Pain management in hospice and palliative care: A primer for pharmacists

The goals of this paper are to (1) provide a brief overview of palliative care, including its purpose and philosophy and how hospice care fits under the larger palliative care umbrella; (2) introduce pain assessment in patients with life-limiting illnesses; and (3) review pain management strategies in palliative care, with a focus on pharmacotherapy.

Palliative care is a specialized field of medicine focused on providing patient- and family-centered care for those with life-limiting illnesses at any stage of their disease trajectory. When patients approach their end of life and the focus of care becomes comfort and quality of life, the decision may be made to enter hospice care. Pain management is an essential aspect of palliative and hospice care. An effective pain assessment should help elucidate the cause and type of pain, guiding selection of therapy. Options for treating pain may include nonpharmacological approaches such as physical therapy, interventions such as nerve blocks, and pharmacotherapy. Opioids are the mainstay of pain pharmacotherapy in palliative care, although, depending on patient-specific factors, nonopioids or adjuvant agents may be used instead of or in addition to opioids. Safe and effective pain medication use in serious illness requires careful consideration of which agents should be most effective and well tolerated; clinicians should also be prepared to anticipate and respond to medication adverse effects.

Because of the outsized importance of safe and effective medication management to treat pain in patients with life-limiting illnesses, pharmacists are particularly well suited to intervene and help guide appropriate therapy.