of:
- adjuvant analgesics
- opioids:
- routes of administration
- switching / rotation
- treatment of adverse effects and toxicity
Clinical assessment tools
- Pain scales, such as:
- Pain Assessment in Advanced Dementia (PAINAD)
- visual analogue scale (VAS)
- Wong–Baker Faces
Investigations for cancer pain
- Imaging, such as:
- bone scan
- CT scan
- MRI
- PET scan
- x-ray
Procedures for cancer pain
- Epidural block / infusion
- Implantable devices
- Intrathecal block / infusion
- Peripheral nerve block
- Plexus block
- Radiofrequency ablation
- Sympathetic block
- Cancer pain management in:
- patients on opioid replacement
- the setting of substance misuse
- Radiotherapy for pain management
- Safe prescribing in patients with:
- frailty
- low body weight
- organ failure
- Surgery for pain management, such as surgical management of fractures
- Systemic cancer treatment in the management of cancer pain
- Understand and have treatment strategies for psychosocial effects and drivers of pain
