Principles of nonpharmacological management of pain in palliative care
This topic addresses nonpharmacological management of pain caused by advanced and progressive disease in the last year of life. Such pain is likely to be persistent and progressive, with episodes of exacerbations.
Nonpharmacological management of pain in palliative care includes patient education (including managing expectations about level of pain relief likely to be achieved) and psychosocial, spiritual and physical interventions.
Nonpharmacological interventions may be used alone for mild pain, or in combination with drug therapy. The Pain and Analgesia guidelines provide guidance on nonpharmacological management of acute and chronic pain that can be applied to patients with palliative care needs—see Nonpharmacological management of acute pain and Multidimensional approach to chronic pain management. However, this guidance must be tailored to the individual and clinical context, considering the potential benefits and burdens of the treatment, and the patient’s prognosis, ability to engage with the intervention, and preferences and goals of care. Some interventions become difficult as a life-limiting illness progresses (eg continuing work may not be possible in advanced disease or when undergoing burdensome therapies).
For information on equipment and aids, see Use of equipment and aids in palliative care.