Pain treatment in a palliative unit or team of a university hospital

A Palliative Care Unit and Team provides a model for delivering care, in which narcotic analgesics can be optimally effective in the treatment of cancer pain. Our rapidly expanding knowledge of pain physiology and narcotic pharmacokinetics will not benefit patients unless we design more appropriate organizational structures to implement therapy and to teach symptom control. The Palliative Care Service model, as developed at several university hospitals in Canada, is designed to assist and complement oncology departments. Its primary role is to provide a consultation service to cancer patients wherever they may be in the health care system (home, O.P.D., hospital). A multi-specialty and interdisciplinary team offers assessment and therapy of pain and other symptoms. The McGill Pain Questionnaire is one useful tool in evaluating pain treatment. The Service also provides the university with a Palliative Care Unit designed for patients with advanced cancer who have complex symptomatology. Hospital organization must reflect the fact that environmental and psychosocial factors alter pain perception and response. Oral morphine is more effective when administered in a Palliative Care Unit than when it is given to patients in other settings. The Unit provides personnel skilled in analgesic titration and a supportive environment in which psychological, social and spiritual components of the pain experience can be evaluated and treated.