Palliative Care Methods for Controlling Pain
Palliative care is used to manage a disease or medical condition that is serious or life threatening by easing pain and other associated physical, emotional, or psychosocial symptoms.
Palliative care also eases other distressing symptoms, like depression, anxiety, fatigue, insomnia, and shortness of breath. Palliative care provides advanced care planning and a support system to help you live a life that is as active, fulfilling, and as pain-free as possible.
Palliative care may last for weeks, months, or years, and the relief of moderate to severe pain during that time can greatly improve quality of life. The biggest problem with palliative care is that many people are referred for care too late. By starting this type of care early, and by using the right type of pain management, nearly all pain problems can be relieved or reduced.
Principles of palliative care and pain medicine
The first step in managing pain is to do a total pain assessment. You may be asked to choose a number from 0 to 10 to rank your pain, with 0 being very mild pain and 10 being the worst possible pain you could have.
Keep in mind 3 important principles when deciding how to manage pain. First, pain should always be treated right away. A delay allows pain to get worse. Second, you should not be afraid of becoming addicted to pain medicine. If medicines are used in the right way under close supervision of a healthcare provider, this is rarely a problem. Of course, if you believe that you are losing control of how you are using pain medicines, you should discuss this with your healthcare provider right away. Third, most pain problems can be controlled by using the World Health Organization's step-care approach:
Step 1. Start with a nonsteroidal anti-inflammatory drug (NSAID). Examples of NSAIDs include over-the-counter drugs like ibuprofen and stronger NSAIDs that your healthcare provider may prescribe. An alternative to NSAIDs for step 1 pain is acetaminophen.
Step 2. If pain continues or gets worse, your healthcare provider may prescribe a weak opioid medicine, like hydrocodone. A weak opioid may be combined with a nonopioid pain reliever.
Step 3. If pain continues or gets worse, your healthcare provider may prescribe a stronger opiate. Examples of strong opioids include morphine and fentanyl.
Understanding opioid drugs
Opioid drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opioid drugs is available, and they can be taken in a variety of ways. One drawback of these medicines is that, over time, you will almost certainly develop a tolerance to the one you're taking and need higher doses to get the same effect. One way your healthcare provider may get around this problem is by switching the type, dose, or the way the drug is given.
These are common ways in which opioid drugs can be given:
Oral medicines. These can be taken in pill or liquid form and can be short acting or long acting (sustained release).
Adhesive patch. This can be applied to the skin to release medicine over time. An example of this is a fentanyl patch.
Opioid drug injection. This shot may be given under the skin or into a muscle.
Opioid drug IV. An opiate may be given directly into the blood through an intravenous line.
Medicine pump. Opiate medicine can be given through a pump attached to an IV line that you control. This is called patient-controlled analgesia.
Spinal injection. For pain that's hard to control, a pain-control specialist may give an opioid drug directly into the spinal cord area.
Understanding helper drugs
These medicines, called adjuvant analgesics, can help control pain in certain situations. These are commonly used adjuvant drugs:
Steroids. These are strong anti-inflammatory medicines that may help relieve pain by decreasing inflammation. They may be used along with other pain relievers for nerve, bone, or other types of pain.
Antidepressants. Treating any existing depression or anxiety can make pain easier to control. These drugs may also be useful in pain caused by nerve damage.
Anticonvulsants. These medicines are usually used to control seizures, but they can also help control nerve-related pain.
Local anesthetics. These are medicines that can block pain signals in the body. A pain specialist may inject a local anesthetic to block pain.
Muscle relaxants. Antianxiety medicines and muscle relaxants may be used along with pain medicine if pain is aggravated by tension or muscle spasms.
Bisphosphonates. These medicines are sometimes used to prevent fractures in people whose cancer has spread to the bone. They can play a key role in relieving bone injury and pain.
Other pain control interventions
Surgery is often the last thing a patient or his or her healthcare provider would consider at end of life. But at times surgery can provide pain relief and increase function. Surgery's primary goal can be to relieve specific symptoms. For instance, a healthcare provider may recommend surgery to stabilize a hip fracture in someone with advanced cancer. The surgery is not going to treat the cancer or lengthen the patient's life, but it may be the best way to reduce hip pain and improve mobility. Radiation therapy can also be used to improve pain and control symptoms. Because surgery involves risk, the healthcare provider must clearly define treatment goals for both the patient and the patient's family.
If you or a loved one needs palliative care, many options are available. Work with your healthcare provider to find the right approach. You can also get help from a pain medicine specialist or a palliative care specialist. Remember: You have a right to be as free of pain as possible. There is no reason to let pain decrease your quality of life.
October 14, 2017
Cancer Pain Management: General Principles and Risk Management for Patients Receiving Opioids. UpToDate, Overview of comprehensive patient assessment in palliative care. UpToDate, Pain Assessment and Management in the Last Weeks of Life. UpToDate
Moe, Jimmy, MD,Taylor, Wanda, L., RN, PhD