Managing pain in patients who have pre-existing chronic noncancer pain in palliative care

Managing pain in the last year of life can be especially complex in patients with pre-existing chronic noncancer pain. Consider both the approach to managing pain in palliative care and the general principles of chronic pain management in patients with chronic noncancer pain. Early specialist advice is strongly recommended.

Patients with chronic noncancer pain have multiple types of pain; consider each type in the pain management plan. It is particularly important to manage expectations of the level of pain relief that will be achieved and to focus on achievable goals; total freedom from pain is unlikely. Use caution when starting or increasing the dose of an opioid; closely assess the benefit and harms and seek early specialist advice. If patients are already taking regular opioid therapy, the Pain and Analgesia guidelines outline considerations in acute pain management in opioid-tolerant patients, that can be applied to general pain management in palliative care.

As patients near the last days of life, the considerations for chronic noncancer pain management no longer apply; management becomes symptom- and comfort-based—see Pain in the last days of life.