Palliative Pain Issues

Pain often presents with a very complex mixture of medical, psychological, and social factors. Physicians frequently approach persistent pain with apprehension and biases. Patients and families often believe pain can be cured, while clinical medicine is still far from cure or even consistent success. This chapter outlines an approach that allows physicians to be dispassionate about the process of pain management, yet compassionate for their patients in pain. It presents a strategy and framework for understanding and approaching patients with advanced medical illness who have complex pain issues. Through a discussion of the overall goals of therapy relative to pain relief goals, this approach helps physicians and their patients determine the actual or inferred pathophysiology of pain, the contributing factors that impact the pain experience, and the numerous barriers that complicate pain assessments and treatment. Utilization of opioid analgesics, adjuvants, and nonpharmacologic are also incorporated into this model.