PM03 TERMINAL CARE – PAIN RELIEF IN ADVANCED CANCER

Pain is the Fifth Vital Sign. Relief of pain should be achievable in up to 90% of cancer patients. Many patients however continue to suffer unnecessarily as a result of inadequate pain management. 75% of those with advanced malignancies experience severe pain caused directly by the disease and/or the treatment. Nocioceptive pain is most responsive to intervention, the control of visceral and neuropathic pains is more difficult. The mainstay of pain management in the terminally ill is opioid medication. Morphine remains the drug of first choice. Oxycodone, fentanyl and methadone are now available and alternative options. Though the oral route of administration is preferred, parenteral (particularly sub-cutaneous administration) opioid may be necessary during the final days of life. The phenomenon of ‘wind-up’ (the fading efficacy of an opioid) will be discussed as will the role of the anaesthetic agent ketamine in managing this complication of opioid therapy. The risk of iatrogenic addiction to medicinally prescribed opioid is miniscule. Analgesic adjuvant medications for neuropathic pain have a role as may spinal and intrathecal delivery systems of opioid medication. In cases of intractable pain in the terminally ill deep sedation is a medically, legally and ethically acceptable management option.