Palliative Care ; Pain Management

Pain is a very prominent and distressful symptom in patients presenting at the end of life. In the cancer population, its prevalence is over 75% for those with advanced disease. In other palliative conditions, it is also a frequent symptom though often underestimated. A systematic review reported a prevalence of pain at 20-78% (median 41) in CHF patients, 21-77% (median 68) in COPD patients, and 21-64% (median 52) in CRF patients. Additionally, patients with neurological palliative conditions, such as stroke or ALS, may also experience significant level of pain. It has been shown that 68% of end of life stroke patients have symptoms or manifestations of pain.The key points of pain management in palliative patientsThe effective relief of pain in a palliative patient depends mainly on a comprehensive assessment to identify the different physical, psychological, social, and spiritual aspects that are specific to each patient, and optimally intervene on a multidisciplinary level. The pain syndrome must be assessed with detail to ascertain which components of pain prevail, as this will lead to the optimal choice of intervention (i.e., pharmacological, interventional) for each individual. Pharmacological management is one of many modalities in pain control. The choice of pharmacologic intervention should be considered in conjunction with a patient’s primary issues as well as their underlying comorbidities as all medications have distinct actions and potential side effects. Furthermore, there is variability between patients in terms of response to a particular agent.It is important to anticipate and address concerns of pain early in the disease process for patients with terminal disease or at end of life. Anxiety and other psychosocial stressors will play a role and must also be thought of by providers.