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APPROACH TO THE PATIENT WITH CANCER-RELATED PAIN
The aim of palliative care is to allow patients with advanced cancer to be pain-free or for their pain to be sufficiently controlled that it does not interfere with their ability to function or detract from their quality of life. It has been demonstrated that satisfactory pain control can be achieved for nearly 95% of patients with cancer, using drugs and other treatments which are readily available and including appropriate attention to the psychosocial aspects of care. That the results achieved in routine clinical practice are less satisfactory indicates the need for improvement.
The prerequisites for good pain control in patients with advanced cancer include:

  • accurate and detailed assessment of each pain
  • knowledge of the types of pains suffered by patients with cancer
  • different therapeutic approaches to chronic pain
  • knowledge of which treatment modalities to use
  • knowledge of the actions, side effects and pharmacology of analgesics
  • assessment and treatment of other aspects of suffering which may aggravate pain — physical, psychological, social, cultural, spiritual
  • treatment of pain as part of a co-ordinated plan of total care
  • continuing reassessment

The interrelationships between pain and the other causes of suffering have important implications for clinical practice:

  • Pain can cause or aggravate problems related to other causes of suffering and it is necessary to control pain before the other problems can be treated successfully.
  • Pain can be caused or aggravated by problems related to other causes of suffering which must be addressed before good pain control can be achieved

In the first situation the initial step must be to control pain, as it is not possible to have meaningful discussions about psychological, social or spiritual concerns if a patient has uncontrolled pain. In the opposite situation, psychosocial or spiritual problems may be causing or aggravating pain and no amount of well prescribed analgesia will relieve the pain until the responsible psychosocial issues are addressed.
The treatment of pain needs to be part of a holistic and multidisciplinary approach to patient care. The clinical importance of the relationship between pain and the other aspects of suffering cannot be under-estimated and lack of attention to psychosocial problems is a common cause of unrelieved pain.
• Successful management of pain requires assessment of all aspects of a patient's suffering and treatment must be part of a co-ordinated plan of total care.
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