Management of Persistent Pain in the Palliative Setting
This is a fundamental aspect of caring for palliative patients. Pain may be a patient’s greatest fear and adequate pain relief is essential for their comfort and dignity.
Several principles should be followed closely:
- The characteristics and cause of each pain should be established (there is often more than one type of pain).
- Pain is most often due to tumour involvement but also can be related to its treatment (e.g. mucositis, etc.), to complications of general illness and debility (e.g. constipation, pressure areas, etc) and can also be completely unrelated to the cancer (e.g. arthritis, IHD, etc).
- Analgesics should be charted and given regularly (PRN administration is not usually effective).
- Adequacy of pain relief and development of side effects should be monitored regularly.
- Patients must be reviewed carefully for concurrent problems if analgesic requirements increase.
- Oral regimens are the most acceptable and convenient.
- When using opioids, simple analgesics such as Paracetamol should be continued and co-analgesics may also be necessary.
- The concept of ‘Total Pain’ is used widely in Palliative Care and acknowledges that cancer pain is caused by and influenced by many issues. Physical pain is only one component – attention must be given to psychological problems, social problems, intellectual, spiritual and cultural issues and other concurrent physical symptoms.
Topic Code: 4040