Pain management.

Abstract

Successful management of pain can be accomplished in nearly all terminally ill patients. Pain must be assessed in terms of its physical, psychological and social components. Spiritual care and control of environmental factors are just as important as drug therapies. Once the cause of the pain is identified, an individualized plan of treatment can be developed. Nondrug therapies are tried first. When drugs must be used, the pain is treated by regular dosing to prevent recurrent breakthroughs--no PRN orders are used. The pain is blocked and its memory erased so that continued, uninterrupted relief is given. Drug management should provide ease of administration to maintain patient independence, unclouded and normal affect, and minimal troublesome side effects. Anticipatory treatment of expected problems with constipation and nausea should be done. By using a reproducible pain measurement scale, titration of drugs is carried out in a stepwise fashion, increasing dosage or potency until the desired effect is achieved. With multimode therapy, no patient should have to suffer the aching/agony pain cycle of terminal illness with cancer.