Treatmenttreatment modalities to consider

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Nociceptive pain

(stimulation sensory nerves)

Neuropathic pain

(direct nerve involvement) e.g.

brachialgia, sciatica

Dysaesthesia: superficial burning pain

Pressure pain

• Tumour-associated oedema, e.g. raised intracranial pressure

Bony metastases and other tissue destruction

Muscle spasm pain

Viscus (hollow organ) obstruction, e.g. colic, tenesmus

Metabolic effects • Hypercalcaemia

Skin infiltration/ulceration aspirin opioids antidepressants antiepileptics e.g. carbamazepine antidepressants corticosteroids aspirin

NSAIDs aspirin diazepam clonazepam baclofen antispasmodics biphosphonates (APD)

aspirin opioids opioids corticosteroids radiotherapy antidepressants neurosurgery NSAIDs spinal morphine local anaesthetic opioids opioids opioids opioids local anaesthetic TENS

radiotherapy neurosurgery radiotherapy (the most effective)

hormones orthopaedic surgery opioids chlorpromazine corticosteroids palliative surgery radiotherapy corticosteroids treat infection dressings palliative surgery radiotherapy

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