Pain management plans in palliative care
All patients with palliative care needs who have pain should have an individualised pain management plan with goals and interventions targeted to factors contributing to their pain experience. See Assessing pain in palliative care for advice on identifying factors contributing to the patient’s pain experience.
Consider components of a multidimensional approach when developing a management plan with patients and their carers—see Setting a symptom management plan in palliative care. Collaborating with patients and their carers to create achievable goals helps to plan and implement an effective approach to pain management. Discuss expectations of pain management, the likelihood of benefit and harm of proposed interventions, and set short- and long-term goals of care. These goals may include degree of pain relief and tolerability of potential adverse effects. Relief of pain may need to be balanced against a patient’s preference to avoid adverse effects. As a life-limiting illness progresses, it may be appropriate to set more realistic goals associated with mobility or social activity1. For information on discussing goals of care, see Discussing goals of care in palliative care.
Consider both pharmacological and nonpharmacological strategies to reduce or prevent pain as part of the management plan. Include treatment options the patient or their carer can start if pain control is suboptimal or if problems occur.
Ensure patients have clear instructions (both verbal and written) about the proposed pain management plan.
Regularly and frequently review and monitor patients, their symptoms and the effectiveness of pain management—see Monitoring analgesic therapy in palliative care and Reviewing symptom management plans in palliative care. Revise and adapt the plan as a patient’s illness progresses and goals of care change.
The Cancer Council Australia website has a template to help patients with cancer pain to set and track their pain management plan.
What is the nature of the pain(s)?
Are there any patient-related or other practical issues that might influence treatment choice (eg patient motivation and capability to engage with treatment, factors related to medication management, social and physical environment)?
What nonpharmacological strategies could help with the pain?
What drug(s) could help manage the pain?
If multiple drugs are required, can they be introduced one at a time, or should they be introduced simultaneously?
What route of drug administration is appropriate?
What actions are required to ensure the drugs are available and administered appropriately? For strategies to help patients and carers with medication management, see Assisting patients and carers with medication management in palliative care.
What information and education should you give the patient, their carer(s) and other healthcare professionals?
What alternatives can be considered if the initial plan is not successful?
What will be the approach to pharmacological management when the patient cannot swallow?
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Patient factors |
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fear of becoming addicted or tolerant to analgesics fear of analgesic adverse effects inability to adhere to complicated regimens inability to understand dosing recommendations communication difficulties (eg language differences, cultural considerations, intellectual impairment) |
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Clinician factors |
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difficulty performing pain assessment lack of understanding of current therapeutic approaches insufficient understanding of opioid therapy, and uncertainty about its role concern about tolerance and disorders of opioid use concern about analgesic adverse effects concern about the regulations for prescribing controlled prescription drugs |
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System factors |
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access and availability of drugs and nonpharmacological interventions cost of treatment location of services |
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Note: NB1: For other factors that influence medication management, see Factors that influence medication management for patients with palliative care needs.
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