Pain management

Pain is a clinical problem in diverse haematological disorders, notably in sickle cell disease, haemophilia and myeloma. Acknowledgement of the need to manage pain effectively is an essential part of successful patient care and management in clinical haematology.

Pain may be local or generalised. More than one type of pain may be present and causes may be multifactorial. It is most important to listen to the patient and give him/her the chance to talk about their pain(s). Not only will this help determine an appropriate therapeutic strategy, the act of listening and allowing the patient to talk about their pains and associated anxieties is part of the pain management process.

Engaging the patient in 'measuring' their pain is often helpful; it enables specific goals to be set and provides a means to assess the effectiveness of the analgesic strategy.

Basic to the control of pain is to manage and remove the pathological process causing pain, wherever this is possible. Analgesia must be part of an integrated care plan which takes this into account.

Analgesic requirements should be recorded regularly as these form a valuable 'semi-quantitative' end point of pain measurement. Reduction in requirements, for example, is an indicator that attempts to remove or control the underlying cause are succeeding.

Managing pain successfully involves patient and family/carer participation, a collaborative multidisciplinary approach in most categories of haematological disorder related pain; medication should aim to provide continuous pain relief wherever possible with a minimum of drug related side effects

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