Canterbury DHB
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Adequate pain relief is fundamental for the comfort and dignity of patients in the palliative and terminal phases of their illness. Addiction to opioids is not believed to be a risk in this patient group.
Paracetamol is an excellent analgesic with a good side effect profile. Care should be used if it is thought possible that the paracetamol could mask a fever.
NSAIDs are generally avoided in patients who may have low platelets or a bleeding disorder.
Morphine is the opioid of choice. Consider a concurrent routine laxative prescription.
Other opioids can be of use in specific situations such as renal failure or if there is notable morphine toxicity. These include oxycodone, fentanyl and methadone.
Note: For patients already on methadone, refer to Prescribing, Supply and Administration of Methadone and Buprenorphine/Naloxone (Suboxone®) on the intranet.
Analgesics are most effective when given regularly. Administration on a PRN basis is generally ineffective, as the patient must experience pain in order to request analgesia.
Additional drugs may enhance the analgesic effect of opioids, e.g. anti-inflammatories and bisphosphonates in bone pain, and co-analgesics such as corticosteroids, tricyclic anti-depressants, and anticonvulsants in neuropathic pain.
Side effects may occur from analgesics, and often these can be anticipated. Patients taking opioids should be warned about nausea, vomiting, sedation, and constipation. These problems should be anticipated and treated accordingly.
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Topic Code: 5062
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