Pharmacotherapy of Pain in Populations with Serious Illness: Best Practices and Emerging Issues (P9)

Abstract

1.Improve the ability to offer safe and effective opioid therapy to patients with serious illness by augmenting conventional guidelines with new information about side effect treatment, management of risks associated with drug abuse, and targeted treatment of breakthrough pain.2.Improve the ability to use adjuvant analgesics to manage bone pain, visceral pain, and neuropathic pain syndromes.3.Use NSAIDs more effectively based on an improved understanding of potential risks and benefits. Given the prevalence of pain in the medically ill, specialists in palliative medicine need a strong skill set in pain management. Pharmacotherapy is the mainstay approach and clinical guidelines for the use of three categories of drugs opioids, nonopioids, and so-called adjuvant analgesics are evolving with new research and experience. Opioid guidelines now confirm that morphine is not the drug of choice but one among many, and differences in risk profiles, particularly as this pertains to methadone, influence drug selection. The importance of breakthrough pain is now clear and treatment decisions have been complicated by the appearance of multiple fentanyl preparations, which have the benefit of more rapid onset but uncertain cost-utility relative to conventional drugs. Opioid side effect management is becoming more sophisticated, particularly with the recognition of side effects such as hypogonadism and sleep-disorder breathing, which may not be perceived by clinicians as being opioid-related. The management of risks associated with the abuse potential of opioid drugs is now viewed as a key responsibility, given the increase of prescription drug abuse in the United States. All of these advances in the safe and effective use of opioids are mirrored in changes that have occurred in the use of other analgesic categories. Slow progress toward mechanism-based treatment has highlighted the non-opioid options for pains of varied mechanisms, such as bone pain, visceral pain and neuropathic pain. Drug combination therapy may offer the optimal balance between analgesia and side effects. This session offers an update on the pharmacotherapy of pain in those with serious illness.