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Pain management in palliative care
The requirement for palliative care will rise in the coming years due to demographic change. The number of people with chronic diseases will increase. Pain occurs in up to 70% of patients with advanced cancer and patients with chronic diseases, like heart failure or multiple sclerosis. The goal of palliative care is symptom control and keeping the quality of life as high as possible till end-of-life.
Much can be done medically and without medication-based treatment. Suffering from chronic pain, especially cancer pain, can be controlled in the majority of cases with inexpensive oral drugs. The use of the World Health Organization (WHO) analgesic ladder guides to systematic pain relief. The choice of drug is based on the severity of pain and not the stage of the disease. It should always be adjusted if pain level alters. Where pain is permanent, analgesia needs to be prescribed in a continuous basis supplemented with additional, fast acting substances for breakthrough pain.
Determining the characteristic of pain, neuropathic or nociceptive, can be useful for the choice of drugs. For neuropathic pain, antidepressants and anticonvulsives are the recommended first option. If enteral application forms become impossible during the end-of-life period and transdermal application unreliable, drugs must be given by subcutaneous, intravenous or intrathecal ways.
Non medical treatments, like physical or interventional techniques, are an important pillar in supporting pain management in the context of an individual treatment concept. Interventional procedures like nerve blocks, epidural or intrathecal techniques can be considered, when pain is localised to a specific area and cannot be controlled with oral or transdermal analgesics.
The following article describes treatment concepts in palliative care to control pain-conditions in patients with chronic, not curable, diseases.