Pain Management in the Home-Care and Hospice Patient

Pain is one of the most common clinical complaints of home-care patients. As sicker patients are being sent home earlier due to federally mandated prospective reimbursement for hospitals, more patients in pain are being treated at home. However, pain is frequently not well managed even though we usually have the necessary treatment modalities to do so. This is due largely to most health care professionals lacking up-to-date information on the pathophysiology of pain and the pharmacology of analgesic drugs. There is a need for pharmacists to educate both health professionals and patients on appropriate drug therapy for pain management. Pain is a perception with physical and emotional components. Acute pain, chronic benign pain, and chronic malignant pain differ and often require different treatment. Drugs are one of several treatment modalities that are important in pain management. Titration of analgesics to effect is important. For chronic pain, time-contingent dosing is important. Relative analgesic doses and dosing schedules are reviewed. Some drugs other than analgesics that can be useful in pain management are discussed. Patients with terminal illness often have great emotional burdens, which can complicate pain management. Some common reasons for unsuccessful pain management are described.