Aust Fam Physician
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The components of a holistic pain assessment process in advanced cancer are presented. Central to the assessment and management process is recognition of different types of cancer pain, which have their own individual management emphasis. An overview of nociceptive cancer pain management is presented outlining current drugs available and the 'analgesic ladder' approach.
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Neuropathic pain is often a reason for an unfavourable response to morphine or other opioids in treating cancer pain. This type of pain is difficult to manage and may co-exist with nociceptive cancer pain. There is still a potential for opioid responsiveness, although the doses needed will be higher, and adjuvant drug therapies are best employed concurrently with opioid drugs. ⋯ Less commonly, agents such as baclofen and clonidine, and sympatholytic drugs such as prazosin can be employed for sympathetically maintained neuropathic pain (discussed in Part 3). The type of agent selected will depend on the natural history of the disease process, as well as a description of the pain--the lancinating pains tending to respond better to anticonvulsants. Non invasive neurostimulatory approaches such as transcutaneous electrical nerve stimulation (TENS) may be useful in management, and a few patients may require an invasive procedure such as dorsal column stimulation.
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We sought to determine the impact of general practitioner communication on the efficient management of patients who present to the emergency department. Casemix, severity, time of presentation, the quality of the letter and the reception of a telephone call were considered. ⋯ Despite the ability of general practitioners to select appropriate cases for referral, only the telephone call results in a quantifiable benefit for patients who attend their general practitioner. The high inter-rater reliability affirms the use of referral letters as audit tools in general practice. Better practical use could be made of general practitioners' referral communication to the emergency department.
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The family doctor has always had a significant role in caring for terminally ill patients. Giving support to patients in their last few weeks or hours of life can be an emotionally demanding, clinically frustrating, time-consuming task. The advent of home palliative care services has given patients, families and doctors access to a home hospice team that can provide invaluable support.