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| Pharmacological options |
Name
Side effects
treatment if the pain level is mild. It may also be considered a good
medication to add to an opioid treatment.
constipation, dizziness, nausea, vomiting, respiratory depression
to 2 gms in liver disease.
The options which are considered
as the safest nowadays are ibuprofen and naproxen.
have a benefit in pain mediated by inflammation (e.g., bone metastases,
musculoskeletal or skin pain) through the blockage of prostaglandins
biosynthesis
irritation, bleeding
failure
(among them morphine) through the enzyme CYP2D6. 10 mg codeine usually
equivalent to 1 mg of morphine.
may have an increased risk of side effects. Sedation, nausea, vomiting,
dizziness, constipation, CNS depression, sweating, headache, lethargy,
confusion, light-headedness.
remains its action against cough, probably through its pro-drug.
opioid, about five times less potent than morphine. Not considered to be
“at risk” for addiction due its weak action on the mu opioid
receptors.Due to its blockage of serotonin and norepinephrine reuptake, may
have an additional benefit in neuropathic pain.
are several limitations: a ceiling dose of 400 mg/day, an increased risk of
seizures in predisposed patients, and more adverse effects than other opioids
such as nausea and vomiting, especially in the geriatric population.
has been the most extensively studied.
toxicity. Sedation, hypotension, increased sweating, constipation, dizziness,
drowsiness, nausea, vomiting, dry mouth, somnolence, respiratory depression.
less potent than morphine. Unfortunately, it is only available in combination
with APAP or NSAIDs. It is metabolized to hydromorphone.
hypotension, increased sweating, constipation, dizziness, drowsiness, nausea,
vomiting, dry mouth, somnolence, respiratory depression.
but around five times more potent
high doses
opioid. Unfortunately not available as parenteral formulation. Slightly more
potent than morphine (10 mg morphine=7.5 mg oxycodone). Targets not only mu
receptors as other usual opioids but also kappa receptors, which explains why
it may have a better action on neuropathic pain and may produce less nausea
and vomiting.
sedation, constipation, dizziness, nausea, vomiting, sweating, respiratory
depression
Renal impairment
morphine
lipid soluble opioid which can be administered parenterally, transdermally, transmucosally,
buccally, intranasally but not orally. Extremely potent (around 100 times
morphine)
sweating, headache, vertigo, lethargy, confusion, light-headedness, nausea,
vomiting, respiratory depression.
medication, support of anesthesia
neurotoxic effects of its metabolites (increased risk of seizures in
predisposed population) and its high risks of addiction.
opioid. Poor reputation due to the variability in half-life for individuals
requiring careful titration and optimal compliance (half-life prolonged with
prolonged use).
dizziness, sedation, nausea, vomiting, constipation, respiratory depression
Coanalgesics or adjuvant analgesics
better tolerated, antiepileptic
and drugsanticonvulsants: gabapentin and pregabalin for neuropathic
pain
The Multidimensional Approach
Palliative care adopts a multidimensional approach to pain management, recognizing that effective treatment requires a nuanced understanding of the unique aspects of an individual’s pain experience. This approach considers physical, psychological, social, and spiritual factors influencing the perception of pain.
1. Medication Management:
Pharmacological interventions form a cornerstone of pain management in palliative care. Medications, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant medications, are carefully prescribed to address varying degrees of pain. The goal is not only pain relief but also minimizing side effects and optimizing the patient’s overall comfort.
2. Holistic Therapies:
Complementary and alternative therapies play a crucial role in palliative care, offering patients additional avenues for pain relief. Techniques such as massage, acupuncture, aromatherapy, and music therapy have shown effectiveness in enhancing physical and emotional well-being. These holistic approaches provide patients with a sense of control over their pain management.
3. Psychological Support:
The emotional toll of a life-limiting illness can exacerbate physical pain. Palliative care teams often include psychologists or counselors to help patients navigate the emotional aspects of their journey. Techniques such as cognitive-behavioral therapy (CBT) and mindfulness meditation contribute to better coping mechanisms and emotional resilience.
4. Spiritual Care:
Palliative care acknowledges the importance of spiritual well-being in the overall experience of pain. Chaplains or spiritual care providers are integral members of the palliative care team, offering support, counseling, and facilitating patients’ exploration of their spiritual beliefs to find meaning and peace.
5. Communication and Shared Decision-Making:
Effective communication is vital in pain management within palliative care. Open dialogues between healthcare professionals, patients, and their families ensure that treatment plans align with individual preferences and values. Shared decision-making empowers patients to actively participate in their care, fostering a sense of autonomy and dignity.
Conclusion
Palliative care’s commitment to pain management goes beyond merely alleviating physical discomfort; it seeks to address the multidimensional nature of pain, acknowledging the profound impact it has on an individual’s overall well-being. By embracing a holistic approach that combines medication management, complementary therapies, and psychological and spiritual support, palliative care aims to provide comfort and dignity to patients, honoring their journey with empathy and compassion.
