Alternate Routes of Opioid Administration in Palliative Care: Pharmacologic and Clinical Concerns

Pain relief at the end of life is a major factor in allowing patients to attend to personal matters and alleviating suffering. The majority of pain management modalities are pharmacological. Among these, opioids are key to pain relief in the preponderance of patients. Yet, most studies show that health professionals lack the attitudes, skills, and knowledge to employ opioids well. This review addresses the problems that clinicians encounter when faced with the need to use opioids for pain relief in ways not commonly addressed in their training due to complications of the underlying disease. The use of sustained release oral preparations to relieve the need to ingest medication every four hours, novel oral preparations of opioids, and the less commonly used routes of administration are discussed. How clinicians can correlate these issues with the altered pharmacokinetics that can be anticipated are explored.