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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
Susan Gravier and Paul Tait from CareSearch and Southern Adelaide Palliative Services discuss the newly revised Symptoms and Medicines pages in the palliAGED Practice Centre and how this information and resources can help nurse practitioners and general practitioners in symptom management of older Australians in their last days of life.
People living with a life-limiting illness, such as cancer, frequently report moderate to severe pain and describe in detail how it affects activities of daily living and quality of life. What matters most – be it spending quality time with grandchildren, time in the garden, or writing down their favourite life anecdotes – becomes hard work and wearisome in the face of uncontrolled pain. Yet in managing this beast that is pain, management with opioids has its own share of issues. Fortunately, with some thought at the point of prescribing, whether initiating or reviewing therapy, general practitioners (GPs) can anticipate these issues. Here are five tips to improve confidence with opioid use in the terminally ill.
Pain is one of a range of common symptoms experienced by palliative patients. Keep in mind that a patient with a life-limiting illness can experience, on average, 12 or 13 different symptoms through their disease trajectory. Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’. Each of us has a number of influences that affect the way we perceive pain. The important thing to appreciate is that the perception of pain is unique to the individual. The pathophysiology of pain is complex. Although it may help to classify pain as nociceptive or neuropathic to guide management, the reality is that pain is a syndrome with neuropathic, nociceptive, emotional, and psychosocial overlays. The cause of pain is often multifactorial and can involve the disease, its treatment, previous experience, and pre-existing morbidity. Not surprisingly, the management of pain is complex but it always begins and ends with assessment.
In its 'Dying Well' report published in September last year, the Grattan Institute said 14% of Australians die in their own home. The option of care at home is often well-received by patients and carers alike. Enablers for people to remain at home include support from their general practitioner (GP) as well as access to good symptom control. Given the small proportion of people who require support at home in the last days of life and the infrequency of managing this patient group, there are some simple tips for GPs to consider with regards to prescribing medicines. These five tips help the GP to anticipate the barriers to timely access to good symptom control and possibly avoid an unnecessary hospitalisation for an issue that could have been effectively managed in the community.