Relieving pain & anxiety in palliative care
Many people receiving palliative care and their families worry about pain. But pain isn't inevitable and most pain can be managed. It's important to talk to your doctor or nurse about any pain you're feeling or any worries you have about pain or your treatment.
We often use medicines to manage pain for people receiving palliative care. These may be mild pain relievers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or aspirin. Or they may be stronger pain relievers called opioids. The most commonly used opioid is morphine.
You might also have other types of medicines to go with your pain relief. These may include steroids such as prednisone, antidepressants such as nortriptyline or amitriptyline or anticonvulsant medicine such as gabapentin.
The goal of pain management is to keep your pain under control as much as possible and try to prevent it flaring up, not just to try to treat it when you have it. So, it's important to take your medicine as your doctor prescribes, even if you're feeling OK.
Some medicines used in palliative care are used "off label" or "off-licence". This means we use them to treat things they aren't approved for on the licence or use them in ways that aren't approved. Your doctor will explain whenever they want to use a medicine like this so you can make an informed choice about what you take.
Complimentary techniques can also help with pain or anxiety. They may be used alongside your regular medications. Techniques include massage, relaxation and breathing techniques. They also include pacing the tasks you do and learning new ways of doing your everyday tasks. An occupational therapist or physiotherapist can give you advice about these treatments.
The following pages give information about morphine, oxycodone, methadone and fentanyl. These are opioid medicines that are all used to treat pain in palliative care. Midazolam is sometimes used to treat anxiety.
You may also find the information on medication for chronic pain useful.
HealthInfo recommends the following pages
Written by HealthInfo clinical advisers. Endorsed by Canterbury DHB and community palliative care specialists. Last reviewed November 2020.
Sources
The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public
Canterbury Community HealthPathways – Cough in palliative care, retrieved December 2016.
Canterbury Community HealthPathways – Dyspnoea in palliative care, retrieved December 2016.
Canterbury Community HealthPathways – Pruritus (itch) in palliative care, retrieved December 2016.
Canterbury Community HealthPathways – Weakness and fatigue in palliative care, retrieved December 2016.
Canterbury DHB – Palliative care guidelines (http://cdhb.palliativecare.org.nz/4207.htm), retrieved August 2016.
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Palliative Care Australia – Facts about morphine and other opioid medicines in palliative care, retrieved February 2017.
Palliative Care Australia – Learn more about pain and pain management, retrieved February 2017.
South Island Alliance – Health of older people useful resources (https://www.sialliance.health.nz/programmes/health-of-older-people/useful-resources/), retrieved September 2022.
UpToDate – Managing pain when you have cancer, retrieved February 2017.
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Page reference: 360226
Review key: HIPAL-17434
