Pharmacologic Management of Pain at the End of Life

摘要: Although many patients experience debilitating pain at the end of life, there are options to improve analgesia and quality life. Pain assessment using a validated tool, with attention patient function specific goals, helps tailor individual treatment plans. The World Health Organization ladder offers stepwise guideline for approaching management. However, terminal illness, strong opioids necessary efficient effective analgesia. Equianalgesic dosing tables expert guidelines aid in initiating, monitoring, adjusting doses oral parenteral opioids. Clinicians should feel comfortable administering repeat dose after time peak analgesic effect if is still pain. In constant pain, scheduled long-acting may significantly control. Among subtypes, visceral management usually requires multiple drugs. Neuropathic responds well adjuvant pharmacotherapies, such as anticonvulsants or antidepressants, addition Opioid-induced hyperalgesia can occur any an opioid, but more common higher morphine hydromorphone. With appropriate counseling, most history substance abuse will comply plan.