Key Questions on Palliative Care Pain Relief

GP and specialist in palliative care medicine Dr Rebecca Smithson explains key issues for managing pain in patients undergoing palliative care

Key Points

• Pain scales add useful information in assessing the benefit of pain relief and can also help when assessing patients who are non-verbal, or who have cognitive impairment.
• In an opioid-naïve patient, it is normal to initially use immediate release (IR) preparations to assess the dose of modified release (MR) opioid required.
• Side-effects with opioids are common and include nausea and vomiting, constipation, sedation, itch, dizziness, visual hallucinations and respiratory depression. Constipation tends to persist whereas the others may be transient.
• Hallucinations, sedation, muscle twitching or plucking motions with the hands, and hyperalgesia can be signs of opioid toxicity.
• Factors influencing the choice of opioid and delivery system include renal and hepatic function, stability of pain, absorption and efficacy.
• Dexamethasone is a useful option for pain from raised intracranial pressure, spinal cord compression, bowel obstruction, bony secondaries, nerve compression and liver capsule stretching.