Principles of managing acute pain in palliative care

Acute pain usually occurs due to an acute illness (eg appendicitis, shingles infection), or following surgery or trauma (eg fall, whiplash). It lasts less than 3 months, and usually resolves when the underlying illness or injury has healed.

The Pain and Analgesia guidelines provide comprehensive guidance on acute pain management that can be applied to patients with palliative care needs, with the following additional considerations:

• Consult the patient’s pain management plan.
• Attempt to relieve the cause of the pain (eg immobilise a fracture, insert an indwelling catheter to manage urinary retention).
• Management is guided by the potential benefits and burdens of investigations and treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.
• Acute severe uncontrolled pain is a medical emergency—see Emergencies in palliative care for principles of emergency management in palliative care.
• If an opioid is required for acute pain management in patients who take regular opioid therapy, see Considerations when using opioids for acute pain in patients who take regular opioid therapy in palliative care.
• If pain is expected to continue, see Approach to managing pain in palliative care for the approach to ongoing pain management.
• Acute pain (and the need for opioid therapy) may be perceived by patients or their carers and families as a sign of treatment failure or disease progression.

For management of breakthrough and incident pain, see As-required oral opioids for breakthrough pain in palliative care and Incident pain in palliative care.