Wednesday, January 6, 2010

Pain Management in Palliative Care Patients

Although the majority of patients with cancer have pain, proper use of opioids and adjuvant drugs can provide adequate relief in most cases. Jacox et al [14] found that 75%-85% of patients received adequate pain control with oral, rectal, and transdermal drugs.

Morphine is often referred to as the "gold standard" in palliative care because it is effective, inexpensive, and easy to titrate, and it can administered using many routes including oral, rectal, parenteral, subcutaneous, and spinal. Titration typically begins with a low oral dose at the outset ( Table 2). The typical starting dose is 10-30 mg every 4 hours as needed for pain with 10 mg every 2 hours when needed for breakthrough pain. When changing to a stronger opioid, the patient should be reassessed to monitor the efficacy of the new medication.

Assessment and Management of Pain in Palliative Care Patients ...

Patients receiving palliative care often require frequent escalations in opioid dosage to attain good pain control. Foley et al found that 20% of patients...

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