Palliative Care Management of Pain and Other Symptoms

MISS N R MAPURISA MBBS III

Objectives
Define palliative care (WHO) Explain how to manage pain according to the WHO
analgesic ladder

Describe approach to management of common symptoms that patients may experience Give basic advice on how patients can maintain good nutrition

WHO Definition of Palliative Care (2002)

Approach that improves the quality of life of patients and their
families

through the prevention and relief of suffering by means of

early identification, impeccable assessment,

treatment of pain
and other problems, physical, psychosocial and spiritual.

Principles 1
A holistic approach
with concern for the emotional, spiritual and social aspects of the patients care as well as controlling their physical symptoms

A patient-centered approach
that deals with what the patient thinks is the most important in all aspects of his/her care

Palliative Care: Principles 2

A problem oriented approach
in taking time to deal with each problem in turn, no matter how small

Attention to detail
time spent here can bring great relief to the patient

Honesty and respect

this should be shown at all times and the truth given when asked for, in terms understandable by the patient. False reassurance helps no one

Palliative Care: Principles 3

Based on mutually agreed upon goals between the patient and
provider

The goal may not necessarily be NO pain, but a lessoning of pain that
enables the patient to regain quality of life

All medications have side effects, and it can be a trade-off

3 severe 2 moderate
Opioids for moderate to severe pain:

1 mild
Non-opioids: Aspirin Paracetemol NSAIDs Adjuvants

Opioids for mild to Morphine moderate pain: step 1 A/Codeine and/or A/Dihydrocodeine Adjuvants Tramadol step 1 and/or Adjuvants