The pharmacological approach to management of pain in palliative care
Oliver Jones takes you through a logical approach
Pain is a common feature of terminal disease. As a preregistration house officer, managing this pain can be bewildering. This article presents some principles of management. It is important to remember that pain control is only one aspect of terminal care. Empathy and attentiveness are no less important than appropriate pharmacological intervention.
The nature of incurable disease results in pain being almost invariably chronic and often progressive. Analgesia should be prescribed as a regular medication to prevent the onset of pain. This is best achieved through a system that avoids the patient depending on a nurse or relative for regular drug administration. This is most easily achieved with oral treatments (or infusion pumps, as described later). If simple analgesics such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) are not effective then oral morphine regimens are the next line of treatment.
Effective palliation of pain in terminal care is a small,