Pharmacology of Pain Management at the End-of-Life

Assessment and management of pain at the end of life is a manifold issue with a deep impact on the patient's quality of life. With a better understanding of pain management's key principles at the end of life, caregivers can contribute to providing comfort and solace to their dying patients. 

Studies of dying patients reveal that up to 57 percent describe moderate or severe pain in the last month of life and 23 percent experience uncontrolled pain in the last week of life.  Untreated pain can be devastating to the patient and family or other loved ones not only because of the suffering it produces, but also because it interferes with the ability to complete important tasks at the end of life.  Pain management at the end of life is a right of the patient and the duty of the clinician.  

A key element to achieving satisfactory pain relief for the patient at the end of life is knowledge of pain reduction medications.  Failure to treat pain effectively can result from a lack of clinician training regarding end-of-life care or from the fear of violating ethical, moral, and legal tenets in the administration of pain medication to the dying patient. Clinicians may have an exaggerated misperception of the risk of hastening death when treating patients with opioids. Furthermore, some clinicians may be unclear about the clear associations between sedation for intractable pain, anxiety, delirium and sleep disturbances at the end of life as they relate to pain management.  

This presentation will highlight the latest pharmacologic modalities to treat pain at the end of life.  In addition to discussing the pharmacology of opioids, we will also state the importance of NSAIDS, benzodiazepines, antidepressants, hypnotics and anticonvulsants in pain management.  The importance of drug-drug interactions and organ failure with regards to end-of-life pharmacology will be highlighted. 14