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End Of Life Case Study

Decent Essays

Section 1: Management of Pain at the End of Life
Case 1 cont’d. Alan’s pancreatic cancer pain is 9/10 on a numeric pain scale. The pain is worse at night, better leaning forward, and only slightly improved with 10 mg of Oxycodone taken every 4 hours prescribed by the physician in the Emergency Room. Alan has no allergies or history of opioid use or misuse.
Family practitioners are well suited to provide end-of-life care because their training emphasizes treatment of the whole person, managing comorbidities, and coordination of care. Hospice care by definition is interdisciplinary and available around the clock, to allow even solo practitioners to manage terminal patients using a multidisciplinary team. Treatment focuses not only on medical …show more content…

Their availability as short and long acting medications, as well as various routes of administrations, makes them easy to use in most end-of-life circumstances. Most patients with end-of-life pain have already been treated using short acting opioids. Short acting opioids may be optimized by increasing dose and frequency. Though this approach has limitation and often the addition of a long acting opioid is necessary to control the pain.2 In patients with terminal pain, it is frequently necessary to use opioids in higher doses. Opioids act as pure agonist, and mixed agonist and antagonist. The latter in higher dosages can result in withdrawal. Therefore only pure opioid agonist should be used, to prevent un-necessary opioid withdrawal. Initial choices of opioids, may include short acting tramadol, hydrocodone, and oxycodone. However if they do not control end-of-life pain other opioids should be initiated. Morphine is typically the gold standard of initial terminal opioid prescribing, available in a long acting oral formulation, inexpensive, and on Hospice formulary.2 Other long acting opioids to consider are hydrocodone, hydromorphone, oxycodone, oxymorphone, and fentanyl.(Table 1) Though Methadone has been used as well, one must be familiar with its use and risks and prescribe with

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