Palliative pain: putting the patient back in control of their analgesia

A common reason for admission to palliative care wards is severe cancer-related pain. The delivery of therapy, an essential component in combating pain, is complicated by boundaries imposed by the law and quality use of medicines standards, which patients do not necessarily face in their own homes. These boundaries significantly delay the time until the patient is relieved of pain. Subcutaneous patient-controlled analgesia (PCA), delivered via a continuous ambulatory drug device, offers a potential method of mitigating these boundaries. This case series describes the experiences of the first four patients treated when subcutaneous PCA was introduced to an Australian palliative care ward and offers comments for consideration for future studies and wider implementation of use. It is noted that although PCA was generally effective overall, considerations about the patient's mental state and pain behaviours should be made before deciding to initiate PCA in lieu of nurse-administered breakthroughs.