End of Life - Pain Management

Theresa Kristopaitis, M.D.
Director, End of Life Curriculum
Loyola University Chicago
Stritch School of Medicine

This module has been designed for students to asses their knowledge of pain management.

I can define "Pain".

I can categorize different types of pain.

 World Health Organization 3-Step Ladder

For each of the analgesics listed in the flash card activity, decribe

a) in which step of the WHO pain ladder it belongs b) routes of administration available (oral and/or IV)

I know what an "adjuvant analgesic" is 

Order the listed opiates from LEAST potent to MOST potent

Test your pain management skills with this case.

Test your pain management skills with this case.

I know how to prevent opiate induced constipation 

Test your pain management skills with this case.

A 66-year old man with metastatic prostate cancer develops slowly progressive right-sided pelvic pain in the region of known pelvic metastases. He describes dull-aching pain rated at 8/10 in the lateral pelvis and sharp shooting pain that radiates down the left leg. The pain limits mobility and awakens the patient from sleep. He has no focal motor or sensory deficits. An x-ray shows blastic metastases in the lateral pelvis. He is undergoing a course of palliative radiation therapy. Morphine immediate release 30mg ever 4 hours controlled his pain until the past several days. The dose currently decreases his pain from 8/10 to 6/10 for 1-2 hours at best.

Final stop - how do opiates work?