Skip to Main Content

++
++

“Pain is a more terrible master than Death itself.”

++

Dr. Albert Schweitzer

++

Basic principles of the diagnosis and management of pain syndromes are similar across all clinical settings. Details of the application of these principles, however, can vary significantly depending on the clinical context. One context that is especially important is the care of patients with incurable, progressive, and ultimately fatal illnesses who are in or approaching the terminal phase. This is sometimes referred to as the context of “palliative care,” and that term, while not fully satisfactory,1 is used throughout most of the discussions in this chapter. The range of pain syndromes that arise in these situations include most of the acute and chronic pain syndromes addressed in detail in other chapters in this text, and their management primarily involves the same diagnostic and therapeutic strategies and skills. Nonetheless, pain management in the “end-of-life” or “palliative care” setting often raises clinical and ethical issues that are at least somewhat different from those in other settings. This chapter focuses primarily on those differences.

++

The World Health Organization (WHO) has defined palliative care as: “The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families . . Palliative care . . affirms life and regards dying as a normal process . . neither hastens nor postpones death . . provides relief from pain and other distressing symptoms . . and integrates the psychological and the spiritual aspects of care, . . [including helping] the family cope during the patients illness and in their own bereavement.”2

++

A more recent statement developed by the Task Force on Palliative Care of the Last Acts Campaign,3 formulated by representatives of many leading U.S. professional organizations, states that “palliative care affirms life and regards dying as a natural process that is a profoundly personal experience for the individual and family. The goal of palliative care is to achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to personal, cultural and religious values, beliefs, and practices.” The Task Force goes on to specify five “core precepts” of the evolving field of palliative care:

++

  • 1. Respecting patient goals, preferences, and choices
  • 2. Comprehensive caring of the patient
  • 3. Utilizing the strengths of interdisciplinary resources
  • 4. Acknowledging and addressing needs and concerns of family caregivers
  • 5. Building systems and mechanisms of support for the field.

++

While it is clear that the field of palliative care encompasses a far broader range of issues than the narrower field of pain management, it is also clear from these definitions that the two fields overlap in important ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.