1. Pain Cases GPVTS Nov 08

2. Case 1 : Hospice patient - RM 67/f 2004: Ovarian cancer oophrectomy +salpingectomy chemotherapy 2008: Pathological fracture to L5 treated with Radiotherapy

3. Case 1 cont. Admitted to hospice 1 week later for symptom control. main symptoms: Pain – lower back, dull ache and intermittent sharp pain. Drowsiness – past 24hrs medications: MST 60mg bd, pregabalin 150mg bd, paracetamol 1g qid

4. Case 1 O/E T=37.4, pulse= 88, CVS/RESP/NEURO: NAD Q1: what are the possible causes of RM’s drowsiness Q2: what are the possible options to manage pain?.

5. CASE 2: House call DM 77/M 2008: Gastric Cancer Not for chemotherapy/Radiotherapy Poor prognosis

6. Case 2: cont Main symptoms : pain : Epigastric – severe dull ache Vomiting : increasing over past few days. Dysphagia : new onset Medications: omeprazole 40mg od, MST 120mg bd and PRN oramorph. metoclopramide 10mg tds

7. Case 2 cont O/E – unwell, grey, restlessness, abdo: pain on light palpation in epigastrium. Q1: what analgesics / medications should be started? Q2:what other considerations are there in managing this patient?

8. Case 3: telephone call: PF 80/f 2007: Rectal Cancer Anterior resection + tumour debulking chemotherapy + radiotherapy. 2008: Referred to palliative care.

9. Case 3 cont Meds: alfentanil 120mg and 12.5mg levomepromazine by csci Q1. What prn medication should PF be on and at what dose?

10. Case 4: Busy surgery TM 66/f Long history of osteoarthritis known: previous gastric ulcer and renal impairment awaiting knee replacement had previous joint injections for pain

11. Case 4 : cont main symptom: severe left knee pain. medications: co-codamol 30/500 qid, tramadol 100mg qid Q1 what medication could be started? Q2. what side effects should you warn the patient about?