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Palliative Care Methods for Controlling Pain

Palliative care is used to manage a disease or medical condition that can no longer be cured, primarily by easing pain.

Woman in pain

Palliative care also eases other distressing symptoms, such as 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 as 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 too late. 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 pain assessment. You may be asked to choose a number from zero to 10 to indicate how severe your pain is, with zero being very mild pain and 10 being the worst possible pain you could have.

You should keep in mind three important principles when deciding how to manage pain. First, pain should always be treated promptly. A delay allows pain to get worse. Second, you should not be afraid of becoming addicted to pain medicine. If medications are used properly, this is rarely a problem. Third, most pain problems can be controlled by using the World Health Organization's step-care approach: 

  • Step one. Start with a nonsteroidal anti-inflammatory drug (NSAID). Examples of NSAIDs include over-the-counter drugs like ibuprofen and stronger NSAIDs that your doctor may prescribe. An alternative to NSAIDs for step one pain is acetaminophen (Tylenol).

  • Step two. If pain continues or gets worse, your doctor may prescribe a weak opiate medication, such as codeine. A weak opiate may be combined with a nonopiate pain reliever.

  • Step three. If pain continues or gets worse, your doctor may prescribe a stronger opiate. Examples of strong opiates include morphine and fentanyl.

Understanding opiate drugs

Opiate drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opiate drugs is available, and they can be taken in a variety of ways. One drawback of opiate drugs is that, over time, you may develop a tolerance to the one you're taking and need higher doses to get the same effect. One way your doctor may get around this problem is by switching the type, dose, or the way the drug is given.

These are common ways in which opiate drugs can be given:

  • Oral medications. These can be taken in pill or liquid form and can be short acting or long acting (sustained release).

  • Adhesive patch. This can be applied to the skin to release medication over time. An example of this is a fentanyl patch.

  • Opiate drug injection. This shot may be given under the skin or into a muscle.

  • Opiate drug IV. An opiate may be given directly into the blood through an intravenous line.

  • Medication pump. Opiate medication 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 difficult to control, a pain-control specialist may give an opiate drug directly into the spinal cord area.

Understanding helper drugs

These medications, called adjuvant analgesics, can help control pain in certain situations. These are commonly used adjuvant drugs:

  • Steroids. These are strong anti-inflammatory medications that may help relieve pain by decreasing swelling. They may be used along with other pain relievers for nerve, bone, or other types of pain.

  • Antidepressants. Treating any existing depression or anxiety can make pain easier to control. These drugs may also be useful in pain caused by nerve damage.

  • Anticonvulsants. These medications are usually used to control seizures, but they can also help control nerve-related pain.

  • Local anesthetics. These are medications that can block pain signals in the body. A pain specialist may inject a local anesthetic to block pain.

  • Muscle relaxants. Antianxiety medications and muscle relaxants may be used along with pain medication if pain is aggravated by tension or muscle spasms.

  • Bisphosphonates. These medications 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 his or her doctor would consider at end of life. But at times surgery can provide pain relief and increase function. Surgery's primary goal can be to relieve specific symptoms. For instance, a doctor may recommend surgery to stabilize a hip fracture in a patient 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. Radiation therapy can also be used to improve pain and control symptoms. Because surgery involves risk, the doctor must clearly define treatment goals for both the patient and the patient's family.

If you or a loved one needs palliative pain control, many options are available. Work with your doctor 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.