Palliative Care Methods for Controlling Pain
Palliative care is used to manage a disease or medical condition that is serious or
life-limiting. The goal is to ease pain and other physical, emotional, or psychosocial symptoms.
Palliative care also aims to ease 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 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 very late in the course
of the disease. 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, discuss this with your healthcare provider right away. Third, most
pain problems can be controlled by using the World Health Organization’s step-care
Step 1. Start with a nonsteroidal anti-inflammatory drug (NSAID). Examples include over-the-counter
drugs like ibuprofen and other NSAIDs that your healthcare provider may prescribe.
An alternative to NSAIDs for step 1 pain is acetaminophen. This may be combined with
another medicine to address pain, a side effect of treatment, or another symptom.
Step 2. If pain continues or gets worse, your healthcare provider may prescribe an opioid
medicine to treat mild to moderate pain. An example is hydrocodone. This type of opioid
may be combined with a non-opioid pain reliever.
Step 3. If pain continues or gets worse, your healthcare provider may prescribe a stronger
opioid medicine. Examples include morphine and fentanyl.
Understanding opioid medicines
Opioid medicines work best for moderate to severe pain. A wide range of opioid medicines
is available, and they can be taken in a variety of ways. One drawback of these medicines
is that, over time, you will likely 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 medicine is given.
These are common ways in which opioid medicines can be given:
Oral medicines. These can be taken in pill or liquid form and can be short-acting or long-acting
Adhesive patch. This kind is applied to the skin to release medicine over time. An example of this
is a fentanyl patch.
Opioid medicine injection. This shot may be given under the skin or into a muscle.
Opioid medicine IV. This medicine is given directly into the blood through an intravenous (IV) line.
Medicine pump. Opioids 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 medicine
directly into the spinal cord area.
Understanding helper medicines
These medicines are called adjuvant analgesics. They can help control pain in certain
cases. Commonly used adjuvant medicines include:
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 can make pain easier to control. These medicines
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
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. Muscle relaxants may be used along with pain medicine if pain is aggravated by muscle
Antianxiety medicines. These medicines may be used along with pain medicine if tension or anxiety aggravate
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 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 ease 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. Because surgery
involves risk, the healthcare provider must clearly define treatment goals for both
the patient and the patient’s family. Radiation therapy can also be used to ease pain
and control symptoms.
If you or a loved one needs pain control and 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.