Internal Medicine — Palliative Care and Pain Medicine

Internal Medicine · Clinical Specialties

How it begins

Palliative care constitutes a care approach aimed at improving the quality of life of patients and families facing the problems associated with a life-threatening illness, through the prevention and relief of suffering through early identification, rigorous evaluation and treatment of pain and other physical, psychosocial and spiritual problems. Pain medicine,…

What it covers

1. Concepts, Definitions and Delimitation of the Field
2. · The concept of “total pain” (Cicely Saunders)
3. · Fundamental principles of palliative action
4. Care Models, Trajectories and Prognosis
5. · Illness trajectories at the end of life (Lunney)
6. · Tools for identifying palliative needs
7. Multidimensional Assessment of the Palliative Patient
8. · Symptomatic assessment instruments
9. · Advance decision planning (PAD)
10. Neurobiology of Pain and Pathophysiological Classification
11. · The nociceptive pathway: from the periphery to the cortex
12. · Physiopathological classification of pain
13. · Breakthrough pain
14. Clinical Evaluation of Pain
15. · Anamnesis of pain: the acronym ALICIA / OPQRST
16. WHO Analgesic Ladder and Non-Opioid Analgesics
17. · Paracetamol (acetaminophen)
18. · NSAIDs (non-steroidal anti-inflammatory drugs)
19. · Metamizole (dipyrone)
20. Opioids: Pharmacology and Clinical Use
21. · Morphine: the reference opioid
22. · Practical start and indicative doses
23. · Other major opioids
24. · Adverse effects of opioids and their management
25. Opioid Rotation and Equianalgesia Tables
26. · Guidative equianalgesia table
27. Analgesic Adjuvants and Interventional Techniques
28. · Adjuvants for neuropathic pain
29. · Other relevant adjuvants in palliatives
30. · Interventional techniques (the "fourth step")
31. Control of Digestive Symptoms
32. · Nausea and vomiting
33. · Constipation
34. · Malignant intestinal obstruction (MIO)
35. · Anorexia-cachexia and others
36. Control of Respiratory Symptoms
37. · Dyspnea
38. · Cough
39. · Premortem rattles ("death rattles")
40. · Massive hemoptysis
41. Neuropsychiatric Symptoms: Delirium, Anxiety and Depression
42. · Delirium
43. · Anxiety and depression
44. · Insomnia and asthenia
45. Other Symptoms: Cutaneous, Genitourinary and Systemic
46. · Pruritus
47. · Sweating and hot flashes
48. · Pressure ulcers and tumor wounds
49. · Lymphedema
50. · Genitourinary symptoms
51. · Mouth: oral care as a pillar
52. · Anorexia-cachexia syndrome (enlargement)
53. Routes of Administration, Infusers and Compatibilities
54. · Drugs administered subcutaneously
55. The Agony and Care of the Last Days
56. · Principles of management in agony
57. Palliative Sedation
58. · Indications: most frequent refractory symptoms
59. · Drugs
60. Emergencies in Palliative Care
61. · Metastatic spinal cord compression
62. · Superior vena cava syndrome
63. · Hypercalcemia of malignancy
64. · Convulsive attacks, hemorrhages and others
65. Clinical Communication and Transmission of Bad News
66. · The SPIKES protocol to give bad news
67. · The conspiracy of silence (pact of silence)
68. · Other difficult communication situations
69. Grief and Family Care
70. · Models of the grieving process
71. · Grief accompaniment
72. Ethical Aspects and Legal Framework at the End of Life
73. · Instruments of prospective autonomy
74. · Deliberation methodology
75. Non-Oncological Palliative Care
76. Integrative Synthesis
77. · Ten operating principles for the internist