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Guidelines On

Guidelines On

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Published by UZNAPM
The European Association of Urology (EAU) Guidelines Group for Pain Management have prepared this
guidelines document to assist medical professionals in appraising the evidence-based management of pain
in urological practice. These guidelines include general advice on pain assessment, with a focus on treatment
strategies relating to common medical conditions and painful procedures.
The European Association of Urology (EAU) Guidelines Group for Pain Management have prepared this
guidelines document to assist medical professionals in appraising the evidence-based management of pain
in urological practice. These guidelines include general advice on pain assessment, with a focus on treatment
strategies relating to common medical conditions and painful procedures.

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Published by: UZNAPM on Jan 03, 2010
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01/15/2013

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Guidelines on
PainManagement 
P. Bader (chair), D. Echtle, V. Fonteyne, G. De Meerleer, E.G.Papaioannou, J.H. Vranken
© European Association of Urology 2009
 
 
Table of ConTenTs Page
1. INTRODUCTION 61.2 Reference 62 BACKGROUND 72.1 Definition of pain 72.2 Wat is suffering? 72.3 Nociception and innervation 72.4 Neuropatic pain 82.5 Innervation of te urogenital system 92.6 Pain evaluation and measurement 102.6.1 Pain evaluation 102.6.2 Assessing pain intensity and quality of life 102.7 References 113 CANCER PAIN MANAGEMENT (General) 133.1 Classification of cancer pain 133.1.1 References 133.2 General principles of cancer pain management 143.3 Non-parmacological terapies 153.3.1 Surgery 153.3.1.1 References 153.3.2 Radionuclides 153.3.2.1 Clinical background 153.3.2.2 Radioparmaceuticals: pysical caracteristics 163.3.2.3 Indications and contraindications 163.3.2.4 Contraindications 173.3.2.5 References 173.3.3 Radioterapy for metastatic bone pain 193.3.3.1 Clinical background 193.3.3.2 Mecanism of pain relief by radioterapy 193.3.3.3 Imaging 203.3.3.4 Radioterapy sceme 203.3.3.5 Spinal cord compression 203.3.3.6 Patological fractures 213.3.3.7 Side-effects 213.3.3.8 References 213.3.4 Pysical/psycological terapy 253.3.4.1 Pysical terapies 253.3.4.2 Psycological terapies 253.4 Parmacoterapy 253.4.1 Antibiotics 263.4.2 Cemoterapy 263.4.3 References 263.4.4 Bisposponates 263.4.4.1 Mecanisms of action 263.4.4.2 Effects and side-effects 263.4.4.3 References 273.4.5 Systemic analgesic parmacoterapy- te ‘analgesic ladder’ 283.4.5.1 Non-opioid analgesics 293.4.5.2 Opioid analgesics 303.4.5.2.1 Opioid administration 30Non-invasive routes 30Invasive routes 31Dosing 323.4.5.2.2 Adverse effects and teir management 323.4.5.2.3 Adjuvant analgesics 333.4.5.2.4 References 34
2
UPDATE MARCh 2009
 
3.4.5.3 Treatment of neuropatic pain 363.4.5.3.1 Antidepressants 373.4.5.3.2 Anticonvulsant medication 373.4.5.3.3 Topical analgesics 383.4.5.3.4 NMDA receptor antagonists 383.4.5.3.5 Oter drug treatments 383.4.5.3.6 Summary treatment of neuropatic pain 393.4.5.4 Invasive analgesic tecniques 393.4.5.4.1 Periperal nerve cateterisation in temanagement of cancer pain 393.4.5.4.2 Neurolytic blocks to control visceralcancer pain 403.4.5.4.3 Epidural and intratecal opioid application 403.4.5.4.4 Cemical rizotomy 403.4.5.4.5 Cordotomy 403.4.5.5 References 413.5 Quality of life 433.5.1 Conclusions 443.5.2 References 44 4 PAIN MANAGEMENT IN UROLOGICAL CANCERS 444.1 Pain management in prostate cancer patients 444.1.1 Clinical presentation 444.1.2 Pain due to local impairment 454.1.2.1 Invasion of soft tissue or a ollow viscus 454.1.2.2 Bladder outlet obstruction 454.1.2.3 Ureteric obstruction 454.1.2.4 Lympoedema 454.1.2.5 Ileus 454.1.3 Pain due to metastases 454.1.3.1 Bone metastases 454.1.3.1.1 hormone terapy 464.1.3.1.2 Side-effects 464.1.3.1.3 Efficacy 464.1.3.1.4 Problems 474.1.3.1.5 Radioterapy 474.1.3.1.6 Ortopaedic surgery 474.1.3.1.7 Radioisotopes 474.1.3.1.8 Bisposponates 474.1.3.1.9 Calcitonin 484.1.3.1.10 Cemoterapy 484.1.4 Systemic analgesic parmacoterapy (te ‘analgesic ladder’) 494.1.5 Spinal cord compression 494.1.6 hepatic invasion 504.1.7 Pain due to cancer treatment 504.1.7.1 Acute pain associated wit ormonal terapy 50Luteinising ormone-releasing ormone (LhRh) tumour flare inprostate cancer 504.1.7.2 Cronic pain associated wit ormonal terapyGynaecomastia 504.1.8 Conclusions 504.1.9 Recommendations at a glance (stage M1) 514.1.10 References 514.2 Pain management in transitional cell carcinoma patients 544.2.1 Clinical presentation 544.2.2 Origin of tumour-related pain 544.2.3 Pain due to local impairment 544.2.4 Pain due to metastases 554.2.5 References 554.3 Pain management in renal cell carcinoma patients 56
UPDATE MARCh 2009
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