Clinical Pharmacy

Biography

Biography: Sonia Amin Thomas

Abstract

Studies have shown that appropriate management of pain in the oncology patient can significantly increase quality of life and eventually overall survival. All patients should be asked to rate their pain on a scale of one to ten every time they arrive for a check-up, and scheduled reassessments should be performed. A common scale used for adults is the Wong-Baker FACES. The World Health Organization (WHO) has come up with a 3-step ladder based on the pain scale for treatment options. On a scale of 1 to 10, if the pain is rated from 1-3 (mild pain), it is suggested to start with acetaminophen, aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). If the score is a 4-6 (moderate pain), it is suggested to add a mild opioid (i.e., tramadol or codeine). If the score is a 7-10 (severe pain), it is suggested to add a strong opioid (i.e., morphine, hydromorphone, fentanyl, methadone or oxycodone. Oncologic pain is one of the most difficult supportive care issues to manage, as it is subjective. Many physicians struggle with outpatient management of oncologic pain in adults; and pharmacists can play a key role in recommending agents, titration and conversions. Another area in which pharmacists can play a key role is managing adverse effects associated with pain medications. An important aspect of pain management is breakthrough cancer pain (BTCP), which is also an area for improvement.